Giving Billions Isn't Easy

By Karl Taro Greenfeld

Patty Stonesifer, 43, may have the best job in the world. What she does every day as chairwoman of the Bill and Melinda Gates Foundation is think about how to give away chunks of money that amount to the annual income of a small nation. That's not as simple as it sounds. She will tell you it's an easy thing to do badly: to write checks to the wrong people and tell them to come back in a few years when they need a little more. But to do it well, to apply all those billions where they will make the most difference, is a job and an obsession that take up almost every minute of her post-Microsoft career.

Think about it: the world's problems are a drowning pool of need. Even Bill Gates' $65 billion--most of which he has vowed to give away before he dies--won't make a dent if it's managed poorly.

Stonesifer, sitting in a coffeehouse in Redmond, Wash., draws a diagram of a river, then stick-figure babies floating in the river and then her plan for heading upstream to where those babies are falling into the river and solving the problem there. She's told this story two dozen times. But there is a fervor in her brown eyes and a drill-to-the-core focus that made her the top female executive at Microsoft until her retirement, at age 40, in 1997. She does not draw a salary for her work with the Gates Foundation. "We have an approach here that is very much based on the enthusiasm the Gateses have," Stonesifer says. "We can cause enormous health improvements rapidly." She talks in terms of saving millions of lives, of improving billions of lives.

The foundation, with $22 billion in assets, of which it spends $1 billion each year, is the most richly endowed philanthropic organization on earth, last year surpassing Britain's Wellcome Trust. Or look at it this way: Gates, 44, has given more money away faster than anyone else in history. For Stonesifer and the Gates family--Bill, his wife Melinda and his father Bill Sr.--that means sitting down with doctors, scientists and veteran philanthropists. It means performing the research and hard-nosed analysis that Gates and Stonesifer had done for years in developing software products, but applying it instead to eradicating malaria or polio in developing countries.

Gates' first great non-Microsoft project, started in 1997, was paying billions to wire America's libraries. He deployed high-tech task forces that fanned out across the U.S. equipped with computers, modems and software, bridging the digital divide for poorer school districts. There is a room on the second floor of the Gates Foundation's new Seattle office complex that is command central for that initiative, where huge national maps are studded with pins showing which library districts have been wired--22,530 computers in 4,540 libraries in the U.S. and 4,024 computers in 1,435 libraries in Canada. So far, about $92 million has been spent on the library program. This is the war room of a battle Bill is winning. The wiring project will last until 2005, and is being expanded to libraries around the world.

The foundation is as spartan in structure and style as an Internet start-up. There are just 25 employees, in contrast to 525 for the venerable Ford Foundation. The Gates Foundation staff members wade through more than 3,000 serious funding requests each month. And that doesn't count the perpetual-motion machines and colonic-cleansing devices with which promoters could save the world if only Bill and Melinda would throw a few million dollars their way. Worthy projects are filtered up by Stonesifer, Dr. Gordon Perkin and Bill's dad for review by Bill and Melinda.

The foundation sees its role as filling the breach where the private sector is not addressing a crisis. The industrialized world's ailments, from indigestion to breast cancer, are already the focus of drug-company research. Cure a First World disease, and reap millions in profits. But cure a Third World disease such as malaria--the No. 1 killer in tropical climes--and there is hardly a penny to be earned. Those patients don't have health insurance. That is why the Gates Foundation has made finding a malaria vaccine a priority, along with eradicating scourges such as hookworm, hepatitis B, leishmaniasis (a parasitic disease transmitted by sand flies that affects 15 million people a year), HIV, guinea-worm disease and tuberculosis. The foundation is spending nearly $400 million a year on its global-health initiative, mainly by developing new vaccines and cures and making existing cures more available to the people who need them.

Bill Gates scrutinizes each project and often asks very specific questions. In one series of internal e-mail messages provided to TIME, Gates asked who would own the intellectual property arising from a particular vaccine program. Another exchange had him doubting that the per-dollar impact of a given program is "super-high."

Gates, when you sit down with him in his Redmond office, rocks back and forth as he falls into a reverie about "the world-health thing." He says, "The more people know about this--about the millions of lives that can be saved, about the millions of children who are dying of disease every year that we have cures for--then how can you not do something about it? The most important priority for me is saying we could save millions of lives a year." That is a heady thought even for the richest man in the world. How many of us will ever be able to say we saved millions of lives?

For Gates, that prospect blunts the criticism of those who say his generosity is meant to burnish his image amid the Justice Department's antitrust suit against his company. (Though the Bill and Melinda Gates Foundation was founded in 1997, a year before the suit was filed, he has accelerated his donating schedule in the 16 months of the trial.) "I have a high enough level of visibility that people will second-guess anything I do," Gates says, shrugging. He has come to see his life as something of a tripod: there are his wife and children, his company and "this other area, in philanthropy, where I'm seeing that by engaging the smart people and highlighting the possibilities, there's a chance to do something that every day I feel good about."

--K.T.G.