盖茨夫妇如何改变数十亿人的生活？

关于乐观主义的说法在卢旺达已经有些很有力的证据。四分之一世纪前，一场种族灭绝将原已十分贫穷的东非国家一分为二，所以想研究可能性的话卢旺达是个好案例。在前卫生部长阿格尼斯·比纳格沃医生等人的领导下，卢旺达在医疗基础设施、基层保健、大规模儿童疫苗接种和孕产妇保健方面稳步投入。

多年来，盖茨基金会、全球疫苗免疫联盟、全球基金和健康伙伴基金会之类机构一直投入大笔资金支持，其中健康伙伴基金会由多年在卢旺达生活的保罗·法默联合创立。但很多创新和策略都来自本土。与此同时，儿童死亡率已从撒哈拉以南非洲地区最高降到最低。

该转变非常惊人，连哈佛大学全球卫生和社会医学教授、结核病治疗著名先驱法默也专门成立学术中心研究，该中心名为全球卫生公平大学。（比纳格沃任副校长。）

“我们在很多地方都发现：政府与联合国机构、非政府组织和其他机构合作投资的真实例子，但通过投资年轻人真正推动未来发现，”德斯蒙德·赫尔曼说。“不仅卢旺达如此，埃塞俄比亚、孟加拉国和其他地方也一样。”

“我们一定要认清世界上事情的真实情况……但也要相信世界会越来越好。”——梅琳达·盖茨

但盖茨和几乎全球所有卫生专家都表示，该工作必须持续下去。令人清醒的事实是，卢旺达和尼日利亚一样处于危险边缘。如果抗击疟疾、结核病、艾滋病和热带疾病的努力缓慢甚至限于停滞，疾病病例不会保持稳定，而是会上升。下一代的孩子们也会失去发展的机会。

这就是为什么去年10月举行的三年一次筹资活动上，盖茨夫妇如此努力为全球基金提供捐款，还有之后向全球疫苗免疫联盟补充资金。两家机构都是盖茨基金会的分支，二人花了很多慈善资金支持类似的医疗项目。

“他们生活中的选择很多，”沃伦·巴菲特说，“现在他们不仅花很多钱，还投入大量时间和精力改善世界各地人们的生活。仔细想想吧。”（财富中文网）

本文另一版本将发表于2019年5月出版的《财富》杂志上。

译者：冯丰

审校：夏林

The argument for optimism has some awfully good evidence in Rwanda. A quarter-century after a genocide tore the already poor East African country apart, Rwanda is a case study in what’s possible. Led by physician Agnes ¬Binagwaho, the nation’s former health minister, and others, Rwanda has steadily invested in health infrastructure, primary care, massive childhood vaccination, and maternal health.

Groups like the Gates Foundation, GAVI, The Global Fund, and Partners in Health—cofounded by Paul Farmer, who lived in Rwanda for years—have financed the effort substantially. But much of the innovation and footwork has been homegrown. Child mortality, meanwhile, has dropped from one of the highest rates in sub-Saharan Africa to one of the lowest.

The turnaround is so extraordinary that Farmer, a Harvard professor of global health and social medicine and a celebrated pioneer in treating tuberculosis, has launched an academic center to study it: the University of Global Health Equity. (Binagwaho has been named vice chancellor.

“We see it in lots of places: real examples of governments making investments—working with UN agencies, with NGOs, with others, but really driving their own future by investing in their young people,” says Desmond-Hellmann. “It’s happening not just in Rwanda, but also in Ethiopia, Bangladesh, and elsewhere.”

“We have to be able to see the reality of what’s going on in the world … But we [also] have to believe in the world getting better.” – Melinda Gates

But it’s work that has to be sustained, say the Gateses—and virtually every other global health expert. The sobering truth is that Rwanda, like Nigeria, is on a knife’s edge: If efforts to combat malaria, TB, AIDS, and tropical diseases slow or even remain static, the cases of disease don’t stabilize, they go up. And the next generation of kids loses ground.

It’s why the Gateses are so focused now on replenishing contributions for The Global Fund, a triennial fundraising push that takes place in October—and the financial refueling of GAVI after that. These two institutions are the outstretched limbs of the Gates Foundation, and the couple have spent more of their philanthropic dollars supporting health delivery programs like these than anything else.

“They could have elected to do anything with their lives,” says Warren Buffett, “and both of them are not only spending money but huge amounts of their time and energy around the world to make life better for people. Think about that.”

A version of this article appears in the May 2019 issue of Fortune.