After the birth of her first child a decade ago, Melinda Gates, the wife of Microsoft Corp. founder Bill Gates, left her job as a manager at the software giant and devoted her time to caring for their children and quietly guiding strategy for the Bill and Melinda Gates Foundation, the philanthropic powerhouse the couple founded.
Now that her third child is nearing school age, the 42-year-old Mrs. Gates is stepping into the limelight as an outspoken advocate for closing the global health gap. On Thursday, she plans to announce an expanded initiative with President Bush and first lady Laura Bush's summit on fighting malaria, a mosquito-borne disease that kills one million people a year, mostly children under five.
The Gates Foundation plans to award $83 million in new grants for vaccine research, treatment programs and expansion of its model malaria-control program in Zambia to five more countries. The new grants will bring the foundation's spending on malaria to $765.8 million. The foundation also has given $650 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which also finances malaria control.
The Gateses' new alliance against malaria with the president and first lady -- following a high-profile partnership with former President Bill Clinton -- culminates several years of behind-the-scenes consultation with the Bush White House on its AIDS program. The President's Malaria Initiative, a $1.2 billion effort, aims to cut malaria's death toll in half in 15 countries.
In excerpts from a wide-ranging interview, Mrs. Gates talks about juggling responsibilities for her young family and the foundation's management of its global health program, brainstorming with her famous husband and stepping out of her previously unseen internal work for the foundation and into the public arena.
WSJ: How do you, as a woman who is viewed as being reserved, counter the impression that you have been living in Bill's shadow?
Mrs. Gates: Ha, ha! I think it's really important for people to understand Bill and I are behind this foundation, and it's important for people to understand it's us as a couple. I made a decision a year after our last child, Phoebe, was born, to step out. I was [already] doing a lot of internal strategy work. What was happening, because I had chosen not to step out, was that public thought the foundation was really Bill. It wasn't; it was both of us. Then we did a joint trip to Africa. And slowly but surely as our children got older, I decided to speak out more publicly. Our youngest child is four years old now, and I took some of the time I gave to the foundation internally, and made it external. As all our children start going to school full-time, the time I spend at home reading [about global health] continues to increase. The time I spend at the foundation has continued to increase. As Bill starts to transition in his role at Microsoft, and goes full-time at the foundation, my role will increase in advocacy, in internal work and in trips -- all of which I enjoy doing.
WSJ: How do you use your own voice for advocacy, and how do you choose the issues and events to focus on?
Mrs. Gates: It's a work in progress for me. One of the things for Bill and me to constantly remember is that this is a chance for us to shine a light in dark corners of the world with AIDS and malaria. Here's a way forward we see as a couple, and perhaps a way for others to step into gaps. I select where I will step forward and speak according to what issues resonate for me. I spoke at the International AIDS Conference in Toronto because it resonates with me. We both wanted to move the discussion back to prevention. People were working on antiretroviral drugs, and that's wonderful. But if we move away from prevention, it's a disaster.
I pick things I feel strongly about emotionally and mindfully. A lot of issues around mothers and children resonate strongly. That's why I go to the developing world. I stand back from statistics. To go out to a village and be with a mother and child in a village helps me when I go back to Seattle and choose issues for the foundation to work on.
WSJ: What strengths do you each bring to this project?
Mrs. Gates: That's one of the things people misunderstand about Bill and me: We bring a lot of [the same] talents to the foundation. We think, we read an incredible amount, we discuss the issues at home, we go into the field, and it gets ingrained. I got to travel more than Bill in recent years due to Bill's work at Microsoft, and now he's been going out to the developing world. We're both totally passionate.
WSJ: How are you juggling malaria with other disease priorities -- HIV, tuberculosis, childhood diseases -- these days?
Mrs. Gates: We're constantly talking about priorities. Bill and I did quite a lot of reading on global health on our recent time off in October. We asked, "How do we make sure we don't spread ourselves too thin?" We wrote an email saying these are our top eight priorities: beginning with HIV, TB, malaria. Under AIDS we culled out separately a microbicide for AIDS. We've got to push on that more than we have been. We develop a portfolio, and make sure we're constantly pushing with the global health team. Sometimes we need to step back and ask, "Have we prioritized enough? Are we focused on what we believe as a couple?"
WSJ: How do these malaria grants illustrate broader foundation goals and philosophy?
Mrs. Gates: Bill and I founded the foundation under the premise that all lives have equal value. When we go down the list of diseases, starting with HIV/AIDS, it doesn't take long to find the greatest inequities. Behind AIDS and tuberculosis, it doesn't take you long to get to malaria. As we started to look at malaria from the beginning, it became clear you couldn't focus just on a vaccine. It's the long-term solution. But you also need to work on acute cases of malaria on the ground today, on the things we could get to mothers and children in villages. And how can we use the tools we've got. We began a comprehensive program helping mothers and infants, and controlling malaria in Zambia, and now it's going into five other countries.
I was in Zambia in March 2006 with the purpose of seeing the program on the ground. When we approved that grant, we said you've got to be kidding. Hasn't somebody tried this? Then we said why has nobody tried it? Are we crazy? You need a government that wants to tackle malaria in such a large-scale way. I was able to see what it takes. It takes the health minister signing up. It takes this enormous effort on the part of government, massive coordination between NGOs [non-governmental organizations] on the ground and new ones coming in. It was fascinating to sit with NGOs and hear about the mistakes they'd made, and about how difficult it was to get [mosquito] nets from point of entry out to the village and the mother. By the time I got there, they'd been talking with each other, and distributing out the work, figuring out how to get trucks there, how to get the nets, breaking the problem down. That was fantastic.
WSJ: How do you harmonize your projects on malaria with the White House and other partners, rather than having separate malaria projects jostling and competing in the field?
Mrs. Gates: To be honest, it's a bit like in Zambia. There were already lots of partners on the ground, involving the copper mining industry and others. There was this readiness and willingness to come together, to come to the table. Sometimes it just takes a third party to get people coming together. We were able to get people to the table. The government was huge. As soon as we sat down we were able to share lessons learned, and the pitfalls.
WSJ: Do the new malaria grants -- in size or timing -- reflect the new money from financier Warren Buffett, which will allow the $31.9 billion Gates Foundation to eventually double its grantmaking?
Mrs. Gates: With the Warren Buffett money, we can deepen the efforts. Instead of one country, we can work in five. His money lets us expand the global health efforts.
WSJ: How do you bring other powerful partners on board with your global health agenda, and how does this partnership reflect the way you and Bill are managing the foundation?
Mrs. Gates: Advocacy is part of this White House summit, making people realize malaria is an issue. When people hear us talk about the Global Fund [to Fight AIDS, Tuberculosis and Malaria], and we've made another substantial grant to Global Fund, it makes people realize their dollars will be effective. When the White House gets involved, they raise awareness. We can say here are some places we've gotten involved and you can step in to the gap.
In every single thing we do, we say, 'What is our unique role and how do we get others interested and make sure it's ongoing?' It's going to take the involvement of governments. These are enormous, intractable problems. It takes governments.
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