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but if you just go outside Bangalore you will see that everything about India shining
is refuted 。。。 ＇In the villages＇ alcoholism is rife and female infanticide and crime
are rising。 You have to bribe to get electricity； water； you have to bribe the tax
assessor to assess your home correctly。 Yes； the middle and upper classes are taking
off； but the 700 million who are left behind； all they see is gloom and darkness and
despair。 They are born to fulfill their destiny and have to live this way and die
this way。 The only thing that shines for them is the sun； and it is hot and unbearable
and too many of them die of heatstroke。〃 The only 〃mouse〃 these kids have ever
encountered； she added； is not one that rests next to a computer but the real thing。
There are thousands of such villages in rural India； China； Africa； and Latin America。
And that is why it is no wonder that children in the developing world…the unflat
world…are ten times more likely to die of vaccine…preventable diseases than are
children in the developed flat world。 In the worst…affected regions of rural southern
Africa； a full one…third of pregnant women are reportedly HIV…positive。 The AIDS
epidemic alone is enough to put a whole society into a tailspin： Many teachers in
these African countries are now afflicted with AIDS； so they cannot teach； and young
children； especially girls； have to drop out either because they must tend to sick
and dying parents or because they have been orphaned by AIDS and cannot afford the
school fees。 And without education； young people cannot learn how to protect
themselves
from HIV…AIDS or other diseases； let alone acquire the life…advancing skills that
enable women to gain greater control over their own bodies and sexual partners。 The
prospect of a full…blown AIDS epidemic in India and China； of the sort that has already
debilitated southern Africa； remains very real； largely because only one…fifth of
the people at risk for HIV worldwide have access to prevention services。 Tens of
millions of women who want and would benefit from family…planning resources don't
have them for lack of local funding。 You cannot drive economic growth in a place where
50 percent of the people are infected with malaria or half of the kids are malnourished
or a third of the mothers are dying of AIDS。
There is no question that China and India are better off for having at least part
of their population in the flat world。 When societies begin to prosper； you get a
virtuous cycle going： They begin to produce enough food for people to leave the land；
the excess labor gets trained and educated； it begins working in services and industry；
that leads to innovation and better education and universities； freer markets；
economic growth and development； better infrastructure； fewer diseases； and slower
population growth。 It is that dynamic that is going on in parts of urban India and
urban China today； enabling people to compete on a level playing field and attracting
investment dollars by the billions。
But there are many； many others living outside this cycle。 They live in villages or
rural areas that only criminals would want to invest in； regions where violence； civil
war； and disease compete with one another to see which can ravage the civilian
population most。 The world willbe entirely flat only when all these people are brought
into it。 One of the few people with enough dollars to make a difference who has stepped
up to this challenge is Microsoft chairman Bill Gates； whose 27 billion Bill and
Melinda Gates Foundation has focused on this huge； disease…ravaged；
opportunity…deprived population。 I have been a critic of some of Microsoft's business
practices over the years； and I do not regret one word I have written about some of
its anticompetitive tactics。 But I have been impressed by Gates's personal commitment
of money and energy to address the unflat world。 Both times I spoke to Gates； this
is the subject he wanted to talk about most and addressed with the most passion。
379
〃No one funds things for that other 3 billion；〃 said Gates。 〃Someone estimated that
the cost of saving a life in the U。S。 is 5 or 6 million… that is how much our society
is willing to spend。 You can save a life outside of the U。S。 for less than 100。 But
how many people want to make that investment？
〃If it was just a matter of time；〃 Gates continued； 〃you know； give it twenty or thirty
years and the others will be there； then it would be great to declare that the whole
world is flat。 But the fact is； there is a trap that these 3 billion are caught in；
and they may never get into the virtuous cycle of more education； more health； more
capitalism； more rule of law； more wealth 。。。 I am worried that it could just be half
the world that is flat and it stays that way。〃
Take malaria； a disease caused by a parasite carried by mosquitoes。 It is the greatest
killer of mothers on the planet right now。 While virtually no one dies of malaria
today in the flat world； more than 1 million people die from this disease each year
in the unflat world； about seven hundred thousand of them children； most of them in
Africa。 Deaths from malaria have actually doubled in the last twenty years because
mosquitoes have become resistant to many antimalarial drugs； and commercial drug
companies have not invested much in new antimalarial vaccines because they believe
there is no profitable market for them。 If this crisis were happening in a flat country；
noted Gates； the system would work： Government would do what it needed to do to contain
the disease； pharmaceutical companies would do what they needed to do to get the drugs
to market； schools would educate young people about preventive measures； and the
problem would be licked。 〃But this nice response works only when the people who have
the problem also have some money；〃 said Gates。 When the Gates Foundation issued a
50 million grant to combat malaria； he added； 〃people said we just doubled the amount
of money ＇worldwide＇ going to fight malaria 。 。 。 When the people who have the need
don't have the money； it takes outside groups and charities to get them to the point
where the system can kick in for them。〃
Up to now； though； argued Gates； 〃we have not given these people a chance ＇to be in
the flat world＇。 The kid who is connected tothe Internet today； if he has the curiosity
and an Internet connection； is as ＇empow380
ered＇ as me。 But if he does not get the right nutrition； he will never play that game。
Yes； the world is smaller； but do we really see the conditions that people live in？
Isn't the world still really big enough that we don't see the real conditions that
people live in； the kid whose life can be saved for 80？〃
Let's stop here for a moment and imagine how beneficial it would be for the world；
and for America； if rural China； India； and Africa were to grow into little Americas
or European Unions in economic and opportunity terms。 But the chances of their getting
into such a virtuous cycle is tiny without a real humanitarian push by flat…world
businesses； philanthropies； and governments to devote more resources to their
problems。 The only way out is through new ways of collaboration between the flat and
unflat parts of the world。
In 2003； the Gates Foundation launched a project called Grand Challenges in Global
Health。 What I like about it is the way the Gates Foundation approached solving this
problem。 They didn't say； 〃We； the rich Western foundation； will now deliver you the
solution；〃 and then issue instructions and write some checks。 They said； 〃Let's
collaborate horizontally on defining both the problem and the solutions…let's create
value that way…and then ＇the foundation＇ will invest our money in the solutions we
both define。〃 So the Gates Foundation placed ads on the Web and in more conventional
channels across both the developed and the developing worlds； asking scientists to
respond to one big question： What are the biggest problems that； if science attended
to them and solved them； could most dramaticallychange the fate of the several billion
people trapped in the vicious cycle of infant mortality； low life expectancy； and
disease？ The foundation got about eight thousand pages of ideas from hundreds of
scientists from around the world； including Nobel laureates。 It then culled through
them and distilled them down to a list of fourteen Grand Challenges…challenges where
a technological innovation could remove a critical barrier to the solving of an
important health problem in the developing world。 In the fall of 2003； it announced
these fourteen Grand Challenges worldwide。 They include the following： How to create
effective single…dose vaccines that can be used soon after birth； how to prepare
vaccines that do not require refrigera
tion； how to develop needle…free delivery systems for vaccines； how to better
understand which immunological responses provide protective immunity； how to better
control insects that transmit agents of disease； how to develop a genetic or chemical
strategy to incapacitate a disease…trans