Bill Gates's Billions Reshape the Health of World's Neediest
By STEPHANIE STROM
The New York Times
Philanthropists do not typically lavish their money on swine. Or mosquitoes, for that matter.
But Bill Gates is no ordinary philanthropist. If immunizing pigs can end the spread of tapeworms, which cause virulent neurological disorders, he will pay to vaccinate them. If mosquitoes can be neutralized as malaria carriers by altering their genetic code, his money -- and lots of it -- will support the research.
"The basic science that can be applied to these problems has been advanced greatly," Mr. Gates, the chairman of Microsoft, said in a recent interview at the company's headquarters in Redmond, Wash. "So all you have to do is take a modest amount of the rich world's resources to have a huge impact on the poor world."
"Modest" is a relative term, particularly when the person using it is the world's richest man and is speaking of his plans to solve intractable health problems on a global scale.
The Bill & Melinda Gates Foundation, which has distributed $6.2 billion since its founding less than four years ago, has pledged more than half of that total, or $3.2 billion, to improving health in the developing world. The foundation's influence now rivals that of the World Health Organization and Unicef.
Here is one point of comparison: The Global Fund to Fight AIDS, Tuberculosis and Malaria, a partnership of 14 countries with private charities, foundations and industry, plans to spend roughly $1.5 billion to fight those diseases over the next two to three years, some $50 million or $60 million of which comes from the Gates Foundation. The Gates Foundation on its own has already spent more than $610 million on those diseases, and will spend at least another $478 million by the end of 2005.
The foundation's influence can already be seen in rising vaccination rates in some of the world's poorest countries, in clinical trials of drugs that are promising but have limited commercial potential and in new devices that make the delivery of health care easier and cheaper.
Dr. Tore Godal, executive secretary of Global Alliance for Vaccines and Immunization, a major Gates beneficiary, said it had delivered more than 180 million doses of vaccines since 2000, thus saving more than 100,000 lives. Mr. Gates figures that his philanthropy will have touched more than a million lives by the end of the decade, and his goal is to reach tens of millions more.
"Bill Gates is going to be remembered more for what he did for international public health than what he did for the world of computers," predicted Richard T. Mahoney, a professor at Arizona State University who has wide experience dealing with health issues in poor countries.
Those who think of Mr. Gates as a ruthless billionaire monopolist, the man who was so testy and sarcastic with government prosecutors during the Microsoft antitrust trial, may find it hard to reconcile that image with one of a humorously self-deprecating philanthropist.
Many suspected that Mr. Gates's plunge into works of charity, which took off at the time of the trial, was aimed at polishing his image.
But if his foundation is a public relations exercise, it is one that experts in the field agree is innovative, ambitious and bold.
"It seems to me -- and I've been following his work -- that this is a guy with a vision," said Michael Bailin, president of the Edna Clark McConnell Foundation. "He's willing to put his money out there and make some big but good gambles on some of the most important issues there are."
Where the fledgling Gates Foundation once sought guidance from philanthropic bluebloods like Rockefeller and Carnegie, budding philanthropists are now turning to Gates for advice. In April, Michael S. Dell, the computer billionaire who is quietly increasing his philanthropy, sent Janet Mountain, the new executive director of his foundation, to Seattle to see how the Gates Foundation does things. What she saw was a foundation that spreads its wealth generously but cautiously, hedging its bets by financing collaborative efforts that involve governments, private industry, scientists, nonprofit groups and agencies like Unicef.
Fully 80 percent of the foundation's contributions to global health are funneled through public-private partnerships that bring together all the parties needed to sustain successful programs.
In part, that approach is a necessity: the foundation needs a big conduit to accommodate its big grants.
But it is also smart philanthropy, experts say. "They don't focus on defining a problem and looking to singlehandedly address it, although they certainly could," said Melissa A. Berman, president and chief executive of Rockefeller Philanthropy Advisers. "They look at a whole system and how that system can be used to address the problem on a very large scale. They are always looking at the grander vision."
The rising influence of the Gates Foundation has been matched, perhaps not surprisingly, by a growing interest in global health among world governments, a trend perhaps best reflected in President Bush's commitment of $15 billion to fighting AIDS in Africa. The president could have been reading from a script prepared by Mr. Gates when he said during a stop in Botswana last week that the "first thing I want the leadership of Africa to know is the American people care deeply about the pandemic that sweeps across this continent."
A Passion for Health
While the bulk of Mr. Gates's philanthropy goes to two areas, global health and education, he makes it clear that health is his passion.
"In health, I get very involved in the sense of learning about it," Mr. Gates said. "I'm very excited we're doing education, but it's a little bit different. I haven't read 80 books on education, I've read three key ones."
His foundation's largest grant to a single entity was the $750 million that got the Global Alliance for Vaccines and Immunization off the ground. The alliance's charge is to prevent the deaths of three million children a year by improving the supply and distribution of vaccines and by developing new ones.
Mr. and Mrs. Gates have committed several hundred million dollars to their biggest dream, eliminating AIDS, with the largest portion, $126.5 million, going to the International AIDS Vaccine Initiative.
Then there are dozens of grants in the tens of millions of dollars, like the $50 million that helped set up the Global Alliance for Improved Nutrition.
But the health-related grant that shows Mr. Gates at his Jimmy Neutron best is the $200 million the foundation will spend to underwrite research to solve "grand challenges," the thorniest problems and obstacles in the science of health.
"The goal of this is to create buzz everywhere, not limited to Harvard and Oxford but at Makarere University in Uganda and the University of Cape Town," said Dr. Richard D. Klausner, the former director of the National Cancer Institute who oversees the foundation's global health efforts.
An international panel of scientists is peppering Dr. Klausner with e-mail messages proposing potential challenges. For instance, the foundation might challenge scientists to find a way to keep tuberculosis patients from relapsing. Or to find new combinations of nutrients to protect children against death and mental impairment caused by malnutrition. Or to find genetic ways to prevent the transmission of diseases from animals to humans.
If solutions are found, the National Institutes of Health has promised to finance their rollout.
Mr. Gates calls the global challenges "one of the wildest things" the foundation has done. "What it's going to draw out of the woodwork in terms of intelligence and thinking and just shedding light on the fact that issues that may seem mundane, like mosquito genetics or refrigeration requirements, actually really do affect lives," he said. "Raising the visibility is a big topic for us: How do you turn global health into a grass roots political issue?"
One way is simply by talking. The normally reticent Mr. Gates recently gave a long interview to Bill Moyers and talked with Tom Brokaw about the foundation's effort to wire libraries, which is ending this year.
Mr. Gates jokes, though, that his penchant for nattering about morbidity rates and the ravages of dengue fever have made him less popular at cocktail parties, and he says he has little interest in the social rituals of of philanthropist's life. He only reluctantly agreed to meet Bono, the lead singer of the band U2 who campaigns for debt relief and AIDS prevention, as a courtesy to his old friend and co-founder of Microsoft, Paul Allen.
"I have to admit, I didn't think I wanted to spend time with Bono," Mr. Gates said. "I mean, you know, I don't meet with rock stars. What would I talk with them about?"
Their meeting changed his mind. "I mean, this guy is a genius, and not just a music genius," Mr. Gates said. "So I didn't expect it to be fun the way I know it would be fun to meet with my TB expert or to spend time talking with Rick Klausner and brainstorming about how we do this stuff."
The Effect of Big Grants
The Gates Foundation's generosity is in part a function of the tax code: with assets of $24 billion, the foundation spends more than $1 billion a year, sometimes in grants of $100 million or more, to maintain its tax exemption.
Big grants allow its beneficiaries to devote more time to their missions and worry less about raising money, which the foundation hopes will increase their efficiency and effectiveness. The Global Alliance for Vaccines and Immunization, for instance, has no responsibility for raising money. A separate organization, the Vaccine Fund, handles that.
The Gates Foundation's willingness to shoulder the majority of the financing burden in one case left a beneficiary speechless.
The foundation had pledged $100 million for children's vaccines, dwarfing all previous gifts to support immunization in the developing world. Yet Mr. Gates and his wife kept asking the scientists at a dinner at their home in November 1998 what they would do if they had even more money.
Mr. Mahoney and others there assumed that the couple were talking about possible contributions from other donors. But the scientists knew that the huge Gates grant would probably discourage others from giving.
"We were all hemming and hawing and politely trying to explain the problem," Mr. Mahoney said.
Finally, someone asked whether Mr. Gates was suggesting that he might be putting up more money for vaccines, and he said he was. "As we all walked out of the home, no one could form a complete sentence," Mr. Mahoney recalled. "The best most people could do was 'Jeez.' "
Mr. Gates is aware that his grants can have a chilling effect. The first $1.5 million that he gave to the International AIDS Vaccine Initiative in 1998 helped the group raise $50 million more, and a later gift of $25 million helped draw more dollars.
But when the foundation gave the group $100 million in 2001, two or three donors that had been negotiating the terms of their gifts to the group pulled back, said Dr. Seth Berkeley, its president.
"There is no question that there is an effect of their financing slowing and stopping other funders," Dr. Berkeley said. "But I'd rather have their support and have to work harder to get more from other sources than not have it at all. No question about that."
Leveraging Charity
In the same way that Mr. Gates's big donations reflect calculated risk-taking, the foundation's grants also hedge against gambles going bad.
Consider its efforts to eliminate polio. In April, the foundation announced that it was putting up $25 million, which with a match from Rotary International and the United Nations Foundation would seed a fund to pay off World Bank loans that countries used to buy and administer polio vaccines.
Nigeria, which has the highest incidence of polio in Africa, was the first to bite, borrowing $28 million from the bank. If it uses the money to eradicate polio, the fund will pay down the loan, but because the terms of the loan are so long the fund expects it will effectively repay only a fraction of every dollar borrowed, providing tremendous leverage for the philanthropy behind it.
Pakistan borrowed $20 million in May, and other countries are lining up.
"This is an innovative and smart way of making a grant, which can be used as a model for a variety of similar programs," said Harvey P. Dale, founding president of the Atlantic Philanthropies and director of the National Center on Philanthropy and the Law at New York University.
Mr. Gates is clearly intent on spending his billions effectively, but he says he measures the effect of his philanthropy in simple terms.
"With world health," he said, "every life you save is a wonderful thing, so it's not this question of whether you solve it or you don't. The chance of completely solving the problems has long odds.
"But really, the thing is that you get to save the first child, the second child, the third child. You can just feel good about that."
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