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MICHELE NORRIS, host:

To find out more about how the Gates Foundation operates, we spoke to Tom Paulson. He's global health reporter for the Seattle Post Intelligencer. The foundation is based in Seattle. Paulson was at today's press conference in New York. He says the foundation works with schools and technologies in the U.S., but its greatest success has been in global health.

Mr. TOM PAULSON (Seattle Post Intelligencer): They actually, for example, they went in and they gave an incredible amount of money, when they first started in 2000, $750 million to get children basic vaccines around the world and I think now, at this point, with the millions of children who have received these vaccines, you could say they've probably saved half a million lives.

That was just the beginning of their approach and they basically went into areas like malaria vaccine research, etcetera, that, frankly, had been almost completely neglected.

NORRIS: And how, when they decided to spend, they spent money on malarial research, on drug resistant TB, on polio, how do they sort of do the research and the development in making these decisions?

Mr. PAULSON: Well Bill, Melinda and Bill, Sr., Bill Gates, Sr., all go out and they set up little fact-finding missions and they actually get people together in a room to debate and they listen to the debate. And that's done in the developing world on occasion.

But probably more typically what they do is they talk to experts. They've actually hired many of the top experts in some of these fields and their staff debate these things, come up with game plans and then people are asked to make proposals. And then they pick what they think are the best ones, in some cases the highest-risk ones, but the ones that have the most chance of making an impact.

NORRIS: In the business world, Bill Gates was very results-oriented. He really focused on authority and also on accountability. Where's the accountability in the foundation? How do they know that they're getting their money's worth?

Mr. PAULSON: Well, one of their mantras is results. They're not going to fund a proposal that doesn't have a yardstick at the end that can measure the impact. And, for example, getting back to the childhood immunization, because they can't continue to pay for having these kids immunized forever, they want governments to pick up the tab so success is governments paying for more vaccines five years, ten years down the road. And failure is for the Gates to continue to pay for it.

NORRIS: In making decisions about the programs that they choose to fund, does it basically cast light on some programs and leave others forever in the darkness? Because if all the research and therefore all the money and sort of the best minds move in one direction, does that mean that there are other things that perhaps are more low-tech approaches to disease eradication that just don't happen because they never see the light of day?

Mr. PAULSON: Yeah, well I think it's important to stress that there are many, many needs out there. There's a lot of things - we tend to focus on what they're giving money to, and not as much focus on what they don't give money to.

They have talked about new areas. Water. Clean water's very important to most people in poor countries. It's a huge carrier of disease and they haven't really put much money into that because it's complicated, it involves property rights, it involves dealing more intensively with government. They say they're going to look at that.

They also say they're going to look at doing more in agriculture and we'll see. I mean, the risk there is that they may overly diversify their portfolio and not be able to have much of an impact in any one area.

NORRIS: Tom Paulson, thanks so much for talking to us.

Mr. PAULSON: Thank you.

NORRIS: Tom Paulson is the global health reporter for the Seattle Post Intelligencer. And we should note that NPR receives funding from the Bill and Melinda Gates Foundation.

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