比爾•蓋茨的小兒麻痹癥之戰(zhàn)

比爾•蓋茨(Bill Gates)走進日內瓦世界衛(wèi)生組織(World Health Organization)總部地下室管理全球流行病的辦公室，準備參加一個會議，迎接他的卻是壞消息：盡管他已經拿出七億美元來努力消滅小兒麻痹癥，此病卻正在非洲各地蔓延。
Bill Gates walked into the World Health Organization's headquarters in Geneva-for a meeting in an underground chamber where global pandemics are managed-and was greeted by bad news. Polio was spreading across Africa, even after he gave $700 million to try to wipe out the disease.

去年夏天，小兒麻痹癥曾肆虐一時，本周在已經有19年沒有出現(xiàn)過小兒麻痹癥的塔吉克斯坦又爆發(fā)了新的疫情。該病的蔓延威脅著全球最為宏大的健康運動之一，即消滅這種令患者殘疾的疾病。這也是微軟(Microsoft Corp.)創(chuàng)始人之一蓋茨作為“全職”慈善家的新職業(yè)生涯中的一個挫折。
That outbreak raged last summer, and this week a new outbreak hit Tajikistan, which hadn't seen polio for 19 years. The spread threatens one of the most ambitious health campaigns in the world, the effort to destroy the crippling disease once and for all. It also marks a setback for the Microsoft Corp. co-founder's new career as full-time philanthropist.

下周，參與抗擊小兒麻痹癥的各個組織──包括世界衛(wèi)生組織、聯(lián)合國兒童基金會(Unicef)、國際扶輪社(Rotary International)和美國疾病預防控制中心(U.S. Centers for Disease Control and Prevention)──計劃宣布重大戰(zhàn)略調整，以更好地應對疫情爆發(fā)以來所暴露出來的不足。
Next week, the organizations behind the polio fight, including WHO, Unicef, Rotary International and U.S. Centers for Disease Control and Prevention, plan to announce a major revamp of their strategy to address shortcomings exposed by the outbreaks.

小兒麻痹癥是蓋茨慈善事業(yè)的一項核心內容。去年，身家數(shù)十億美元的蓋茨到抗擊小兒麻痹癥的主要戰(zhàn)場之一非洲，與醫(yī)生、救援人員和一位穆斯林蘇丹共商大計，以推進根除小兒麻痹癥的努力。
Polio is a centerpiece of Mr. Gates's charitable giving. Last year the billionaire traveled to Africa, one of the main battlegrounds against the disease, to confer with doctors, aid workers and a sultan to propel the polio-eradication effort.

去年6月在世界衛(wèi)生組織流行病中心召開的會議上，世衛(wèi)組織官員艾偉德(Bruce Aylward)對蓋茨說，沒有任何辦法來粉飾過去12個月的情形。他講述了在那些據(jù)信已經沒有小兒麻痹癥的國家，小兒麻痹病毒是如何蔓延的。
'There's no way to sugarcoat the last 12 months,' Bruce Aylward, a WHO official, told Mr. Gates in the meeting in the underground pandemic center last June. He described how the virus was rippling through countries believed to have stopped the disease.

蓋茨問道：那么，我們接下來做什么？
Mr. Gates asked: 'So, what do we do next?'

這個問題問到了全球衛(wèi)生領域中最核心的話題之一：抗擊小兒麻痹癥這類具體疾病是否會更好地服務人類社會？還是應該同時追求一系列更廣泛的健康目標──改善衛(wèi)生條件、擴大免疫范圍、提供清潔飲用水，盡管這些措施不會消滅任何一種疾病，卻有可能提高發(fā)展中國家人們的整體健康水平？
That question goes to the heart of one of the most controversial debates in global health: Is humanity better served by waging wars on individual diseases, like polio? Or is it better to pursue a broader set of health goals simultaneously-improving hygiene, expanding immunizations, providing clean drinking water-that don't eliminate any one disease, but might improve the overall health of people in developing countries?

新的計劃將兩種手段結合起來。去年夏天的疫情爆發(fā)讓人們認識到：只有同時加強發(fā)展中國家的整體衛(wèi)生體系，針對具體疾病的戰(zhàn)斗才能取得勝利。
The new plan integrates both approaches. It's an acknowledgment, bred by last summer's outbreak, that disease-specific wars can succeed only if they also strengthen the overall health system in poor countries.

如果計劃成功，這項進行了調整的行動有望在未來幾十年重塑全球衛(wèi)生戰(zhàn)略，并推動抗擊其他疾病的努力。如果失敗的話，則可能成為人類抗擊疾病的歷史上最昂貴的判斷失誤之一。畢竟，20多年的努力加上82億美元的資金都沒能消滅小兒麻痹癥。
If successful, the recalibrated campaign could shape global health strategy for decades and boost fights against other diseases. A failure could rank the effort as one of the most expensive miscalculations in mankind's long war with disease. Already, polio has evaded a two-decade-long, $8.2 billion effort to kill it off.

巨額捐贈人一直更喜歡抗擊具體的疾病，也就是所謂的“垂直”戰(zhàn)略。其目標是復制1979年人類對天花的勝利。天花是有史以來唯一一種被根除的疾病。與此相反，更廣泛的“水平”戰(zhàn)略的目標則不甚明確，很多年都可能不會在全球整體健康狀況數(shù)據(jù)中有任何體現(xiàn)。
Big donors have long preferred fighting individual diseases, known as a 'vertical' strategy. The goal is to repeat 1979's victory over smallpox, the only disease ever to be eradicated. By contrast, the broader, 'horizontal' strategy has less well-defined goals and might not move the needle of global health statistics for years.

對于也在為其他可能面臨類似挫折的疫苗提供資金的蓋茨基金會，抗擊小兒麻痹癥的戰(zhàn)斗是一個教訓。在抗擊小兒麻痹癥的戰(zhàn)斗中，他的基金會支持的是一個遵循過時游戲規(guī)則的項目。去年小兒麻痹癥的死灰復燃迫使對游戲規(guī)則進行重大修改。
The polio fight is a lesson for Mr. Gates's foundation, which is funding other vaccines that could face similar setbacks. In the polio fight, his foundation backed a program that was following an outdated playbook. Polio's resurgence last year forced a major rewrite.

去年蓋茨的尼日利亞之行幫助改變了抗擊小兒麻痹癥的戰(zhàn)略。尼日利亞有著向其他國家“輸出”小兒麻痹病毒的劣跡。當時《華爾街日報》的一名記者隨蓋茨同行。
The shift on polio was informed by Mr. Gates's trip last year to Nigeria, a nation with a history of exporting the virus to other countries. Mr. Gates was accompanied by a Wall Street Journal reporter

2008年蓋茨從微軟退休后，就把自己塑造成了全球健康大使。他利用自己的明星效應和蓋茨基金會340億美元的捐款來努力推動企業(yè)、衛(wèi)生組織和各國政府來提高發(fā)展中國家的健康水平。
Mr. Gates has forged himself as a global-health diplomat following his 2008 retirement from Microsoft. He is using his star power and $34 billion philanthropy to try to push businesses, health groups and governments to improve health in developing countries

在昔日龐大的伊斯蘭帝國中心、如今灰塵滿天的尼日利亞城市索科托，蓋茨驅車前往一個宮殿，走過一排喇叭手，抬頭看到寶座上身穿飄垂的長袍、頭戴穆斯林頭巾的男子──索科托的蘇丹、尼日利亞7,000萬穆斯林的精神領袖。
In the Nigerian city of Sokoto, the dusty center of a once vast Islamic empire, Mr. Gates drove to a palace, walked past a row of trumpeters and found himself looking up at a man on a throne wearing a flowing robe and turban-the Sultan of Sokoto, spiritual leader of Nigeria's 70 million Muslims.

就在蓋茨向蘇丹做自我介紹的時候，燈光在搖曳之間熄滅了。
Just as Mr. Gates introduced himself to the sultan, the lights flickered out.

在昏暗的房間里，蘇丹坐在鑲金座椅上對蓋茨說，歡迎你來到真實的世界，真實的第三世界。
'I want to welcome you to the real world-to the real third world,' the sultan said to Mr. Gates from his gilded chair in the darkened room.

像蘇丹這樣的人是重要的盟友。2003年，尼日利亞北部的伊斯蘭頭領散布流言說，小兒麻痹疫苗可以使穆斯林女孩失去生育能力。頭領們叫停了疫苗接種，任由病毒擴散。世界衛(wèi)生組織說，病毒最終傳到了20個國家。
Men like the sultan are important allies. In 2003, Islamic leaders in northern Nigeria spread rumors that polio vaccines sterilized Muslim girls. Leaders halted vaccinations, allowing the virus to spread. The WHO said the virus eventually infected 20 countries.

截至去年年初，全球1,600例小兒麻痹癥病例中有一半發(fā)生在尼日利亞。這名蘇丹能使這場戰(zhàn)役重回正軌。
By the start of last year, Nigeria was home to half of the world's 1,600 polio cases. The sultan could help get the campaign back on track.

這名蘇丹向蓋茨和一屋子宗教領袖宣布支持這場消滅小兒麻痹癥之戰(zhàn)。他說，我們將向你們表明我們的承諾，你此行不會白費。
Speaking to Mr. Gates and a room of religious leaders, the sultan declared his support for the polio fight. 'We want to show you our commitment,' he said. 'The time you have taken to come here will not be in vain.'

但他也懷疑只針對一種疾病是否明智。這名蘇丹說，其它健康問題也應考慮，而不是只朝著消除小兒麻痹癥這一個方向努力。他列舉了肺結核、艾滋病、瘧疾、霍亂和血吸蟲病。
But he, too, questioned the wisdom of targeting one disease. 'Other health issues should be looked into,' the sultan said, 'instead of just facing one direction with polio eradication.' He ticked off tuberculosis, HIV and AIDS, malaria, cholera and a parasitic infection known as 'snail fever.'

自30年前取得了消滅天花的全球性勝利之后，人們熱衷于針對單一病種進行類似的垂直打擊。小兒麻痹癥計劃也遵循這種方式，并取得了巨大的進展。在世衛(wèi)和扶輪國際等捐助人的帶領下，截至2000年，這場戰(zhàn)役把全球小兒麻痹癥的發(fā)病次數(shù)從1988年的35萬例大幅減少到不足1,000例。參加戰(zhàn)役之人原計劃在2000年之前徹底消除這種疾病。
After the global victory over smallpox 30 years ago, a rush of energy went into similar 'vertical' attacks on single diseases. The polio program followed that approach and made great gains. Led by WHO and donors such as Rotary, the campaigns by the year 2000 slashed the world's polio cases to under 1,000 from 350,000 in 1988. Polio fighters planned to eradicate the disease by 2000.

然而時至今日，耗費了數(shù)十億美元之后，小兒麻痹癥仍然存在。
That date came and went. But polio persisted, eating up billions of dollars.

批評人士主張逐步放棄消滅小兒麻痹癥的作法，把騰出的資金用于防控多種疾病。在某些國家，防疫體系甚至忽略了其它疾病的防控，把消滅小兒麻痹癥計劃當成自己仍在運轉的證明。蓋茨在尼日利亞親眼目睹了這一現(xiàn)象。
Critics argued for a shift away from killing polio to free up money for controlling multiple diseases. In some countries, polio campaigns became an example of a functioning vaccination system even as other diseases were missed. Mr. Gates saw that himself in Nigeria.

索科托市的一家衛(wèi)生所設置在一輛豐田小型貨車內，車內堆放著健怡可樂。蓋茨走進車內后立刻靠在一張木質桌子上翻閱兒童防疫記錄。他指著一名男孩的白喉疫苗接種記錄問道，你知不知道這個孩子是否打過第一針白百破三聯(lián)疫苗？這名男孩顯然漏打了疫苗，但他身旁的醫(yī)務人員卻無言以對。
Arriving at a Sokoto health clinic in a Toyota minivan stocked with Diet Coke, Mr. Gates stepped inside and was soon leaning on a wooden desk, flipping through children's vaccine records. 'Do you know if this child had the first dose of DPT?' he asked, pointing to a record of a diphtheria vaccination of a boy who appeared to have missed a treatment. A health worker beside him didn't have an answer.

這名醫(yī)務人員說，由于政府供藥系統(tǒng)有問題，診所里也沒有乙型肝炎和黃熱病疫苗。
The clinic also had no hepatitis B and yellow fever vaccines, the workers said, because the government's system for supplying medicine wasn't working.

與之形成鮮明對比的是，診所前的消滅小兒麻痹癥工作正緊鑼密鼓地展開。醫(yī)務人員看管的冰箱里裝滿了給孩子用的疫苗，許多孩子聚集在周圍。
By contrast, in front of the clinic, a polio campaign was in full swing. Health workers tended coolers filled with vials of vaccine for children gathered there.

次日在首都阿布賈召開的會議上，尼日利亞初級衛(wèi)生保健工作負責人帕泰(Muhammad Ali Pate)又開始了一場“垂直與水平”的討論。他說，即使尼日利亞減少了小兒麻痹癥病例，沒有一個更健全的醫(yī)療保健體系，這一進步也難以維系。
At a meeting the next day in the capital, Abuja, Nigeria's head of primary health care, Dr. Muhammad Ali Pate, reopened the vertical-vs.-horizontal debate. Even if Nigeria lowers polio cases, he said, the gains 'can't hold' without a broader health-care system, he said.

蓋茨坐在來賓席聽他的發(fā)言。他面前桌子的名牌上寫著“我們的客人”的字樣。帕泰展示了一幅卡通蒸氣機火車的幻燈片，車廂上分別標注著“教育”和“疾病控制”。他說，小兒麻痹癥應當只是這列火車的一個車廂。
Mr. Gates listened, seated behind a name tag that read 'Our Guest.' Dr. Pate showed a slide of a cartoon steam-engine train with cars labeled 'Education' and 'Disease Control.' Polio should be just one car in that train, he said.

蓋茨并不否認這一點。他在接受采訪時說，尼日利亞當然需要一個運轉正常的衛(wèi)生系統(tǒng)，但要分輕重緩急。這個世界已經如此接近消滅小兒麻痹癥的目標，像尼日利亞這樣的國家應當把消滅小兒麻痹癥當做其首要任務。一旦成功，將能騰出數(shù)百萬美元的資金，可用于改善更廣闊的醫(yī)療保健領域。
Mr. Gates didn't disagree-certainly Nigeria needs a functioning health system, he said in interviews. But it was a matter of priorities, he said. With the world so close to killing polio, countries like Nigeria should make eradication a top priority, he said. Victory would free up millions of dollars to pay for broader health improvements.

他說，因此徹底消滅小兒麻痹癥的好處巨大。
'So the benefit of finishing is huge,' he said.

在飛機上，蓋茨籌劃了其它有助于贏得這場戰(zhàn)役的舉措，并拒絕了一位宗教領袖的建議：強制免疫。蓋茨開玩笑說，我說，把他們捆起來，讓我們把不打疫苗變成非法行為。之后他又嚴肅地引述了美國推行強制免疫接種失敗的例子。
On the plane, Mr. Gates strategized about what else would help win the fight, balking at one religious leader's suggestion: forced vaccinations. 'Strap 'em, down, I say! Let's make it illegal' to not take the vaccine, Mr. Gates joked. Then he got serious again, citing failed attempts in the U.S. to enforce compulsory vaccinations.

在許多方面，蓋茨在內心中仍是一名科技狂人。在飛機上，他詳細解釋了一系列科學問題，例如基因分型的進展，以及研究表明孟加拉國的疾病免疫率較高是由于糞口傳播，即人們喝的水受到了污染，其中含有少量的疫苗。
In many respects, Mr. Gates remains a tech geek at heart. Aboard his plane, he expounded on an array of scientific topics: From developments in genotyping, to research showing that Bangladesh's high disease-immunity rates are due to 'oral-fecal' transmission (when people ingest vaccines from contaminated water).

蓋茨在尼日利亞獲得了外交上的勝利。上文提到的那位蘇丹和尼日利亞官員承諾將在小兒麻痹癥免疫接種方面發(fā)揮更積極的作用。在訪問結束前，他對參會官員說，現(xiàn)在真的是全球成功消滅小兒麻痹癥的重要關口。
In Nigeria, Mr. Gates scored a diplomatic triumph. He won commitments from the sultan, and from Nigeria's governors, to take a more active role in polio vaccinations. 'We really stand at the threshold of global health success on polio,' he told the assembled governors at the close of the trip.

然而僅三天后，2,000英里之外的烏干達又出現(xiàn)了新的病例。一名婦女走進醫(yī)院稱他的兒子無法移動自己的左腿。這是烏干達12年間的首例小兒麻痹癥病例。
However, just three days later, a new front opened 2,000 miles away in Uganda. There, a woman walked into a hospital to say her son couldn't move his left leg. It was Uganda's first polio case in 12 years.

小兒麻痹癥還突然開始在馬里、多哥、加納和科特迪瓦出現(xiàn)，這里已連續(xù)四年沒有出現(xiàn)小兒麻痹癥病例。肯尼亞的一名女孩成為這個國家自2006年以來的首位小兒麻痹癥患者。
Cases also popped up in Mali, Togo and Ghana and Cote d'Ivore, which hadn't reported polio for four years. A girl in Kenya became that country's first polio case since 2006.

小兒麻痹癥通過受人類糞便污染的水體傳播，在感染人群中的致畸率僅為1/200，發(fā)現(xiàn)數(shù)起案例可能就意味著已有數(shù)千人被感染。這迫切需要采取大規(guī)模的防疫行動。
Polio, which spreads through water contaminated by human feces, paralyzes just one person for every 200 infected. Discovering just a few cases could mean that thousands have been infected. That demands massive vaccination campaigns.

2009年2月28日，前述世衛(wèi)官員艾偉德正和妻子、兒子一起在日內瓦選購生活用品時，突然收到一封有關烏干達疫情的加急電子郵件。艾偉德站在一個波菜展示臺旁邊，在手機上工作了半個小時，啟動了一套方案。10天后，烏干達48,000名兒童接種了疫苗。
On Feb. 28, 2009, Mr. Aylward, the WHO official, was grocery shopping in Geneva with his wife and son when he got an urgent email about the Uganda case. For 30 minutes, Mr. Aylward stood next to a spinach display, working his phone and setting in motion a plan that 10 days later vaccinated 48,000 children in Uganda.

像這種成本高昂的應急行動在去年變得越來越常見。艾偉德說，蓋茨基金會已劃出4,700萬美元專門用于應急行動。到6月上旬，這筆錢正在逐漸減少。
Costly emergency responses like this became increasingly common last year. The Gates Foundation had set $47 million aside for emergencies, Mr. Aylward said. By early June, the money was running down.

就在這個月，蓋茨飛往日內瓦，去參加世界衛(wèi)生組織地下室的那次會議。
That month, Mr. Gates flew to Geneva for the meeting in the WHO's underground room.

艾偉德后來回憶說，他當時宣布了一些好消息，來抵消疫情反彈的壞消息。在描繪了疫情的爆發(fā)之后，他把話題轉移到尼日利亞防治小兒麻痹取得的進展，并講述了一種新疫苗良好的試驗結果。
Mr. Aylward came with good news to offset the bad news about polio's resurgence, he recalled later. After describing the outbreaks, he shifted to Nigeria's progress against polio and described positive results from a trial of a new vaccine.

但據(jù)數(shù)位參加一次后續(xù)會議的人士稱，盡管有這些好消息，疫情反彈的風險仍然存在。美國疾控中心高級顧問科基(Steve Cochi)說，當時事情正變得明顯起來，病毒幾乎是控制不住的；這可以說是證實了我們最壞的一些擔憂。
But those positives didn't offset the risks of polio's revival, say several attendees of a follow-up meeting. 'It was becoming evident that the virus almost knew no bounds,' said Dr. Steve Cochi, senior adviser at Centers for Disease Control. 'It kind of confirmed some of our worst fears.'

一個月后，在美國的西雅圖，蓋茨基金會的人員做報告時，定格在一張幻燈片上。這張幻燈片顯示，基金會的小兒麻痹癥撥款正在逼近10億美元。對于一個似乎已陷入停滯的計劃來說，這個數(shù)字令人吃驚。一位與會人士說，在不對項目進行評估的情況下，我們不可能找山田忠孝和蓋茨要更多的錢。山田忠孝(Tachi Yamada)是蓋茨基金會高級官員。
A month later in Seattle, Gates Foundation officials paused at a PowerPoint presentation showing the foundation's polio grants were approaching $1 billion. It was a staggering amount for a program that appeared to be stalling. 'We can't go to Tachi and Bill and ask for more money,' without reviewing the program, one person said, referring to Mr. Gates and Tachi Yamada, a top foundation official, according to an attendee.

8月份，專家們受世界衛(wèi)生組織的委托趕赴安哥拉、巴基斯坦、阿富汗、印度和尼日利亞，對項目進行評估。其中一支隊伍在非洲發(fā)現(xiàn)，由于醫(yī)療體系薄弱，小兒麻痹癥在一些國家一度消失后又死灰復燃。在印度北部，衛(wèi)生條件差、營養(yǎng)不良和其他腸道問題，被認定會降低小兒麻痹癥口服疫苗的藥效。
In August, experts commissioned by the WHO landed in Angola, Pakistan, Afghanistan, India and Nigeria to evaluate the polio program. In Africa, a team found that once polio had been ended in some countries, weak health-care systems let it return. In northern India, bad sanitation, malnutrition and other intestinal issues are believed to hurt the oral polio vaccine's effectiveness.

這些發(fā)現(xiàn)同蓋茨在尼日利亞獲得的信息差不多，并標志著蓋茨基金會和這次行動的其他支持者在爭論完全“垂直”策略能否成功的過程中，出現(xiàn)了一個轉折點。
These findings echoed the message to Mr. Gates in Nigeria, and marked a turning point among the Gates Foundation and other backers of the polio fight in the debate over whether the strictly 'vertical' polio strategy could succeed.

10月份，蓋茨基金會召集該計劃的支持者在其西雅圖總部進行一場較為徹底的反思，這些支持者包括聯(lián)合國兒童基金會、美國疾病控制與預防中心和扶輪國際。兩個星期后，基金會又邀請獨立專家來幫忙。這些會議的結果將反映于下周出爐的修訂版計劃中。行動的支持者表示，今年全世界只報告了71起小兒麻痹案例，而去年同期是328例，這讓他們受到了鼓舞。
In October, the Gates Foundation summoned backers of the program, including Unicef, CDC and Rotary, to its Seattle headquarters for a major rethink. Two weeks later it called in independent experts for help. The outcome of those meetings will be reflected in the revamped plan coming next week. Polio backers say they are buoyed by reports of just 71 polio cases worldwide this year, vs. 328 in the year-earlier period.

新的策略如果在5月份得到世界衛(wèi)生組織各成員國的批準，它將為在2012年年底前接近根治小兒麻痹癥定下宏偉的目標。新的計劃鞏固了作為行動核心的“垂直”方針，同時也加進了一個“水平”策略，比如就保健和環(huán)境衛(wèi)生等話題為衛(wèi)生工作人員提供培訓。
If approved in May by member nations of the WHO, the new strategy will set ambitious goals for getting close to eradicating polio by the end of 2012. The plan bolsters the core 'vertical' approach of polio program but also adds a 'horizontal' strategy, including training for health workers on topics such as hygiene and sanitation.

尼日利亞將成為一個重要的試驗場。自蓋茨訪問以來，這個國家在防治小兒麻痹癥方面已經取得長足進步。但艾偉德說，消除尼日利亞和其他三個小兒麻痹癥根深蒂固的國家中至少一個的疫情，將是接下來三年的主要挑戰(zhàn)。他說，如果不能實現(xiàn)這個目標，那么整個行動還會不會繼續(xù)，就會存在疑問。
Nigeria will be a key testing ground. The country has made strong progress against the disease since Mr. Gates's visit. But stopping polio there, and in at least one of the three other countries where it's deeply rooted, will be the main challenge in the next three years, Mr. Aylward says. Failure to achieve that goal will raise questions over whether the program continues, he says.

資金是一個很大的障礙。這場防治小兒麻痹癥的行動未來三年將需要26億美元資金，目前存在14億美元的缺口。蓋茨基金會將繼續(xù)為行動撥款，但它表示，這個缺口是它無法填補的。
A big hurdle is money. The polio program is $1.4 billion short of the $2.6 billion it needs over next three years. The Gates Foundation will continue its polio grants, but says it can't make up the shortfall.

但資金也只是蓋茨在新職業(yè)中遇的諸多問題之一。他建立基金會，就是看中了救命疫苗的前景，這也反映了他利用科技解決問題的喜好。而撥款流向國的政治、宗教和社會障礙也有可能對科技形成阻礙，這從防治小兒麻痹癥的行動中就可以看出。蓋茨仍在學習怎樣在這些障礙之中做到游刃有余。
But funding is just one worry for Mr. Gates in his new career. He built his foundation on the promise of life-saving vaccines, reflecting his penchant toward finding technological solutions to problems. As polio shows, technology can be hampered by political, religious and societal obstacles in the countries where he's spending his money. He's still learning how to navigate through those forces.

去年在尼日利亞的時候，蓋茨坐在酒店后面的草坪上，就在琢磨這個問題。他說，科學可以讓這份工作簡單化，但人性的因素才是最終的考驗。
In Nigeria last year, Mr. Gates sat on the lawn behind his hotel reflecting on that. Science can simplify the job, he said, but 'the human piece is the ultimate test.'