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Abstract
On February 1, 2001, the Bill and Melinda Gates Foundation announced that it would donate $20 million to eradicate lymphatic filariasis, better known as elephantiasis. The only surprise was the disease named, as it is likely that few in the developed world would have heard of it. The disease is a perfect choice for the Gates Foundation.
| The Gates Foundation is altering the face of philanthropy - and medicine. |
Sometime last August, the Gates Foundation became the world's largest philanthropic foundation when Bill Gates pumped more money into its endowment. Last year it gave away a few coins short of $1 billion, tops on the list of donors compiled by the Chronicle of Philanthropy - and of that sum, $554.5 million went to global health and research. The amount and thrust of that giving is beginning to alter the faces of both philanthropy and biomedicine.
On May 9, 2001, a new organization, the Academy for International Health Philanthropy (AIHP), will meet at the Royal College of Physicians in London to discuss how foundation grants for global health can be better coordinated in the future. No one from the Gates Foundation is on the program, however. They march to their own drummer.
| The Gates march to their own drummer. |
Nonetheless, AIHP is influenced strongly by the Gates model, and a number of other philanthropies, including those created by the once and future billionaires of Silicon Valley and the high-tech industry, are also changing as a result of the Gates influence.
With $21.1 billion in endowment, Bill and Melinda Gates can afford any drummer they want. Because the Gates endowment is diversified and not all in Microsoft stock, the recent collapse of the NASDAQ and of high-tech stocks has not seriously affected it. Under federal law, nonprofit foundations must give away 5 percent of their assets every year.
| Grant proposals look suspiciously like business plans. |
The way the money is dispensed is a radical change from the old days when the Rockefellers and Fords were the kings of giving. Now, grant proposals are usually invited, not volunteered, and the researchers are required to come up with what look suspiciously like business plans.
For example, one of the founders of AIHP is Steve Kirsch. The founder of Infoseek, an Internet company purchased by the Disney Corp. in 1999, Kirsch and his wife, Michele, created a foundation with their Disney profits worth $78 million. The Kirsch Foundation's Web site clearly states that the foundation doesn't accept unsolicited proposals for medical and scientific grants. It also expects its investigators to collaborate with others as a way of "leveraging" resources.
To find likely recipients, Kirsch hired Sarah Caddick, a neuroscientist, as director of medical and scientific programs. With extensive connections in biomedicine, she suggests what and whom to fund, and for how much. She asks each researcher for a two-page "concept," rather than a proposal, to see if the researcher is thinking along the same lines as Kirsch. The document is more of a memo than a formal proposal - and a lot shorter than most proposals.
The researchers she invites don't have to prove themselves, she says; she knows they can whip out a memo. Another reason for this approach is the great unkept secret in science: scientists usually write proposals for the work they've already done - and know works - in order to fund the work they want to do. It's the work they want to do that interests Caddick.
| The Gates Foundation doesn't accept unsolicited proposals. |
The Gates Foundation, too, says officially that it does not accept unsolicited proposals, but in fact it occasionally does. Mostly, its money goes to researchers (and fields) spotted by its board of advisers who are invited to apply. The foundation attained considerable cachet when it hired Bill Foege, former director of the U.S. Centers for Disease Control and one of those credited with the eradication of smallpox, as an adviser.
It was Foege, for instance, who described a gap in measles protection in the Third World. Children from shortly after birth to about nine months old are unusually susceptible to measles because they retain enough antibodies from their mother to neutralize the vaccine, but not enough to protect them from the disease. About 1 million children die each year because of the immunity gap. Foege knew the pharmaceutical industry would not be interested in the problem because there is insufficient profit to be made in solving it. The result: a grant to the University of Maryland School of Medicine's Center for Vaccine Development that no one in Baltimore had asked for. The director, Myron M. Levine, was "asked" to put in a proposal and immediately received a $20 million grant that transformed his research and his center, to his great pleasure.
| Others are following the Gates model. |
"The effect of the Gates Foundation is not direct," says Kirsch's Caddick, "but others are following the lead."
Gates' sometime rival as the world's richest man and as ruler of the software world, Oracle Corp.'s Larry Ellison, has a foundation that was once - like many in Silicon Valley - focused primarily on the problems of aging, a typical Baby Boomer concern. The Ellison Medical Foundation made substantial contributions to the cause of world health last year, although Ellison is unlikely to admit that Gates influenced him. Ellison has two Nobel laureates, Joshua Lederberg and Eric Kandell, on his advisory panel. Applications for Ellison grants are strictly by invitation.
The new model fits the donors, men (usually) who have made a fortune doing things their own way, and who are not inclined to follow the old rules. "These folks started companies by solving problems with creative solutions," says Michelle McGurk of the Community Foundation Silicon Valley, which works with Kirsch and others. "In some cases they are motivated by personal experiences, something that happened to them or to people in their families. They think, 'If I can solve the problems I've been involved with in my business, I can use the same creativity to solve these other problems.'" They are particularly attuned to using technology as a key tool in the solution.
| Donations for public health are not new. |
Donations for public health, particularly in the developing world, are not new, of course. Steve Lawrence, director of research at the New York-based Foundation Center, points out that the Rockefeller Foundation has been doing this since the beginning of the last century. But since the early 1990s, Lawrence says, the trend has moved toward directly funding nongovernmental organizations and collaborators overseas.
For instance, Gates works with the Global Alliance for Vaccines and Immunizations and its subsidiary the Global Fund for Children's Vaccines, formed to make sure children have access to the right vaccines.
| But the approach is new. |
The use of the money for diseases that generally are ignored in the developed world or for orphan diseases is new. So is the approach. In one $100 million grant to the World Health Organization and other groups, the Gates Foundation divided the money into three main areas:
Virtually no one else funded things like that before the Gateses. One international official called the effect "galvanizing." The Gates money also is galvanizing philanthropy in other respects. The sheer size of the Gateses' purse is one part of it, says Kirk O. Hanson, a senior lecturer at the Stanford University Graduate School of Business. For one thing, Gates and the new billionaires are relatively much richer than Andrew Carnegie, Henry Ford, or John Rockefeller ever were, so there is more money to give away.
| Gates began giving away his money while still in his thirties. |
Second, this is new money, from a new industry, based on the West Coast, not the East, with West Coast sensitivities. Also, the Carnegies and Rockefellers waited until they were old men to start dispersing their fortunes, and most of it was given away after they died. Gates hasn't seen 50 yet and began giving away money while he was in his 30s.
Until recently the entrepreneurs of Silicon Valley and the technology industry - with the exceptions of William Hewlett and David Packard - were notorious for their lack of charity, partly because they were very busy and partly because of a strong libertarian streak in the industry. Scott McNealy, founder of Sun Microsystems, once was asked why he was not giving away more of his fortune. "Why should I?" he said famously. He has since recanted, and he and others have changed their outlook, although the level of giving in Silicon Valley is generally below that in other areas of the U.S.
| People realize they can make a difference. |
"It takes people a while to get used to being very rich," says McGurk, "to realize it is for real. Eventually, they ask themselves, what next? Many have young families and did not come from a culture of giving. Suddenly they realize they could make a difference."
Joel N. Shurkin is the senior editor at HopkinsHealth at Johns Hopkins University School of Medicine, and is a freelance writer. He is the author of nine books, mostly on the history of medicine and science. He shared a Pulitzer Prize as part of the team that covered Three Mile Island for the Philadelphia Inquirer.
Andrzej Krauze is an illustrator, poster maker, cartoonist, and painter who illustrates regularly for HMS Beagle, The Guardian, The Sunday Telegraph, Bookseller, and New Statesman.
Finding Funders - a resource from the Foundation Center for locating foundations and funding opportunities.
Nonprofit Motive - profiles the new philanthropists. From the September, 1999 issue of Wired.
Global Health Council - includes international health news, advocacy opportunities, publications, membership information, and more.
Eliminating Lymphatic Filariasis - from the World Health Organization, discusses the disease and its elimination program and includes links to related resources.
Towards the Eradication of Guinea Worm: A Danish-Ghanaian Collaboration - a news article from Parasitology Today, 1999, 15:4:127-129. Full text available from BioMedNet.
Measles Vaccines, New Developments and Immunization Strategies - discusses the WHO's eradication policy. From Vaccine, 1999, 17:13-14:1726-1729. Full text available from BioMedNet.
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