S omeday, the global philanthropic and practical influence of the Bill & Melinda Gates Foundation might more than equal the enormous impact of Microsoft, the company Bill Gates cofounded in 1975.

It’s not an impossible goal. According to New York Times columnist Nicholas Kristof, Gates describes himself as “equally maniacal” about his new career as a full-time humanitarian and “has thrown himself into work at his foundation. He is now trying to do to malaria, AIDS, polio and lethal childhood diarrhea what he did to Netscape, and he just may succeed.”

The Gates Foundation was established in 2000, when Gates, the richest man in the world for 15 years straight (he’s now third), stepped down as Microsoft chief executive officer. He began devoting more and more time to his foundation until July 2008, when he committed his full energies to changing the world through giving. (He remains Microsoft chair.)

As Gates, 53, told The Rotarian during a recent sit-down in San Diego, “the three magic elements – the opportunity for breakthroughs, the chance to play a unique role, and the opportunity to work with smart people on interesting problems (the things I loved about my job at Microsoft) – are all present in the foundation work that I do.”

In 2007, the Gates Foundation awarded Rotary International a US$100 million challenge grant to underwrite Rotary’s commitment to eradicate polio. Rotary pledged to match the grant dollar for dollar, and as of January 2009, it had raised nearly $73 million. That grant was one of the largest challenge grants ever given by the Gates Foundation and, until recently, the largest grant received by Rotary, which has made polio eradication its top priority since 1985.

On 21 January, however, the Gates Foundation set a new record by pledging an additional $255 million. Rotary committed to raising another $100 million by 30 June 2012. Gates made the announcement during an enthusiastically received surprise appearance at Rotary’s International Assembly in San Diego. There, the audience also learned that the governments of Germany and the United Kingdom had committed a combined $280 million to the Global Polio Eradication Initiative. Though that amount will not count toward Rotary’s US$200 Million Challenge, it will target the four countries where polio still rages: Afghanistan, India, Nigeria, and Pakistan.

When he appeared at the assembly, Gates already had visited India and was planning a February trip to Nigeria.

By the time the world is certified polio-free, Rotary will have raised $1.2 billion for polio eradication. “Just as important,” Gates told the audience, “you have kept it high up on the world’s list of priorities. Together with WHO, UNICEF, CDC, and other partners, you’ve stopped millions of cases of polio. And you’ve saved more than a million lives. Without Rotary, the world wouldn’t be anywhere close to a 99 percent decline in polio.

“We are making this grant and asking you to raise a total of $200 million because we know that eradication doesn’t come in an instant. We know that it’s a formidable challenge to eradicate a disease that has killed and crippled children since at least the time of the ancient Egyptians. We don’t know exactly when the last child will be affected.

“But we do have the vaccines to wipe it out. Countries do have the will to deploy all the tools at their disposal. If we all have the fortitude to see this effort through to the end, then we will eradicate polio.”

After Gates’ appearance, interviewer David Rensin met with him in a conference room stocked with coffee, peanut M&Ms, assorted fancy nuts, health bars, and bottled water. Also sitting in was Vince Aversano, editor in chief of The Rotarian.

Gates walked in right on time. He shook hands, helped himself to some M&Ms, settled into a chair across from Rensin, then got down to business.

The Rotarian: UN Secretary-General Ban Ki-moon recently said that polio will be history, like smallpox, and he credits Rotary and its partners. What is it about Rotary that makes you especially willing to back its commitment with this much cash?

Bill Gates: In the world of global health, success builds on success, and Rotary, in its commitment to eliminate polio, is unique. Rotary has taken a very strong leadership role, and we knew, based on Rotary’s track record, that they would obviously be the key partner. My father was [an honorary Rotary club] member, and lately I’ve been learning more about Rotary and its geographic reach and its commitment to help on polio. I’m more and more impressed, the more I learn.

TR: Why did you decide to give the gift directly to Rotary as opposed to the whole polio initiative, whose partners include Rotary, the U.S. Centers for Disease Control and Prevention, UNICEF, and the World Health Organization?

Gates: You can say the World Health Organization is at the center of the polio fight or that Rotary is at the center. Both are true. WHO is a United Nations organization and, although wonderful, there are complexities in how they have to manage funds and do things. We’re learning as we go and innovating in different ways in different countries, brainstorming about how and where the funding should be targeted. Giving directly to Rotary is ideal because they’re just dedicated to the polio fight and not subject to the same complexities as a UN organization. It may be that Rotary, in turn, will grant [funds] through UNICEF, or directly to an NGO [nongovernmental organization] in one of the four countries where polio still exists, or to the endemic countries themselves. Rotary might even write a check to a vaccine manufacturer. You have to keep all these immunizations going as long as there’s any of the disease spreading within a region. We’re pretty close to the end on polio. Time makes so much difference.

Giving to Rotary also allows the fight to take place in the challenge format. Of the most recent gift, $155 million is not part of the challenge, but we felt best about having that in Rotary’s hands.

TR: Three of the four polio-endemic countries are contiguous. Nigeria is almost like a wild card, surrounded by countries that have eradicated polio. What are the problems there?

Gates: The coverage rate is our big challenge. Nigeria has a huge population, with big growth in the north. That’s the area where the problem is getting the leadership to spread the word that this is a safe and important vaccine. It’s about getting the word out. In 2003, vaccinations in a large part of that area stopped. We’ve been rebuilding since then, but we’re not at the level of vaccination you need to eliminate polio.

TR: Because there are still a lot of misconceptions about the disease?

Gates: The word went out five years ago that it was a dangerous vaccine. Some progress has been made in getting people to say, “No, that’s wrong. In fact, it’s the opposite. This vaccine is good for you.” People care a lot about their children’s health, and obviously we have to tap that as a positive force for getting them to take the vaccine. Now, a few of the states are at the [vaccination] levels we need, but there are still three states, including Kano, that are not. We’ve been talking to the leadership there – including the new health minister, about whom the people are enthusiastic – about what we should do to help get the word out.

TR: You went to India in November and met with officials and experts dealing with outbreak response activities. You also met with Hashmin, a little girl who had the disease. What do you learn from going out in the field, as compared with meeting officials?

Gates: Hashmin is what it’s all about. I met her when I was on a trip with my dad and my two sisters. She’s paralyzed for life. Kids in slums are most at risk; Hashmin had some drops of the vaccine, but given all the other diseases and nutritional challenges, not enough to fully protect her. Unfortunately, polio is not a disease you can treat. Once you get the disease, it ravages some of your nerve cells, and the effect is permanent. You can’t be restored. All we have is a vaccine that’s preventive.

TR: Was administering the vaccine an emotional moment?

Gates: Yeah.

TR: Any tears?

Gates: This is an oral vaccine, so all you’re doing is [giving] drops. Some of the children are crying.

TR: I meant you.

Gates: [ smiles ] Not giving the vaccine. But meeting Hashmin, and knowing that she’s still too young to be aware that she’s even got polio – that was very emotional. When I made the trip to India, polio was the big theme. I’ll probably be back in India in the next three months, with polio as the only reason to go. This trip to Nigeria [in February] is 100 percent a polio trip. My intent is to learn about the disease and help make sure that our resources are being used well, along with talking to government leaders and thanking Rotary for their great work; that is now my full-time effort.

TR: What part do government health officials play?

Gates: In India, we also spent a lot of time with the health minister talking about the campaign, what new measures need to be taken, what new tools we can add. For instance, we have the technology that allowed us to track Hashmin’s case back to a spread coming out of Uttar Pradesh [State], which is close to Delhi. That’s important. The quality of the execution in India is really quite amazing. The government of India is funding a very high percentage of the polio activities. In New Delhi, we met with the vaccinators who map the neighborhoods and mark the households.

TR: Was 2008 a good year?

Gates: All of us expected better progress in 2008, but the number of cases actually went up – not to a huge number, but enough that we know we need to apply some new tactics.

TR: Is that what triggered the $255 million gift – just a year after the first $100 million?

Gates: About two years ago, people thought we were on the glide slope to success. Then, as challenges came up last year, that changed to saying the fight was winnable, but we were going to have to put more into it and pay more attention, particularly in the endemic countries. The news is that these are not the easy years. The last two have in some ways been the most difficult.

The money came out of a meeting that my wife, Melinda, and I had with our polio team. I write about this in my first annual letter about my work with our foundation. We asked our team, if we kept giving as we had been giving, would there be a good chance of success? The more I probed, the more they talked about the problems and challenges. So I raised the question, if we gave more money, would that raise the chances of success? They came back 30 days later and said yes. The extra time and some of the new ideas would take additional money. We decided to do two things: give more ourselves and reach out to everybody else who’s involved, including Rotary and the governments, and get them to give more as well.

TR: So much potential money is bound up in the corporate sector. How do you motivate the business community to adopt humanitarian issues as a core value?

Gates: I’ve talked broadly about what I call “creative capitalism.” The vast majority of the power, innovation, and ability to execute in the world is in business. The drug companies understand drugs and vaccines; the cell phone companies have the communications infrastructure; the food companies, through their buying and formulation and labs, understand seeds and things. If each company can think about how 5 percent of their innovative power could focus on the needs of the poorest and how we could tap more scientists, more resources, more abilities, it would be great.

Rotary is one of the best examples. They took on polio, and it drew them together. I wish we had more organizations and businesses taking on challenges like that. Businesses can match the gifts their employees give – such as [when] someone has given to the Rotary polio campaign. Or they could donate their expertise or supplies. Each business has to pick a particular theme. I think this can be very energizing.

Rotary will always stand out as a unique example. But there are great examples of businesses – particularly the larger businesses – that are trying to make a difference. GlaxoSmithKline is the best of all the drug companies. Novartis and Merck are also doing good things. Some are not.

The head of our global health work is Tachi Yamada. He was one of the leading executives of GlaxoSmithKline, so he knows all the people. The CEO of Novartis, Daniel Vasella, is on our global health advisory board. I’m in regular meetings with Johnson & Johnson about some AIDS projects they have, also with Pfizer about what they can do.

In every industry, you have some leaders who are key because they set the example. If we could get everybody to be as good as the best – the best in the food, cell phone, drug, banking [industries] – then what we would have would be quite phenomenal. Businesses that are involved with Rotary have made the choice, whether it’s in their community or the world, that the relationship between business and humanitarianism [should be] positive. I’m sure that some of them get business from other Rotarians, and that standing up and being a good citizen is of benefit to them. That’s not to deny governments credit. The biggest dollars for all these battles against disease come from the governments – I mean the big, big numbers, like for AIDS treatment, or the overall vaccination budgets.

TR: Could governments still do more?

Gates: Whenever we get people in Rotary or in businesses involved, we always ask them to lend their political voice to the cause. If we have a country that’s not giving as much money as it should to the polio fight, we’ll sit down with Rotary and get the Rotary leaders to tell us who’s who, and get their involvement in making sure that all the rich countries are doing their part.

TR: Is working full time at the Gates Foundation as consuming and demanding as running Microsoft?

Gates: Oh, sure. In my annual letter, I talk about how the three magic elements – the opportunity for breakthroughs, the chance to play a unique role, and the opportunity to work with smart people on interesting problems (the things I loved about my job at Microsoft) – are all present in the foundation work that I do. I loved my work then, and I love my work now.

TR: You once said that a big motivation at Microsoft was never allowing yourself to rest on your laurels, or to think that one success guaranteed the next. Is that also a common thread?

Gates: It was always interesting to see what the competition was doing. If they were doing something smart, we had to do something smarter. In the case of the Gates Foundation, the competition is the disease. The AIDS virus mutates. The poliovirus is trying to succeed, and our success comes at the expense of its success.

A problem is that in richer countries, most people aren’t paying much attention to the disease. Of course, nobody’s against polio eradication, but they have a lot of other things to consider in terms of their time and dollars. That’s where the marketplace doesn’t work perfectly. Some needs aren’t heard because, from a dollar point of view, they’re not speaking loudly enough.

Unless people have heard about a problem and seen the potential for success, they’re just not going to get that involved. Rousing people and telling the story in a very straightforward way, making sure that the money will be well spent, is important. My credibility as a successful businessperson is one reason they can feel good about their dollars being well spent. So I have to make sure I’ve spent the time to make sure all our money – and their money – is spent in the best way.

TR: Is there a best way?

Gates: It’s very tricky to think about how to use existing resources and how to get the causes put forward. The role the Gates Foundation can play is not on the scale of government or business, or even academia at large. Yet there are certain kinds of causes that our foundation is perfectly suited for, and it turns out that funding some of these drugs and vaccines for the diseases of the poorest really fits in.

TR: Have you met with President [Barack] Obama about global health?

Gates: I met with President Obama several times when he was a [U.S.] senator. About two weeks ago, Melinda and I were on a call with him to talk about global health and education, both of which he’s keen on making a priority. Obviously, the economy is the top priority. We’ve seen an increase in awareness of global health and a sense that progress is being made with malaria, AIDS, and polio. I think President Obama will help push that forward. Secretary of State [Hillary] Clinton has an interest too. We’ve worked with the [William J.] Clinton Foundation on a lot of these things. [And] the new administration will pick up from where the last one left off.

TR: The prevailing wisdom, however, is that the previous administration wasn’t that involved in global health issues.

Gates: In terms of AIDS, the last administration was quite phenomenal. Former President [George W.] Bush really deserves a lot of credit for the PEPFAR effort, the President’s Emergency Plan for AIDS Relief. Now those dollars are being used in a broader way for health systems as well as for AIDS treatment. I’m hopeful that the U.S. government will continue to do its part. As I say in the [annual] letter, the U.S., on a per capita basis, has not been as generous as some other countries. But it’s on an increase, which is good, and has focused a lot of that increase on health, which is good. But Norway, Denmark, the Netherlands, Sweden – they’ve always been the most generous.

TR: How seriously is the global economic crisis affecting giving?

Gates: The budget in the U.S. is very tight now, but then you have the stimulus package, and everybody wants their cause to get connected to the stimulus. Foreign aid for global health has a pretty distant connection to the stimulus. But even Secretary of Defense Robert Gates has talked about the need for these things as part of what the U.S. does, and Obama has been very positive on that. Still, we can’t just rely on the top politicians. We need a broad base of understanding and energy behind these issues to expect a sustained effort year after year, politician after politician. With polio, it’s just a matter of years until we can see success. But with something like malaria or AIDS, it will take in the neighborhood of 20 years before we eliminate it in lots of places and reduce the burden dramatically everywhere. But having success with polio will help us with those campaigns. Success builds on success.

TR: A good deal of the Gates Foundation’s money comes from your friend Warren Buffett. How did you convince him to give such an enormous amount?

Gates: Well, I actually never spoke to him about the gift. It was completely a surprise to me. At a gathering of friends he has every couple of years, I had presented on global health and talked about how you can save a year of life for less than $100. I went through the progress that had been made, and he could see I was engaging all of my passion on it. But I was still completely stunned when he made the decision. It’s now a year and a half since he made that announcement, and it’s made a huge difference. There’s no way we could make these polio grants if we didn’t have the resources that Warren provided. Basically half of our resources come from his gift.

TR: How has being friends with Warren Buffett influenced or changed you?

Gates: Warren’s a man of great integrity, with fairly straightforward beliefs about what’s important. People look to Warren for his thoughts and insights because he had warned of some of the economic problems that took place. It was kind of unusual that both presidential candidates mentioned him as having the potential to help out. He won’t choose to take a full-time job [with the U.S. administration] because he’s got his Berkshire [Hathaway] work, but it makes me feel good knowing that his advice is being sought by the people who are looking at what’s going on with the economy.

TR: Do you find time to pursue your common passion for playing bridge?

Gates: Warren’s a good bridge player. He plays a lot. I was thinking I’d get more time for bridge, but the foundation’s work has been intense enough that I’ve played less in the last five months than I have in a long time.

TR: There’s so much to do. Do you often feel overwhelmed?

Gates: I don’t, really. Well, I wasn’t sure who to take a photo with this morning. [ laughs ]

TR: There’s one nagging question that’s been on our minds. When you write e-mail, do you include a salutation like “Dear …” and sign it? What’s the etiquette?

Gates: No, they can see who it’s from. If you’re sending e-mail to someone whom you don’t know, then you might use almost a typical business letter format. But for everyone else you’re exchanging e-mail with, you don’t do that.

TR: Do you and Melinda personally make all the major decisions at the Gates Foundation?

Gates: Yes. Polio eradication is the area we’ve grown the most in our global health budget. It’s a dramatic increase for us. The benefits of eradicating polio alone are phenomenal, but we are also deeply aware that success or failure in any part of global health has a dramatic effect on everything else in global health.

TR: What do you mean?

Gates: If people felt eradicating polio wasn’t achievable, that would hurt all of global health. Success will invigorate all of global health – in the same way that getting rid of smallpox did in its time.