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"Katrina created one tragedy and revealed another," Melinda Gates said in a speech after the hurricane. "We have to address the inequities that were not created by the hurricanes but exposed by them. We have to ensure that people have the opportunity to make the most of their lives." That just about captures the larger mission she and her husband have embraced. In the poorest countries, every day is as deadly as a hurricane. Malaria kills two African children a minute, round the clock. In that minute a woman dies from complications during pregnancy, nine people get infected with HIV, three people die of TB. A vast host of aid workers and agencies and national governments and international organizations have struggled for years to get ahead of the problem but often fell behind. The task was too big, too complicated. There was no one in charge, no consensus about what to do first and never enough money to do it. In Muslim parts of Ethiopia, aid workers can't talk to teenage girls about condoms to prevent AIDS; but in Tanzania they're encouraged to. How you cut an umbilical cord can determine whether a baby risks a fatal infection, but every culture has its own traditions. They cut with a coin for luck in Nepal and a stone in Bolivia, where they think if you use a razor blade the child will grow up to be a thief. There is no one solution to fit all countries, and so the model the Gates Foundation and Bono have embraced pulls in everyone, at every level. Think globally. Act carefully. Prove what works. Then use whatever levers you have to get it done.
The challenge of "stupid poverty"--the people who die for want of a $2 pill because they live on $1 a day--was enough to draw Gates away from Microsoft years before he intended to shift his focus from making money to giving it away. He and Melinda looked around and recognized a systems failure. "Those lives were being treated as if they weren't valuable," Gates told FORTUNE in 2002. "Well, when you have the resources that could make a very big impact, you can't just say to yourself, 'O.K., when I'm 60, I'll get around to that. Stand by.'"
There have always been rich and famous people who feel the call to "give back," which is where big marble buildings and opera houses come from. But Bill and Melinda didn't set out to win any prizes--or friends. "They've gone into international health," says Paul Farmer, a public-health pioneer, "and said, 'What, are you guys kidding? Is this the best you can do?'" Gates' standards are shaping the charitable marketplace as he has the software universe. "He wants to know where every penny goes," says Bono, whose DATA got off the ground with a Gates Foundation grant. "Not because those pennies mean so much to him, but because he's demanding efficiency." His rigor has been a blessing to everyone--not least of all Bono, who was at particular risk of not being taken seriously, just another guilty white guy pestering people for more money without focusing on where it goes. "When an Irish rock star starts talking about it, people go, yeah, you're paid to be indulged and have these ideas," Bono says. "But when Bill Gates says you can fix malaria in 10 years, they know he's done a few spreadsheets."