Richard Klausner Spends to Save Lives

One of the most difficult challenges in global health today is coming up with a vaccine for malaria. Researchers have been trying in vain for years to figure out how to stop the complex and tenacious parasite, which manages to elude the body's immune system. Their work has also been hampered by a lack of funding. The major drug companies are reluctant to pour millions of dollars into creating a drug for Third World countries that could not afford to buy it.

The Gates Foundation speeds up the development process by identifying the most promising and least funded candidates and by funding multiple trials. With a $50 million grant from the foundation, the Malaria Vaccine Initiative, based in Rockville, Maryland, is sponsoring ongoing trials on four different candidates, with a fifth on the way. One, dubbed MSP-1, had been in the works for 15 years, but the funding for field trials wasn't readily available. "I'm not sure when we would have had the resources to do it," says physician and lieutenant colonel Gray Heppner, who oversees malaria-vaccine development at the Walter Reed Army Institute of Research. "An important concept would have been lost."

Maybe MSP-1 will prove to be the vaccine that the world has been waiting for. More than likely, however, it's another important piece of the puzzle, another stone in the bridge between research and the real world, another significant advance that brings the Gates Foundation closer to defeating malaria. And maybe that will be enough to mobilize other researchers and donors around Third World health crises. "It's really my goal for people in this country and elsewhere to think that global health is the most exciting and important thing to work on," Klausner says. "I want to stimulate the creativity of the world toward these problems."

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Venture Philosophy
The Bill & Melinda Gates Foundation is a far cry from a traditional checkbook philanthropy. Instead of more or less throwing money at complex global-health problems and walking away, the foundation's staff has a highly interactive approach, from the approval process all the way through the execution of the grant. Much like venture-capital funding, a grant from the Gates Foundation is an investment -- in a new method of diagnosing a disease in the Third World, an experimental vaccine, or improved access to an effective drug in a region without roads or hospitals.

Not surprisingly, Bill Gates is interested in seeing a return on his money. In global health, that return means a grant that has lasting value, one that acts as a catalyst for other investments, commitments, and research, and one that demonstrates an effective health-care technique so that local governments and health agencies will be willing to adopt it.

The foundation takes a business-inspired approach to accountability that turns conventional grant making on its head. In its grants to Third World governments, the relationship is structured in such a way that the return on investment is built in. The grant is contingent on governments doing their part, whether that means providing enough nurses to administer care, agreeing to immunize a certain number of children, or increasing health-care spending. Other grants include regular milestones. If partners can't provide the Gates Foundation with the necessary evidence to prove that they are delivering what they promised, they risk losing their funding. Better accountability leads to better sustainability, ensuring the foundation that its impact isn't short-term. The solutions endure through the agencies and governments that provide health service after the grant is complete.

The message, says Dr. Richard Klausner, who directs the global-health program, is that this is a partnership, not a handout. "We're active partners," he says. "It's not just, 'Okay, you have the grant, and we'll read your annual report.' We're going to be actively and intellectually engaged. We'll also be helpful, and we'll give feedback about what's working and what's not. The process is very interactive."

Chuck Salter (csalter@fastcompany.com) is a Fast Company senior writer. Learn more about the Bill & Melinda Gates Foundation on the Web (www.gatesfoundation.org).