Riches to the Poor

TIME: How did you decide to give most of your fortune back to the world?

MELINDA: It was clear to us that we didn't want to leave it to our kids. When we started to look at where the largest inequities [are], global health really stood out, because by every measure, if you can improve people's lives through health, you improve all measures of society.

TIME: There are so many inequities. How do you go about deciding what to fund?

BILL: It's the diseases that get no attention. We look at the top 20 and make sure that there's money for creating new drugs, for delivering those drugs, [and] for creating the infrastructure to make sure those lives get saved.

TIME: Which responsibility do you find more challenging, making the money or giving it away?

BILL: Well, they're both a huge responsibility but also very enjoyable. It's working with smart people, taking on long-term challenges that have been daunting. Every breakthrough is so exciting, so I love that, whether it's great software, a great new drug or a great way of getting drugs delivered.

MELINDA: I've enjoyed watching [Bill] at Microsoft. He enjoys it immensely, but I think when we got into the field of giving it away, it's been fun for us to do as a partnership. All the learning that we do, from every trip we go on, every meeting we're in, we're sharing in all of that greatly, so for me, that's deeply rewarding.

TIME: Do you find that each of you is interested in different aspects of the problem?

BILL: The biology of some of these diseases is perhaps more fascinating to me.

MELINDA: And I've gotten a little bit more in the field than Bill--because he has a day job. To be out in the villages, talking with the women, seeing what really makes an impact on their lives, that really helps me when I come back to the foundation and go through the numbers, go through the grants and say, Can this really make a difference?

TIME: It must put a human face on these overwhelming numbers.

MELINDA: It absolutely does. When we were in Mozambique, seeing the mothers with babies who are dying of malaria, I think for both of us it really gave us a face to what we're trying to do in the whole area of malaria.

TIME: How appropriate is it that billionaires are funding some of the most important work in global health? Isn't this work that should be done by governments?

BILL: [Pause] Well, it should be done. Leaving it to philanthropy is risky because, you know, the right person may not come along. And yet there's no part of any rich world government that's been chartered to help create drugs for diseases in poor countries.

MELINDA: I think that was the biggest surprise to us when we came to this. We thought some of these problems were being worked on. So when you would come and start to research, you'd say, My gosh, it's not being handled. You realize there is a vacuum that does need to be stepped into.

TIME: How important is the issue of reproductive health as a way of combatting AIDS?