BILL GATES: Well, the foundation grew its spending pretty quickly during the pandemic. And even as that pandemic spending has gone away, we're still achieving record levels just because the need is there. In fact, our resources can't possibly cover all those needs, so we're trying to set a good example to governments, philanthropists that particularly this health work is so impactful that even in the face of all the world's challenges, we need to keep funding things like buying vaccines for all the world's children.

BRIAN SOZZI: Compared to prior World Economic Forums, where do you sense the world or the community is in terms of focusing on health?

BILL GATES: I'm a little worried. The world's dealing with a lot of challenges right now. And the fact that, you know, we still have 5 million children die before the age of five, it isn't as visual. It's not like a plane crashing or a bomb hitting a building, and yet, you know, these deaths one by one add up to that 5 million.

And we have made progress. At the turn of the century, that number was 10 million. Vaccines are a big part of that. The last few years, with the pandemic, our progress has plateaued.

And, in fact, if we don't maintain attention, if we don't fund this vaccine fund that's been the most effective spending of $8, we could actually see that number go back up. So staying on the agen-- for anything to stay on the agenda is hard. Health deserves to be on that agenda, particularly, health in the poorest countries.

JULIE HYMAN: And of course, a lot of the work you do at the foundation is marrying tech and innovation with some of these really thorny problems like health. You have brought a couple of items that sort of combine scientific advances-- yeah, he's got his backpack. It just shows-- I mean, a lot of these things are portable. They're small. They're easy to carry around.

So I just wanted to give people examples, right, of what we're talking about. So this here is an HPV single-dose vaccine. Talk us through what that is.

BILL GATES: Yeah, it's kind of amazing. You know, vaccines often start in the rich world, even if the need is everywhere. This HPV protects women from cervical cancer. And when it started out, we knew that three doses would work. But the foundation funded a lot of studies that showed that the vaccine is so good that a single dose is enough for full protection.

And that means we can reach a lot more women, twice as many as if it was a two-dose vaccine. So that's a very new thing. The other show and tell we've got-- you know, you're probably familiar with this instrument when it's connected up to, like, a $20,000 box. Here, we're getting the cost to be in the $400, $500 range.

And we're actually putting a lot of software with it so that as you scan a pregnant woman, you can say, OK, will this delivery be challenged so you have to get to a health center, or will it be an easy delivery? And so we can prevent about 50% of maternal death by being able to tell in advance, will there be problems.

BRIAN SOZZI: When you're traveling around the world and you're bringing this technology to these lower income countries, what are some of the biggest barriers that you see? Is it just a cost? Is it the number of doctors on the ground? Or is it just all the above?

BILL GATES: Well, basically, most people don't get to see a doctor. And so you want to make it so even somebody without full medical training because the software is doing the analysis-- in US or any rich country, a very well trained person has to look at this image data and try to figure out what they're seeing.

We avoid that completely because it would never work in places like Africa. Keeping the funding for primary health care as the African countries have financial challenges. They're paying higher interest rates. It's a tough cycle for them. And so it's got to be very inexpensive technology.

JULIE HYMAN: And what about policy? Is that a barrier as well in some countries?

BILL GATES: Getting countries to adopt new technologies, you know, when we can show that, for example, the vaccine works in a single dose, we do get quick takeup. We work with people like WHO that set global standards. We're a very substantial funder of the work that WHO does.

BRIAN SOZZI: There's been some talk initially here that the world remains still unprepared for the next pandemic. Do you agree with that?

BILL GATES: Oh, absolutely. The speed at which we've lost attention on what we need in terms of systems and tools is rather stunning. People have gone to, hey, I'd rather not talk about it. And of course, looking back and saying, OK, we made some mistakes, you know, what did we learn? What would we do next time? There's not enough of that happening.

JULIE HYMAN: And what do you think needs to be done then on that front?

BILL GATES: Well, I wrote a book in order to push on this. I'd say I've learned a lot since then. We need to invent new tools. Our vaccine doesn't last long enough. It doesn't provide broad enough protection. It doesn't block infection. It's a miracle in terms of preventing severe disease. But we didn't get it as soon as we'd wanted to. Diagnostics, you had to wait to get diagnosed. And that meant that people were still spreading the disease.

A few countries did that well, and they had a much lower death rate. The sewage sampling where you could actually see the virus in a population, we need to have that up and running all the time so that we see these things way quicker than we would otherwise. And then we need to staff the global organizations so that we do fire drills. For fires, we do drills. For military, war games, we do drills. Sadly, pandemics need to be added to that list of something that when it happens, you're ready to go.

BRIAN SOZZI: Are you surprised by a lot of the talk on vaccine fatigue? And this is, I think, primarily really focused on the United States.

BILL GATES: Well, sadly, the fact that the pandemic raised a lot of misinformation about vaccine and increased vaccine hesitancy, that's not just in the United States. Vaccines are phenomenal. You have to work to build trust in that because it's kind of not intuitive that you stick a metal needle in a child's arm, they cry, and that's the most important thing to make sure they don't die of measles or dozens of other diseases.

In fact, we're using vaccines to actually eradicate polio. By getting enough vaccines out, will make that a disease that completely goes away, which it just shows that if we accept vaccines, we get them out, fund them, it's pretty phenomenal.

JULIE HYMAN: I want to talk about another technological innovation that's having an effect on your work. That's AI, or at least generative AI in particular. It's being used, for example, with this device here. Do you see it as sort of supercharging the work that you're doing in health and in other areas?

BILL GATES: Absolutely. And we do research work to make new tools. And the AI is because they help us protein shapes and biological systems, they'll speed up that upstream work. But also because you can talk to an AI on a cheap cell phone, and we've already got in most places that network in place, you can get health advice. And so on the delivery side, we can be a lot better. This is just one of many examples. And on the innovation. So we'll get our HIV vaccine years sooner than we would without these AI tools.

BRIAN SOZZI: Are you concerned about the pace that AI is moving in terms of innovation?

BILL GATES: There's a lot of things in terms of making it cheaper, faster, more accurate. Most of the applications are just helping you be more productive. When I sit down to write something, often getting hints from the AI, having it look things over, simplify things, I've found it's a real productivity increase.

Likewise, for coders, you're seeing 40%, 50% productivity improvement, which means you can get programs sooner, you can make them higher quality, make them better. So mostly, what we'll see is that the productivity of white collar will go up.

JULIE HYMAN: Do you think that there does need to be governance around the globe around AI?

BILL GATES: Well, certainly, AI can be used for all-- it can be used for cyber attacks. It can be used to design a bioterrorism weapon. Whenever we have new technologies, they're used to achieve positive goals and for some challenging things as well. So far, every technology we've come up with, even though we have some like nuclear weapons that are still to this day very, very scary, we've managed to keep them under control.

And so the idea that there's a lot of talk getting government people to understand AI. Could it be something where it's almost too addictive to sit there and talk to it? What should the guidelines be? When we had computers, books, video games, we had to think, OK, what's the tasteful appropriate use to just get the good and minimize those negative things?

JULIE HYMAN: Well, I think about social media if there is a parallel in recent years. And it feels like there was a retroactive attempt to regulate social media that wasn't quite so successful, and there were perhaps some harms from social media. Do you think that there's applicable lessons to AI from that?

BILL GATES: Well, what we're seeing in social media is that people will often cluster around extreme views or even misinformation. And I think that's part of human behavior that you want to try and avoid. Nobody's ever come up with a set of regulations that fully deal with that. Different countries are going to try different things. I hope we get better in that area.

The AI comes a little bit on top of that, makes it easier to generate information. You'll have things that look like videos and images. And so it underscores the need to say, OK, what's the good part of social media, and what's the part either for young people or misinformation that regulations could reduce?

BRIAN SOZZI: How influential do you think AI in its current form will be on this coming election in the US?

BILL GATES: I'm not sure for this year it's going to be that big of a thing. I mean, you want things that are generated by computers to be labeled that way. And people are talking about news organizations, OK, let's make sure before somebody watches, they know that this is an illusion just like when you have text you say, OK, where did you get that information from? But I don't think it'll be a huge impact.

JULIE HYMAN: Since Brian brought up the election, I want to point to something you wrote about in your Gates Notes looking ahead to 2024 when you said, this election will be pivotal-- for the presidential election in the US, that is-- will be pivotal for climate and health. Can you dig into that a little bit for us?

BILL GATES: Well, I'm a huge believer in more generosity to poor countries to help them with their climate challenges, so-called climate adaptation, and to drive health. Our biggest R&D budget for health in the world is the US government R&D budget.

The US government in HIV under President Bush created an HIV program called PEPFAR that saved tens of millions of lives. And so the US government is the biggest player. And getting a group in that maintains generosity, spends that money well for health challenges and climate challenges, I hope we achieve that.

BRIAN SOZZI: Can-- go ahead.

JULIE HYMAN: Do you want to put a fine point on it and tell us which one you think is going to do that?

BILL GATES: Well, we'll have administrations that are more or less engaged in those issues. You know, I'm a voter--

JULIE HYMAN: You think the current administration is engaged in this issue?

BILL GATES: Very. Yes. I mean, in both health and climate, they've been very engaged. I'm one voter. You might guess how I'm going to vote, but we've been able to work with every administration and try to get-- it's human charity. It's caring. It's creating a stable world. So hopefully, we can make the case no matter who's elected.

BRIAN SOZZI: Yeah. How impactful has the Inflation Reduction Act been to the green movement and the work you do with the foundation?

BILL GATES: The IRA has helped these early stage companies that my group called Breakthrough Energy is funded over hundreds of those companies. And I'd say about 30 of them are able to go build pilot plants aggressively because with the tax credit, they get bootstrapped. So even though at first their technology is expensive, every one of these companies, we only put money in as if we know it can get so that the price eventually is the same as the current way of, say, making steel or cement or providing transportation.

JULIE HYMAN: And one last question because I know you have to run. Since you talked about Breakthrough, I was struck in reading your different recent commentary how optimistic you are. And particularly on climate and energy, it can feel daunting. So where do where does that optimism come from? Because it feels like there's not a lot of urgency necessarily around these issues.

BILL GATES: Well, I do worry that things like global health are not as much on the agenda as they should be. Everything that's bad, eventually you measure through human health. Climate is bad if you have more malaria or more malnutrition. And so just saying, OK, what are the breakthroughs, whether it's labeled climate or not to improve the human condition, we should continue to do those.

Because of human innovation, we've come a long ways even since the year 2000. And it's not that visible to people, and yet emissions per person have gone down, total emissions are about to peak. Will we hit the deadlines? That's what's at risk. Because of innovation, we'll eventually get emissions down, but I do worry that we're going to miss a lot of the milestones that we've set for ourselves.

JULIE HYMAN: Bill Gates, thank you so much for being here. Really appreciate it.

BRIAN SOZZI: Thank you so much. Appreciate it.