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The foundation is as spartan in structure and style as an Internet start-up. There are just 25 employees, in contrast to 525 for the venerable Ford Foundation. The Gates Foundation staff members wade through more than 3,000 serious funding requests each month. And that doesn't count the perpetual-motion machines and colonic-cleansing devices with which promoters could save the world if only Bill and Melinda would throw a few million dollars their way. Worthy projects are filtered up by Stonesifer, Dr. Gordon Perkin and Bill's dad for review by Bill and Melinda.
The foundation sees its role as filling the breach where the private sector is not addressing a crisis. The industrialized world's ailments, from indigestion to breast cancer, are already the focus of drug-company research. Cure a First World disease, and reap millions in profits. But cure a Third World disease such as malaria--the No. 1 killer in tropical climes--and there is hardly a penny to be earned. Those patients don't have health insurance. That is why the Gates Foundation has made finding a malaria vaccine a priority, along with eradicating scourges such as hookworm, hepatitis B, leishmaniasis (a parasitic disease transmitted by sand flies that affects 15 million people a year), HIV, guinea-worm disease and tuberculosis. The foundation is spending nearly $400 million a year on its global-health initiative, mainly by developing new vaccines and cures and making existing cures more available to the people who need them.
Bill Gates scrutinizes each project and often asks very specific questions. In one series of internal e-mail messages provided to TIME, Gates asked who would own the intellectual property arising from a particular vaccine program. Another exchange had him doubting that the per-dollar impact of a given program is "super-high."
Gates, when you sit down with him in his Redmond office, rocks back and forth as he falls into a reverie about "the world-health thing." He says, "The more people know about this--about the millions of lives that can be saved, about the millions of children who are dying of disease every year that we have cures for--then how can you not do something about it? The most important priority for me is saying we could save millions of lives a year." That is a heady thought even for the richest man in the world. How many of us will ever be able to say we saved millions of lives?
For Gates, that prospect blunts the criticism of those who say his generosity is meant to burnish his image amid the Justice Department's antitrust suit against his company. (Though the Bill and Melinda Gates Foundation was founded in 1997, a year before the suit was filed, he has accelerated his donating schedule in the 16 months of the trial.) "I have a high enough level of visibility that people will second-guess anything I do," Gates says, shrugging. He has come to see his life as something of a tripod: there are his wife and children, his company and "this other area, in philanthropy, where I'm seeing that by engaging the smart people and highlighting the possibilities, there's a chance to do something that every day I feel good about."
--K.T.G.