Wall Street Journal - June 9, 2008

Together, they head the world's largest charitable foundation, tackling such problems as public-health issues in Africa, India and elsewhere and the U.S. public-school system.

She talked with Walt Mossberg about the challenges of bringing vaccines to poor children in Africa and how involved she and Mr. Gates are in the day-to-day running of the foundation. Here are edited excerpts of that discussion.

Size Is Relative

MR. MOSSBERG: Other than the fact that you have more money than any foundation has ever had -- it's like $60 billion now -- what's the difference between the way you approach your work and most other foundations and [nongovernmental organizations] have approached their work?

MS. GATES: One of the things to understand about the amount of money that our foundation has is people first look at that and say, oh my gosh, that's an amazing thing. But you've got to look at the scale of the problems that we're working on. The state of California spends $60 billion in one year to educate the students in the state of California, so we could be out of business at the end of this year if we just put it all into that, right? Or if you look at NIH [the National Institutes of Health], their budget is $29 billion a year, and they're tackling some of the issues that we're interested in.

We're always saying to ourselves, "What is the catalytic role that a foundation can play in the world?" Knowing the scale of the problems that we've decided to tackle, how do we bring others along into these problems we are working on -- the U.S. education system; gigantic global health issues [such as] HIV AIDS, malaria, tuberculosis; work against poverty, what we call global development.

Ultimately to solve those problems it's going to take governments. But what can a foundation do that a government can't do? We can take risks with our money that a government won't take.

We've got a pipeline of malaria vaccines. People haven't wanted to work on malaria vaccines. We have to try and say to the pharmaceutical companies: Here is the market potential, and here are some other ways to tackle this. We're trying about seven different malaria vaccines. Only one or two are going to hit.

A government's not willing to risk their money in that way, but if we can work with the pharmaceutical companies to take out some of the risk, to get some of the R&D costs down, get a real malaria vaccine, then we work with governments to go out and distribute it massively. We can create the wedge to get it started and to have the magic start to happen.

One of the things we'll go through is that lifeboat drill: What if we didn't have $60 billion, what if we had $1 billion left to spend, what's the last thing out the door -- what thing would we still be doing at the end of the day? If Bill was sitting here, he'd say we work on an HIV AIDS vaccine, and I completely concur with that.

A Question of Priorities

MR. MOSSBERG: You've got to be constantly bombarded by people who want to tell you how to spend that money. How do you deal with that?

MS. GATES: It's gotten easier over time. Around the time that we got married, Bill was getting all these letters, and they're heartbreaking. I remember one he carried around in his briefcase for a month about a child who needed a kidney, and these parents couldn't pay for this kidney. They're gut-wrenching, and what do you do? Do we give money to that person? We started having his dad help us look at some of these.

Our foundation stands for all lives have equal value. All lives. Whether a woman, or a man, or a child lives in Boston, or Botswana, or Bangladesh, the truth is today the world does not treat all lives with equal value.

Once we said these are what we think the world's biggest problems are, then it was actually easier. The person who comes and wants money because they do have a horrific cancer situation in the United States, that's not our focus. We can say, if we'd spend $20,000 helping that person, it's $20,000 that doesn't go to buying life-saving vaccines to these kids that have absolutely zero voice in the developing world.

You don't even think about those vaccines you get for your kids in the first two years of life, right? There are millions of children -- these 10 million children that die before age 5. A huge portion of those deaths don't have to happen if we just took the vaccines we have today and delivered them to the developing world.

We're saying to the manufacturers, you ought to get your money off of the rich world, but give very inexpensive doses for the developing world.

MR. MOSSBERG: You are the co-chair of the foundation. Do you go there every day, have an office there, run it on an active basis?

MS. GATES: The CEO runs the foundation day in and day out, and Bill and I are both very clear that we don't want to do the active, day-to-day management of the foundation. That said, we are extraordinarily involved.

There always needs to be family presence inside the building of the foundation, and we've been so incredibly fortunate. Bill's dad, who started working on this with us in 1994, is in the office of the foundation four out of five days a week, and he's 83 now. I'd always said that when our last daughter went to school full time I would start being in the building more, and that's exactly what happened this fall. Now I'm in at the foundation two days a week, and that will probably grow to three very soon.

While the CEO runs the foundation, Bill and I set the strategy. We're doing constant reviews of the strategies we've already set forward, of what strategies we might want to add.

I have spent a lot of time -- and Bill increasingly in the last few years -- out in the field. I'm out in the developing world -- India or Africa -- a minimum two times a year. I travel in the U.S. to see the education work up close, what's working and what's not working.

MR. MOSSBERG: How will this change with Bill switching his focus in 30 days?

MS. GATES: I knew when Bill transitioned from Microsoft he wasn't going to be wearing a tool belt around the house. Nor did I want him to. He's going to take a bit of time off this summer. He starts full time into his new role Sept. 2, which coincides also when we have Jeff [Raikes, the new chief executive of the foundation] starting. I'll be there three days a week.

Bill's still sorting out exactly how much time, but I think he will give a day a week to Microsoft. And he'll probably spend two or three days on the foundation a week.

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