Mosquitoes, malaria and education

I wrote a letter last week talking about the work of the foundation, sharing some of the problems.
And Warren Buffet had recommended I do that being honest about what was going well,
what wasn't, and making it kind of an annual thing. A goal I had there was to draw more people
in to work on those problems, because I think there are some very important problems that don't
get worked on naturally. That is, the market does not drive the scientists, the communicators,
the thinkers, the governments to do the right things. And only by paying attention to these things
and having brilliant people who care and draw other people in can we make as much progress
as we need to.

So this morning I'm going to share two of these problems and talk about where they stand. But
before I dive into those I want to admit that I am an optimist. Any tough problem, I think it can be
solved. And part of the reason I feel that way is looking at the past. Over the past century,
average lifespan has more than doubled. Another statistic, perhaps my favorite, is to look at
childhood deaths. As recently as 1960, 110 million children were born, and 20 million of those
died before the age of five. Five years ago, 135 million children were born so, more and
less than 10 million of them died before the age of five. So that's a factor of two reduction of the
childhood death rate. It's a phenomenal thing. Each one of those lives matters a lot.

And the key reason we were able to it was not only rising incomes but also a few key breakthroughs:
vaccines that were used more widely. For example, measles was four million of the deaths back
as recently as 1990 and now is under 400,000. So we really can make changes. The next
breakthrough is to cut that 10 million in half again. And I think that's doable in well under 20
years. Why? Well there's only a few diseases that account for the vast majority of those deaths:
diarrhea, pneumonia and malaria.

So that brings us to the first problem that I'll raise this morning, which is how do we stop a
deadly disease that's spread by mosquitoes?

Well, what's the history of this disease? It's been a severe disease for thousands of years. In
fact, if we look at the genetic code, it's the only disease we can see that people who lived in
Africa actually evolved several things to avoid malarial deaths. Deaths actually peaked at a bit
over five million in the 1930s. So it was absolutely gigantic. And the disease was all over the
world. A terrible disease. It was in the United States. It was in Europe. People didn't know what
caused it until the early 1900s, when a British military man figured out that it was mosquitoes.
So it was everywhere. And two tools helped bring the death rate down. One was killing the
mosquitoes with DDT. The other was treating the patients with quinine, or quinine derivatives.
And so that's why the death rate did come down.

Now, ironically, what happened was it was eliminated from all the temperate zones, which is
where the rich countries are. So we can see: 1900, it's everywhere. 1945, it's still most places.
1970, the U.S. and most of Europe have gotten rid of it. 1990, you've gotten most of the northern
areas. And more recently you can see it's just around the equator.

And so this leads to the paradox that because the disease is only in the poorer countries, it
doesn't get much investment. For example, there's more money put into baldness drugs than
are put into malaria. Now, baldness, it's a terrible thing. And rich men are afflicted. And so that's
why that priority has been set.

But, malaria even the million deaths a year caused by malaria greatly understate its impact.
Over 200 million people at any one time are suffering from it. It means that you can't get the
economies in these areas going because it just holds things back so much. Now, malaria is of
course transmitted by mosquitoes. I brought some here, just so you could experience this. We'll
let those roam around the auditorium a little bit. There's no reason only poor people should have
the experience. Those mosquitoes are not infected.

So we've come up with a few new things. We've got bed nets. And bed nets are a great tool.
What it means is the mother and child stay under the bed net at night, so the mosquitoes that
bite late at night can't get at them. And when you use indoor spraying with DDT and those nets
you can cut deaths by over 50 percent. And that's happened now in a number of countries. It's
great to see.

But we have to be careful because malaria the parasite evolves and the mosquito evolves.
So every tool that we've ever had in the past has eventually become ineffective. And so you end
up with two choices. If you go into a country with the right tools and the right way, you do it
vigorously, you can actually get a local eradication. And that's where we saw the malaria map
shrinking. Or, if you go in kind of half-heartedly, for a period of time you'll reduce the disease
burden, but eventually those tools will become ineffective, and the death rate will soar back up
again. And the world has gone through this where it paid attention and then didn't pay attention.

Now we're on the upswing. Bed net funding is up. There's new drug discovery going on. Our
foundation has backed a vaccine that's going into phase three trial that starts in a couple months.
And that should save over two thirds of the lives if it's effective. So we're going to have these
new tools.

But that alone doesn't give us the road map. Because the road map to get rid of this disease
involves many things. It involves communicators to keep the funding high, to keep the visibility
high, to tell the success stories. It involves social scientists, so we know how to get not just 70
percent of the people to use the bed nets, but 90 percent. We need mathematicians to come in
and simulate this, to do Monte Carlo things to understand how these tools combine and work
together. Of course we need drug companies to give us their expertise. We need rich-world
governments to be very generous in providing aid for these things. And so as these elements
come together, I'm quite optimistic that we will be able to eradicate malaria.

Now let me turn to a second question, a fairly different question, but I'd say equally important.
And this is: How do you make a teacher great? It seems like the kind of question that people
would spend a lot of time on, and we'd understand very well. And the answer is, really, that we
don't. Let's start with why this is important. Well, all of us here, I'll bet, had some great teachers.
We all had a wonderful education. That's part of the reason we're here today, part of the reason
we're successful. I can say that, even though I'm a college drop-out. I had great teachers.

In fact, in the United States, the teaching system has worked fairly well. There are fairly effective
teachers in a narrow set of places. So the top 20 percent of students have gotten a good education.
And those top 20 percent have been the best in the world, if you measure them against the
other top 20 percent. And they've gone on to create the revolutions in software and biotechnology
and keep the U.S. at the forefront.

Now, the strength for those top 20 percent is starting to fade on a relative basis, but even more
concerning is the education that the balance of people are getting. Not only has that been weak.
it's getting weaker. And if you look at the economy, it really is only providing opportunities now to
people with a better education. And we have to change this. We have to change it so that
people have equal opportunity. We have to change it so that the country is strong and stays at
the forefront of things that are driven by advanced education, like science and mathematics.

When I first learned the statistics, I was pretty stunned at how bad things are. Over 30 percent
of kids never finish high school. And that had been covered up for a long time because they
always took the dropout rate as the number who started in senior year and compared it to the
number who finished senior year. Because they weren't tracking where the kids were before
that. But most of the dropouts had taken place before that. They had to raise the stated dropout
rate as soon as that tracking was done to over 30 percent. For minority kids, it's over 50 percent.
And even if you graduate from high school, if you're low-income, you have less than a 25 percent
chance of ever completing a college degree. If you're low-income in the United States, you have a
higher chance of going to jail than you do of getting a four-year degree. And that doesn't seem
entirely fair.

So, how do you make education better?

Now, our foundation, for the last nine years, has invested in this. There's many people working
on it. We've worked on small schools, we've funded scholarships, we've done things in libraries.
A lot of these things had a good effect. But the more we looked at it, the more we realized that
having great teachers was the very key thing. And we hooked up with some people studying how
much variation is there between teachers, between, say, the top quartile the very best and the
bottom quartile. How much variation is there within a school or between schools? And the answer is
that these variations are absolutely unbelievable. A top quartile teacher will increase the
performance of their class based on test scores by over 10 percent in a single year. What
does that mean? That means that if the entire U.S., for two years, had top quartile teachers, the
entire difference between us and Asia would go away. Within four years we would be blowing
everyone in the world away.

So, it's simple. All you need are those top quartile teachers. And so you'd say, "Wow, we should
reward those people. We should retain those people. We should find out what they're doing and
transfer that skill to other people." But I can tell you that absolutely is not happening today.

What are the characteristics of this top quartile? What do they look like? You might think these
must be very senior teachers. And the answer is no. Once somebody has taught for three years
their teaching quality does not change thereafter. The variation is very, very small. You might
think these are people with master's degrees. They've gone back and they've gotten their Master's
of Education. This chart takes four different factors and says how much do they explain teaching
quality. That bottom thing, which says there's no effect at all, is a master's degree.

Now, the way the pay system works is there's two things that are rewarded. One is seniority.
Because your pay goes up and you vest into your pension. The second is giving extra money to
people who get their master's degree. But it in no way is associated with being a better teacher.
Teach for America: slight effect. For math teachers majoring in math there's a measurable effect.
But, overwhelmingly, it's your past performance. There are some people who are very good at
this. And we've done almost nothing to study what that is and to draw it in and to replicate it, to raise
the average capability or to encourage the people with it to stay in the system.

You might say, "Do the good teachers stay and the bad teacher's leave?" The answer is, on
average, the slightly better teachers leave the system. And it's a system with very high turnover.

Now, there are a few places very few where great teachers are being made. A good
example of one is a set of charter schools called KIPP. KIPP means Knowledge Is Power. It's an
unbelievable thing. They have 66 schools mostly middle schools, some high schools and
what goes on is great teaching. They take the poorest kids, and over 96 percent of their high
school graduates go to four-year colleges. And the whole spirit and attitude in those schools is
very different than in the normal public schools. They're team teaching. They're constantly
improving their teachers. They're taking data, the test scores, and saying to a teacher, "Hey, you
caused this amount of increase." They're deeply engaged in making teaching better.

When you actually go and sit in one of these classrooms, at first it's very bizarre. I sat down and
I thought, "What is going on?" The teacher was running around, and the energy level was high. I
thought, "I'm in the sports rally or something. What's going on?" And the teacher was constantly
scanning to see which kids weren't paying attention, which kids were bored, and calling kids
rapidly, putting things up on the board. It was a very dynamic environment, because particularly
in those middle school years fifth through eighth grade keeping people engaged and
setting the tone that everybody in the classroom needs to pay attention, nobody gets to make
fun of it or have the position of the kid who doesn't want to be there. Everybody needs to be
involved. And so KIPP is doing it.

How does that compare to a normal school? Well, in a normal school, teachers aren't told how
good they are. The data isn't gathered. In the teacher's contract, it will limit the number of times
the principal can come into the classroom sometimes to once per year. And they need
advanced notice to do that. So imagine running a factory where you've got these workers, some
of them just making crap and the management is told, "Hey, you can only come down here once
a year, but you need to let us know, because we might actually fool you, and try and do a good
job in that one brief moment."

Even a teacher who wants to improve doesn't have the tools to do it. They don't have the test
scores, and there's a whole thing of trying to block the data. For example, New York passed a
law that said that the teacher improvement data could not be made available and used in the
tenure decision for the teachers. And so that's sort of working in the opposite direction. But I'm
optimistic about this, I think there are some clear things we can do.

First of all, there's a lot more testing going on, and that's given us the picture of where we are.
And that allows us to understand who's doing it well, and call them out, and find out what those
techniques are. Of course, digital video is cheap now. Putting a few cameras in the classroom
and saying that things are being recorded on an ongoing basis is very practical in all public
schools. And so every few weeks teachers could sit down and say, "OK, here's a little clip of
something I thought I did well. Here's a little clip of something I think I did poorly. Advise me when
this kid acted up, how should I have dealt with that?" And they could all sit and work together on
those problems. You can take the very best teachers and kind of annotate it, have it so everyone
sees who is the very best at teaching this stuff.

You can take those great courses and make them available so that a kid could go out and watch
the physics course, learn from that. If you have a kid who's behind, you would know you could
assign them that video to watch and review the concept. And in fact, these free courses could
not only be available just on the Internet, but you could make it so that DVDs were always
available, and so anybody who has access to a DVD player can have the very best teachers.
And so by thinking of this as a personnel system, we can do it much better.

Now there's a book actually, about KIPP the place that this is going on that Jay Matthews, a
news reporter, wrote called, "Work Hard, Be Nice." And I thought it was so fantastic. It gave you a
sense of what a good teacher does. I'm going to send everyone here a free copy of this book.

Now, we put a lot of money into education, and I really think that education is the most important
thing to get right for the country to have as strong a future as it should have. In fact we have in
the stimulus bill it's interesting the House version actually had money in it for these data
systems, and it was taken out in the Senate because there are people who are threatened by
these things.

But I I'm optimistic. I think people are beginning to recognize how important this is, and it
really can make a difference for millions of lives, if we get it right. I only had time to frame those
two problems. There's a lot more problems like that AIDS, pneumonia I can just see you're
getting excited, just at the very name of these things. And the skill sets required to tackle these
things are very broad. You know, the system doesn't naturally make it happen. Governments
don't naturally pick these things in the right way. The private sector doesn't naturally put its
resources into these things.

So it's going to take brilliant people like you to study these things, get other people involved and
you're helping to come up with solutions. And with that, I think there's some great things that will
come out of it.

Thank you.