The casual-trousered philanthropists
Dhaka airport looks slightly different as Bill and Melinda Gates’s private Bombardier jet touches down in the early-morning heat. Two enormous hand-painted portraits of the couple have been hastily put up next to the runway, and on the road just outside, another huge sign welcomes the world’s biggest philanthropists to the capital.
The Gateses are here as part of a four-day trip to Bangladesh and India, where they will be given a firsthand look at what their gargantuan charity, the Bill & Melinda Gates Foundation, is doing in the region, and where it might next direct its attention.
The couple make a trip like this every year, but the travel arrangements aren’t usually on this scale. As soon as they leave their plane, they are whisked into a 10-car entourage, complete with a military escort and an ambulance, and swept through the city’s unusually empty streets.
Police have erected dozens of road blocks to keep back drivers and pedestrians. Snipers stand ready on almost every tall building as the cavalcade heads towards the Dhaka Sheraton, the city’s most luxurious downtown hotel.
An advance party, including several former White House aides, has been out here for several days, working on an itinerary that has been closely guarded from all but the couple’s personal staff and the handful of journalists travelling with them.
The original schedule was cut back because of suicide bomb attacks in other Bangladeshi towns a week earlier, and yesterday there was talk of the entire trip being cancelled after an explosive device was found under a bus in Dhaka itself. Each member of the delegation has had to wear a special metal lapel badge showing the US and Bangladeshi flags to identify themselves to security officers.
The Gates’s visit may have all the trappings of a visit by a head of state, but neither of them looks at all stately on their first stop in Dhaka’s slums. When the cavalcade stops, Bill Gates emerges with tousled hair, casual white trousers, a blue fleece and brown shoes. Melinda wears a beige skirt, purple top and sandals. A modest gold ring is her only jewellery.
They both sound almost apologetic about the upheaval their visit has created. “It’s an extreme case,” Gates tells the journalists travelling with them.
“It’s not our preferred mode of transportation,” adds Melinda. “We would not have this high level of visibility normally.”
But the head-of-state analogy is not out of place. Bill Gates is the world’s richest man, with a personal fortune of $26bn. Add in the $280bn value of Microsoft, the corporate giant he created in 1975, and his economic clout matches Bangladesh’s GDP. But Gates spends more on other people’s health and education than any government, not least those in the Indian sub-continent, where Microsoft invests and hires heavily and its founder is feted as a capitalist hero.
I have come on this trip to try to understand what has driven him and his wife to transform themselves from the world’s richest hi-tech corporate couple into its most generous philanthropists. Their extraordinary foundation now has an endowment of $30bn, making it the largest charity in the world. Since it was formed in 2000, it has spent $6bn on global health alone, and its annual disbursements now exceed those of the World Health Organisation. Indeed, the foundation’s donations are so large that - if they are well used - they may provide a legacy that lasts long after the world has forgotten Microsoft.
What makes the Gateses so different from other important philanthropists is that they have become benefactors while still relatively young: most foundation founders did not have the time or energy to do such work before they retired. Their main aim is to reduce inequalities around the world. In the US, that is primarily through educational reform and grants for the under-privileged. Elsewhere, it is to harness science to tackle some of the developing world’s most intractable problems: the “neglected” diseases that include malaria, tuberculosis and Aids.
As a pharmaceutical industry reporter, I have been struck by the charity’s omnipresence in global health affairs. Whenever you study the diseases of the poor, and the development of new vaccines and drugs, Gates Foundation money, admirers and projects are never far behind. As well as finding out why the Gateses had become such active donors, I wanted to see what difference their philanthropy had made, and whether the direction of their influential work might be about to change following the abrupt departure last September of their most senior health expert, Rick Klausner.
It does not take much time with the Gateses to realise that one big factor in their philanthropic work is 41-year-old Melinda. If Bill Gates has the scientific authority and wealth in this partnership, his wife has the political skills and the emotional drive to implement decisions. One of our scheduled stops in Dhaka is the slum of Uttarmuqda, where the couple sit cross-legged on the floor of a ruined house, surrounded by flood-water and rubbish, to hear 20 local women explain how they obtained small loans through a “micro-finance” system that the foundation is thinking of supporting.
“Was it worse than Calcutta?” Bill asks Melinda afterwards.
“These were pretty good slums, as slums go,” she replies. “It’s not as bad as the rag pickers in Calcutta. But it’s pretty gut-wrenching.”
Later in the day, we go to Dhaka’s International Centre for Diarrhoeal Disease Research, which has been funded by the Gates Foundation. Inside the institute, Melinda goes straight to a screaming child lying on a bed underneath a thick green plastic sheet with a hole in the middle out of which comes a tube that runs into a bucket under the bed. “That’s the most important invention of the 20th century: a bed with a bathroom attached,” says David Sack, the centre’s director. The bed allows nurses to see instantly how much fluid cholera-infected patients are losing, so that patients can be quickly rehydrated.
As Bill Gates perches on the edge of the bed and asks questions about drug-treatment regimes, Melinda leans over the scrawny child and - after asking his young mother’s permission - picks him up. A discreet squirt of alcohol disinfectant is sprayed on her hands as she goes to a second ward, where her eyebrows furrow at the sight of another sick young child.
Melinda Gates’s background gives little hint that she would win Time magazine’s 2005 person of the year for philanthropic work, along with her husband and the rock star Bono. Born and raised in Texas, she studied computer science and economics at university and earned an MBA from Duke University. By the 1990s, she was working for Bill Gates as a product unit manager at Microsoft, where women used to wear T-shirts bearing the slogan “Marry me, Bill”. In 1994, Melinda did just that. The couple now have three children
She stepped down from the company, but her involvement in philanthropy is fundamental. “I’m spending 15 to 20 hours a week on the foundation,” she told me. She helps determine the overall strategy with her husband and scrutinises all grants of more than $10m. There are also periodic trips to developing countries to see how the money is being spent
Bill Gates makes one such trip a year, but spends less time on the foundation than his wife. “I have a full-time job with Microsoft,” he said on our second day, in New Delhi. “This is my spare time. But a lot of my reading is for the foundation.
He says he also mixes health with business when he meets political leaders. In Bangladesh, for example, he paid a courtesy visit to the Bangladeshi prime minister, Khaleda Zia, and in India held meetings with the president, prime minister and Sonia Gandhi, at which health was also discussed alongside IT
To understand how Bill and Melinda Gates came to create their foundation and how it became such a central part of their lives, you need need to travel far from the slums of Dhaka, to Washington State on the west coast of the US
The affluent city of Seattle, the capital of Washington state, is best known for its coffee (Starbucks started there) and its rain. When I flew there early last month I arrived on the first sunny day for an entire month
Gates grew up in the city’s northern suburbs in a community called Laurelville, a few miles away from Redmond, now home to Microsoft’s sprawling campus headquarters. Between the two is Gates’s own luxury mansion, overlooking Lake Washington
Not far away in an old industrial dockyard is an anonymous-looking three-storey building that used to house a cheque-processing centre. There is no sign to identify it outside, but this is the Bill & Melinda Gates Foundation. I was there to meet another important person behind Gates’s philanthropy: his father, William H. Gates
Bill Gates Snr, a successful lawyer, still lives in Laurelville. He shares not just his son’s name but some of his expressions, including a penchant for sticking out his jaw and gazing into near-spac
The practice of giving to the community is traditional for many families in Seattle, and the Gateses were no exception. Mary Gates, Bill’s mother, was a prominent local philanthropist. When she died of breast cancer in June 1994, more than 1,000 mourners attended her memorial service, where the mayor of Seattle, Norm Rice, described her as “an extraordinary civic leader and philanthropist, a champion for social justice and a remarkable human being”.
Bill Gates Snr was also active in the family-planning organisation International Planned Parenthood Federation, and several other community bodies
“Mary and I were typical involved Seattle-ites,” he told me. “There were the boy scouts, the orthopedic hospital and the United Way [a community volunteer body]
“The family had been locally involved in United Way, and Mary was on the board nationally and then internationally. We did sort of press Bill to have a United Way campaign, though at first he put us off and said he had other things to do
But by 1994, important changes were happening in Bill Gates’s life. He married Melinda on January 1, fulfilling one of his mother’s two wishes for him. By the time of her death in June, he was responding to her second request - to get more involved with philanthropy. (She wrote to Melinda just before the wedding, saying: “From those to whom much is given, much is expected.”
His father explained what happened next. “It began with a conversation I had with Bill and Melinda in 1994,” he said. “I and they were conscious of the fact that they were not being sufficiently attentive to the demands of the local community. Letters were not being answered, phone calls not returned. I was hearing about it, and it was not something they were unaware of. It was a flat spot in their performance
“Undoubtedly part of the impetus was that Bill just had so much wealth. For years he talked about the fact that he was ultimately going to give it away. He’s no dummy. He began to see that he didn’t need to wait. In the early days he was an entrepreneur wanting to keep control of his company. Then that changed.
Since he was retiring from his law practice at the time, Gates’s father suggested establishing a foundation that he could help run, after consulting his son about what to support. The William H. Gates Foundation began in his basement in 1994 and was soon attracting so much mail that the postman began to complain. By the end of the year, it had an endowment of $94m
Melinda Gates told me there had been other triggers as well. She said the couple had taken a holiday to Africa in 1993 where they saw poverty and ill-health first-hand. “At the time we married, we thought we would get involved in philanthropy after we retired,” she said. “The more we started to learn about the issues, the more we got engaged. Disease doesn’t wait.
Gates said his moment of truth came when he read the 1993 World Development Report, a dry 330-page document full of tables and statistics with a clear message in the introduction: “Countries at all levels of income have achieved great advances in health... Yet developing countries, and especially their poor, continue to suffer a heavy burden of disease, much of which can be inexpensively prevented or cured.
“We got our feet wet; met these people, saw how neat they were, how committed and how under-funded,” he told me as he ran through a list of his motivations. “Our Africa trip, having our own kids, Melinda, Dad. It seems almost fate-driven that these things would link up and point in the same direction.
Other factors may have pushed the Gates Foundation to grow. In 1997 Ted Turner, the founder of CNN, pledged a $1bn donation to the United Nations and criticised other wealthy business people for failing to be sufficiently community-spirited
Gates himself says he was inspired by conversations with Warren Buffett, the veteran US activist investor
In 1997, the US launched antitrust proceedings against Microsoft for abuse of its dominant position in software. Gates’s public reputation slumped, and at the start of 2000 he stepped down as the company’s chief executive to become its chairman and chief software architect
At the same time, he merged the William H. Gates Foundation with the Gates Learning Foundation, a charity he had set up in 1997 to fund education reform, college scholarships and internet access in libraries around the US
The result was the Bill & Melinda Gates Foundation, into which he donated much of his personal shareholding in Microsoft, swelling the combined endowment to $21bn. If his philanthropic acts up till then had been “stunning”, says his father, “then this was prodigious”
To the critics, Gates’s donations brought not only welcome positive publicity, but also considerable personal tax breaks. Simply to retain its tax exempt status, his foundation must give away five per cent of its income every year. The more the endowment grows through investment or new Gates money, the more it must spend
When I asked Gates whether his philanthropic work had been motivated by a desire to improve his public image, he retorted: “In that case, we sure picked a dumb thing to fund.” While others have chosen more obvious causes in the arts, or health matters affecting ordinary Americans, he focused on neglected diseases, which are both more obscure and often raise delicate ethical questions
Not all recipients of the Gates Foundation’s funding are easy to sell to Middle America. One day, in the southern Indian city of Chennai, we made our way to a tiny community clinic in the city that the foundation funded and provides treatment and HIV prevention for male sex workers. We were greeted by a colourful group of transvestites and transsexuals, all of whom had tales of abuse and harassment
There was a display of condoms hanging on the far wall, and Bill asked the men whether they engaged in safe sex. At the end of a 30-minute discussion, one of them said: “And what do you think of us?” A mute Gates turned quickly to Melinda, who swiftly said: “I think it’s great that you are willing to speak out and share.
“We thank you for thinking of us as human beings,” the man replied
On another day, on a visit to a crowded clinic in the northern Indian state of Uttar Pradesh I met a woman named Shanti who was waiting to see a nurse with three of her seven grandchildren. She had brought them in for vaccinations against diphtheria, tetanus and polio that are routine in the west, but absent in much of the developing world, where basic diseases such as these kill tens of thousands each year
After a sharp rise in immunisation during the 1980s and 1990s, momentum stalled and by 2002 the proportion of children receiving such injections in Uttar Pradesh had slumped to 20 per cent
One reason was the type of glass syringes that were used. They had thick needles that could be boiled for re-use, but which became blunt and could sometimes cause infection because they were not properly sterilised.
“The children used to cry a lot,” said Shanti. “They didn’t want to come. They had a lot of swelling for two to three days.
An answer came from a Gates-funded body in Seattle, the Program for Appropriate Technology for Health (PATH), which developed cheap “auto-disable” syringes that block after a single use and can safely be thrown away
Gates’s money also helped to develop a special ink for the labels of vaccine vials that changes colour at higher temperatures to show health workers when the vaccine has been spoilt and should not be used
Both these simple but important technological developments have been supported by the Global Alliance on Vaccines and Immunisations (GAVI), a group set up with strong pressure from Gates, comprising representatives from governments, drugs companies and charities, that picked up the baton on immunisation in 2000 at a time when the large-scale campaigns of Unicef and the World Health Organisation were running out of steam
GAVI is Gates’s response to criticism that he is obsessed with “blue sky” scientific research: supporting academics and pharmaceutical groups to develop vaccines and drugs for diseases such as HIV, malaria and tuberculosis which face such funding and scientific obstacles that they will take years to come to fruition, and may never prove successful.
Some public-health experts argue that his money would be better spent on ensuring that existing medicines and techniques already proved in the field were used more widely to save lives now.
There is little doubt that the foundation’s focus has broadened in recent years from practical implementation to encompass more long-term discovery.
This shift was epitomised by the Gates Foundation’s “Grand Challenges in Global Health”, 14 projects on vaccines, drugs, insect control and nutrition that awarded $450m in grants to scientific researchers last year.
The Challenges project was the brainchild of Rick Klausner, former head of the US government-funded National Cancer Institute. Hired in 2002 to run the Gates Foundation’s global health programme, Klausner says that he did as the benefactors requested, before leaving last September to explore new ventures. Others hint at personality clashes and the need to shift from research back towards the development and distribution of treatments
Gates is prickly about any suggestion that his philanthropy is not applied to practical uses. “We’re interested in the impact we can have,” he said with a note of irritation when I caught up with him at the World Economic Forum in Davos in January, where he had just made another monumental commitment: $900m over the next decade to help control tuberculosis.
“What do you call a new TB drug that reduces treatment from six months to two months?” he asked. “Do you call it the work of a mad scientist who only wants to stay with their test tubes? Is that a practical or an impractical person, using technology to deal with things in the real world?”GAVI is his principal rejoinder, and a symbol of how he operates with all its strengths and weaknesses. It is the largest single recipient of his funding and it claims to have averted 1.7 million deaths.
Recognising that even his money is far from enough, Gates is using his political leverage to bring immunisation to the attention of government donors who will prove essential if it is to be sustainable. So far six countries, led by the UK under the influence of Gordon Brown, the chancellor, have between them pledged $4bn. GAVI estimates this will save five million lives over the next decade
The Gateses have also brought a tough managerial approach to their philanthropy. “Their people were pretty shocked at some early meetings,” recalled Mark Kane, who ran PATH’s Children’s Vaccine Program, which worked closely with GAVI in providing technical assistance. “There was good discussion, but then people went home, forgetting the most important part: to summarise, draw up points for what to do next, empower people, and make them responsible. Coming from the corporate world, they wanted to introduce a lot more rigour to public health.
Kane has just retired, his programme no longer funded by Gates. He does not criticise the decision, but says it reflects the way in which his former sponsors risk drifting away from practical assistance to ensure medicines and vaccines reach those who most need them. “The public health arena is a very messy world that is hard to deal with, with UN agencies, the public sector, the developing world. From a management point of view, it’s cleaner and neater to invest more upstream,” he says. “We had the best immunisation team in the world with expertise downstream, with people working on delivery systems, logistics, systems work and safety. There are very few sources of funding for that. Before Gates there were very few. Now there are very few again. There is always the risk that one day we could have a lot of undeliverable products in the pipeline.
Anne-Emanuelle Birn, a researcher at the University of Toronto’s department of public health sciences, goes further. “I’m not anti-vaccines, but I am against technical solutions in a vacuum,” she says. She fears there is a risk that the longer term programmes of the Grand Challenges project will only have a modest impact unless the programme’s leaders take into account the practical economic and political problems of the developing world.
It is an issue to which the Gates Foundation is sensitive. Gates himself is mulling over several new areas of funding that tackle some of the underlying causes of ill-health, including water, sanitation, hygiene and nutrition.
But others fear that even without such new areas of interest, the substantial cost of developing new drugs will stretch even Gates’s capacity to bring many of his projects to fruition.
For Tachi Yamada, the head of research and developing at the pharmaceutical giant GlaxoSmithKline, who takes over as head of the foundation’s global health programmes in June, the mission is clear. “My challenge is to deliver on the foundation’s promise of applying excellent technological solutions to people in the third world - and implement them,” he says.
The appointment of someone with industry experience reflects the foundation’s current evolution. With the fundamental science under way, it needs to ensure laboratory ideas can be successfully turned into products ready for use. As Gates approaches retirement over the coming decade, that will leave the challenge of how best to ensure they reach everyone in need.
For the moment, however, Gates himself leaves little doubt of his determination to pursue his mission to give people in the developing world access to the best of science and healthcare in the struggle against disease.
“We’ve picked our themes,” he said over dinner on our last night in Chennai. “The purpose has been set down. 盖茨夫妇行善记（上）
随着比尔•盖茨和梅琳达•盖茨(Melinda Gates)的私人庞巴迪(Bombardier)喷气机在清晨的热浪中着陆，达卡机场看上去也有点不同于往日。两幅这对夫妇的巨大手绘肖像，被匆忙摆在了飞机跑道旁，在外面的一条公路上，还有另一个巨大的牌子在欢迎这对世界上最慷慨的慈善家来到该国首都。
此行是盖茨夫妇四天孟加拉国和印度之旅的一部分，他们将在两国亲自考察其庞大的慈善基金――比尔及梅琳达•盖茨基金会(Bill & Melinda Gates Foundation)在该地区的运作，同时考虑基金会的下一步工作重点。
这对夫妇每年都进行一次这样的旅行，但行程安排通常都没有这么大规模。他们一下飞机，就由10辆车组成的车队护送走了，在该市异常空旷的街道上飞驰而过。车队中包括一支军事护卫队和一辆救护车。
警方竖起了数十个路障以阻挡司机和行人。在车队前往市中心区最豪华的达卡喜来登酒店(Sheraton)时，狙击手在几乎每幢高楼上都随时待命。
包括数名前白宫副官在内的先头部队已到达当地数日，他们负责制定严密的保卫路线，阻止除该夫妇的随身侍从和少数随行记者之外的所有人。
由于一周前在孟加拉国其它城市出现了自杀式炸弹袭击，因此原定计划被缩减，昨天有传言说整个行程都会被取消，因为在达卡的一辆巴士下面发现了爆炸装置。代表团每个成员都得佩戴显示美国和孟加拉国国旗的特殊金属翻领徽章，以向安全官员表明身份。
盖茨夫妇的派头堪与国家元首相比，但在首站造访达卡的贫民窟时，他俩看起来一点也不高贵。车队停下时，比尔•盖茨头发乱糟糟地下了车，穿着白色休闲裤，蓝色羊毛衫和棕色鞋子。梅琳达穿着米色裙子，紫色上衣和凉鞋。她身上唯一的首饰是一枚不大的金戒指。
他们两人似乎都对来访造成的混乱局面感到抱歉。“这是极端情况。”盖茨对随行记者说。
“这不是我们首选的交通方式，”梅琳达补充道，“通常我们都不会这么大肆张扬。”
但是，与国家元首的类比并非不恰当。盖茨是世界首富，其个人财富高达260亿美元。加上他1975年创办的企业巨擘微软集团的2800亿美元价值，他的经济影响力堪比孟加拉国国内生产总值(GDP)。但盖茨在公众卫生和教育上的投入超过任何政府，其中相当一部分在印度次大陆。微软在该地区投资巨大，并有大量雇员，其创始人被誉为资本家英雄。
我此行目的在于弄明白，是什么促使他和妻子从全球最富有的高科技企业夫妇转变成为最慷慨的慈善家。他们非同寻常的基金会目前拥有300亿美元捐款，是全球最大的慈善团体。该基金会自2000年成立以来，仅在全球卫生事业上就投入了60亿美元，目前的年支出超过了世界卫生组织。基金会所获捐款的确太庞大了，只要善加利用，该遗产会一直延续下去，甚至在微软被世人遗忘很久以后。
盖茨夫妇与其他重要慈善家不同之处在于，他们成为慈善家时都相对还很年轻。大多数基金会创始人在退休前，既没有时间也没有精力做这项工作。盖茨夫妇的主要目的是减少全球的不平等现象。在美国，实现这一目标的主要手段是推动教育改革，给穷困阶层拨款。在其它地方，则是利用科学解决发展中国家最棘手的一些问题：包括疟疾、肺结核和艾滋病等“被忽视”的疾病。
作为一名制药业记者，我对该慈善机构在全球卫生事务中无所不在印象深刻。每当你去了解穷人所患疾病和新疫苗及药物的开发情况时，往往会发现盖茨基金会的资金、仰慕者和项目的身影。除了弄清楚为什么盖茨夫妇变成了如此活跃的捐赠者，我还想了解他们的博爱带来了什么样的变化，还有去年9月最资深的卫生专家里克•克劳斯纳(Rick Klausner)突然离职后，他们富有影响力的工作是否会改变方向。
和盖茨夫妇同行，不用多久就能意识到，他们慈善工作的一大因素是41岁的梅琳达。如果说比尔•盖茨在此项夫妻合作中拥有科学权威和财富，那么他的妻子则有执行决定的政治技巧和情感动力。Uttarmuqda贫民窟是我们在达卡的计划停留站，在一间破败的房子里，盖茨夫妇盘起双腿席地而坐，周围都是洪水和垃圾，他们在听20位当地妇女解释，如何通过一个“微型融资”体系获得了小额贷款。基金会正在考虑对这一融资体系给予支持。
“这比加尔各答还糟糕吗？”比尔事后问梅琳达说。
“就贫民窟来说，这些算是很不错的了，”她回答道，“没有加尔各答的拾荒者那么糟，但非常让人痛心。”
当天晚些时候，我们去了达卡的国际腹泻疾病研究中心(International Centre for Diarrhoeal Disease Research)，该中心由盖茨基金会资助。在中心内，梅琳达径直走向了一个正在高声尖叫的孩子，孩子躺在床上，身上铺着一张厚厚的绿色塑料床单，床单中间有一个孔，一根管子自孔里通向床底的桶里。该中心主任戴维•萨克(David Sack)介绍说：“这是20世纪最重要的发明：带有厕所的床。”这种床可以让护士立即看见霍乱患者失去了多少体液，这样病人就可以很快补充体液。
比尔•盖茨在床沿坐下，询问有关药物治疗的问题，而梅琳达则在这个骨瘦如柴的孩子跟前俯下了身子，在征得他年轻母亲的同意后把他抱了起来。在她前往第二间病房时，为慎重起见，她的双手被喷上了酒精消毒剂。当看到另一个生病的小孩时，她皱起了眉头。
