Q&A with Patty Stonesifer (extended)

The Gates Foundation's gatekeeper on how the organization makes decisions on where to send aid, its goals, and the level of Bill's involvement

Patty Stonesifer, a former Microsoft executive, has been president of the Bill & Melinda Gates Foundation since 1997. In an interview with Senior Writer John A. Byrne, she discusses the Gates' philanthropy. Edited excerpts follow. Note: This is a longer version of the Q&A that appears in the December 2, 2002, issue of BusinessWeek.

Q: To what extent did earlier philanthropists influence Bill and Melinda?


Bill is a history buff, and there is no doubt that he looked at change makers and philanthropists before the whole ramp-up in giving. Carnegie and Rockefeller were engaged at the center of society. They identified gaps where they thought their resources could cause a major change. That is the big takeaway that Bill and Melinda had. They wanted to find the place where the opportunity is great to reduce society's burden.

We learned that from looking at people who had made great changes before. Our library project took a lot from the examples of Carnegie, and our health initiatives were informed by looking at Rockefeller's work in yellow fever, with the vaccine, and the Green Revolution. Bill also listened to [former U.S. President] Jimmy Carter speak about what he saw in his work around the world.

Q: How did Bill make the decision to step up and make philanthropy an important part of his life?


Until early 1997, Bill Sr. [Gates's father] was working out of a cardboard box in his basement, going through requests and then sending them onto Bill and Melinda, who would sit on their sofa on weekends and go through them. There was a moment in 1998 when he and Melinda read an article on a Sunday in The New York Times on children's diarrhea outside the U.S. [The story told how thousands of poor children die every year from this condition.] He did what anyone else would do. He said, "My God, that's huge." He tore out the article, sent it to Bill Sr., with a note that said, "Is there something we can do about this dad?"

We started small by making some grants [in the field of health services to poor children in Africa and India] and bringing on experts in the field. Then, Bill read a very important World Bank report on the health issues around the world that described the burden of disease on the 4 billion people who are the poorest folks on the planet.

Q: So that led to the decision to fund vaccines for the poor, right?A: The light bulb didn't go on at the $24 billion level then. They just went a lot faster through that process because they realized they had the opportunity to make a bigger change. We brought on two doctors in 1999. Both of them are great teachers and learners and have great networks.

It is very much the nature of Bill and Melinda [to focus] on what can be done with 21st century technologies and sciences to reduce diseases. Polio vaccine is 50 years old, and we're delivering it to some regions of the world for the very first time.

The necessity at that time was to find the centers of excellence that were doing great work and were able to expand. We put several grants into an International AIDS vaccine initiative that has its roots in the Rockefeller health program. The global alliance for vaccines and immunization came out of a group of leaders here when we made a $100 million grant to a local organization. They were going to work on children's vaccines. They brought together a strategy advisory council. Bill said at a dinner at his home. "Think big. What needs to be done to change things?"

A proposal was written, and we were the initial funders of that. The idea came here but largely on the basis of a bunch of leaders who were saw the opportunity to improve vaccinations over the years.

Q: You've pledged $750 million for this global vaccine initiative. That's the biggest focus to date, right?


That's the single biggest grant so far, but we also made a billion-dollar commitment in 2000 to the Gates Millennium Scholarship program, for scholarships for minority students in need to attend any university of their choice. There was a significant financial gap for many minorities. There was a very big gap in master's and PhD programs for minority students. We hope there will be 20,000 students participate in the next decade.

We always thought that a big part of our focus in the U.S. would be education. Education is a great opportunity-leveler. We also saw big gaps in the minority scholarship space. This program is administered by the United Negro College Fund.

Q: So far, most of your major initiatives have been done in partnership with existing organizations. Why not do more things on your own?


There are many organizations out there that have the expertise, the passion, and are closer to the problem. If we have a vision of an inequity we'd like to address, then finding people who are close to the problem and have credibility is what we want to do.

Q: What are you doing to measure the impact of the dollars you give?


Proof is real important to us. Our program [to put technology in U.S. libraries] started in 1997, and we have specific data on usage in many states. We use a third-party evaluator, and we have changed some of our programs because of it. You have to prove the cost of the hepatitis-B vaccine is cost effective in Mozambique.

Q: How actively engaged are Bill and Melinda?


Bill and I discuss things via e-mail every day. That said, Bill Sr. and I are just getting through doing a big grant submission that we'll go over at his house over the weekend -- several hundred million in grants. Then, we'll all meet before the end of the month to hash through the final decisions.

They spend a tremendous amount of time on the strategic decisions: What models we should use, what interventions and what partners to choose. And they approve every grant over $1 million in health. We have delegated authority for everything under $1 million. Anything outside the strategy would go to Bill, even if it's $10,000.

Q: What have the Gates's learned from their philanthropic efforts so far?


We have all been impressed by the number of really phenomenal leaders in the fields that we entered that needed the resources and assistance. But it's harder in philanthropy to know you did the right thing. We really have learned that there are very few quick fixes to these problems. The reason there are big society inequities is because they come from deep complex and historical pressures.

The bigger the issue, the more you have to determine you're in it for the long haul. There is no quick fix, no matter how good the leadership is. Long-term solutions require thoughtful, committed programs of work.

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