蓋茨: 先進科學技術不能拯救世界(2)

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It takes more than money to rid the world of a scourge such as polio - though having buckets of cash certainly helps. Also needed are ambitious thinking, organisational know­how and the ability to bring new ideas to bear on old ­problems. These are also the kind of things that go into creating a successful technology company. This time around, though, Bill Gates the CEO has had to take a back seat to a less familiar persona: Bill Gates the diplomat.

要讓世界根除小兒麻痹症這樣的災禍，光有金錢是不夠的，雖然雄厚的資金必然是有益的。我們還需要深遠的思考、組織技巧、以及用新理念來對付老問題的能力。這些也恰恰是用來創建一家成功高科技企業的要素。但這一次，首席執行官比爾•蓋茨不得不讓位於一個世人不太熟悉的人物：外交家的比爾•蓋茨。

When the Gates Foundation made polio eradication a priority five years ago, the global anti-polio effort was running into the sand. More than 10 years of progress had given way, at around the turn of the millennium, to a stalemate as vaccination efforts in the countries still harbouring the disease failed to reach the coverage levels needed to push it into extinction. The organisations behind the existing drive - such as Rotary International, the business group that had long led the effort - “had sort of naively assumed it was on track, but it wasn't”, Gates says. “The idea that business as usual was going to get us there - it had to be broken out of that, because it wasn't going to ­succeed. It ­probably would have been better to just give up than do business as usual. But that would have been horrific.”

當蓋茨基金會在5年前決定優先努力根除小兒麻痹症時，全球範圍抗擊這種疾病的努力正舉步維艱。在世紀之交前後，當時已經進展10多年的項目在現實面前非常無力，那些仍存在小兒麻痹症病例的國家裏，疫苗接種的覆蓋尚未達到能根除疾病的水平。這些致力於該運動的組織，比如長期領導這一努力的商業團體“國際扶輪社”(Rotary International)“似乎有點天真地認爲一切都在正軌上，但事實卻並非如此。”蓋茨說，“有人認爲一切照常就會達到目標，但這不會成功，我們必須跳出這種想法。乾脆放棄也許比一切照常更好，但那將是非常可怕的。”

Gates seems to relish nothing more than challenging business as usual, often by applying a dose of more ambitious thinking. It was the same impetus that led him to rethink familiar approaches to philanthropy, throwing his money into the urgent pursuit of solutions to big problems rather than attempting a drip-feed of donations that would amount to little more than a Band-Aid. While the foundations started by the likes of Howard Hughes and pharmaceuticals boss Sir Henry Wellcome are still among the handful of the world's richest decades after their founders' deaths, the Gates Foundation has been programmed to dole out all its cash and wind itself up 20 years after their deaths.

蓋茨似乎最喜歡挑戰“一切照常”，他經常爲此展開更爲深遠的思考。同樣的動力促使他反思人們熟悉的慈善做法，並最終決定把自己的大量財富花在爲重大問題尋找解決方案這一緊迫任務上，而不是進行小打小鬧的捐贈、到頭來不能徹底解決問題。儘管霍華德•休斯(Howard Hughes)和製藥業大佬亨利•惠康爵士(Sir Henry Wellcome)創立的基金會，在其創始人去世幾十年後仍位居世界上少數財力極爲雄厚的基金會之列。蓋茨基金會則計劃在蓋茨夫婦去世後的20年內捐出所有資金，然後進入清盤程序。

The instinct to shake up the complacent and challenge the intellectually lazy doesn't always win Gates friends. Putting his personal money and reputation on the line to eradicate a disease has also risked accusations of vanity - a case of the “ego philanthropy” that can distort goals when the super-rich get involved. Wiping out a disease has only happened once before, when the World Heath Organisation declared in 1980 that ­smallpox had been eliminated. Helping to finance and organise a second ­eradication would cap the Gates Foundation's emergence as the most significant private charity in the world of global health. It would also set the stage for the next items on the list of diseases it hopes eventually to wipe out, starting with malaria.

撼動自滿、挑戰思維惰性的本能，並不總能讓蓋茨贏得朋友。爲根除一種疾病而押上自己財富和聲譽的做法，還有可能被人指責爲“虛榮”——“自我慈善事業”指的就是這種情況。當牽扯到超級富豪時，這種慈善可能會扭曲目標。根除一種疾病的案例以往只發生過一次——世界衛生組織(WHO)在1980年宣佈天花已被根除。若能幫助資助和組織根除第二種疾病，蓋茨基金會將一躍成爲全球健康領域最重要的私人慈善機構。此舉還將爲該基金會奠定基礎，利於將目標轉向其希望最終根除的其他疾病，爲首的就是瘧疾。

Gates brushes off questions about the merits of the eradication effort and whether other initiatives might be a better investment in terms of the immediate number of lives saved. “Eradications are special,” he says. “Zero is a magic number. You either do what it takes to get to zero and you're glad you did it; or you get close, give up and it goes back to where it was before, in which case you wasted all that credibility, activity, money that could have been applied to other things.”

有人質疑根除疾病努力的價值，認爲若按被挽救之生命的直接數量來衡量，其他善舉會不會是更好的投資。面對這些質疑，蓋茨表示不屑。“‘根除’是一件很特別的事情。”他說，“零是一個神奇的數字。你要麼盡一切努力來達到零，然後對自己實現了目標感到欣喜；要麼在接近目標後放棄努力，然後發病率反彈至原有水平——在這種情況下，你白白浪費了大量信譽、精力和資金，而這些你原本可以投入到其他事業上。”

Since he threw his organisation behind the effort, polio has been eradicated in India. But it remains rooted in Afghanistan, Nigeria and Pakistan, spilling over sporadically into their ­neighbours. That these three countries remain among the world's most ­difficult to operate in - in Pakistan, the Taliban has taken to bombing vaccination teams, accusing them of being in cahoots with the CIA - provides a clue about why, nearly 30years after the eradication campaign began, polio persists. Eradication has little to do with making advances in science and technology - though work on new vaccines targeted more directly at the strains of the disease that remain has helped in the fight.

有賴蓋茨基金會的支持，小兒麻痹症在印度已得到根除。但這種疾病在阿富汗、尼日利亞和巴基斯坦仍然流行，偶爾還蔓延到鄰國。這三個國家仍是世界上最難開展慈善工作的，在巴基斯坦，塔利班曾對疫苗接種小組實施炸彈襲擊，並指責他們與美國中央情報局(CIA)同流合污。這一事實實則說明了爲什麼在“根除”努力啓動近30年後，小兒麻痹症仍然存在。能否根除疾病與科技是否取得進步關係不大，儘管在這一努力中，新疫苗（這些疫苗更直接地瞄準現存疾病類型）的研製工作起到了幫助作用。

Take one of the biggest challenges to managing immunisation campaigns against polio and other diseases in the developing world: getting vaccines to where they're required while keeping their temperature in a narrow 2C-8C range to prevent them spoiling. Running the so-called “cold chain” needed for this to happen - from big refrigerators in regional distribution centres to the cases vaccinators carry into the field - requires painstaking logistical organisation. Often, kerosene or other fuels used in refrigeration are in short supply or antiquated equipment fails due to lack of maintenance. According to Gates, problems like these are too low-tech to attract the world's best brains. “Unfortunately, it's a very mundane, practical thing,” he says. “It's not sexy from a scientific point of view.”

在發展中國家開展針對小兒麻痹症和其他疾病的免疫活動，最大的挑戰之一是把疫苗運送到需要的地方，並在這一過程中確保它們的溫度保持在2至8攝氏度的狹窄溫度範圍內，以防它們變質。要做到這一點，就需要所謂的“冷鏈”：從區域配送中心的大冰箱，到接種人員手中的接種箱。運營“冷鏈”需要進行周密的後勤組織。經常發生的情況是，製冷所用的煤油或其他燃料供應短缺，或者設備陳舊，年久失修出現故障。蓋茨稱，這樣的問題技術含量太低，難以吸引世界上最優秀的大腦。“遺憾的是，這是一件很平凡、實際的事，”他說，“從科學的視角看，它不夠‘性感’。”

A businessman's understanding of incentives helps. The number of fridges needed is not large enough to provide a ­profitable market for manufacturers so the foundation has had to make financial commitments in advance. The business model of the vaccine makers gives them little reason to lower their manufacturing costs to make their products more affordable, he adds. Their high costs are more than covered by prices they can charge in the developed world and any mistakes they might make as a result of tampering with their carefully regulated ­production processes would jeopardise that existing business. “That's not science - that's, how the hell do you make 50 cent vaccines?”

此時商人蓋茨對激勵機制的理解是非常有用的。由於所需的冰箱數量不夠、不能爲製造商提供一個有利可圖的市場，蓋茨基金會不得不預先作出財務承諾。他補充說，疫苗製造商的商業模式使得它們沒理由降低生產成本、讓自己的產品在價格上更合適。在發達國家能夠開出的價格，足以覆蓋它們的高成本。如果它們因改變自己精心調校好的生產工藝而釀成任何差錯，那就可能危及現有業務。“這與科學無關——這個問題是，你如何才能製造50美分的疫苗？”

Management methods that would be immediately familiar to anyone involved in the fast-moving technology world are also being brought to bear. These include employing the rapid cycle of trial and error that new tech companies engage in before ­pouring money into a formula that works - a process known as ­“scaling”, which takes place as they race to capitalise on a new market before rivals emerge.

瞬息萬變的科技行業的參與者所熟悉的管理方法也被引入。包括採用快速的試誤週期——新的科技公司往往會先進行試誤，然後再砸下重金將其中一種管用的設計方案投產，這個過程稱爲“規模化”，目的是讓它們搶在競爭對手出現之前獨佔一個新市場。

Apoorva Mallya, a senior program officer who works on ­country implementation, puts the success in stamping out the disease in India partly down to pouring money into local initiatives that had the potential to be effective across the ­country, but which were being conducted on too small a scale to make a difference. These included assigning community ­mobilisers to individual districts and neighbourhoods before vaccination drives began in order to organise meetings of women and overcome distrust or resistance. “We went in and funded them for a massive expansion across India,” he says.

在國家層面負責實施的高級項目官員艾普瓦•馬爾雅(Apoorva Mallya)認爲，他們之所以能夠在印度成功根除這種疾病，一定程度上是因爲他們將大筆資金投向了地方性的項目；這類項目本已具備在全國有效實施的潛力，但因規模過小影響力不足，包括在疫苗接種活動開始之前向各區和街道指派社區動員者，由其組織婦女開會，克服不信任或抵制情緒。他說：“我們介入其中並提供資金，讓他們在印度各地大規模推廣。”

Another method familiar from the tech world involves more effective data collection and analysis. Vaccination drives fail if too many children fall through the net. To get a better understanding of effectiveness, the foundation has paid for teams of researchers to use statistical sampling to see if adequate coverage levels have been reached.

從高科技行業借鑑的另一種方法涵蓋了更有效的數據收集和分析。如果有太多兒童“漏網”，疫苗接種努力就會失敗。爲了更好地掌握行動的效果，蓋茨基金會資助了一些調研小組，用統計抽樣來判斷是否已達到足夠高的接種率水平。

Measurement is also being brought to bear to build a more detailed understanding of how costs are incurred in vaccination drives. Without that data, it's hard to know where to focus attention to make global health programmes more effective, says Orin Levine, who runs the foundation's vaccination efforts. “We don't necessarily differentiate where the costs are in the system yet, so it makes it harder to say an innovation in [a particular area] will be something we really want,” he explains.

爲了更細緻瞭解疫苗接種項目的各項成本，蓋茨基金會還引入了一些測算手段。負責該基金會疫苗接種工作的奧林•萊文(Orin Levine)表示，如果沒有這些數據，就很難知道應當在哪裏集中注意力，才能使全球健康計劃變得更加有效。他解釋說：“目前我們並未把整個系統中的各項成本都細列出來，也就是說很難說某一領域的某項創新是我們真正想要的東西。”

This kind of rigour would be familiar inside an engineering-centric company such as Microsoft, where rationality reigns. But in the more chaotic world of global aid, with its loose alliance of government agencies, NGOs and charities - many of them operating with only partial information - it does not pay to assume such disciplines. Learning to work in that world is one of the greatest adjustments.

在微軟這種以工程爲中心、理性至上的企業中，人們對這種嚴謹不會陌生。但在由政府機構、非政府組織和慈善機構組成鬆散聯盟的全球援助領域，局面則更爲混亂，很多機構是在僅掌握部分信息的情況下開展工作。在這樣的環境中，要貫徹這樣的紀律難免吃力不討好。學會在該領域工作是蓋茨作出的最大調整之一。

“The fact that people don't understand numbers and systems thinking and science and logic, that's OK,” Gates says - though his famous impatience might belie such a claim. “I only need a half of the people who contribute to really think in a way where I can say, hey, come on, there's a theory of change here, do you get it, do you get if that piece doesn't happen, it completely messes up that piece?”

“人們不理解數字和系統思維、不理解科學和邏輯，這沒什麼，”蓋茨說——儘管他那出了名的不耐煩令我不敢全然相信他的這一說法。“我只需要一半參與者真正以合理方式思考，我可以說，嗨，這是變革理論，你要明白，如果不（按照變革的要求）去這麼做，就會徹底搞砸。”

Like many self-made business people, Gates is wary about the ability of governments to deal with some of society's most pressing problems. Personal experience might have something to do with it. More than a decade ago, his fight with the US Department of Justice over whether Microsoft had acted illegally to defend its PC software monopoly ended in defeat, though a settlement with the George W Bush White House saved the company from the forced break-up that a judge had ordered.

與許多白手起家的商人一樣，蓋茨也擔心政府應對某些最緊迫社會問題的能力。他的這種擔心可能在一定程度上源自他的親身經歷。10多年前，他與美國司法部(US Department of Justice)圍繞微軟是否曾採取非法行動維護其PC軟件壟斷地位展開過較量，並最終成爲戰敗的一方——儘管與小布什(George W Bush)政府達成的和解挽救了微軟，倖免不必按照此前法官命令的那樣強制分拆。

Gates describes himself as a natural optimist. But he admits that the fight with the US government seriously challenged his belief that the best outcome would always prevail. With a ­typically generalising sweep across history, he declares that governments have “worked pretty well on balance in playing their role to improve the human condition” and that in the US since 1776, “the government's played an absolutely central role and something wonderful has happened”. But that doesn't settle his unease.

蓋茨稱自己是一個天生的樂觀主義者。但他承認，與美國政府之間的那場鬥爭嚴重挑戰了他的信念，他原來一直相信最終勝出的總是最好的結局。他以一種典型的、歸納總結歷史的語氣宣稱，政府“總的來說在改善人類生存條件方面很好地發揮了自己的作用”，在美國，自1776年以來，“政府發揮了絕對核心的作用，推動實現了一些壯舉”。但是，這並沒有緩解他的不安。

“The closer you get to it and see how the sausage is made, the more you go, oh my God! These guys don't even actually know the budget. It makes you think: can complex, technocratically deep things - like running a healthcare system properly in the US in terms of impact and cost - can that get done? It hangs in the balance.”

“你越接近第一線、看到臘腸是如何製作出來的，就越有可能說，天哪！這些傢伙其實對預算一頭霧水。你不由得會想：如果讓他們去做些複雜的、在專業管理方面有點深度的事情，比如在美國運行一個有影響又具有成本管理的醫療系統，他們能夠辦到嗎？這有點懸。”

It isn't just governments that may be unequal to the task. On this analysis, the democratic process in most countries is also straining to cope with the problems thrown up by the modern world, placing responsibilities on voters that they can hardly be expected to fulfil. “The idea that all these people are going to vote and have an opinion about subjects that are increasingly complex - where what seems, you might think... the easy answer [is] not the real answer. It's a very interesting problem. Do democracies faced with these current problems do these things well?”

問題不只是政府可能無法勝任相關任務。按照這種分析，多數國家的民主進程也在艱難應對現代世界帶來的種種問題，讓選民承擔他們顯然很難履行的責任。“有人主張，讓所有人都去投票、就某些領域中日益複雜的課題形成一個意見——而在這些領域中，你也許會認爲，那些貌似……容易的答案並不是真正的答案。這是一個很有意思的問題。面對當前這些問題的民主國家，在此類事情上做得到底好不好”

Compared with fixing the US healthcare system, the issues of global health and development taken on by Gates' foundation are, by his own estimate, relatively straightforward. But the work has required him to develop new skills: a willingness to engage with politicians and to develop reserves of diplomacy and ­persuasiveness. With more than 1,000 staff members and the ambition to shape the broad strategies directed at solving the problems it takes on, the foundation does much more than simply hand over money. It relies on partnerships with a wide range of government agencies and other bodies to have any effect - and that has forced Gates, the uncompromising and impatient tech leader, to apply the human touch.

按照他自己的估計，與修復美國醫療體系相比，蓋茨基金會應對的全球健康和發展問題要更加直截了當。但這項工作要求他習得新的技能：培養與政界人士接觸的意願，修煉外交手腕和說服力的內功。蓋茨基金會所做的遠不只是發放資金，該基金會擁有1000多名工作人員，並立志要針對問題塑造整體上的解決戰略。要想產生實際影響，它必須與各類政府機構和其他組織建立合作關係，這迫使蓋茨這個不妥協和不耐煩的科技行業領袖學會跟人打交道。

Workers at the foundation say that he has been closely involved even at a regional and district level in winning the needed political backing. Gates, for instance, says he personally “bonded with” Nitish Kumar, the highly rated chief minister of the Indian state of Bihar, over the latter's strong backing for vaccination efforts.

基金會的工作人員稱，蓋茨一直密切參與爭取必要政治支持的工作，甚至在區域和地區層面上也是如此。例如，蓋茨說，他與印度比哈爾邦(Bihar)備受好評的首席部長尼蒂什•庫馬爾(Nitish Kumar)結下了很好的私交，以確保後者能夠鼎力支持疫苗接種。

Sometimes in the field of global development, however, it is enough simply to be Bill Gates: the fame and wealth work their own magic. “If... I need to go to the Indian parliament and say, 'Let's get serious about vaccines,” then yes - since I'm giving my own money [on a] large scale and spending my life on it and I'm a technocrat - yes, that can be quite valuable.”

然而，在全球發展這個領域，有時僅僅做回比爾•蓋茨就足夠了：他的名氣和財富會自動產生魔力。“如果……我需要去印度議會說，‘讓我們認真對待疫苗接種工作’，那麼沒錯——由於我拿出自己的大量財富、全身心地投入這項事業，而且我是個技術官僚——這一切可能相當有價值。”

If this brand of international development diplomacy has required new skills, however, some things haven't changed. Talk to almost anyone who has worked with Gates and they have a story about his intensity. On trips to the developing world his tirelessness wears out those around him. Inside the foundation, he shows the kind of endurance that once inspired and exhausted Microsoft product managers. “He wants to do the work with us at the most granular level. He will sit in four-hour meetings with us going over slide page after slide page,” says Raja Rao, who heads the foundation's work on perfecting the cold chain. “I've seen him sit in a room for 11hours non-stop just talking about ­technology, eating snacks and drinking Diet Coke.”

不過，如果說進行此類關注國際發展的外交活動需要習得技能，那麼有些東西是一直沒有改變的。曾與蓋茨共事的人幾乎都會談到他對工作的高度投入。在前往發展中國家的旅途中，他馬不停蹄讓周圍的人筋疲力盡。在蓋茨基金會內，他展現出了曾經鼓舞（並且累壞）微軟產品經理的那種耐力。“他要和我們一起做那些最瑣碎的事。他會參加我們的4小時會議，逐頁審閱幻燈片。”在該基金會負責冷鏈完善工作的拉賈•拉奧(Raja Rao)表示，“我見過他坐在一個房間裏，連續11個小時不停地談論技術、吃零食、喝健怡可樂(Diet Coke)。”

Many of the works on the bookshelves in Gates' office overlooking Lake Washington are scientific tomes on the diseases that he is combatting - of which, with characteristic diligence, he now has a deep personal understanding, according to others at the foundation. A voracious reader - he has always taken ­periodic breaks from his regular routine to read about and ponder the biggest problems he has taken on- his conversation is littered with references to authors. Given the smallest excuse, he plunges into a description of the different types of polio and vaccines - and then into the genetic tests that show how the disease once ­persisted and spread in areas like Uttar Pradesh even when full outbreaks were rare.

在蓋茨俯瞰華盛頓湖的辦公室裏，書架上擺放着很多關於蓋茨所抗擊疾病的科學著作。據蓋茨基金會的人介紹，憑藉着標誌性的勤奮，如今蓋茨對這些疾病有了深刻的個人理解。蓋茨是一個博覽羣書的人，他有一個保持了很久的習慣，那就是每隔一段時間暫時告別日常事務，專心閱讀和思考自己選擇應對的重大問題。他在談話中也頻頻引用不同作者的觀點。哪怕得到最小的由頭，他也會滔滔不絕地介紹不同類型的小兒麻痹症和疫苗，然後又說，基因測試顯示，這種疾病如何一度在印度北方邦(Uttar Pradesh)等地持續出現和傳播，儘管極少有疫情全面爆發的情況。

This is the Gates who once ruled Microsoft with a command of detail and intellectual intensity that led to the kind of culture that was capable of dominating the tech world - even as it tipped over into behaviour that brought a regulatory backlash. “I was a kind of hyper-intense person in my twenties and very ­impatient,” he says. “I don't think I've given up either of [those] things entirely. Hopefully it's more measured, in a way.”

當年的蓋茨正是憑藉這樣高強度的思維和對細節的掌握來領導微軟的，它催生了能夠主導高科技行業的那種文化——也催生了最終招致監管反彈的越線行爲。“我在20多歲時是那種繃得非常緊的人，非常沒有耐心。”他說，“我並不認爲自己在這兩方面已完全改變。只是希望自己變得更有分寸了。”

If the manner has mellowed, though, the uncompromising attitude is still very much in evidence. It is at once one of the strongest assets and one of the biggest hindrances in his plan to save some of the world's poorest from the fate to which a sometimes oblivious world has left them. Knowing how to pursue an unflinching personal logic without alienating people remains a work in progress for him.

不過，如果說蓋茨的舉止已變得更有分寸，那麼他的不妥協態度可以說仍十分明顯。蓋茨的計劃旨在拯救世界上一些最貧窮的人羣，使他們擺脫這個有時對苦難視而不見的世界帶給他們的命運。就該計劃而言，蓋茨的不妥協態度既是最強大的資產之一，也是最大的障礙之一。明白如何在不得罪人的情況下追求堅定的個人邏輯，對他而言仍是一種需要進一步修煉的內功。

“When we had a meeting a couple of years ago, when people weren't thinking through the polio thing very well, I was pretty critical,” he says. His message to the assembled workers: “'Hey, this is not good thinking, this is not good, this is not going to get us there.“”

蓋茨說：“在兩三年前的一個會上，當有關人員未能周密考慮根除小兒麻痹症的項目時，我的態度相當不客氣。”他向與會工作人員傳達的信息是：“這種思路可不行，它不夠好，不能讓我們達到目標。”

The new Gates, though, was not prepared to leave it at that. After the meeting was over, he did what husbands the world over are liable to do at such times: “I said to Melinda, was I too tough on that, who should I send mail to, was that motivational, ­de-motivational? It's all a matter of degree.”

不過，“新”的蓋茨並沒有打算不去想這件事了。會後，他做了世界各地的有家男人在這種時候都可能會做的事：“我對梅琳達說，我在這事上太嚴厲了嗎？我應該給誰發封郵件？我的話是有激勵作用還是讓人泄氣？這些全都是一個‘度’的問題。”