Coca-Cola is easily one of the most recognized brands in the world. Could linking some of the most impoverished people in Africa to the corporate giant's supply chain be a win-win for both?

The Gates Foundation is funding a project to help farmers in Kenya and Uganda produce fruit for Coca-Cola. Coca-Cola says the farmers can help it meet a critical need to increase production as global and local demand for fruit juice grows.

ELLEN CREAGER/MCCLATCHY NEWSPAPERS

The ubiquitous Coca-Cola brand reaches every corner of the world.

The $7.5 million Gates grant will go to TechnoServe, a U.S.-based nonprofit, to train mango and passion-fruit farmers to improve their quality and increase production, and to provide the farmers with credit.

TechnoServe works with large corporations like Coca-Cola, using a private sector approach to align corporate interests with those of small enterprises in developing countries, and increase profits for both.

The project aims to bring 50,000 farmers into Coca-Cola's supply chain for the first time and to double their incomes by 2014.

For some perspective on this new partnership, I asked Chris MacDonald, a business ethics expert who teaches at Saint Mary's University in Halifax, Canada and is a Senior Fellow at Duke University. He has written about Coca-Cola's work in developing countries, including this report on an African water project.

"This clearly seems like a positive thing, over all," he said in an email about the new Gates-funded partnership. But the way it's set up makes all the difference. "It would be best if these farmers are being brought into Coca Cola's supply chain in a way that doesn't leave them dependent on it," he said. "Being dependent on the purchasing whims of any particular company seems dangerous, maybe a mixed blessing."

I also checked the Business & Human Rights Resource Centre, which keeps track of the record of many companies, including Coca-Cola. The company has come under fire for its water use in India. Yet it has also taken steps to build or repair water infrastructure in African countries.

Coca-Cola said the partnership will also serve as a model for the way it approaches other developing country markets where it does business.The four-year, $11.5 million partnership includes a $3 million contribution by Coca-Cola and $1 million from its bottling partner Coca-Cola Sabco.

Including loans to farmers as part of the project also raises some questions. "Anything that requires farmers to go into debt is at least a little worrisome," MacDonald said. While debt can be useful for people expecting incomes to rise, "I hope those farmers are getting some good, impartial advice about their financial planning."

The Gates Foundation's longer term goals for African agricultural development are eradicating poverty and improving food security. With a company whose main product isn't healthy, "there's reason to be worried about the company extending its reach, and hence its market, into more and poorer countries," MacDonald said.

Groups from soccer fans to music lovers and microfinance supporters are organizing events around Puget Sound to raise money for Haiti relief efforts.

On Thursday, Jan. 21, Casuelitas Caribbean Cafe in Belltown will serve Caribbean snacks and Haitian rum punch from 6-10 p.m. Proceeds go to to earthquake relief in Haiti through the Florida Association for Volunteer Action in the Caribbean and the Americas (FAVACA), a nonprofit helping people in the region for more than 25 years. Benefit includes sale of Haitian steel oil drums and a raffle. Details are here.

On Saturday, Jan. 23, Sounders FC fan club Gorilla FC will host a fund-raising event at the George & Dragon pub in Fremont with midfielder Steve Zakuani and defender James Riley as a benefit for Wyclef Jean's Yele Haiti Earthquake Fund. Details are here.

On Sunday, Jan. 24, Seattle restaurants are teaming up to hold a dine around Seattle event to raise money for NetHope and other relief organizations. More details are here.

On Thursday, Jan. 28, Seattle Greendrinks, SeaMo, ReVision Labs and Global Washington will jointly host a benefit for Fonkoze, a microfinance and development organization in Haiti working on emergency relief and long term reconstruction. Suggested donation of $20 includes live music, 6 to 9 p.m. at the Pike Brewery. Details are here.

On Thursday, Jan. 28, a benefit concert and auction called "Seattle Helping Haiti" will be held at the Moore Theater with proceeds going to the American Red Cross. Details are here.

I'll be updating this post as I learn of other events.

Do you have a story to share about Haiti? We're putting together a collection of first person accounts here.

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Previous events

On Monday, Jan. 18, the Nectar Lounge will host a benefit party, "Haiti We Stand," for Convoy of Hope.

On Tuesday, Jan. 19, Seattle-based World Concern and radio stations SPIRIT 105.3 and PRAISE 106.7 are holding a drive and looking for volunteers to take calls from the broadcast studios in Shoreline. Training will be provided. Contact Jacinta Tegman at World Concern (206) 546-7524 or jacintat@worldconcern.org

On Wednesday, Jan. 20, Re-Bar will present "One World: A Benefit for the Victims of the Earthquake in Haiti," to benefit the American Red Cross and Wyclef Jean's Yele Haiti. More details are here.

On Wednesday, Jan. 20, Lucid Live Jazz Lounge and other venues along University Avenue in the U District will hold a benefit with live music to support the efforts of Lucid owner David Pierre-Louis. With help from Seattle's jazz community, Pierre-Louis traveled to Haiti last Thursday to locate his mother in Port-au-Prince and bring emergency supplies. He's expected to be at the Seattle benefit to raise more funds for relief efforts. Details are here.

The Bill & Melinda Gates Foundation is making its first grant in response to the earthquake in Haiti -- $1 million to Catholic Relief Services (CRS) to aid its initial relief efforts, including immediate food, shelter, water, sanitation, health and other needs of people affected by Tuesday's earthquake.

UPDATE: On Friday, the foundation made a second grant -- $500,000 to Partners in Health (PIH) for immediate- and medium-term medical care through its existing 10 health facilities and temporary mobile clinics. The grant will also help pay for medical supplies, tents, blankets, water, and other essential items. Partners in Health has worked in Haiti for more than 20 years to bring medical care to poor communities.

CRS "has experienced personnel and a stock of emergency supplies in Haiti," the Gates Foundation said in a statement today. Catholic Relief Services personnel in Haiti were struggling to make sure that their 300 staff members are safe and accounted for, as well as beginning relief operations by preparing food supplies to be brought in Friday from the Dominican Republic. The CRS blog has some details about the situation on the ground.

"The humanitarian conditions are catastrophic, and much more will need to be done to address the immediate situation, as well as support the sustained recovery efforts in the weeks and months ahead so that people can rebuild their lives," the Gates Foundation statement said. "The foundation is continuing to monitor the situation and exploring additional opportunities to provide support for the relief efforts."

The largest private charitable foundation says it approaches emergency relief by trying to assist organizations that deliver food and clean water, improve sanitation, provide medical attention and shelter, and prevent or minimize outbreaks of disease.

It listed 10 relief groups actively working in Haiti for people looking for organizations to support.

Sam Dryden, an investor and entrepreneur, was named the Gates Foundation's new director of agricultural development today.

Dryden, a managing director of New York-based Wolfensohn & Company, an investment company, will begin the new post on Feb. 1. He replaces Dr. Rajiv Shah, who was sworn in Thursday as the administrator for USAID.

"Sam brings a wealth of experience to the foundation -- not only in agriculture, research and business, but also in a wide variety of projects related to agricultural development and public-private partnerships," said Sylvia Mathews Burwell, president of the foundation's Global Development Program. "His strong leadership qualities will help the team deliver on our strategy to help small farmers improve their lives."

In his new position, Dryden will lead a team attempting to help the world's poorest farming families boost productivity and incomes with better seeds, management training, access to markets and effective policies. The foundation, which has targeted agricultural improvements as one of its core missions, has committed $1.4 billion to agricultural development initiatives in Africa and South Asia.

Dryden has written and lectured widely on food security and economic development issues and served as an adviser on rural development for the World Bank and the Rockefeller Foundation.

At Wolfensohn, which was founded by former World Bank President James Wolfensohn, Dryden focused on investments in alternative energies. He formerly headed Emergent Genetics, which develops and markets seeds. Emergent Genetics, the third largest cotton seed company in the U.S., was acquired by Monsanto in 2005 in a $300 million deal.

The foundation's choice of Dryden raises a red flag for organizations that advocate against genetically modified crops, Bill Freese, science policy analyst for the Center on Food Safety, told the AP.

"Appointing someone like this as head of their agriculture project is a bad sign," Freese said.

Dryden has also been president and chief executive of Agrigenetics, a seed company now part of Dow AgroSciences, and was founder of Big Stone, a private venture and development company. His career began as an analyst with the U.S. Department of Commerce's Bureau of Economic Analysis.

Dryden has 25 years of experience as an investor and entrepreneur in the life sciences. He has served on a number of international boards and commissions focused on agriculture development, economic development and food security.

Ugandans could face the death penalty for being homosexual, according to a bill under consideration in the Ugandan parliament. The Anti-Homosexuality Bill can be traced back to remarks by several American evangelicals, as today's story details.

The bill has drawn worldwide outrage, and well known U.S. Christian leaders have condemned it as "un-Christian."

Seen from a global health perspective, the implications for addressing the HIV/AIDS pandemic are dire and could reverse the country's previous successes. The legislation would impose the death penalty for active homosexuals living with HIV.

Doctors treating HIV-positive gays could also be prosecuted for "aiding and abetting homosexuality," and some are clearly afraid.

World Vision, the Christian relief agency which has worked in Uganda since the mid-80s, said the legislation could undermine its work by stigmatizing people in communities it targets, according to Rudo Kwaramba, World Vision Uganda national director.

"Uganda is one of the first countries in which we started HIV education and prevention programs," Kwaramba said in a statement. "One of World Vision 's prevention models aims to reduce any stigma which may deter people from seeking to know their HIV status."

World Vision President Richard Stearns has been instrumental in getting more evangelical churches involved in addressing the HIV/AIDS pandemic. Such churches had been reluctant to help before because they regarded AIDS as a gay disease, or opposed condom distribution.

Kwaramba said World Vision is committed to working in Uganda regardless of whether the legislation is passed. However, to comply with the law, they could be forced to report homosexuals to the authorities.

The largest private international aid agency, World Vision has more than 500 staff members in the country.

As in other nations, "World Vision's work in Uganda is community-based and child-focused; the sexual orientation of those we serve, or those with whom we collaborate, does not arise," Kwaramba said.

Cassandra Nelson is no stranger to conflict and crisis, having worked for Mercy Corps in hot spots all over the world, including Afghanistan, Iraq, Gaza, Pakistan and Darfur.

But as she spent November in the Democratic Republic of the Congo, she was immediately struck by two things: how much violence is still raging there, and how rich the potential is if the country can move beyond it.

CASSANDRA NELSON/MERCY CORPS

Women in the Democratic Republic of the Congo build stoves out of clay for cooking more efficiently and reducing the use of firewood, which contributes to deforestation and is dangerous for the women traveling greater distances from camps to gather wood.

"It's a spectacular country," she said, "lush and mountainous and everywhere you look are flowers. One moment you see that vista, and then you turn your head the other direction and see some of the worst human suffering you've seen in your life... you just think how can this all be in one place?"

More than a decade of fighting has claimed at least 5 million lives and left more than a million people displaced, pushed into makeshift camps to seek refuge. The war has caused nearly seven times the number of deaths of the 1994 genocide in neighboring Rwanda, according to the Portland-based humanitarian group. The worst violence has been in eastern Congo, near Goma, the capital of Nord-Kivu province.

Recently "there's been a real perception that things have stabilized," Nelson said, but "the moment you leave Goma, things have not changed one bit. Every night there are gunfights and people getting killed."

Women and girls in eastern Congo have paid a terrible price.

Rape has become so common "it is almost a fact of life," Nelson said. "They're terrified of it but sometimes I get the sense they think it's unavoidable. It's happened to everyone."

As women go out to collect firewood for light, heat and cooking, they risk attacks by militia in the jungles and sometimes by government soldiers, too, she said. "Out in those woods there are a lot men with guns. It's either rape or it's harassment -- people stealing their wood or beating them."

The conflict has also taken a heavy toll on the environment. A recent UN study estimated that two thirds of the Congo Basin Forest will have disappeared within 30 years if the present rate of deforestation continues. Illegal logging and charcoal production remain a lucrative industry used to finance the ongoing conflict and buy guns for rebel militia groups, Nelson said. The strain on resources is even more severe as desperate people move into new areas and set up camps.

"First they're going out one kilometer and pretty much everyone has picked those," Nelson said. "In some places women go out 14 kilometers. People are literally spending half their day collecting wood."

CASSANDRA NELSON/MERCY CORPS

Congolese women make and store briquettes they created out of manure, which reduces deforestation and offers a safer alternative than searching for wood.

Mercy Corps is applying a practical solution to address both environmental destruction and women's security -- a fuel efficient stove.

The simple stoves can be made from sand, clay and brick found locally, and they consume less than half the wood of traditional cooking fires. That means women don't have to leave the relative safety of the camps as often.

About 30,000 stoves have been made through the Mercy Corps program and 10,000 distributed this year, Nelson said. Women are also learning to make briquettes from manure and other refuse, which burn more cleanly and are cheaper than charcoal. Besides saving trees, the stoves and briquettes provide a way to earn income for women who make and sell them.

So far Mercy Corps has trained 360 people to pass on the stove building knowledge to more women. "As they go home they take skills back and introduce this method to their villages," Nelson said.

The stoves have generated $160,000 worth of credits in the carbon market from the reduction in carbon emissions, she said. Mercy Corps uses the proceeds to teach women living in camps vocational skills, including animal husbandry, beekeeping and horticulture.

While the country continues to struggle with conflict and corruption, progress is measured in reducing danger and harm.

In the future, she said, "if the violence can ever be brought under control, it is a country with amazing natural resources and so much potential."

Like a rider through a treacherous mountain pass, Greg Mortenson negotiates through seemingly impossible obstacles to find safe passage for his schools in Pakistan and Afghanistan, choosing hope over fear and calling his only real enemy "ignorance."

Mortenson visited Seattle Tuesday and Redmond this morning to talk about his new book, "Stones into Schools: Promoting Peace with Books, Not Bombs, in Afghanistan and Pakistan." I spoke with him by phone on Tuesday while he awaited his flight from Portland. The Pacific Northwest is his biggest support network, where his champions hail from public libraries and book clubs to military bases and places of worship. His group Pennies for Peace carries on the work at home through programs for youth, teaching them about the world and how their philanthropy can make a difference. People in the Snohomish School District held a district-wide drive and raised more than $50,000.

The mountain climber and humanitarian founded the nonprofit Central Asia Institute, which has created 131 schools with the goal of advancing girls' education in rural Afghanistan and Pakistan.

COURTESY OF GREG MORTENSON

Greg Mortenson (third from right in back) with tribal chiefs from Urozgan province in southern Afghanistan, a Taliban stronghold where his institute established the first girls high school.

In "Three Cups of Tea," he writes about building schools for girls in the rugged mountains of Pakistan, while his new book focuses on neighboring Afghanistan.

Mortenson, 51, gives the mountains of remote Afghanistan the motto of his native Montana, "The last best place." There he found "a combination of courage, tenacity, hospitality, and grace that leaves me in awe," he writes. Such places often "represent the best of who we are and the finest standard of what we are meant to become."

I asked him how he manages to maintain his safety, let alone build girls schools, in Taliban strongholds:

TARA BISHOP

Author Greg Mortenson, son Khyber and daughter Amira in Gultori war refugee girls' school in Pakistan.

Establishing trust with local leaders is key, he said. "The Pashto word menawatay means the right of refuge. It means you will protect a guest with your life. Your honor in the tribal group is measured on your ability to provide hospitality for your guest. We have to take a lot of precautions, but my kids and wife do go to several places in Pakistan and Afghanistan."

(He was kidnapped and held for eight days in Pakistan in 1996.)

"Primarily we've tried very hard to work with the elders and we've put them in charge. The communities run the schools. When I am passing between two different feuding clans we'll sit there in the middle of nowhere and wait, and a military commander, a commandant, will send his emissaries. We'll have cup of tea and they will pass me off."

"It's absolutely imperative we build relationships..." As Mortenson's voice trailed off, he said he would call right back after passing through airport security in Portland. It took a lot longer than he thought. The U.S. Army veteran, whose advice has been praised by military commanders such as Admiral Mike Mullen and General David Petraeus, was detained again.

"Every time I come back into the country it's really difficult," he said later. "My passport is somehow marked. They ask me where I've been. I have to go into a special room. I don't look forward to coming back here for that reason."

Why choose to work in the remote Wakhan Corridor in Afghanistan?

"Our mission is to promote and set up schools, especially for girls, in areas where there is not education, generally in areas of physical isolation, religious extremism, conflict and war or natural disaster. Wakhan is the most remote. I think what really drew me there 10 years ago in 1999 a dozen Kirghiz horseman came over. They traveled six days a week, 16 hours a day on horseback. They were sent by their tribal leader to ask me to build a school in their region, the most isolated area in Afghanistan. You need to go in a jeep four days over rugged mountain and another three to four days by horseback over precipitous trails."

Why is girls' education the answer?

"Educating girls at least to a fifth grade level reduces infant mortality, and where I work about one out of three children dies before the age of 1. It reduces the population explosion. I think of all the problems in the world today -- we have global warming and wars -- I think there's just too many people on the planet. The number one way to reduce people is female literacy.

What I have seen is people coming home from the bazaar and they have vegetables or meat wrapped in newspaper. You'll see the mother very carefully unfolding a newspaper and asking her daughter to read the news to her. It's very empowering for a woman in an isolated area to read the news.

When mothers have an education they are less likely to encourage their sons to get into terrorism or violence. The Taliban's primary recruiting grounds are illiterate and impoverished societies. Most educated women refuse to allow their sons to join the Taliban."

On Afghanistan today:

"In the year 2000 there were 800,000 mostly boys in school, a Unicef figure. Today there are 8.4 million children in school including 2.5 million females. This is the greatest increase in school enrollment in any country in modern history. This is something few Americans are aware of.

Unfortunately the bad news is in the last three years in Afghanistan, the Taliban have bombed, burned or destroyed over 1,000 schools, and 850 schools in Pakistan. Ninety percent of the schools are girls schools. I think the reason they are bombing girls schools is because their greatest fear is not a bullet. It's a pen."

TERU KUWAYAMA

A school in a remote part of Afghanistan created by the Montana-based non-profit Central Asia Institute.

On what he teaches in the schools:

There are 131 schools now, plus another five dozen tent schools in refugee camps, serving 58,000 students (most of them girls): "Reading, writing, arithmetic, social studies. Elders come in twice a week and do storytelling to children...also hygiene, sanitation and nutrition. Since there's no health care, we teach teachers how to screen for vitamin deficiency, polio. We teach five languages by fifth grade, including Arabic and English, Dari in Afghanistan and Urdu in Pakistan and Pashto, and they also speak their tribal tongue. We are required by both countries to teach Islamiat studies, two to three hours a week studying the Koran and Islam. We teach kids to read and understand Arabic -- that's the difference between [our schools] and extremist madrasas. They teach how to read Arabic but not understand it. When you understand the Koran, there's nothing that says girls can't go to school. The two worst sins one can commit are killing someone and committing suicide. The real enemy anywhere is ignorance."

Does he still get threats here?

"I still get hate mail. I get threats. I've had threats all over the country. Our house was smashed by supremacists. People don't like the fact that I'm helping Muslims out. [Other] people don't like that I'm talking to the military. My wife says if people on the extreme right and extreme left don't like you, then you're doing the right thing. Americans are really great people. We're compassionate and courageous. There's too much emphasis on fighting terrorism, based on fear. If we promote peace, it's based on hope."

Did you manage to hear Mortenson's talk last night or read his books? Please share your thoughts.

By Sandi Doughton

Fear is as infectious as any virus, and gives many Americans a warped view of the dangers posed by vaccines, genetically engineered crops and other beneficial technologies, New Yorker writer Michael Specter said in Seattle Tuesday.

Touting his new book "Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens our Lives," Specter took aim at the kind of anti-science sentiment he says is hijacking public discourse and policy.

JOHN MACDOUGALL/AFP/GETTY IMAGES

Ice sculptures by Brazilian artist Nele Azevedo melt on the steps of Berlin's Concert Hall in a WWF event aimed at calling attention to the earth's melting poles. Specter's book on denialism has been criticized for not tackling the issue of global warming.

"We need to step back and look at the other side of every issue - and we never do," Specter said at a lecture at the University of Washington sponsored by the World Affairs Council.

He was particularly critical of parents, like many who live on Vashon Island, who refuse to vaccinate their children. "This is insane," he said. "Vaccines are the most effective public health measure in the history of the world, except for clean water."

Study after study has shown no evidence that vaccines cause autism, yet people ignore a mountain of data and instead focus on unproven horror stories from neighbors or things they read on the Web, he said. "People jump to conclusions. They decide what makes sense to them intuitively."

While vaccination rates climb in the developing world, they are dropping in the United States and Western Europe - endangering more than the families who chose not to give their kids the shots, Specter said. Last year, children in Minnesota died of haemophilus influenzae for the first time since a vaccine was introduced 18 years ago.

Specter has written for The New Yorker about Bill Gates and his technologically-oriented crusade to improve global health. He's also covered the quest to develop synthetic life-forms, the AIDS epidemic and computer hackers.

Specter's Seattle audience was receptive to his pro-science message, but others have accused him of uncritically accepting arguments in favor of genetically engineered crops. See Tom Philpott's take in Grist.

The same review in Grist also took Specter to task for failing to grapple with the growing numbers of Americans who reject the overwhelming scientific evidence for global warming.

But Specter said he intentionally left that out because it's already been extensively covered.

Seattle's global health experts are busy in laboratories and in the field, working on problems such as HIV/AIDS and malaria. So busy, in fact, that they don't always know about work being done down the street.

Washington's health expertise is spreading around the globe.

A new study being unveiled today attempts to bridge the information gap. It shows the breadth and depth of the state's role in global health, mapping out nearly 500 projects of global health organizations in Washington in 92 countries with 587 unique partners.

The two maps are based on data from nine local organizations and will be expanded in the future to include others.

This map shows where local organizations currently have projects.

This map shows where Seattle organizations have offices and labs.

Produced by the Washington Global Health Alliance, the maps are designed to help local organizations discover potential collaborations and shared facilities, and showcase global health as a powerful and emerging sector in the region.

"Everybody recognizes that to address these issues, the more information the better and the fewer barriers the better," said Lisa Cohen, founding director of the alliance.

Alliance members include Fred Hutchinson Cancer Research Center, Institute for Systems Biology, PATH, Public Health - Seattle & King County, Seattle Biomedical Research Institute, Seattle Children's Hospital Global Alliance for the Prevention of Prematurity and Stillbirth, the University of Washington, Washington State University and the Bill & Melinda Gates Foundation.

The Gates Foundation is not included in the tally because the study focuses on organizations doing work in the field, not those funding them.

Many of the founding members of the alliance have doubled in size over the past five to seven years. Global health organizations expanding in South Lake Union are redefining the area beyond the original life-sciences cluster.

The alliance can help state businesses and non-profits get connected to opportunities in places where global health projects have paved the way, such as China and India, Cohen said.

Through the alliance, local health authorities hope to apply methods used in global health projects to improve health of people here in the Seattle area.

"A lot of people think global health is over there and doesn't have relevance here," Cohen said, but the H1N1 pandemic has made the links clear.

Community health workers, for example, have been vital to programs internationally, bringing medicine and information about prenatal care and disease prevention to people in rural areas. Such a model could work here, especially in South King County, where workers with language and cultural skills could help train diverse populations living below the poverty line who are unfamiliar with the health system, Cohen said.

It's a massive project taking shape during a steep decline in real estate development and commercial property values.

The Bill & Melinda Gates Foundation's new 900,000-square-foot headquarters, comprised initially of two six-story, boomerang-shaped buildings on 12 acres near the Seattle Center, is scheduled to be finished in April 2011 at an estimated cost of $500 million.

Update: The WSJ's Robert Frank asks: Does a charitable foundation need a $500 million complex?

The Gateses said Friday they are making a $350 million payment of personal funds into their foundation's $34 billion endowment for construction costs. The couple made the one-time payment to distinguish money for the campus from money they have given for grants.

The foundation purchased the parcel of land from the City of Seattle for about $50 million.

The construction project has been going on more than a year and is now about 40 percent complete. Here's a view of it from a live Web cam. It will house the foundation's nearly 800 employees, now working in five locations, and an 11,000-square-foot visitor center.

At the heart of the campus is an atrium six stories high that is completely open and enclosed by glass windows.

On the site at 500 Fifth Ave. N., 400 workers are busy welding steel, pouring concrete, operating now three cranes and reinforcing an underground sewer line. The building takes close to 7,000 tons of steel for the structure and more to reinforce the 67,000 yards of concrete. The project is being led by Sellen Construction based on a design by NBBJ architects.

Green building features include a living roof on the parking garage and a million-gallon rainwater storage tank to reduce water use. The project is aiming for a Gold rating in LEED Certification, an environmental building standard.

Taking a look at some other recent developments, the non-profit Mercy Corps completed its new global headquarters in Portland, transforming and expanding a historic downtown building at a cost of $37 million.

For its new headquarters in a building complex now under construction in South Lake Union, Amazon.com signed a deal to lease about 800,000 square feet for about $700 million, with an option to double that.

However, a recent national report predicted that the recession and bank troubles will continue to weigh down the Seattle market next year, with WaMu's collapse and new but mostly unoccupied office towers combining to push the downtown office-vacancy rate above 20 percent.

Northwestern Mutual bought the WaMu Center tower from JPMorgan Chase for $115 million, less than one-third of what it cost to build.

The Gates Foundation's headquarters is the biggest project in Brian Duke's 27 years at Sellen Construction, where he is senior superintendent.

The design and communications effort needed to pull it off is huge, he said.

Cranes operate in close proximity to high-voltage power lines. When winds are above 20 miles per hour, the cranes have to stop, which could slow progress over the winter. In the record heat this summer, temperatures on the steel decking reached 120 degrees.

One challenge was removing contaminated soil -- 600,000 tons of it, load by load. The soil and groundwater were contaminated from decades of fuel storage and vehicle maintenance.

Workers also had to rebuild part of a live sewer main in the middle of the project, he said. First they had to demolish an old brick manhole from the early 1900s, being careful not to damage the line, which runs underneath Republican and serves the South Lake Union neighborhood.

Duke said he draws inspiration from the foundation's charitable aims. "It makes it easier to come to work," he said. "Your job isn't just a construction worker; it has some meaning."

By Sandi Doughton

Lancet editor Dr. Richard Horton joked that his lecture at the University of Washington Monday night would be "metrics-free," but the outspoken Brit couldn't help making the case for better data to guide global health and development programs.

Many of the current darlings of philanthropy, such as microcredit, have little solid evidence to back them up, Horton said. One recent study in the Philippines concluded that the small loans did not improve community well-being and actually led to contraction of small businesses.

"These fashions that grip us in waves ... when you actually end up looking at the data can often seem to be very, very thin," he said.

When the book "Dead Aid: Why Aid is Not Working and How There's a Better Way for Africa," argued that $1 trillion in international aid has only increased corruption, war and poverty, the development community had little to offer in rebuttal, Horton told the audience of faculty and students.

"We have badly failed to gather data on what a trillion of aid has done."

UW global health professor Steven Gloyd said he picked Horton to present the Steven Stewart Gloyd endowed lecture partly because of the UK-based Lancet's courage in publishing controversial papers, including one that estimated 650,000 civilians have been killed in the Iraq war, and one by researchers at the UW's Institute for Health Metrics and Evaluation that found many childhood vaccination numbers were inflated.

Horton, who works closely with IHME, is known for poking at the powerful, including the pharmaceutical industry and the medical establishment. His journal recently published a critique of the Bill & Melinda Gates Foundation's accountability and emphasis on technological solutions to global health problems.

But like everyone else in global health, the Lancet has received money from the giant philanthropy: $200,000 to publish a series on maternal and child mortality.

Horton said he'd like to see universities like the UW provide a forum where data on development and global health can be freely available - and critically evaluated.

The UW can also provide a counterbalance to Seattle's global health giant, the Gates Foundation, Horton said.

"I would hate it if Seattle was only seen as the center of technology in global health. The university can provide that added perspective to what comes out of the Northwestern U.S., and that's absolutely critical."

Amina S. Ali, African Union ambassador to the United States, made her first visit to Seattle this week, seeking to build bridges with Washington state institutions, which she says are playing a more important role in African business and development.

Ali, who is from Tanzania, represents an organization of 53 countries formed in 2002 and loosely based on the European Union, with the goal of helping integrate the continent to give it a stronger voice in the global economy while also addressing social, economic and political issues. The AU launched its first diplomatic mission in the U.S. in 2007.

Ali is the second high-level diplomat to come through Seattle in a week to meet the Gates Foundation, with a message to focus more on improving maternal health. Both Ali and U.N. Secretary General Ban Ki-moon warned that the world's goal of improving the health of mothers and children is falling further behind.

The African Union is calling attention to the issue in a new campaign to reduce deaths of women in pregnancy and childbirth.

"We found for the last 10 years the donor community is focused on HIV/AIDS, and it's a stubborn problem," she said. "But there are other issues that confront women and children that nobody is talking about. There's no reason women in Africa should die in childbirth."

"We are thinking what can we do to bring women's issues to the top?" Part of the problem is a shortage of doctors and nurses, she said. Throughout parts of rural Africa, the ratio is 1 doctor to every 40,000 to 100,000 patients.

Like Ban, Ali also talked about the important role business can play in solving global issues. In Seattle, she met with Microsoft, the Trade Development Alliance and the African Chamber of Commerce.

Mobile phones are now helping medical diagnosis, she said. In Tanzania, patients living 1,000 miles from a city are using mobile phones to send information about illnesses and receive diagnosis.

For all the wrangling over trade with China, the U.S. should take a look at the way it's investing in Africa, she said.

"Americans should start to think why the Chinese have gone to Africa while the Americans have not taken advantage of that," she said. Americans have been more cautious, sitting on the sidelines. Chinese have been aggressively pursuing business, and while the relationship is not always easy, they are helping Africans solve key infrastructure problems, especially in building ports, she said.

One thing that has mitigated risk for the Chinese companies is a Chinese government development fund targeting Africa. The $10 billion China-Africa Development (CAD) fund aims to promote economic cooperation between China and Africa and advance Africa's economic development by providing money to Chinese companies starting ventures there.

Ali said she hopes the United States can create a similar, large fund to help American companies bridge the gap and start to invest more in the continent to transform its future.

Such a fund could go a lot further than simply giving money to government aid programs, she said. "Give the fund to your own people to invest in Africa," she said.

"It can be done," she said. "China 20 years ago -- it was nothing, and then the private sector decided to work with them. Let's try to work with Africa."

Calling themselves "impatient optimists," Bill and Melinda Gates plan to talk directly to lawmakers and others in Washington D.C. tonight to push for continuing U.S. funding for global health.

CHUCK BURTON/ASSOCIATED PRESS

The Gates will tout the success of foreign aid, including contributiosn to the GAVI Alliance, a global initiative to immunize children in poor countries, which has prevented an estimated 3.4 million deaths over the last decade.

"In our visits to developing countries, Bill and I have met countless people who are alive, healthy, and productive as a result of U.S. global health programs," Melinda Gates said today. "We want Americans to know how much their generosity is accomplishing, and how much it's appreciated."

U.S. spending on global health has increased steadily, but it still makes up less than one percent of the federal budget. It was close to $8 billion this year, up from $1.5 billion in 2001.

The U.S. has started some ambitious development projects, even though the country's top post on foreign aid remains unfilled, and many pressing issues are vying for resources and attention.

The Bill & Melinda Gates Foundation has become an increasingly important and active player in global health and development. Its annual budget is more than $3.5 billion, and about half of that goes toward global health. The United Nation's annual budget is just under $4.2 billion.

The couple started a project called Living Proof to promote the success such funding has achieved in developing countries. Positive stories about foreign aid aren't getting told, they say.

The Gates Foundation has spent about $12 billion on global health since 1994.

Their aim is to cut the number of child deaths in half worldwide by 2025. Preventable deaths of children under five have declined worldwide to about 9 million in 2007 from 12.6 million in 1990, despite population growth, according to this report.

The presentation will be webcast live at www.livingproofproject.org at 4 p.m. Pacific.

U.N. Secretary General -- it's a position that seems both enormously important and also largely thankless, but nonetheless a job that very few people are actually qualified to do. Secretary General Ban Ki-moon, 64, has had mixed results, but as he acknowledged in an interview, he is facing an unprecedented onslaught of global crises all at once. The success of the United Nations is determined by the political will of its 192 member states, not just the man at the helm.

The vast size of the bureaucracy can be crippling, as Ban wrote himself last year: "There is bureaucracy, I discovered -- and then there is the U.N."

MIKE SIEGEL/SEATTLE TIMES

U.N. Secretary General Ban Ki-moon visited Seattle to spread the word about climate change.

Today he met with many groups in Seattle, starting with a breakfast meeting at the home of Bill and Melinda Gates, followed by a talk to the World Affairs Council on the U.N. in the 21st century and a lunch sponsored by the Greater Seattle Chamber of Commerce to address businesses about climate change and environmental stewardship. Ban also gave the Political Science Department's 2009 Severyns-Ravenholt Lecture at the University of Washington, where he received an honorary degree of Doctor of Laws at a ceremony in Meany Hall.

Under Ban's leadership, the U.N. has strengthened its role as a peacekeeper, improved the economic situation of the world's poorest, removed land mines, made progress toward nuclear disarmament and focused the world's attention on climate change, UW Regent Bill Gates Sr. said in conferring the honor.

"A great Seattle philosopher once said knowledge speaks but wisdom listens," Ban said, quoting Jimi Hendrix.

He called for a "renewed multilateralism," global cooperation that accepts "how closely our fates are interlinked" and "recognizes the rights and responsibilities of all nations."

Multilateralism is not just not just about government, he said. "It is about all of you. You and me and business and civil society organizations around the world - we all have a stake in our common future."

Ban has been visiting U.S. cities six weeks before the a major climate change conference in Copenhagen. He said he has been meeting with Senators and hopes the U.S. Senate will take action before then on a bill to limit carbon emissions.

"I was very much encouraged by such a strong commitment by President Obama," he said, "but we need now more than a commitment -- we need some actual concrete contribution by the United States."

Yesterday my colleague Sandi Doughton and I had a chance to sit down with the Secretary General for a brief conversation. Besides today's story, here are some additional excerpts from the interview.

Q: On climate change the U.S. has been one of the parties that has been slow to come to the table. The percentage of Americans who believe that climate change is caused by humans is low compared to other countries. What would you say to those people who don't believe it's real?

A: This is completely a minority view. There are some people who believe that it's not real, but I can tell you clearly this is a very minority view. The science has made it quite clear.

I have been really trying to send out such a strong message raising awareness among leaders and the general public that climate change is now happening much, much faster than one realizes.

I'm reasonably encouraged that climate change has become the top priority agenda of all the leaders of the world. On September 22, I convened a summit meeting where more than 100 heads of state and government participating, including President Obama. It was the first time that a U.S. president had attended this climate change summit meeting.

JAY DOTSON PHOTOGRAPHY

People gathered at Seattle Center over the weekend to form a giant human 350 as part of a synchronous action of 4,300 demonstrations around the world. Activists highlighted 350 as the safe upper limit for carbon dioxide, in parts per million, as a target for reducing carbon emissions. The current amount in the atmosphere is 385 parts per million.

Q: Some say the emergence of super rich philanthropies like the Gates Foundation has undermined the effectiveness of the U.N. and its member organizations, like the WHO.

A: On the contrary that is what we really want -- contributions from the business community as well as philanthropies. We need to have political support, but it doesn't give us all that we need. NGOs and philanthropies and many foundations such as Bill Gates Foundation -- they're taking a very important role. The United Nations stands in the center of mobilizing and raising awareness of climate change and food security. When this H1N1 flu broke out I immediately had a meeting with WHO Director Margaret Chan. We even convened a meeting with international pharmaceutical CEOs in Geneva. We were discussing how pharmaceutical companies could help providing vaccines for developing countries. Major pharmaceutical companies have now donated 150 million vaccines.

Q: Regarding the Millennium Development Goals, in your 2009 report you said progress has slowed if not reversed as a result of the food crisis and global economic downturn. What needs to change?

A: With this economic crisis it's natural we need to have a concern that commitment on Millennium Development Goals may be affected. During the G20 summit meeting in London I raised this issue very strongly and urged them to keep their pledges. Not much has been delivered, particularly when it comes to Africa. In sub-Saharan Africa not a single country is now on track to achieve the goals by 2015. That is why I'm going to convene another summit meeting next year. By then we'll have only five more years to go and we have to take stock. That is one subject I'm going to discuss with Bill Gates.

Q: By working in a quiet, low key manner some people say you have reduced the voice of the U.N. Do you think that criticism is valid and is there anything you plan to do to make your voice more powerful?

A: This is largely a misperception. I believe in diplomacy. Diplomacy involves open and quiet diplomacy. When it comes to very delicate matters you do not discuss these matters very openly. When it comes to universally accepted principles, such as human rights and democracy, you speak out.

The world is now going through multiple crises. Have you ever seen when whole international community has been hit all at once by all these crises: climate change, economic crisis, food security, energy crisis, pandemic? Only one of these would come once every 80 years. Naturally there is a high level of expectation of the international community for what the United Nations should be doing. I can understand the frustrations. The international community has not been able to address all the issues all at once. All these integrated issues require a global response. The United Nations operates on the basis of political will and contributions by member states.

It's too unfair if one just brings all these issues to my personal style... In Darfur there's going to be the largest number of peacekeepers in the history of the United Nations. The number, 26,000, would be bigger than all the peacekeeping operations combined 10 years ago. It was me as secretary general who made this 90 percent deployment happen. The Darfur situation from day one I have taken as number one priority. I have been fighting very seriously with president Bashir and working very hard with military generals. It was me who was able to go there and maybe save at least a half a million people. So I hope you will see the picture correctly. The United Nations has been speaking out, and I have been speaking out."

_____________________________________________________________

What do you think -- has the U.N. been effective? What should it do differently?

Add two new weapons to the potential arsenal against malaria -- chewing gum and chocolate.

They are among dozens of unconventional approaches to global health problems that won backing today from the Bill & Melinda Gates Foundation. The foundation is giving out 76 grants of $100,000 each to researchers in 16 countries.

The awards known as Grand Challenges Explorations, smaller and riskier bets the foundation is making to encourage creativity among scientists around the world, include people in areas such as chemistry, engineering, statistics and business who have never focused on health before.

The third round of projects explore new low-cost ways to diagnose diseases, fight malaria and HIV, and find more effective vaccines. Among the winners:

• Andrew Fung of the University of California, Los Angeles, aims to develop chewing gum that can detect the presence of malaria in a person's saliva. Fung calls his diagnostic tool "MALiVA." During chewing, particles in the gum will react with malaria proteins, which can be detected and characterized when the gum is scanned with a magnet.
• Kate Edwards at the University of San Diego will study whether a brief bout of exercise can make a pneumonia vaccine work better.
• Steven Maranz of Weill Cornell Medical College in New York will test a compound contained in chocolate to find out whether providing children high levels of flavanols, found in chocolate, green tea and nuts, deprives malaria parasites of lipids needed to survive, keeping the infection at levels low enough to elicit a strong immune response and build lifelong immunity.
• Ranjan Nanda of the International Centre for Genetic Engineering & Biotechnology in India will attempt to create a handheld "electronic nose" that gathers and analyzes breath samples to diagnose tuberculosis.
• Margaret Njoroge of Med Biotech Laboratories in Uganda will develop a nasal vaccine for mothers, designed to induce antibodies against malaria in breast milk and pass that immunity on to their babies.
• Researchers at the University of California, Berkeley are attempting to marry a microscope with a cell phone to capture high-contrast fluorescent images of malaria parasites, with software on the phone that can count the parasites and wirelessly transmit the results to clinics.

The foundation is currently considering applications for the fourth round of funding, which closes on Nov. 2, and it's adding a new topic this time around -- new technologies for birth control.

Seeking novel solutions to an old problem, the foundation notes that family planning is one of the most cost effective ways to reduce deaths among mothers and children, but 200 million women in developing countries lack effective contraception.

So far, 262 researchers from 30 countries have been awarded grants through the Grand Challenges program, a five-year, $100 million initiative to promote innovation in global health.

Since the projects are so experimental, I'll be interested to see how the first ones have fared a year after their initial funding, and whether any of them are going on to the next stage in November. Successful projects can compete for a follow-on grant of $1 million or more, but no such grants have been awarded yet.

By Sandi Doughton

Health experts around the globe were chilled earlier this year by the discovery that malaria in Cambodia has evolved resistance to the most promising drug in medicine's arsenal.

With the effectiveness of artemisinin under threat, the Bill & Melinda Gates Foundation is stepping up its investment in new malaria drugs with a $115 million grant to the Geneva-based Medicines for Malaria Venture. The grant brings the foundation's total funding for the group to $317 million.

Malaria has long been a top priority for the Gateses, who in 2007 took the controversial step of calling for eradication of the disease. Many experts question whether that will ever be possible, but foundation CEO Jeff Raikes recently said the world's biggest philanthropy is refocusing its malaria programs with the goal of eradication in mind.

The "E-word," which some malaria scientists utter with trepidation based on past failures, is repeated three times in MMV's four-paragraph press release on the new grant.

In February, MMV and drugmaker Novartis introduced a sweet-tasting version of the combination malaria drug Coartem for African children. The group is funding work on more than 50 drug candidates, ten of which are in clinical development.

Nicholas Kristof, a New York Times columnist and co-author of the book Half the Sky, said the inhuman reality many girls face in the world became crystal clear when he purchased two girls from a brothel in Cambodia for about $200 each, and was given receipts.

"It's no exaggeration to talk about this as truly slavery," he said, speaking to the World Affairs Council tonight at Town Hall.

At the peak of the transatlantic slave trade, about 80,000 people were sold. Today there are 800,000 women and girls being trafficked around the world, he said.

Anywhere from 60 million to 100 million girls have disappeared from the world's population because of female infanticide and inadequate care for girls' health, Kristof said, showing photos of a skeletal child being treated in a feeding center, whose brothers were well fed and healthy.

"Every kid in the feeding center was a girl," Kristof said.

But he argued that even small interventions can transform the situation, and education is the best place to focus resources.

The U.S. has spent $11 billion in aid to Pakistan since 9/11, money which has accomplished "next to nothing," he said. If some of it had gone to education, the impact would be felt by now.

Bangladesh, by contrast, invested in girls education after it split off from Pakistan. Now there are more girls in school than boys, the country is doing relatively well and tackling its remaining problems with home grown solutions such as microcredit.

Supporting local grassroots movements for female education and economic opportunity is one way Americans can encourage change without forcing their cultural values on others, he said.

He finds the rise of social entrepreneurs a revolution that will change the world.

People want to engage in causes larger than themselves because it makes them happy, he said. Asked how he remains hopeful in the face of so much suffering, Kristof said it's because he witnesses so many selfless acts by people working in terrible conditions to save lives.

But when he comes back and sees "people who express their humanity by buying the latest car or having the latest iPod -- that is truly depressing," he said.

He advised young people to travel abroad, go outside their comfort zone, be embedded in the home of a local family.

Some people ask him why we should care about the fate of people in other countries many miles away.

"When you actually see a girl in a Cambodian brothel with her eye gouged out you don't ask that question."

What happened to the girls he bought out of slavery five years ago? Kristoff said he stayed in touch and still visits them. One is married to a good husband who doesn't know her past. The other went back to the brothel temporarily to feed her meth addiction, and later married a police officer. But now the brothel no longer exists. U.S. government pressure on Cambodia to crack down on trafficking made it risky and expensive, so the proprietor turned it into a grocery store.

Begging is a way of life for many women and girls in Africa. Carol Schillios wants to turn them into businesswomen.

Her Fabric of Life store in Edmonds is part of a non-profit that trains young women and girls in Mali, one of the poorest countries in the world. The shop, run entirely by volunteers, then sells the products made by the women -- woven fabrics with traditional patterns, bags and multicolored beaded jewelry.

Schillios funds a school called the Here je Center in Mali's capital that teaches job skills, along with health and nutrition, family planning, AIDS prevention and literacy. The students are paid $20 a week to help support their families while they are studying.

The idea is to reach girls who are begging and get them off the streets before they turn to prostitution. They continue being paid that stipend as artisans after graduation. On an annual basis, it's more than double the average income for a person in Mali.

Schillios decided to focus on Mali after working there as a consultant and meeting Kaaba Soumare, the CEO of a small microfinance institution, who eventually became her local partner.

The shop provides a critical link -- market access to American buyers.

"We're always going to be consumers," but there's a difference she said, holding up a mustard colored place mat. "When you eat on it you know you helped save someone from starving."

A consultant to credit unions and microfinance groups, Schillios says she takes no salary from her non-profit, the Schillios Development Foundation, and relies on volunteers rather than employees.

For the past three months Schillios, 56, has been living in a tent on the roof above her shop, accompanied by her 22-year-old cat Elliette.

She vowed not to come down until 1 million people each donated $1 to her foundation and shared how they are making a difference in the world. So far she's raised $66,000.

The blue tarp covered tent is visible from along Main Street in downtown Edmonds, where she gets stares, waves and donations of coffee and food. Extension cords linked to the shop bring electricity for her laptop, lights and a device that helps her breathe at night. There are bottles of Ibuprofen for achy joints. She's hung a Tibetan prayer flag and a Halloween skeleton for decoration.

One night everything went wrong. The tent leaked. The roof of the makeshift bathroom collapsed in on her. She was so frustrated she took off her clothes and danced on the roof in the rain at 3 a.m.

Eventually she realized her goal of raising $1 million might be too ambitious, so she plans to come down before Christmas. Still she's happy with all the attention drawn to the cause.

One supporter agreed to match donations up to $43,000, $1 dollar for every resident of Edmonds.

Revenue from the Fabric of Life shop has steadily grown since its opening last November, enabling Schillios to channel about $30,000 into grants to the school in Bamako. About 20 women have graduated so far. Not all of them make it-- one of the students died of malaria a few weeks ago.

"We didn't find out the extent of her illness until it was too late," Schillios said. Two others left the program after they became pregnant. Still, she is hopeful she can fund a third class of students this year.

"My dream is we create an industry for the whole country," she said.

Westerners want to help women in developing countries, but their good intentions don't always produce effective solutions. The problem is more complicated, as members of the Seattle philanthropy group Pangea are learning.

Working on issues of poverty and disease since 2003, Pangea's volunteers eventually came to the conclusion that gender equity had to be part of the equation.

"As we traveled and worked with communities we became more and more aware of the challenge facing women in developing countries," said board member Chris Doerr. "Women are also leading the most successful interventions."

PANGEA

Chris Doerr (right), a volunteer with Pangea, and Judith Orawo, head of the Omeko Women's Group in western Kenya. Omeko's tiny community businesses provide jobs for widows and orphans of the AIDS crisis. Pangea funded a simple chicken coop and the start of an egg production business, and the next year helped triple the size of the poultry project, which is now profitable.

The question is how to help them. Pangea has funded a range of women's groups, from economic projects for widows in Kenya and Tanzania to a group training women in traditional healing arts in Mexico to a group providing legal aid to women refugees along the Thai/Burma border.

"They need to find their own pathway to change," says Pangea President Allan Paulson. "Our idea of change and the values we bring to that may be very different. That's part of what we want to learn about and figure out how we can support them rather than come in with a bunch of ideas from outside."

Pangea is an all volunteer philanthropy group for people in the Pacific Northwest who want to travel, take collective action to fund programs, and share what they learn to help educate the local community. Members contribute $1,000 to $10,000 annually, which is pooled to give out in grants. It has 50 members now and aims to grow slowly, adding about 10 new members a year. Pangea makes grants to small community development groups in rural areas in East Arica, Central America and Southeast Asia, providing over $350,000 to NGOs so far.

Working at the grassroots level in rural communities, the most basic things can make a difference in people's lives, Doerr said: washing hands, being able to sell excess produce or cereals; a house with a water-tight roof.

"These communities are unfailingly hospitable and grateful to know that people in other parts of the world care about what happens to them," she said.

Pangea is hosting a program tonight: "Supporting Women as Change Agents" with Shalini Nataraj, vice president of the Global Fund for Women, which kicks off the theme for the year. The group added gender equity to its funding criteria, meaning its grantees must include women in leadership and decision-making roles.

It plans to follow up this fall with a reading program for members, book discussion dinners and film screenings. Next year it will talk about advocacy for women and sponsor a program on grant making through a gender lens.

Understanding how to do it right takes time, members said.

"There's this general belief if you give women a $50 loan to start a cell phone business that will solve all their problems," said Doerr, a Microsoft alum. "The problems are far more profound than that. Women solving their own problems is what we're trying to learn about."

Pangea funded a project in Kenya for women to grow sunflowers and turn them into sunflower oil to generate income, using Pangea's grant to buy an oil press. It didn't work out so well. For one thing they couldn't make enough money from the sunflowers to replace food they would otherwise grow on the land, Doerr said. And their husbands didn't understand the project. The second year, most of the women didn't participate because their husbands wouldn't let them.

Doerr found the problems and cultural disconnects eye opening.

In Tanzania, she talked with one of the leaders of an organization that offers education for AIDS orphans, asking her about the continuing spread of HIV even when condoms are available.

"My naive question was why don't women just insist on condom use? She looked at me like you just don't understand. She said we could say that but then we'll just get beat up worse than we are, and it's not going to change things.

"It's very hard for liberated Western women to understand the conditions women live in in other countries," Doerr said. "Of course they hate being beaten up, but they probably wouldn't like our life either."

Pangea usually supports its grantees for one to three years. It starts by collectively deciding what issue it intends to tackle, and then volunteers in three groups -- focusing on Asia, Africa and Latin America -- evaluate proposals from non-profits seeking grants. Pangea is currently reviewing proposals and will make funding decisions at its annual meeting next month.

"It will be interesting to see how this new focus guides the way people think about the proposals," said Paulson. "It's a work in progress."

Update: Almost seven months after Obama announced a stepped-up civilian effort to bolster troops in Afghanistan, many civil institutions are deteriorating as much as the country's security, the New York Times reports today. System of delivering aid is "broken."

President Obama's Nobel Peace Prize?

Yes, we can celebrate it, but "we must continue to hold the President accountable so that he can, in fact, deliver on the promise of peace," says Kavita Ramdas, CEO of the Global Fund for Women.

But holding him accountable may also mean changing our ideas of what peace and security actually mean.

In Afghanistan, possibly the least peaceful or secure place on earth, it's time for Obama to shift the balance of U.S. troops from soldiers to armies of doctors, midwives, engineers and arborists, Ramdas said, addressing the University of Washington School of Global Health earlier this week.

"Stop feeding the beast," she said. "We have too many guns and way too little butter."

Fortifying militaries might make the public feel safer, but it is eroding the actual security and well being of the world's women, she said.

Ramdas made an argument I am hearing more frequently these days: that the world's security is connected to the welfare of women, especially in developing countries.

Their physical safety diminishes in militarized settings like Afghanistan, Colombia, the Democratic Republic of Congo, Gaza and even within the U.S., she said.

"When militarism combines with the ideology of patriarchy, which accords women intrinsically lower value than men, it results in what most of the world faces today -- stunningly high levels of violence against women in every part of the globe," she said. "The scale of this violence is truly at the level of an epidemic."

Ramdas grew up in a privileged family in New Delhi -- her father is the former head of the Indian navy, turned peace activist. She runs the largest non-profit organization in the world dedicated exclusively to international women's rights. Ramdas is also one of the more outspoken members of the Gates Foundation's program advisory panels.

Almost everywhere, a large presence of troops correlates with high incidences of rape, prostitution, domestic violence and other problems, she said. "Survival sex" is common -- organizations working in such situations report that girls are often resorting to sex for food.

Conversely, where women's health and education is improved, and more females enter the workforce, countries achieve rapid reductions in poverty.

In Afghanistan, an infusion of new troops was supposed to secure control and help pave the way for more "soft power" efforts. But some influential aid groups, including World Vision, have argued that the U.S. should pay more attention to economic development, and separate that work from its military operations.

Ramdas poses a more fundamental question: "If the strategies that we used up to this point have not succeeded in ensuring the safety and well being of women and girls, what makes us think that increased militarization with 30,000 additional US troops is somehow going to improve the situation and security of women in Afghanistan?"

Asked what would she advise Obama in Afghanistan, Ramdas said he should set a time frame of less than five years to invert the balance of U.S. investments toward more development assistance and fewer military troops.

Even in the U.S., "the Third World is alive and well," she said. Close to 15 percent of the population is living below the poverty line, and 70 percent of them are women.

In 2007, 250,000 women and girls in the U.S. were raped or sexually assaulted. "How is it possible we don't see that as a public health crisis?" she asked.

"We must change the way we define health. It must be truly human security that we all fight for."

Journalists Nicholas Kristof and Sheryl WuDunn set out to write a book. By the time they were done they had managed to ignite a movement. In "Half the Sky: Turning Oppression Into Opportunity for Women Worldwide," they compare emancipating women to the abolition of slavery.

The statistics stop you cold: one million children forced into prostitution every year; three million women sold as sex slaves; more women likely to be maimed or killed by male violence than by cancer, malaria, traffic accidents and war combined.

Traveling around the world, the husband-and-wife team profile individual women who are among those forced into sex trafficking and prostitution or faced with appalling health conditions. Even more remarkable, though, is how the women overcome those circumstances and go on to change their lives and help others.

Using the Web and TV, including an appearance on Oprah, to spread their message, Kristof and WuDunn invite people to join the cause of fighting poverty and extremism by educating and empowering women and girls. One local non-profit is organizing book clubs around the country to encourage activism. Kristof, a Pulitzer Prize-winner and New York Times columnist, will visit Seattle next week, talking with educators and giving a speech Thursday at Town Hall, sponsored by the World Affairs Council. He will discuss how our own national security, as well as the prosperity and stability of the world, is tied to the well being of women.

In the week leading up to the talk, I will be featuring perspectives on the issue from local organizations and individuals working on behalf of women around the world. Do you know of one such remarkable person or group? Please share your thoughts and suggestions.

COURTESY OF NICHOLAS KRISTOF

Nicholas Kristof met a group of young refugees who had fled from Darfur in a visit to a refugee camp on the Chad-Sudan border earlier this year.

A: Gendercide is a term to describe the way millions of women and girls die around the world because they don't get the same access to food and health care that males do. It's common when food is scarce to feed sons and starve daughters, or to take a sick son to the doctor while feeling a sick daughter's forehead and saying, "Oh, she'll be better tomorrow.'

Q: At what point did you decide to go from an observer to someone taking an active role in this issue?

A: I went into journalism in part because I wanted to have an impact, but it's a delicate balance - you can't march in as a crusader into a school board meeting you're covering. But we wrote Half the Sky not so much to inform people as because we wanted to shake people up and help address these issues.

Q: What is it that causes so many societies around the world to oppress women?

A: Traditionally, what mattered in many agricultural societies was physical strength, and men tended to have more of that. In addition, conservative sexual mores and taboos about menstruation sometimes led women to be further cloistered, which eroded the ability of women to contribute to the family - and thus devalued them further.

Q: Will eliminating oppression mean that humans have to overcome something in their nature?

A: Oppressive attitudes are often embedded in culture, but we can change them. After all, Sheryl's grandmother had bound feet, and Sheryl certainly doesn't.

COURTESY OF SHERYL WUDUNN

Sheryl WuDunn won the 2009 Dayton Literary Peace Prize for Lifetime Achievement with her husband, Nicholas Kristof, for chronicling human rights in developing countries. Her grandmother grew up in China with bound feet.

A: Empowering women tends to lead to faster economic growth, which in turn tends to undermine extremism and reduce civil conflict. In addition, there's some evidence that countries that marginalize women tend to be more likely to have the macho values of a boy's locker room or an armed camp and are more prone to violence - bringing women into the picture tends to result in more security.

Q: Can you give an example?

A: One example is Pakistan and Bangladesh. They used to be all the same country until Bangladesh split off in 1971, and at that time Bangladesh seemed utterly hopeless. Kissinger described it as an international basket case. But the one thing Bangladesh did was invest in girls, especially girls' education, and today Bangladesh has more girls in high school than boys. All these educated girls then poured into the labor force and were the pillar of the new Bangladeshi garment industry, which buttressed the economy and undermined fundamentalists. All those educated women also reduced birth rates and supported civil society organizations that promote development, like Grameen and BRAC. There are other factors at play as well, but it's fair to say that partly because it educated girls, Bangladesh is more stable and less prone to terrorism and violence than Pakistan itself.

Q: You make the argument that Westerners don't invest enough in changing culture, and connect the boom in Muslim terrorists with the broader marginalization of women. If Muslim women are oppressed but don't feel they are, how can Westerners effectively change that?

A: Sheryl's grandmother probably didn't feel oppressed when her feet were bound, but with education people began to see things differently. It doesn't work for Americans to denounce other cultures as barbaric, but promoting education does have an effect, and so does supporting those within a society who are seeking change. For example, we would be more effective in the Muslim world if we did less speaking through the megaphone ourselves and did more to support women leading the way for change in those countries.

Q: You gave your own blood to try to save Prudence, a woman in Cameroon, only to watch her die when the doctor could not be found. How did that affect you?

A: It was so frustrating. I could have wrung that doctor's neck, although it wouldn't have done much for my humanitarian credentials. I knew intellectually that one woman dies a minute in childbirth, but to see it happen so unnecessarily in front of you - that shakes you, galvanizes you and is hard to walk away from. "Half the Sky" is partly a legacy of that experience and others like it.

Q: Half the Sky refers to a Chinese saying by Mao, whose Communist revolution helped emancipate Chinese women. Yet because of the preference for male babies, China today has a dangerous gender imbalance --119 male births for every 100 girls. This suggests that even revolutions sometimes fail to change entrenched cultural beliefs about the role of males and females...

A: Changing cultures doesn't happen overnight, and the son preference is deeply embedded within Chinese society. But there's no question that China has made vast progress in creating opportunities for Chinese women, and eventually I think that imbalance will right itself. South Korea used to have a similar imbalance, and now it is correcting itself as parents realize that daughters have certain advantages.

Q: Regarding health spending and women's well being in developing countries, is too much money going toward fighting specific diseases like AIDS and malaria and not enough into maternal health programs? Would we be better off eradicating fistula than malaria?

A: It's hugely important to fight malaria, and I don't think we should walk away from that. In the case of AIDS, there's a general recognition that it was a mistake to channel resources just to AIDS while leaving women to die in childbirth unless they also happened to have HIV. We need to do a better job of supporting health systems generally, and improving maternal health tends to do just that.

Q: How do you and Ms. WuDunn, practically the power couple of gender equity issues, divide your own work on the book?

A: With previous books, we wrote different chapters. This time, I wrote the subjects and Sheryl wrote the predicates. No, no, just kidding. We shared the writing and edited each other. Just as couples grow to look alike, so does their writing.

Q: All the publicity surrounding the book and movement has made you something of a celebrity (Indeed you've traveled with a celebrity, George Clooney, to Darfur refugee camps). Is this helpful to your cause?

A: I'm not remotely a celebrity, and I tend to stay away from conferences because I learn more in villages. I'm a deep believer in the need to get out and travel and talk to ordinary people and truly listen to ordinary people. But where there is interest from TV, I welcome it. I've traveled with Ann Curry of NBC to Darfur and Pakistan, and the upshot was that NBC Nightly News did a show on maternal health. A film crew did a documentary about me for HBO, to air next year, and there were times in the Congo with them that I could have wrung their necks, if it wouldn't have undermined my image as a humanitarian. But now I'm so glad they came and did the documentary, because it helps shine a light on atrocities in Congo. And shining a light is the first step to making a difference.

Author appearance:
"Saving the world's women: An evening with Nicholas Kristof," Thursday, Oct. 15, Town Hall, 1119 Eighth St., Seattle; Doors open at 6:30 p.m., program begins at 7 p.m.; cost: $40 members, $60 nonmembers, $40 students; preregister online at the World Affairs Council Website or call 206-441-5910.

Update: I wrote a little more about this partnership in my story today. What's at the heart of this effort seems to be identifying the most urgent health needs of Pro Mujer's clients in Nicaragua and then using microcredit to create a model to finance solutions that are both affordable for the clients and sustainable for the non-profit. Currently the health programs are subsidized by the financial arm.

The partners say they hope the model can be applied anywhere.

"Microfinance alone, healthcare alone or education alone cannot solve all of the issues of poverty," remarked David Valle, CEO of Esperanza International, a Bellevue-based non-profit that is integrating microfinance, healthcare and education in the Dominican Republic and Haiti. "But when these solutions are combined...now you have something powerful!"

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Local non-profits Global Partnerships and PATH will work together on a global health initiative using microfinance to reach women in Latin America.

The two will work with Pro Mujer, an organization that funds microcredit cooperatives in Latin America and combines small loans with other services, such as business training and regular health checkups. More details on the partnership are expected next week.

Microcredit, with networks reaching millions of people in developing countries, is thought to be a promising way to distribute health solutions and other services to the rural poor.

One innovative program by Pro Mujer provides health screenings using a van retrofitted with consultation rooms and staffed by medical personnel. Global Partnerships CEO Rick Beckett described the mobile health clinics in a recent presentation about Pro Mujer's work to provide cervical cancer testing to its borrowers in Peru.

The health screenings increased the number of women tested from one third to about 95 percent over four years, and revealed treatable tumors that could prove fatal if undetected.

Global Partnerships has committed about $52 million toward microfinance in Latin America and is working to help Pro Mujer find a financially sustainable way to fund such health programs.

It's a natural fit for PATH, which could contribute its health systems expertise for the developing world, along with potential technology and commercial partners.

People in the Democratic Republic of Congo have suffered and inflicted on each other atrocities that are impossible for many outside the country to imagine.

The country has been called the "worst humanitarian disaster since World War II" by the International Rescue Committee, a place where 5 million people have died as a result of war, hunger and related consequences over the past decade. Women's bodies have been the battleground.

PHOTOGRAPHER/SOURCE

Dr. Jo Lusi and his wife Lyn Lusi are founders of HEAL Africa, a nonprofit organization with U.S. headquarters in Monroe that trains health professionals in the Democratic Republic of Congo.

In eastern Congo, the worst hit region, military groups prey on the local population, using rape as a weapon.

In the heart of this crisis, a doctor and his wife operate a hospital and 28 "safe houses" to treat, counsel and shelter women and girls brutalized by the violence.

Dr. Jo Lusi, a native of Congo, and his wife, Lyn Lusi, who is originally from Britain, founded the non-profit HEAL Africa, which provides medical care and training for local health workers in the country's rural clinics.

Traveling from remote Goma, in eastern Congo, the Lusis visited Seattle recently, where they have a small U.S. office in Monroe.

"We come here to bring the message of congratulations from the girls to the people who are supporting us," Jo Lusi said. "We want to encourage those who are ready to help and to say Seattle people, you are great! The job is not finished."

A local women's group provided funds for two safe houses, and the group also received matching grants from Microsoft and Boeing, whose employees donated money, and support from Quest Community Church.

The story is not all bad in Congo, Lyn Lusi said. She and her husband have seen volumes, living and working there since 1985.

"This is time to tell people that the work is going well, in spite of all the bad news everyone hears," she said. "We can't stop the war, but we can be present in the communities, helping communities organize and take care of what they can, using the resources they have available."

As an example, she told the story of a girl who had been raped and dared to go to a safe house and talk with a counselor despite urging from her mother to keep quiet.

The girl was taken to the hospital for treatment and she continued to press for justice. The rapist was publicly tried, and the courthouse so crowded the trial had to be held outside. When the man was convicted, there were cheers.

"The foundation of any society is our trust in the system," Lusi said - trust that is slowly being rebuilt one case at a time. "We want to build on the strength of everybody's desire to have a functioning community."

Four years ago Jo and Lyn Lusi asked Judy and Dick Anderson, whom they had met in Congo, to start an organization in the U.S. that could support them. So the Andersons did, working initially from their log cabin in the woods in Snohomish County, where they lived in between humanitarian missions overseas.

After HEAL Africa was mentioned in the bestselling book "Half the Sky," Oprah Winfrey linked to it as one of 8 organizations helping women rape victims listed on her Web site.

"It's like David among the giants," said Judy Anderson.

To cope with the volume of traffic, supporters at Microsoft hosted HEAL Africa's site, which had received 20 online donations today within hours of Oprah's show.

Much of the violence in Congo is fought over minerals, and the area where HEAL Africa works is rich in them.

"Wherever there are minerals there is violence," Lyn Lusi said. "We're cursed by our wealth in Congo."

Everyone with a cell phone may be tied to the conflict.

The mineral coltan is used to make a heat-resistant metal powder called tantalum, a key component in everything from mobile phones to computer chips to stereos and VCRs, as this story describes.

A campaign called The Enough Project examines how demand for electronics products such as cell phones and laptops is helping to fuel the violence and seeks action by President Barack Obama, electronics companies, consumers and Congress to try to end the conflict.

Update Friday: The University of Washington said this morning that it will use $25 million in Recovery Act funding from NIH to create a new Northwest Genomics Center and explore the origins of common heart, lung and blood disorders.

The UW will receive two of the six "Grand Opportunity" large-scale DNA sequencing project awards to examine the genetic connections to the diseases, which account for three of the leading causes of death in the United States.

UW Professor Debbie Nickerson is one of the principal investigators for the two-year national project. She said the new center "will apply cutting edge, next generation sequencing technology to uncover the differences in our genetic code and explore how these may influence traits, such as cholesterol and blood pressure, that impact our risk for developing cardiovascular disease."

The UW center is one of two sequencing centers for the project, with the second located at the Broad Institute of MIT and Harvard in Cambridge, Mass.

"This is one of those times in science when it is just the right moment to scale newly emerging technologies to obtain important medical insights," Nickerson said.

Washington State University said it has received more than $30 million in 42 federal stimulus funding awards, including $9 million from the National Science Foundation, $5 million from NIH and Health and Human Services, and $16 million in Commerce, Energy and other funding related to the Recovery Act.

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Hundreds of health research projects in Washington state have received federal stimulus funding of about $170 million, led by the University of Washington, according to the National Institutes of Health.

The updated NIH database lists millions of dollars in federal stimulus funding to Seattle researchers studying the effectiveness of various cancer diagnostic tools, screening tests and treatments.

On Monday researchers from the Fred Hutchinson Cancer Research Center, UW and Group Health Cooperative will describe their projects, supported by the National Cancer Institute, that are helping to build a hub for cutting-edge cancer research in Seattle. Of the 385 projects funded in Washington state, 359 of them were in the Seattle area.

My colleague Sandi Doughton wrote about the potential windfall from the $787 billion stimulus package to locally-based scientific research efforts earlier this year.

President Obama announced the funding Wednesday as part of a plan to spend $5 billion on medical and scientific research, medical supplies and upgrading laboratory capacity. The funds come from the $787 billion economic stimulus package.

Washington State University has received close to $3 million, including $1.5 million to professor Norman G. Lewis for a project to classify medicinal plants into a comprehensive database to aid the discovery of new medicines. (NIH only lists funding of $1.46 million for the first year, but the total award is $2.75 million, Lewis said.)

One standout nationwide was the UW, which has had more than 240 projects funded so far for a total of $99 million. At UW, professor Debbie Nickerson leads a project to study human genome variation that received $11 million this year.

Besides scientific research, Recovery Act dollars also went toward social services. Building Changes, a Seattle-based non-profit focused on ending homelessness, received a $1 million grant to provide technical assistance and grants to smaller non-profits serving the homeless and at-risk or very low-income families.

Building Changes is one of 35 organizations in the U.S. awarded money through the Strengthening Communities Fund, which aims to improve the ability of non-profits to help low-income people recover from the recession. Other recipients in Washington state include Seattle's Human Services Department and the Confederate Tribes of Colville Reservation, which received about $250,000 each, and the Northwest Leadership Foundation, which received $1 million.

The Institute for Systems Biology was chosen to receive nearly $8 million in federal funds for research into the genetic causes of cancer and potential targeted treatments.

A member of the Cancer Genome Atlas Research Network, ISB will analyze data gathered by research centers around the country with the goal of learning how environmental factors affect genes and cause cells to malfunction, leading to cancer. ISB will then use the knowledge to identify drug targets and therapeutic treatments. The principal investigator at ISB is Ilya Shmulevich.

The Research Network has initially focused on cancers of the brain, breast, kidney, lungs and ovaries. Part of ISB's role is to develop state-of-the-art software and other tools that assist researchers with processing and integrating data analysis.

The award is $7.88 million over five years, with $3.1 million of the funding approved so far, according to the National Institutes of Health. The project is jointly run by the National Cancer Institute (NCI) and the National Human Genome Research Institute (NHGRI), both under the NIH.

Note: The ISB funding was not, as I reported yesterday based on information from ISB, part of the federal stimulus package announced by President Obama in a plan to spend $5 billion on medical and scientific research, medical supplies and upgrading laboratory capacity.

Funding for the Cancer Genome Atlas came from two different sources -- $175 million from the Recovery Act and $100 million pledged jointly by the National Cancer Institute and the National Human Genome Research Institute.

The cancer research funds came to ISB from that second pool of $100 million, ISB spokesman Todd Langton said Thursday. ISB did receive Recovery Act funds -- a $2.3 million grant to complete an atlas of human peptides and a $200,000 grant to study how external factors combine with genetic factors to drive asthma attacks.

A full list of NIH grants as part of the Recovery Act is available here. Other large grants awarded in Washington state include $8.5 million to the Northwest Institute of Genetic Medicine at UW and $8.3 million to the Allen Institute for Brain Science. In fact, various UW researchers have racked up a total of more than $80 million in NIH grants this year alone.

ISB, a non-profit research institute on the north end of Lake Union, is hiring an additional eight people and dedicating some of its existing full time positions to the project, ISB spokesman Todd Langton said.

The institute is pioneering an approach to medicine it calls P4 -- predictive, preventive, personalized and participatory. The idea is that future medicine will consider the unique biology of an individual and his or her probability of developing various diseases, and then design appropriate treatments before a disease manifests.

More than 1,500 Americans die from cancer every day, according to the NIH, and the rate is expected to rise as the U.S. population ages.

Ross Donaldson went from a comfortable life as an American medical student into the front lines of the fight against Lassa fever, a neglected and deadly disease in central Africa. Now a doctor, he has written a book about his experiences called The Lassa Ward. Donaldson gave a talk at UW today and is appearing in Seattle Wednesday at the Greater Seattle Chamber of Commerce and also at Elliott Bay Books. I had a conversation with him about some of the lessons he learned and wants to share.

Q: What did the experience teach you about how make an impact in global health?

A: When I got there I started doing hands-on medical care. One of conclusions I came to is how much bigger impact you can make through training local health care workers, so it's sustainable when you leave and multiplies your impact when you are there.

Q: What do you want people to know about Sierra Leone (where he traveled with the group Merlin to work in a remote hospital)?

A: The situation is quite stark. It's the last country in the world when it comes to health care outcomes. It's really a human rights issue. When I was there 1 out of 8 women were dying in childbirth. In the U.S. it's like 1 in 8,000. I spent a lot of my time going between the maternity ward and the Lassa ward.

Q: You didn't get Lassa fever yourself, did you?

A: No, thankfully I didn't. The day after I got back to L.A. I came down with a serious illness, myocarditis, an infection of the heart. About a third of people die from it, a third are permanently injured and a third recover fully.

My mentor Dr. Conteh I really think is the hero of the book. He's a physician who spent his whole life taking care of patients through wards and at the Lassa ward. Dr. Conteh had worked there close to a decade and had been OK. All it takes is one slip one day. Resources at the hospital are limited, so he was drawing blood from a pregnant woman. A glass vial broke and he cut himself and died from Lassa fever about 5 to 7 days later.

Lassa is one of four communicable hemorrhagic fevers, similar to Ebola or Marburg. Lassa comes from rats originally. In parts of the area people eat rats as a food source -- essentially there's no other protein in the diet. Every once in a while they will eat a rat with Lassa.

Q: Eating rats and dying from fever says a lot about the overall situation.

A: It really connects how important economic prosperity is with health and how the two are intertwined, and also with the political situation. They were fighting over diamonds essentially. I went out into the field -- Merlin had projects for public health outreach - to just tell people not to eat rats, we won't have the initial outbreak and peoples' lives will be saved. I somehow naively thought this would be an easy message to tell. The older men would look at me and say I've been eating rats for years and I'm fine and there's no way I'm going to stop. At first it seemed very foreign to me and then I realized it's similar to conversations I've had here around cigarette smoking. It's part of human nature not to want to change.

Being an advocate for health is a very important part of what I do and what I think physicians should do. Doctors get a lot of the credit but the truth is medicine is really a team effort. It's really the whole system that deserves the credit. When there's a breakdown, it's really the system that needs strengthening so you can bring up the level of care.

Q: Do you think health aid to Africa has been effective?

A: As long as I have been doing this work, there have been debates about the vertical, horizontal or diagonal approach to health programs. In some ways a continuing dialogue is very beneficial to the aid and insuring you're getting the most out of it. Overall I think the aid community is doing a lot of good but continually striving to make sure you're doing the most good is the ethical and moral thing to do.

Q: What would you advise young people who want to work in this field?

A: I have noticed over the last couple years there has been a huge upturn in people interested in global health, and I think that's fantastic. It really is going to take a lot of bright young minds to deal with these problems. The money might come or go, but if you have a good feeling about helping other people that's not something you're going to lose in a recession.

For students it's important to get some kind of skills they can help out with and also to get some experience in the field. Information and opportunities are available on ReliefWeb and Devex.

Is the $8 billion the U.S. spends on foreign aid for global health worth it?

Bill and Melinda Gates say they've seen proof that it is. They're starting a new campaign today called "Living Proof" to convince Americans that their money has been a good investment, saving millions of people in developing countries.

Their message is that those children and adults are surviving and leading more productive lives, "living proof" that U.S-supported initiatives to fight malaria, AIDS, and other diseases are working.

The Gates Foundation has started a major ad campaign that will run over the next five weeks, aimed primarily at policy makers in Washington DC.

Cynthia Lewis, a senior program officer at the foundation, said the couple was struck by the disconnect between the optimism and progress they saw on their trips and the pessimism they were hearing about when they came home.

"When we talk to people in America they don't know where their money has gone or that it's working," achieving major declines in child mortality, she said.

Following media images of crying and emaciated children that helped the world see the problems of poverty and disease, this campaign will show the other side, featuring people like a woman with HIV in Ethiopia who gets treatment, starts her own barber shop and teaches others about HIV/AIDS while they're sitting in her chair.

"For quite a number of years people who advocate have focused on the need," said Iain Simpson, a global health spokesman for the foundation. "That's been a very effective campaign. What we've forgotten collectively to do is come back and say these investments we asked you to make have had a fantastic impact on peoples lives."

The U.S. government spent about $30 billion on foreign aid since 2008, about 1 percent of the U.S. budget, and of the total foreign aid, about $8 billion goes toward health programs.

The U.S. approach to foreign aid has been criticized by various groups, including Global Washington, which asserts that it needs to conform to local priorities and be more transparent.

The programs that will be highlighted by the Gates Foundation include the President's Emergency Plan for AIDS Relief (PEPFAR), which is credited with saving an estimated 1.2 million people by expanding access to HIV prevention and treatment.

Programs supported by U.S. foreign aid delivered 88 million insecticide-treated bednets to protect young children from malaria, life-saving TB treatment programs in 41 developing countries, malaria prevention and treatment for 32 million people and fortified food for tens of millions of children in developing countries, according to the campaign.

Lewis acknowledged it was a difficult case to make to Americans even before the economic downturn hit.

"We think if more Americans learn about progress in global health, they'll be inspired to maintain these investments--even in difficult economic times--so that we can do even more," Melinda Gates said in a statement.

Pro Mujer, an organization that funds microcredit cooperatives in Latin America, also provides women's health screenings, using a special van retrofitted with medical consultation rooms and staffed by a nurse and doctor.

The vans travel into remote parts of southern Peru, combining financial help with preventative health care and education.

COURTESY OF PRO MUJER

Women in Peru get health care during meetings of their microcredit group in a program of Pro Mujer, a non-profit supported by Seattle-based Global Partnerships. The van combines mobile banking with health services to rural areas..

It's based on a simple fact that people who are poor tend to get sick, and people who are sick easily become poor, or deeper in debt. Rick Beckett, CEO of Global Partnerships, gave the example of Pro Mujer's work at a talk last night about the future of microfinance.

About 150 million people around the world have borrowed money through the system of microcredit pioneered by the Grameen Bank. Once the model showed promise, investors started flocking to it.

The last decade has seen an explosion of commercialization, exemplified by Compartamos, a lucrative Mexican bank that started as a non-profit but ended up going public in 2007 and now charges more than 80 percent interest on microloans.

Commercialization is necessary for raising the amount of money needed to get microcredit to the millions who could benefit, Beckett said. But the profit-motive also leads lenders to bypass the poorest people.

Commercial capital goes to the most profitable microfinance institutions. It turns out that poor people at the bottom are not as profitable as others farther up, and it's easier to make money in dense urban areas than in rural ones, he said.

The situation has parallels with healthcare in the U.S. "Economic incentives are very powerful," he said. "You can make a lot more money in health care if you serve healthy 65-year-olds than sick 89-year-olds."

Beckett, who had an earlier career as an investor and led the healthcare practice for McKinsey & Co, said the U.S. needs "vibrant, well capitalized insurance providers that have a different economic motivation" and "socially motivated, probably non-profit insurance coverage."

Likewise the microfinance industry needs organizations like Pro Mujer that make a profit but reinvest it in the effort to improve lives.

Pro Mujer's mobile medical clinics provide cervical cancer testing. Before joining the organization, only about one-third of the women had ever had a gynecological exam. Eventually 95 percent of them had been tested. In Nicaragua, Pro Mujer helped give 9,000 tests over four years, which detected tumors in 700 women who otherwise would not have known they needed treatment.

Global Partnerships is now working on a business enterprise for Pro Mujer so it has a long-term source of funding for the healthcare services. The Seattle non-profit has committed about $52 million toward microfinance in Latin America.

Testing for cervical cancer in developing countries is getting some help from Merck and QIAGEN. The companies said today they would collaborate on a new program to increase access to HPV vaccination and HPV DNA testing in some of the poorest areas of the world, calling the partnership the first time a vaccine manufacturer and a molecular diagnostics company are addressing the burden of cervical cancer together with a comprehensive approach.

Their commitments were announced at the annual meeting of the Clinton Global Initiative.

The Bill & Melinda Gates Foundation is doing more with its money than giving it away. It has been moving into investments, loans and loan guarantees aimed at furthering its programs.

The $30 billion foundation has made several investments so far and others are in the works, as I reported in this story today.

Program related investments or PRIs are one way the Gates Foundation can increase its impact beyond the $3.5 billion a year it makes in grants. The approach also imposes financial discipline on recipients so they operate more like businesses.

What will be most interesting to watch is to what extent the foundation uses its $30 billion endowment towards its charitable goals. It plans to carve off a portion of the endowment to invest in ventures related to its programs, but has not released details about how that will work..

That step could mark a shift from the strategy of the past several years in which it invested its endowment, or asset trust, solely with the goal of maximizing profit.

The next PRI could be a loan guarantee towards U.S. education.

PRIs are set up to further the charitable mission of a nonprofit, not to make money. They are risky and the default risk rises in a bad economy, but they can also be very profitable. The investor can also call in the loan if the recipient is not adhering to the stated mission.

Examples could be a low interest or no interest loan to needy students, an investment in a low-income housing project or a loan to a for-profit pharmaceutical company. In fact a new designation called an L3C, or a low-profit limited liability company, has been created to facilitate such program investments.

The Gates Foundation has made least three program-related investments in the area of global development: $20 million to Africa ProCredit Holding to increase access to banking services for micro entrepreneurs, small businesses and low income groups; $20 million to ASA International Holdings to scale up a proven microfinance model in several countries in Africa and Asia; and $10 million to Opportunity Transformation Investments to create or expand commercial banks for the poor across five African countries.

They are not the same as mission-related investments, which align investment of assets with a charity's mission, and include actions by shareholders to affect the behavior of companies, said Lance Lindblom, chief executive of the Nathan Cummings Foundation.

The Gates Foundation came under fire in 2007 following a report that it was investing in companies contributing to health problems and other human suffering the foundation was working to alleviate through its grants. At the time, the Gates Foundation said it would not alter its approach to investing its endowment.

When screening companies for behavior contrary to a foundation's mission, sorting out responsibility can be difficult, Lindblom said. He advocates that foundations exercise their proxy votes to persuade companies they invest in to act more responsibly.

The current investments of the Gates Foundation's endowment trust can be found here.

How did a tiny non-profit in Fremont attract the attention of a global pharmaceutical giant, a multinational beverage company, governments from India to Senegal and a $1.4 million investment announced this morning by a European venture fund?

COURTESY OF VILLAGEREACH

Women in Mozambique walk for miles and wait for a rural health center to open. The health center is among those supported by Seattle-based VillageReach. .

VillageReach has figured how to get health care into the heart of remote communities that others haven't managed to reach -- the so-called "last mile" -- and pay for it with a for-profit energy business.

With billions of dollars being spent to develop new vaccines, bridging the last mile can mean the difference between lifesaving drugs getting stuck in a bottleneck or reaching the people who need them most.

VillageReach applied a logistics model for delivering and tracking vaccines in remote settings similar to the way UPS might deliver its packages. In fact, VillageReach hired a veteran UPS employee to help improve its operations and industry partnerships.

COURTESY OF VILLAGEREACH

A health center in rural Mozambique is powered by propane supplied by Vida Gas, a company half owned by Seattle-based VillageReach.

The problem typical in developing countries is that medical supplies from big donors like Unicef reach the capital or nearest port city, and national authorities distribute them as far as the provinces, but that's where they sit waiting to be picked up by local health workers -- when they have the time and transportation.

"It's as if your mail is only delivered up to Olympia," said VillageReach President Allen Wilcox.

VillageReach moved that work from a collection-based system to one with dedicated distributors, freeing up health workers to focus on treating patients.

VillageReach worked with the government in Mozambique to set up a fleet of seven trucks and seven field coordinators whose sole job is to get vaccines, equipment and medicines to 261 rural health centers. VillageReach helped acquire some of the vehicles initially, but the trucks are owned and operated by the government health authority.

The field coordinators return to two central offices that have laptops and Internet access, and upload information into an online database. They report what supplies were distributed, how many vaccines were given out and how much inventory was left.
VillageReach has been able to assemble a detailed picture of what is happening at each health center with updates every two weeks, said John Beale, strategic development director, "so we can see the trends for better or worse."

VillageReach can then share the online data with partners in Seattle and with policy makers in Geneva. The management information system VillageReach has developed is receiving a 2009 Tech Award from the Technology Museum of Innovation in Silicon Valley. In Mozambique its program has helped boost vaccination rates from 68 percent to 95 percent, according to an independent study cited by the non-profit.

In a country like Mozambique, where cars and even bicycles are rare, people walk for miles to reach medical care. It's important they find something at the end of the road, said Beale. "The greatest benefit we provide is community confidence in the health care system."

The non-profit supports its work with a propane gas business that also powers much needed refrigeration for the medicine.

The population of northern Mozambique lives largely off the electrical grid. Less than 10 percent of the country has electricity, so most people cook and heat with charcoal or wood.

VillageReach needed energy for critical health services such as sterilizing equipment, helping mothers through childbirth at night and keeping vaccines cold. Propane was their only viable fuel option.

Being entrepreneurs, they launched a company called VidaGas to supply it themselves. The alternative would have been to use donations to buy propane, Beale said, but once those dollars ran out, so would the cold chain upon which the health system depended. "The whole program would not be sustainable," he said.

In 2002 VillageReach partnered with a local non-profit, the Foundation for Community Development, to start VidaGas. (The foundation is headed by Graca Machel, Nelson Mandela's wife. The two paid a visit to Seattle in 1999 and received $30 million for their charities from local donors.)

VidaGas sells gas to the region, offering a cleaner alternative to charcoal, and it's now the largest propane distributor in northern Mozambique. Besides supplying energy for the health system, it's fueling the hotel and tourist industries, small retailers and family homes.

VillageReach is holding up VidaGas as an example of a successful social business that supports a humanitarian mission. Harvard Business School recently published a study of its model for integrating global health programs with social businesses to benefit remote communities.

Luxembourg-based Oasis Capital today announced it will make a $1.4 million investment in VidaGas, which will allow the company to expand its services to more customers and to build additional filling stations.

VillageReach has been hired by the World Health Organization and Seattle-based PATH for a pilot project in Senegal, and by a large pharmaceutical company to conduct a health strengthening program in a remote part of India. The non-profit is also working with a multinational beverage maker to use its vast transport networks to help distribute medical supplies.

Its goal is nothing short of a sea change in global health practices.

"What is unique about VillageReach is we are trying to enhance systems that exist and leave behind a legacy of infrastructure improvements to allow the system to sustain itself," Wilcox said.

Billions of people around the world eat rice as a daily staple. To make it more nutritious,
Seattle-based PATH is taking ordinary rice, blending it with micro nutrients and molding it into fortified rice-like grains.

PATH's new Ultra Rice is being introduced around the world to solve vitamin and mineral deficiencies that cause a host of health problems, from birth defects to blindness.

PHOTO COURTESY OF PATH

Ultra Rice in bins ready for serving to a school in the state of Andhra Pradesh, India.

Tomorrow the Technology Museum of Innovation in San Jose is recognizing the global health non-profit's work on Ultra Rice with a 2009 Tech Award, given to innovators from around the world who are applying technology to benefit humanity.

It will be the third Tech Award PATH has received from the museum. PATH was a Health Award Laureate for its heat-sensitive vaccine vial monitor in 2007 and for its pre-filled Uniject syringes for vaccine delivery in 2003.

Ultra Rice was pioneered by a local father-and-son team, Dr. James P. Cox and his son, R. W. Duffy Cox. at Lynden-based Bon Dente International, the creators of technologies from oyster shucking equipment to methods of eliminating salmonella in eggs. In 1997, the Cox family donated the Ultra Rice patent to PATH.

PHOTO COURTESY OF PATH

School girls in a meal program in India eat fortified Ultra Rice developed by Seattle-based PATH.

Ultra Rice is now being developed by PATH under Project Director Dipika Matthias, with funding from the Bill & Melinda Gates Foundation. PATH has already introduced Ultra Rice into large-scale meal programs funded by governments to test its benefits.

PATH launched a pilot program in December with the Global Alliance for Improved Nutrition (GAIN) and the Naandi Foundation in the Indian state of Andhra Pradesh.

Success depends on how effectively Ultra Rice can be commercialized. PATH is now trying to demonstrate successful models of supply and demand.

The non-profit partners with local pasta manufacturers to produce the Ultra Rice grains and works with rice millers and government food programs to blend and distribute the fortified rice.

It has licensed the technology to commercial partners in Brazil, India and Colombia, who are required to make their Ultra Rice grains available to public-sector buyers and consumers at preferential prices. PATH expects the price of fortified rice to be between 2 and 5 percent higher than the cost of traditional rice.

Longevity Vita Bio-Tech, PATH's first commercial partner in China, plans to integrate pasta-extrusion machinery into its Beijing factory to produce Ultra Rice grains. The Chinese Center for Disease Control and Prevention owns part of Longevity Vita and will help introduce the product in China, according to PATH.

Besides PATH, previous Tech Award winners in health include DataDyne, which developed an open-source program for healthcare workers to collect and share data using mobile devices, and MedMira, which invented technology for a single test to detect HIV and hepatitis in three minutes.

The Tech Award winners are honored at an annual gala in San Jose, and one laureate in each award category receives a $50,000 cash prize. This year's awards gala will be held on Nov. 19.

Dr. Stefano Bertozzi is joining the Bill & Melinda Gates Foundation next week as its new HIV director in the global health program.

An expert in health economics, he will manage grants in HIV vaccine development, biomedical prevention research, diagnostics, development and resistance monitoring, and strategies for introduction and scaling-up of interventions, the foundation said.

HIV is one of the biggest programs at the foundation, which has spent nearly $12 billion on global health since 1994.

For the past 11 years Bertozzi has worked in the National Institute of Public Health (INSP) in Mexico as the director of its Center for Evaluation Research & Surveys, where he leads economics and statistics teams that conduct impact evaluations of large health and social programs.

He also chairs the Steering Committee of aids2031, an international consortium of people from diverse backgrounds looking for new ideas for the global response against HIV/AIDS. I found this video of him in which he talked about the need for a new approach to HIV that is longer term, and building more efficient management systems.

"We've been so caught up in the urgency of people dying that we haven't thought about how to win this fight over the long term," he said.... "It's foolish for us to take an emergency response to prevention."

Bertozzi co-authored this paper that discusses the spread of HIV from sex workers whose clients are willing to pay more not to have to use a condom.

"His intimate knowledge of the medicine, science, economics and policy of HIV will help make this important portfolio have the most impact," said Tachi Yamada, president of the Gates Foundation's global health program. Bertozzi worked with the foundation in his previous roles at UNAIDS, the World Health Organization (WHO) and the World Bank.

Charles "Chip" Lyons is leaving the Bill & Melinda Gates Foundation to head a foundation working to fight HIV/AIDS in children.

Lyons, who is director of special initiatives in the Gates Foundation's Global Development program, has been named president and CEO of the Elizabeth Glaser Pediatric AIDS Foundation, based in Washington D.C., the Glaser foundation announced.

He will start the new job in January, succeeding Pamela Barnes.

Accepting his new role, Lyons said, "I am delighted to join the Elizabeth Glaser Pediatric AIDS Foundation. Its exceptional worldwide reputation and the extraordinary impact it has made in the lives of women and children in those countries hardest hit by the HIV/AIDS epidemic should be applauded."

In 2007, the Elizabeth Glaser foundation received a five-year, $9.7 million Gates Foundation grant to research and develop potential vaccines for the prevention of HIV infection in children.

Before joining the Gates Foundation, Lyons worked for the United Nations Children's Fund (UNICEF) -- as program officer in Mozambique, chief of staff to the executive director at UNICEF headquarters and as president and CEO of the U.S. Fund for UNICEF.

Lyons joins a number of senior executives departing the Gates Foundation this year or leaving the Seattle office.

Heidi Sinclair left her position as chief communications officer in February and started her own consulting firm. Rajiv Shah left his post as the Gates Foundation director of agricultural development in May to join the U.S. Department of Agriculture as under secretary and chief scientist, and Joe Cerrell, director of global health policy and advocacy, will leave Seattle in January to head the foundation's new European office in London.

The Bill & Melinda Gates Foundation is giving $4.8 million to a project to identify new methods of on-site sanitation in developing countries.

The grant to the London School of Hygiene and Tropical Medicine supports a three-year project to research and develop new concepts for sanitation such as improving pit latrines, which are the only option for about 1.7 billion people without access to sewage systems. The London School will research how advances in biotechnology, using enzymes and micro-organisms to convert plant waste to biofuel, for example, might be applied to sanitation.

The London School also received the $1 million Gates Award for Global Health this year.

The Gates Foundation's program on water, sanitation and hygiene is only about three years old but has grown to 19 grants so far totaling about $160 million.

Unsafe water and poor sanitation and hygiene are leading causes of illness and death in the developing world. Improving them could prevent one tenth of global diseases, according to the World Health Organization. About 2.4 million people die from diarrhea and other water-related illnesses every year.

With its water-related grants, the Gates Foundation has funded low-cost, practical solutions that can be commercialized.

Among the recipients is Seattle-based PATH, which is exploring water quality through a $17 million, five-year grant to help develop low-cost filters, gadgets and other water-treatment products.

In 2008 the foundation gave $13 million to an international consortium led by the University of Bristol to develop Aquatest, a simple diagnostic tool that can give a reliable indication of whether water sampled is safe or not.

Since little research has focused on the development and use of pit latrines, the London School said it aims to build knowledge about decomposition processes and evaluate the potential of biotechnology and improved design to accelerate decomposition.

Its goal is to find solutions that can be turned into affordable, sustainable products available on the market. Researchers say such innovations can improve health and reduce costs for sanitation in an environmentally safe manner. The project will combine academic and industrial expertise and provide an innovation fund to turn promising ideas into prototypes.

Locally another non-profit, Seattle-based Water 1st, has been working on projects that integrate water supply, sanitation and health education in four countries, taking safe water as the basis for ending poverty.

As Afghanistan holds its presidential election today, optimism has been dampened by a lack of progress in development on the ground, say leaders of a local humanitarian group active in the country.

While completing peaceful elections would be a positive step, "Afghans I've spoken with don't feel invested in these elections because they're not seeing progress or a viable government in their own communities," said Christine Beasley, country program manager for World Vision, a Federal Way-based group that has worked in Afghanistan since 2001 with a staff of 250 on the ground, mostly local Afghans.

The Christian aid organization decided to pull its 15 foreign staff members out of the country temporarily over security concerns during the election period. They plan to return at the end of August. Local staff are suspending operations and restricting their movements.

COURTESY OF WORLD VISION

An Afghan woman in Badghis Province and her children shell pistachio nuts, earning less than a dollar for every eight kilograms shelled. The province has 300,000 acres of pistachio forest.

Currently uneven distribution of aid, lack of donor coordination and some duplication of services are weakening reconstruction efforts, Anderson said.

World Vision is calling for more attention to economic development, saying civil society resources to support education, jobs, good governance and agricultural alternatives to the poppy trade are crucial to progress.

The U.S. government needs to create a clear development strategy for Afghanistan that is separate from the Department of Defense's counterinsurgency strategy, the group said.

A coordinated development strategy means, "measuring the number of children in school and the content and quality of their education, not just the number of insurgents defeated," said Rory Anderson, World Vision's deputy director for advocacy and government relations.

Gen. David Petraeus, the head of the U.S. Central Command, spoke about the challenges ahead in Afghanistan at a talk in Seattle last month. Later this month, my colleague Hal Bernton will be reporting from Afghanistan and writing a blog from there.

COURTESY OF WORLD VISION

Women at a sewing workshop run by World Vision in Herat, in western Afghanistan near the border with Iran, are the sole breadwinners for their families. Yet they can't disclose their names for fear of reprisals for working outside the home.

"An economic development strategy is not the same as a counter-insurgency strategy--although the end goals may align, the operational approaches are very different and they follow different time frames," said Anderson. "If a free and peaceful Afghanistan is the goal, forcing square pegs into round holes won't work."

Without a distinct development strategy, "the 'civilian surge' is understood to be a military surge, which by itself will not help Afghans take control of their own country," she said.

Another local group working in Afghanistan to address the effects of war is Clear Path International. In Afghanistan nearly a million people are disabled, many because of land mines, according to Clear Path, a Bainbridge Island-based non-profit that helps land mine and bomb survivors.

Clear Path supplies prosthetic devices, builds handicap access ramps in schools in Kabul, advocates for the rights of disabled and provides employment for land mine victims through its Afghan Mine Action Technology Center, which makes de-mining equipment. The center sells the products at a lower price than international suppliers charge, and it uses the revenue to support rehabilitation services. Read more about the group's work here.

Jeff Raikes has kept a pretty low profile in his first year as chief executive of the Bill & Melinda Gates Foundation. The man who built Microsoft Office now runs the largest private foundation in the world, which gives out more than $3 billion a year from an endowment of $30 billion.

Raikes recently talked about the fallout of the economic crisis on the foundation, the importance of risk taking and failure in philanthropy, and his experience working with Melinda Gates, which he said has been the most fun. He spoke at a breakfast last week sponsored by the Puget Sound Business Journal. (I couldn't get in, but thanks to the Seattle Channel I was able to watch it here).

DEAN RUTZ/SEATTLE TIMES

Jeff Raikes grew up a "farm kid" in Nebraska and later gave up a job at Apple to join Microsoft in 1981. "Steve Jobs yelled at me, telling me that Microsoft was going to go out of business," Raikes said.

Not a lot of what he said was new, but he did reveal some insights from his first year, including how serious the stock market plunge hit the Gates Foundation.

"The biggest impact by far is on our partners and the people that our partners and we strive to serve," he said. "It's one of those things if you think about it you get a little depressed."

On Jan. 1, 2008, the Gates Foundation's endowment was $39 billion. In just one year it had dropped to $30 billion.

"That's nine billion," Raikes said. "Part of that is the payout, part of that is the drop in the market. Let's say you have another 10 percent drop in the market. We're paying out $3.5 billion in direct charitable activity. Jan 1, 2010, we're now at $23 billion."

"At one point in time I thought that was the scenario I was looking at," he said. "The good news is the market has come back. The situation isn't quite as dire as it was a few months ago."

"At the end of the day we're very fortunate that Melinda and Bill took a deep breath and decided we're going to keep investing." The foundation's direct charitable giving is up about 10 percent this year, and its endowment stood at $30.2 billion at the end of June.

But the crisis has forced a renewed focus on top priorities, Raikes said, namely the biggest killers of children in the developing world -- HIV/AIDS, tuberculosis, malaria, pneumonia and diarrhea.

"We have to figure out how we can keep the momentum going in the short term while recognizing we have to conserve financial resources for the long term," he said.

One of the most important things he's learned in the first year is how the role of philanthropy differs from business and government.

"The private sector certainly is important but appropriately driven by the profit motive... government has the responsibility to provide services to raise the overall standard of life... You really don't like the government doing risky things with your tax dollars."

The Gates Foundation will take on some risky ventures and challenging ideas that government couldn't take on alone, he said.

"There are going to be times because we're taking risks we will fail... that's part of our role," though the goal is to succeed, Raikes said. "It's not that different frankly from how we operated at Microsoft."

Billionaire Warren Buffett, who is giving the bulk of his fortune to the Gates Foundation, told Raikes the foundation shouldn't be succeeding all the time. Raikes understood the message, but said it's another thing to try to pass it down.

"Warren would say swing for the fence," Raikes said, using a baseball metaphor. "But I've got the 700 or 800 employees at the Gates Foundation saying oh, alright, it's OK for me to fail."

Raikes has known and worked closely with Microsoft Chairman Bill Gates for 28 years. Raikes joined Microsoft when the company had about 100 employees and met his wife, Tricia, there.

He said working with Melinda Gates has been a highlight of the year.

"I knew Melinda at Microsoft, but in particular for me the most new fun in this year has been working with Melinda," he said. "For me she's a tremendous collaborator, a great coach, a great mentor." She has a deeper understanding of how the foundation works than her husband, who was busy at Microsoft until last year, he added.

Raikes said former Microsoft President Jon Shirley and baseball manager Lou Piniella are among his own mentors. He said he looked up to Shirley because he could not only guide others but "personally step in, roll up [his] sleeves and make it happen."

On Sept. 25 Raikes will address the annual meeting of the Greater Seattle Chamber of Commerce, focusing on the impact of the economic downturn on efforts to address family homelessness. Details are here.

Seattle-based PATH announced today it has won the world's largest humanitarian award, the $1.5 million Conrad N. Hilton Humanitarian Prize, for its work creating effective health technologies for the developing world.

Hilton Foundation Chief Executive Steven M. Hilton, who introduced the award during a press conference this morning, said PATH's work helping to develop 85 technologies, along with its commitment to sharing ideas and making sure products are sold at affordable prices, have had a profound impact on alleviating human suffering. More coverage of the award is here.

COURTESY OF PATH/PATRICK MCKERN

PATH CEO Christopher Elias (left) and Conrad N. Hilton Foundation CEO Steven M. Hilton (right) tour PATH's Seattle headquarters following the announcement that PATH has won the 2009 Hilton Humanitarian Prize.

The prestigious award is well deserved recognition for the long-term efforts of its staff, who often work years before seeing the results, PATH Chief Executive Chris Elias said. PATH now has 850 employees working in 20 countries.

Its Seattle headquarters near the base of the Ballard Bridge buzzed with excitement as the news was announced this morning.

The award "will open many doors" for future goals, Elias said, and PATH plans to capitalize on the recognition to expand its partnerships around the world.

PATH will use the $1.5 million in prize money to seed an innovation fund aimed at investing in new technology and health interventions, he said. PATH will begin a five-year drive aimed at raising a total of $25 million for the innovation fund.

The non-profit has an annual budget of $250 million, 65 percent from foundations, 30 percent from governments, and 5 percent from global organizations. Only a small percent of the contributions are unrestricted, a portion Elias calls "innovation capital."

Through the innovation fund, Elias aims to raise the amount of flexible capital from about 3 percent to about 10 percent of PATH's budget.

PATH has used such capital in the past to set up an office in South Africa, which could then begin applying for grants and offering programs that had been successful in East Africa to address similar health problems. Five years later the South Africa office, focused on improving maternal and newborn health, has grown to one of PATH's largest, with a staff of more than 30 people.

"Innovation capital can respond to emerging needs and opportunities," he said.

One goal of the fund is to invest in taking technology innovations that come from 21st century scientific discoveries, such as new diagnostic tools, and applying them to affordable products for the developing world, he said.

The fund will also be used to increase the usage of essential health products PATH has developed and to expand its field presence, particularly in sub-Saharan Africa, Elias said.

The Hilton Foundation will present the award to PATH formally at a Sept. 21 ceremony in Washington D.C with keynote speaker Muhammad Yunus, a Nobel laureate, founder of the Grameen Bank, and former Hilton Prize juror. PATH, which had been nominated for the Hilton award in the past, was the winner this year among about 200 nominees.

Seattle-based non-profit PATH has been chosen to receive the 2009 Conrad N. Hilton Humanitarian Prize, the largest humanitarian award in the world.

Hilton Foundation leaders are in town to talk about the award with PATH during a morning press conference tomorrow that includes speakers from the Bill & Melinda Gates Foundation and Seattle Rotary.

The $1.5 million prize "acknowledges one outstanding nonprofit, charitable, or non-governmental organization that has made significant contributions toward alleviating human suffering anywhere in the world," according to the Hilton Foundation's Web site.

It's also one of the largest monetary prizes -- about equal to the Nobel Prize. Previous winners have included BRAC, a Bangladeshi group that focuses on helping poor rural women using microfinance, Women for Women International, which helps survivors of war, and Partners in Health, which pioneered a comprehensive, community-based approach to improving health.

COURTESY OF PATH

A kiosk where women in a Nairobi slum sell water purified using a process developed by PATH.

PATH has been developing innovative health solutions for the past three decades, from vial monitors that indicate when vaccine is spoiled, to water purification programs, to an initiative to produce the world's first malaria vaccine. Its work has helped make Seattle a global health powerhouse.

Most recently, PATH scientists and collaborators developed methods that protect hepatitis B vaccine from heat and freeze damage, particularly important in parts of the world without proper refrigeration.

The Hilton Foundation, established by the founder of the Hilton Hotels chain, has awarded more than $800 million in grants and reported assets of $3.4 billion. More than half of the grants go to supporting international projects.

The foundation's international prize jury includes Catherine Bertini, senior fellow in agricultural development at the Gates Foundation, who is former director of the United Nations World Food Programme.

Steven M. Hilton, president and chief executive of the Hilton Foundation and the grandson of Conrad N. Hilton, will be speaking at PATH.

I'll report on more details from the press conference tomorrow.

Joe Cerrell, an early Gates Foundation employee who has shaped its communications and policy strategy on global health, will be moving to London to head the foundation's European office.

He'll lead an effort to expand the office in Europe, the foundation said today. Cerrell will oversee policy, advocacy and communications and assume the role in London on Jan. 1. He is currently director of global health policy and advocacy in Seattle.

"Joe has been a senior leader at the foundation for many years and has played a central role in its development and growth," foundation co-chair Bill Gates said in a statement. "He has also led highly successful global health advocacy activities, many of which were conducted with European partners."

He'll be charged with expanding the foundation's partnerships with European non-profits, governments and other groups, as well as managing grants. The foundation currently has major partnerships with development agencies of the United Kingdom, Germany and France.

Cerrell has worked at the Gates Foundation since 2001. Before that he was assistant press secretary to former Vice President Al Gore. He is the son of longtime Democratic political consultant Joe Cerrell, of Cerrell & Associates.

Give up millions of dollars a year by declining a commercial logo on the chests of its celebrated players? It sounded like a bad idea to FC Barcelona's marketing department. Manchester United, which wore the AIG logo on its uniforms until January, made about $25 million a year from the deal.

But the decision to wear the Unicef logo instead, and pay Unicef almost $2 million a year for the privilege, was made by President Joan Laporta, and three years later, it has paid off well, says Marta Segu, executive director of the FC Barcelona Foundation.

"Now the marketing people have said this is one of the most important decisions we have taken," she said. The result is a unique global identity.

The team is promoting the fight against malaria on its jerseys (pictured at right) during its current U.S. tour. Tomorrow FC Barcelona visits Seattle to play against the Seattle Sounders FC.

"Before we had the same value as other clubs like Real Madrid or Chelsea. We have been winners, we make money," Segu said. "Now everybody knows that Barça has another value -- solidarity, social responsibility."

The club gives Unicef 1.5 million euros a year, and 0.7 percent of its revenue goes toward humanitarian causes. The budget of the club's charitable foundation, which was created in 1994 but basically languished for a decade without any real plan, tripled over the last six years to $6 million.

"In 2005 we started making new programs and projects," Segu said. "We decided not only will it be an increase of the brand, the brand will increase all over the world toward our humanitarian dimension."

FC Barcelona's humanitarian work includes a new partnership with United Against Malaria, a coalition supported by the Gates Foundation that I wrote about today (thanks to everyone for the Tweets!) That partnership includes Seattle-based global health non-profit PATH. For Seattle's global health community, so much is riding on success fighting malaria, from SBRI's research toward a vaccine to the Gates Foundation's grand ambitions to wipe out a disease that kills a million people a year.

In Los Angeles, the campaign picked up the support of Major League Soccer Commissioner Don Garber and the Galaxy's Landon Donovan, the best scoring American player (pictured with ball above).

FC Barcelona player Seydou Keita returned to his native Mali earlier this year to distribute bed nets to families there.

"To be able to travel back to Mali and to talk to my people about the importance of fighting malaria was a wonderful experience," he said.

"We're very lucky to have such dedicated fans--and one of the ways that we can thank them for that dedication is to help raise awareness. Since so much of the world pays attention to soccer, we have the opportunity to focus that attention on malaria as well."

DEAN RUTZ/SEATTLE TIMES

After surviving two bouts of malaria, Sanna Nyassi helped raise funds and awareness about disease for Nothing But Nets.

FC Barcelona became the first team to support the UN Millennium Development Goals and now has three partnerships with the UN -- with Unicef to help vulnerable children, including those affected by HIV/AIDS in Africa, with UNESCO to fight racism in sports, and with the UNHCR to provide sports and health programs in refugee camps.

Throughout Africa and in Mexico and India, the foundation set up centers for children that offer hot meals, help with homework, health care and sports and promote gender equality.

For Seattle Sounders FC player Sanna Nyassi, his most recent case of malaria back home in his native Gambia was so serious that he and his mother both worried he might not survive. But he got treated and pulled through, and ended up playing professional soccer for the Sounders the next year. Nyassi said he was a fan of FC Barcelona before, but after hearing about the club's work to help fight the disease, "I liked them more," he said.

Technology holds the key to solving problems of health, education and poverty, Bill Gates made a point of saying in his recent visit to India.

The wholehearted embrace of technology comes as no surprise from the chairman of the world's largest software company. But in the context of philanthropy, perhaps he should have added the words "when appropriate."

MANISH SWARUP/ASSOCIATED PRESS

Indian President Pratibha Patil, left, hands the Indira Gandhi Prize for Peace, Disarmament and Development to Bill Gates as Prime Minister Manmohan Singh, second left, applauds.

Gates touted the benefits of computers to help rural people access video lectures in villages without schools, and mobile devices to help doctors examine patients remotely. Slum dwellers in Bangalore can use mobile phones with SMS messaging and GPS to find jobs as day laborers through a Gates Foundation-supported program called LabourNet. Technology can reduce government corruption if citizens can use mobile phones and public computer terminals to give feedback on public services, he said.

"I am a 24-hour technology person," Gates said.

He visited India to assess the foundation's programs and receive the Indira Gandhi Prize for Peace, Disarmament and Development on behalf of the foundation. His appearances seemed to be a mix of the foundation's work and Microsoft's mission. Gates said Microsoft would like to partner with the Indian government in a project to provide each of India's 1.17 billion citizens with a unique identity number and biometric card.

The visit came after recent suggestions that the Gates Foundation's Avahan program has not lived up to its goals of curtailing the spread of HIV/AIDS. The $258 million initiative has been led by highly paid business consultants rather than people with public health experience. After the Indian government balked at taking on what has become one of India's largest health programs, the Gates Foundation increased its funding by $80 million.

In health and development, high-tech solutions don't always work. They can even make things worse if applied in the wrong way, by diverting resources from more fundamental programs or missing the root cause of a problem, for example.

Sometimes the most appropriate technology is none at all. Ironically this point was made best by one of the Gates Foundation's biggest grantees: PATH.

Its name stands for Program for Appropriate Technology in Health, and the idea behind that was reflected in a speech by Margarita Quintanilla earlier this year in Seattle.

Quintanilla, PATH's country leader in Nicaragua, got her start working at the ground level as a community health coordinator teaching basic concepts as washing hands to avoid diseases and getting regular pap screenings. She realized that technology could not overcome one of the biggest obstacles to health: gender-based violence and its effects, contributing to the spread of diseases like HIV/AIDS, unwanted pregnancy and other problems, all of which are common in India. Her approach was to build projects to teach life skills and health education to pre-adolescent girls and promote respect for women in families.

The more PATH's work grew, the more Quintanilla realized it would have to include "both technical and social approaches to increase the country's capacity to ensure better health," she said.

"We have to be wise and intelligent in our solutions. We have the responsibility of promoting change in the right way."

About 800 people listened to Quintanilla, but billions listen to Gates. As one of the world's most respected voices, he has a unique opportunity to call attention to social issues that no technology alone can solve.
________________________

UPDATE: Nicholas Kristof and Sheryl Wudunn analyze the links between gender discrimination and poverty, child mortality, global health issues and other problems in this excellent magazine series.

Bill Gates announced a new contribution of $80 million today to Avahan, an initiative the Gates Foundation launched in 2003 for HIV prevention programs in India.

Gates is visiting India this week to receive an award for the foundation's philanthropic work and to take stock of the Avahan program. Before today the foundation had already committed $258 million to the program, which involves more than 100 non-profits in six Indian states.

Gates will meet Friday with Ghulam Nabi Azad, the Union Secretary for Health and Family Welfare, to discuss "plans to gradually transition key aspects of Avahan to the government of India and other partners," the foundation said this morning in a statement.

Gates is contributing more funding for the transition after the government questioned the sustainability of maintaining the project on its own.

Avahan, which means "call to action" in Sanskrit, was the subject of a critical report in Forbes magazine last month, which concluded the $258 million project "got lost between B-school and brothel."

The article picked up on a theme that may run through many of Gates programs for better or worse: the tendency to apply business and technology solutions to global health and development problems.

The foundation's most ambitious initiative in India has largely failed to deliver on its goals because it substituted business expertise for practical health experience and spent too much money on things like salaries, travel and marketing, the report contends.

The program is run by Ashok Alexander, an executive recruited from consulting firm McKinsey. He has been among the foundation's highest paid employees, with a salary of about $425,000.

Alexander discussed the program's work in an interview with Conde Nast in December. He was asked how his business background has helped him run an AIDS program.

"This was a marketing challenge," he said. "Our "consumers" were hidden, and the question was how to aggregate them. The women wanted to get into a violence-reduction program, not a condom program. Most HIV programs are supply-side driven: You count treatments and how many condoms are distributed. In this case, the consumer wasn't interested in the product. We had to persuade the consumer it was in her interest to be strong and healthy."

Tachi Yamada, president of the foundation's global health program, wrote a letter in response to the Forbes article.

"There's no evidence for the claim that Avahan has failed to "make a serious difference in India's fight against AIDS," Yamada wrote. "Avahan support has made it possible to provide prevention services to hundreds of thousands of high-risk individuals every month. While it is too early to fully assess Avahan's long-term impact, early signs are encouraging--data from some projects suggest these efforts are increasing condom use and reducing STD infections."

Meanwhile Avahan has begun handing over the reins to the government-run National AIDS Control Organisation. The government body had warned that large parts of the program are unsustainable, according to an Indian official quoted in Forbes.

During the transition, "Avahan will provide financial and technical support to ensure that prevention programs can be sustained over time," the foundation said today. Avahan has awarded more than $100 million in grants for the transition.

Gates is in New Delhi this week to receive the Indira Gandhi Prize for Peace, Disarmament, and Development on behalf of his foundation. The Gates Foundation is being recognized for "pioneering and exemplary philanthropic work around the world and in India in health."

He congratulated the Indian government for its leadership on HIV prevention, saying it could be a model for the rest of the world.

Some fundraising campaigns have done surprisingly well even in the face of recession.

Led by Seahawks CEO Tod Leiweke, the Seahawks helped United Way of King County raise more money this year than any other United Way in the country.

The local United Way announced yesterday it had raised a total of $100.3 million in its 2008-2009 campaign ended June 30. It's the third consecutive year the organization has broken the $100 million mark.

United Way raised about $116 million in 2007-2008, according to its annual report.

Seeing the effects of the plummeting economy on poor families, United Way announced a Response for Basic Needs in November. It has raised $3.7 million for that program, supporting 6 million additional pounds of food into emergency food banks and signing up more than 1,000 people for food stamps.

Earlier this month, United Way held a Climb for the Community. Leiweke, Fine, Seahawks coach Jim Mora, United Way Chairwoman Molly Nordstrom and NFL Commissioner Roger Goodell climbed Mt. Rainier to raise money and awareness for the basic needs campaign. The event raised an additional $380,000.

"The Northwest is a special place," Leiweke said.

Current and former Seahawks were involved last month in an event focused on global humanitarian work. Medical Teams International raised about $1.7 million at its 10th Annual Field of Dreams Dinner and Auction at Safeco Field. The event drew 820 guests, the largest turnout in its decade-long history.

Seahawks Quarterback Matt Hasselbeck and his wife Sarah and Horizon Air CEO Jeff Pinneo and his wife Janey co-chaired the event, with former Seahawks coach Mike Holmgren as honorary chairman.

Fund raising in such a difficult economy takes direct personal involvement and proof of financial efficiency, organizers said.

"The people and businesses here are incredibly generous, but they are also savvy," said Leiweke. They want to know that they're making a smart investment, so it helps that 96 cents of every dollar to United Way go to the community assistance programs.

With Medical Teams International, nearly 97 percent of all proceeds go directly to providing medicines and urgent care to people affected by disaster, conflict and poverty.

Organizers turned Safeco Field into a recreated orphanage in Romania with a flashing light bulb signifying a child dying every three seconds, and attendees walked over cardboard and garbage in recreated "dumps" of Mexico, where entire families live and dig through the rubbish to survive. There were also make-shift medical tents with IV's hanging from tree-branches.

Holmgren's wife, Kathy, a nurse, knows those situations well. As a volunteer with Medical Teams International, she worked in Uganda earlier this year with their daughter, Calla, a doctor, helping families forced from their homes by ongoing fighting in neighboring Democratic Republic of Congo. Three years ago, Kathy Holmgren was on a medical mission in DRC while her husband coached in the Super Bowl.

The non-profit humanitarian relief and development agency has deployed more than 1,900 volunteer teams and shipped over $1.2 billion in antibiotics, surgical kits and medicines to 35 million people in 100 countries. In the Pacific Northwest, Medical Teams runs a mobile dental program for more than 16,000 patients a year with the help of 900 dental professionals who donate their time.

The Obama Administration is proposing a policy change that would effectively lift a ban on HIV-positive visitors from entering the United States.

The issue came up recently when a UK citizen invited to speak at a Seattle global health conference was denied a visa earlier this month. British activist Paul Thorn could not participate in the Pacific Health Summit, despite the interventions of Senator Patty Murray and Congressman Jim McDermott and appeals to the U.S. Consulate in London. Thorn protested the policy in a letter read to the Summit audience.

According to this federal notice, the U.S. Centers for Disease Control and Prevention is proposing to remove HIV from a list of communicable diseases that make non-citizens ineligible for entry into the U.S.

The CDC said the proposed change is in line with an amendment signed last July as part of the U.S. Global Leadership Against HIV/AIDS, Tuberculosis and Malaria. The amendment removed language in the Immigration and Nationality Act that explicitly prohibited HIV-positive non-citizens from entering the United States without a visa waiver, but it was not fully implemented.

"It has been almost a year since enactment, yet people are still being denied entry to the U.S. because HIV has not yet been removed from the HHS list of communicable diseases that prevent entry into this country." McDermott wrote in a letter last week to Health and Human Services Secretary Kathleen Sebelius, urging her to take action.

McDermott said he had been contacted three times over the last few weeks about the issue, both by organizers of the Pacific Health Summit and by two constituents who had friends denied entry into the U.S. at the Canadian border because of their HIV status.

Real time information about farming, health and trading will be available to mobile phone users in Uganda with new technology services developed by the Grameen Foundation, Google and telecom operator MTN Uganda.

HEATHER THORNE/GRAMEEN FOUNDATION

Saurin Nanavati (left), a consultant for the AppLab project, explains how to use the new mobile applications to users in Uganda. AppLab aims to help Ugandans get health, agriculture and trading data on their mobile phones.

The Grameen Foundation saw the proliferation of mobile phones in Africa as a way to get information and services to poor communities in Uganda without Internet access. About 18 months ago it started a project called the Application Laboratory (AppLab), with much of the early work being done in Seattle through the Grameen Foundation's Technology Center. The first suite of those applications is being launched today.

Peter Bladin, Grameen Foundation executive vice president, said AppLab builds on the success of an earlier project, Village Phone, in which local entrepreneurs rent cell phone use to villagers for pennies a call. Uganda now has 50,000 Village Phone and pay phone operators and nine million cell phone subscribers.

Bladin said he sought out Google and MTN Uganda to help scale up the applications and roll them out to other parts of Africa, where Google has seven offices.

The new services can be accessed by existing Village phone operators, as well as by people with their own phones. They are SMS services that work on any phone capable of sending or receiving SMS messages, said Joseph Mucheru, Google's director of sub-Saharan Africa business. In Uganda almost all phones will be able to use the services, he said.

The five applications use Google SMS Search technology and MTN's telecom network. They include Farmer's Friend, a searchable database with agricultural advice and weather forecasts; Health Tips with sexual and reproductive health information, paired with Clinic Finder, to locate nearby health clinics; and Google Trader, which matches buyers and sellers of agricultural produce, commodities and other products.

Local partners helped provide the content. The Busoga Rural Open Source Development Initiative (BRODSI) provides agricultural information created and tested by small-holder farmers, and Marie Stopes Uganda and the Straight Talk Foundation provide health information.

For the Google Trader application, AppLab worked with the International Institute for Tropical Agriculture, TechnoServe and SNV Netherlands Development Organisation to hone the concept with banana farmers and traders in Uganda.

Mobile phone users send an SMS query and receive an automatic answer back from the database. A farmer could ask a question about why the leaves on a tree are starting to wilt, or a mother could ask when her child needs a vaccine. Uganda has about 30 million people with an adult literacy rate of about 74 percent, according to the UN.

Prices for the services are 110 Uganda shillings per request (about 5 cents), on par with sending a text message to a friend in the country. Prices for requests to the trading marketplace are double, at 220 shillings per request.

Grameen Foundation President Alex Counts called the applications "a great example of innovation from and for the base of the pyramid," the billions of people who are at the bottom of the world's socio-economic hierarchy.

Seattle's global health focus on malaria is getting the support of the largest Rotary Club in the world.

The Seattle Rotary is partnering with local health non-profit PATH, which works with African governments on malaria control efforts from a base in Zambia.

With so many organizations involved in malaria-related projects -- from large humanitarian groups to celebrities to public campaigns like Nothing But Nets and corporate efforts like Malaria No More -- I wondered what exactly Rotary would be able to do. It's still tackling polio in a final push toward eradicating the disease.

STEVE RINGMAN/SEATTLE TIMES

Mosquitoes that carry the malaria parasite cling to the I.V. tube in the Childrens Ward of the Morogoro Regional Hospital in Tanzania.

Seattle Rotary President Nancy Sclater, who traveled to Zambia recently to see PATH's work, explained that the malaria partnership is a grassroots effort that starts with Seattle Rotary members joining their counterparts in Zambian Rotary clubs.

"It's hands-on, connecting with people at a grassroots level, member to member and club to club," she said. While Rotary members continue to make trips administering polio vaccine, they can also distribute insecticide treated bednets.

Members will work together to deliver bednets in rural communities, teach people how to use them properly and provide basic health training on malaria symptoms and techniques to avoid it, she said. They will help develop a guidebook about the use of bednets and effective malaria prevention and treatment. Rotary is also hoping to bring African communities and businesses into the effort. Business ties between Seattle and Africa are growing.

"The health and productivity of people in Africa has broad implications globally," Sclater wrote in this message. "There is a continued perception that African nations cannot manage their business; however, there is striking evidence to the contrary."

Using proven strategies like bednets, Zambia has been able to cut malaria prevalence in children by more than half, and cut the number of children dying of malaria in Zambia by a third, according to PATH.

The disease kills one million people a year, mostly African children.

"We may be far removed geographically from children dying in Africa, but it is a cause that demonstrates the growing reputation and commitment Seattle has toward global philanthropy that will help improve the lives of people everywhere," Sclater wrote.

PATH's Kent Campbell said the scientific efforts underway by PATH, SBRI and others to fight the disease need help by community organizations on both sides.

"We need Rotary to support critical program gaps such as insecticide-treated bed nets, procurement, health education and advocacy and commodity management in Zambia that can be replicated by other clubs in other remote areas of Africa," said Campbell, director of PATH's Malaria Control and Evaluation Program.

The program can serve as a model in other African countries, connecting with Rotary's network of 32,000 clubs worldwide. The success of Rotary's polio efforts, while still not finished, is a reason for confidence about the new malaria project, Sclater said.

This week Rotary International announced it has nearly reached the halfway point in its $200 million goal to fund a final push against polio.

The funds announced today will be used to match a $350 million challenge grant recently awarded to Rotary by the Bill & Melinda Gates Foundation, an agreement that will provide $555 million to the global health initiative within the next three years.

This post was written by Sandi Doughton:

In the final hour of a Seattle conference on tuberculosis today, an African activist chided a room full of top health officials, scientists and other experts for their lack of action.

"The gap between rhetoric and reality grows bigger and bigger," said Paula Akugizibwe, regional treatment advocacy coordinator for the AIDS and Rights Alliance for Southern Africa.

Akugizibwe said she won't attend anymore conferences like the Pacific Health Summit, where the same people say the same things, then jet off to yet another conference for more of the same.

"We are sitting in fancy hotels, and people are dying," she said. "We've been talking about this for way too long. It's a travesty."

Many of the world's most powerful public health officials attended the conference, including World Health Organization Director General Margaret Chan, UNICEF chief Ann Veneman, and top officials from the World Bank and the Bill & Melinda Gates Foundation, one of the sponsors.

The topic of the final session was how to boost media coverage of tuberculosis and create a sense of urgency about a disease that kills 2 million people a year, mostly in the developing world.

Press coverage of the conference itself was restricted, though. Journalists were allowed to attend, but not to quote participants by name or affiliation without their express permission.

Laurie Garrett, a senior fellow at the Council on Global Relations and one of the most outspoken flamethrowers in attendance, told the group she couldn't understand why they couldn't create a sense of urgency, when the situation is so dire that officials should be "running around with their hair on fire."

For example, when nearly half a million new cases of multi-drug-resistant TB occur around the world each year, Kenya recently announced it can only afford to provide the costly treatment to 40 patients, Garrett said.

Dr. Krista Dong, who works with TB and AIDS patients in South Africa, said the conference was too focused on technology, like new drugs and vaccines and quicker ways to diagnose tuberculosis. Even if those things were available today, clinics and hospitals in Africa couldn't use them, she said. Most medical workers don't even have basic tools, like the special face masks needed to protect them from TB and prevent its spread. There's no room to isolate TB patients. Instead, they're all crowded into the same room, but then they share bathrooms with other patients.

"If you could lift (one of these hospitals) up and drop it here in Seattle, it would immediately be wrapped, quarantined and burned," Dong said.

Garrett pointed out that the little-known H8, or Health 8, made up of the world's top global health officials, meets Friday in Seattle. She called on the forum, which rarely reveals its agenda or conclusions, to take some concrete steps to help people with tuberculosis.

Global health funding has quadrupled in less than two decades to almost $22 billion, boosted by U.S. public funding, corporate donations and giving from private foundations such as the Bill & Melinda Gates Foundation.

But imbalances remain in directing the money to best combat a range of diseases around the world, according to researchers from the Institute for Health Metrics and Evaluation at the University of Washington.

Well-heeled donors like Gates, corporations and ordinary people donating to their favorite charities are changing the landscape of global health funding, the UW researchers and colleagues from Harvard University reported in a study published today in the medical journal The Lancet. The study represents the first comprehensive picture of funding for global health projects, the authors said.

Besides pouring in more money, the Gates Foundation has changed the balance of power in global health, said Christopher Murray, director of the UW institute and one of the authors. The institute was founded with a $105 million donation from the Gates Foundation to do the type of rigorous analyses of health spending and programs that no one else was doing.

ERIKA SCHULTZ/SEATTLE TIMES

Christopher Murray, director of the Institute for Health Metrics and Evaluation at UW, in his office.

"I think their influence on the field and as a catalyst for other groups to engage has been very strong," Murray said. "The net effect is to bring more groups, more focus on global health and more viewpoints at the table."

The study tracked assistance to low and middle-income countries from 1990 to 2007. The money isn't always getting where it's needed most. "Twelve of the 30 countries with the highest disease burden aren't receiving as much aid as healthier, and, in some cases, wealthier countries," the study found.

For example, Nicaragua and Turkmenistan have roughly the same burden of disease, but Nicaragua receives 33 times as much health funding as the former Soviet republic. Ethiopia, which ranks second in health assistance funding after India, ranks 9th in terms of the level of disease and disability.

The Gates Foundation provides the largest source of private funding, increasing its global health commitments substantially since 2004, to nearly $2 billion in both 2006 and 2007. Private sources of global health funding grew from 19 percent of the total in 1998 to nearly 27 percent in 2007, corresponding to the Gates Foundation's emergence in the field.

Newer Gates-supported organizations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Global Alliance for Vaccines and Immunization (GAVI) now have a central role in mobilizing and channeling global health funds, while funding through institutions such as United Nations and development banks declined, according to the study.

Though international organizations like the World Health Organization and UNICEF have long been criticized for rigid bureaucracies that stifled innovation, their declining role may harm efforts to improve health around the world, the researchers say.

When those organizations are forced to compete for funding, they lose their status as "trusted neutral brokers between the scientific and technical communities on the one hand, and governments of developing countries on the other hand."

Of U.S.-based non-governmental organizations, the Federal Way-based Christian relief group World Vision was the fourth leading provider of overseas health funds, spending $826 million from 2002 to 2006. PATH, the Seattle based non-profit focused on health technology and solutions for the developing world, also made the list as the 15th largest global health funder with $389 million in expenditures.

In recent years, by far the biggest share of money has gone to AIDS/HIV programs. In 2007, $5.1 billion of assistance funding was devoted to AID/HIV. Slightly less than $1 billion was spent on bolstering health systems in developing nations. Malaria programs received $800 million, while efforts to combat tuberculosis received $700 million in 2007.

Murray said it was challenging putting the numbers together because of the difficulty tracing U.S. government funds.

"It's easy to get the budgeted amounts but to get the amount actually spent, the U.S. is not very good about reporting that," he said. "The U.S. needs to be more forthcoming on the details of where their funds go, and relating expenditures to what's achieved."

Data from U.S. based non-profits was easier to find because they are required to report it on their tax returns, he said.

A Lancet commentary on the analysis faulted it for failing to include money spent on water and sanitation programs. "The provision of clean water and sanitation would probably do as much to facilitate good health as dose the assistance provided to direct medical care," wrote Peter S. Heller of Johns Hopkins University.

Post updated June 19

As global health leaders from around the world met in Seattle for the first day of the Pacific Health Summit 2009, one speaker was notably absent.

Paul Thorn, a British activist scheduled to speak today, said he was denied a U.S. visa because he is HIV positive. Thorn, project director of The Tuberculosis Survival Project, was scheduled as to participate in a discussion about the TB battle from the front lines.

The summit focuses on tuberculosis this year, drawing top global experts from government health authorities, research institutions, NGOs, pharmaceutical companies and private foundations.

In a written statement read aloud during that discussion, Thorn apologized for his absence and expressed his disappointment.

"The U.S. government actively discriminates against people who have been tested for the HIV virus and have been diagnosed HIV-positive," he said in the statement read by Lucy Chesire of the Kenya AIDS NGO Consortium.

Thorn said his application was turned down despite the interventions of Senator Patty Murray and Congressman Jim McDermott and appeals to the U.S. Consulate in London.

The U.S. policy gives people two choices: to lie on the application, committing a felony, or to be honest and have the visa rejected "because you are considered an undesirable person and unfit to enter the U.S.," Thorn said.

"I don't want to be either, but being an undesirable seemed like the lesser of the two evils, so I decided to be honest."

Thorn said the policy is wrong because many people who are unknowingly HIV-positive enter the U.S. every year. "The U.S. ban on people with the HIV virus entering the U.S. is one more reason why someone who believes that they may be HIV positive would just rather not know, putting themselves and others at risk of ill health and possibly an early grave."

If the U.S. wants to demonstrate leadership on HIV/AIDS and global health, through hosting such international health conferences, "then they need to accept that non-U.S. citizens with HIV are going to need to be there and participate."

He called on the Obama Administration to change it and others to keep up pressure to that aim. Here is a more in-depth analysis of that policy.

"I think it's outdated," said Darryl Johnson, a retired U.S. ambassador participating in the health summit. Johnson added, though, that he didn't understand why Thorn would not have been granted a waiver.

Thorn created the TB support project after fighting HIV and multi-drug resistant tuberculosis himself. He has been free of TB for more than 12 years after undergoing treatment lasting three years, Thorn said in this interview. He was infected with TB from a nearby patient during a hospital stay in the early 1990s.

(Update: Thorn confirmed in an email message to me June 19: the rejection "wasn't because I had MDR-TB, that was back in 1995 and has been cured. The visa waiver form also specifically asks if the TB is active or not. I was rejected on the visa waiver because I had to tick yes to having a communicable disease as I am HIV-positive.)

One of the key topics for the Seattle conference is the deadly combination of tuberculosis and HIV/AIDS. People with HIV are more susceptible to developing TB, and TB is the leading cause of death among people with HIV/AIDS. In fact, cases of co-infection are as high as 70 percent in some countries. A mutated version of TB that resists most antibiotics spreads most quickly among people with weakened immune systems.

Many deaths could be prevented right now by merging the two forms of diagnosis and treatment, which remain separate in most countries, said Laurie Garrett, senior fellow for global health at the Council on Foreign Relations.

"Shame! Shame! Shame!" Garrett scolded health leaders at a conference kick off dinner Tuesday night.

Tests should be worked up for both diseases "regularly, in the same place by the same people," she said. Instead, they are handled by different departments, with many cases falling through the cracks, and patients spreading TB in waiting rooms when they pick up their HIV medicines. The two diseases are much more destructive together than alone.

Tuberculosis is the number one killer of people with HIV in Africa. In Lesotho, 70 percent of TB cases are co-infection with HIV/AIDS. More coverage on that is here.

If TB diagnosis and treatment were integrated with HIV/AIDS, that alone could make more difference than all "these new drugs you're talking about," Garrett said.

In the Global Fund to Fight AIDS, Tuberculosis and Malaria, most grants go to one designated disease or the other, she said, and the U.S. President's Emergency Plan for AIDS
Relief (PEPFAR) does not adequately fund or track TB.

"How is it morally acceptable for American taxpayers to fund one disease and allow another to run rampant and kill the people they were trying to save with the funding?" Garrett asked.

Leading disease experts from the Center for Global Health Policy will call on President Obama and Congress to mount a concerted and comprehensive response to the deadly combination of HIV/AIDS and TB at a Congressional briefing on June 25.

This post was written by Sandi Doughton.

Four major health gatherings will be held in Seattle next week, all somewhat under the radar and closed to the public.

One little-known group, the H8 (Health 8), consists of the leaders of seven acronym-prone global bodies such as WHO, UNICEF, the World Bank and UNAIDS -- and the Bill & Melinda Gates Foundation, the only private philanthropy with a seat at the table.

The H8 rolls into Seattle the same week as the Pacific Health Summit, the Global Health Research Congress, and a meeting of a group called HIROS, made up of the leaders of government agencies and foundations that fund health research.

So who are all these elite decision makers and what are they planning to do?

WHO Director General Margaret Chan will be here. Also attending one or more of the meetings will be Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases; UNCEF chief Ann Veneman; and seven-time Photographer of the Year James Nachtwey.

The Pacific Health Summit, in its fifth year, brings together global health leaders and private industry, particularly pharma. This year's topic is control of drug-resistant tuberculosis. The research summit, which is in its first year, aims to piggyback on the influx of experts and help complement the higher-level discussions with the nitty-gritty science needed to inform global policies. Many of the world's top TB researchers will attend.

Both the summit and research congress are invitation-only, and some local NGOs were angry to realize they couldn't even attend a session featuring Paul Farmer. (Farmer will give a public presentation during his Seattle visit -- see details)

Journalists can attend both events -- but are forbidden to quote anyone by name or affiliation. The reason given is that participants will able to speak more freely and candidly if they know their comments won't wind up in the newspaper or on Internet.

As for any public or press access to either the H8 or HIROS?

Forget about it.

Little has been published about the H8 and its proceedings. Its meetings are described as "informal" and a few Web entries say its goal is to help the organizations work together to achieve the Millennium Development Goals.

Dr. Paul Farmer, global health and human rights advocate and co-founder of Partners In Health, will be in Seattle next week for a free public event at the University of Washington.

By the time he gets here, he may have decided to take a new job with the Obama Administration.

Farmer will speak about the current climate of global health in a conversation moderated by Dr. Chris Elias, the CEO of PATH. Farmer is the subject of the Pulitzer Prize-winning book "Mountains Beyond Mountains." A conversation with him seems like a tonic for despair and apathy -- he's brutally honest about the disparity he sees, but people still come away feeling optimistic they can do something about it.

I had a chance to meet him a couple of years ago and ask him about his work.

MOUPALI DAS

Paul Farmer will speak at UW's Kane Hall on Thursday at 6 p.m..

In Seattle, he'll talk about the future of global health delivery, the challenge of multi drug-resistant tuberculosis, and how one person has the ability to make a significant contribution to global health. More details are here.

Farmer is the chair of Harvard Medical School's Department of Global Health and Social Medicine and an associate chief at Brigham and Women's Hospital in Boston. He also spends time shuttling between PIH projects in Rwanda and Haiti. There have been suggestions recently that he will be named to a top post at USAID, which would signal a radical shift for that organization.

Arguing that health care is a human right, Farmer approaches ill health as a symptom of deeper issues of poverty and inequality. But he also expresses ambivalence.

"I move uneasily between the obligation to intervene and the troubling knowledge that much of the work we do, praised as humanitarian or charitable, does not always lead us closer to our goal," he said in a recent NPR feature. His goal? "Nothing less than the refashioning of our world."

Soccer Saves, the Seattle non-profit affiliated with Seattle Sounders FC and Save the Children, is starting its first program targeting kids in Ethiopia. I profiled the organization here.

Using the magnet of soccer, the group aims to teach disadvantaged youth about healthy lifestyles by partnering with humanitarian organizations promoting HIV/AIDS education, nutrition, gender equity and reproductive health.

This week co-founder Cliff McCrath is blogging from Ethiopia, where he says Africa's second most populous country now has 5.5 million orphans and vulnerable children. Most have been orphaned because one of both of their parents had HIV/AIDS and died.

Closer to home, the second annual Puget Sound Soccer Challenge kicks off at Qwest Field on Saturday. Employees from Boeing and Microsoft have been competing since 1997, but last year they expanded the event to include more teams and raise money for philanthropy. At 11 a.m. team Boeing plays against Microsoft, followed by Starbucks vs. Expedia at 1 p.m.

On Thursday evening, organizers are throwing a pre-match auction and dance party at the Highway 99 Blues Club in Seattle, with Sounders FC player appearances. All proceeds from both public events will go to the Ronald McDonald House Charities of Western Washington & Alaska.

Jeff Raikes, CEO of the Bill & Melinda Gates Foundation, admits that the world's largest charitable foundation needs to improve its internal processes and the quality of its outside partnerships.

"Our staff also told us that it can be hard to get things done at the foundation," Raikes wrote in his first annual letter as CEO, a post the Microsoft veteran began nine months ago. "We need to clear some hurdles so we can all focus our energy on the people we aim to help."

The feedback came from a survey of employees (the first one the foundation has ever taken) earlier this year, Raikes wrote. His letter is part of the foundation's 2008 annual report, which was released today.

ELAINE THOMPSON/ASSOCIATED PRESS

Jeff Raikes discussed the transition from business to philanthropy in his first annual letter, showing some of the humility and frankness he was known for at Microsoft.

Raikes said his first priority is to "make sure our internal processes run smoothly," and his second is to "improve the quality of our external partnerships." (I guess you don't hone phrases like that without a couple of decades as a software executive. Was he talking about Office?)

"I know we are not doing as good a job as we can in this area," he wrote. "Starting with me, everybody at the foundation needs to make a concerted effort to listen more carefully to what our partners in the field have to tell us."

In a time of economic uncertainty, such changes can make each dollar spent have greater impact, said Raikes.

Looking at finances, the foundation paid $2.8 billion in grants and other charitable expenses last year and expects to pay out $3.5 billion in grants and related expenses in 2009.

It reported endowment assets of $29.5 billion, following a 20 percent drop in its portfolio value last year as a result of the economic downturn. In 2007 its assets stood at $38.7 billion.

Warren Buffett contributed $1.8 billion in shares of Berkshire Hathaway "B" stock to the trust that manages the endowment, while Bill Gates contributed about $183 million in investment management services.

But the world's top two billionaires weren't the only ones giving money.

"Several donors from the general public made contributions to the trust and foundation," according to a footnote in the report. Even though the foundation doesn't solicit donations, it received $10.4 million from individual, unnamed donors in 2008.

Raikes, who grew up on a farm in Nebraska, has had a chance to get back to his roots in agriculture. He traveled to Kenya and Zambia earlier this year to visit projects, including a milk-chilling plant that Gates funded with Heifer International. Raikes said the investments in feed storage and refrigeration are helping African farmers produce more milk with their cattle and find new markets to sell it.

Global health accounted for 65 percent of the foundation's spending in 2008. Raikes said the foundation plans to spend "tens of millions" to help fund the final phase of clinical trials for a malaria vaccine, which started last month.

Jingjing Zhang works for the first and only non-governmental legal aid organization focused on environmental issues in China. It's her job to go after polluters in court.

Zhang, litigation director for the Center for Legal Assistance to Pollution Victims, is in Seattle for a few days, where she's giving a lecture at the University of Washington tonight and meeting with local organizations including EarthCorps, Earthjustice, Sightline and RDI. She was invited to UW as the Severyns-Ravenholt lecturer, named for Marjorie Severyns Ravenholt, a UW graduate who chronicled the development of Asia as a foreign correspondent. Zhang was a Yale World Fellow in 2008 and a visiting scholar at the Yale China Law Center.

COURTESY OF JINGJING ZHANG

Jingjing Zhang, one of China's top public interest lawyers, is an outspoken environmental advocate. She argues cases on behalf of pollution victims across the country.

At 39, she has been an outspoken environmental advocate for more than 10 years. She won a landmark legal victory against a company in 2005 when she represented farmers in Fujian Province, where a chemical factory released Chromium and killed their bamboo trees, took away their livelihood and made them sick.

It was the biggest environmental class action lawsuit in the country, representing more than 1,000 people. At every hearing, hundreds of farmers would show up in the courtroom, she said. Some had left their homes in the countryside days before and ridden to the city in a rented van.

The plaintiffs won compensation for damage to their livelihoods but not for their health.
Still it showed the power of the law could be wielded to protect citizens.

"We are facing this environmental disaster," Zhang said. "If you go to Beijing from the plane you see the whole city covered by yellow and brown air. This is our capital city. If you can't see clean air here, how can you expect industrial cities to be?"

Among NGOs in China, environmental groups are the most active, and public support for environmental protection is growing. The center offers free legal aid to the public and a telephone hotline for people suffering effects of pollution.

Chinese environmental law is actually very strong, Zhang said. "The problem is we have laws on paper. We lack implementation and enforcement. We lack action."

Chinese officials think clamping down too hard will sacrifice jobs, she said. Politicians fear losing control and suspect civil society groups of threatening the government. "They misunderstand," she said. "Our role is a bridge between citizens and the government."

Zhang is now pursuing a case against a huge state-owned iron and copper mining company in Guangdong Province, where heavy metal pollution has leached into groundwater and soil, polluting the river, fish and rice crops. The village has seen a surge in cancers of the liver and digestive system. Of 400 residents, 28 have died of such cancers since 1996 and many more have the disease, she said. The problem has likely spread beyond Guangdong, as rice is sold to other towns and provinces.

Taking on such entrenched business and government interests is a risky endeavor, she acknowledged. Her name Jingjing means be careful, the same characters in a Chinese idiom that translates: "When you walk on thin ice, you must be very careful."

It was given to her by her father, who was persecuted in the 1950s after he spoke out against the government.

But defending the environment isn't a task for the meek, and pollution is an issue without boundaries, she said. "Meeting people who share the same concerns, I feel I'm not working alone."

It seems appropriate that PATH held its biggest event of the year not in a downtown hotel or restaurant but in a Ballard parking garage.

About 750 people packed into PATH's spiffed-up garage this morning for an annual fund raising breakfast, consisting of simple quinoa pudding, empanadas and flat breads.

The global health non-profit displayed some of the ways it channels its money into low tech but effective methods of improving health around the world, from a delivery kit for hygienic home births to a new female condom.

COURTESY OF PATH

A stream in the Korogocho slum of Nairobi is the only water source for thousands of people.

One of its most interesting new creations is called an "electro-chlorinator," which PATH developed with the help of Seattle-based outdoor gear maker Cascade Designs.

Disease persists in many parts of the world where garbage and sewage pollute water that people use for drinking, cooking and cleaning.

PATH CEO Chris Elias described such conditions in the Korogocho slum near Nairobi, where more than 100,000 people live in less than one square mile.

COURTESY OF PATH

A kiosk where local women in a Nairobi slum are selling purified water.

A year and a half ago, PATH used $20,000 from donors marked for "innovation funding," to create a new solution in Korogocho. Those funds are set aside to try riskier but potentially successful new ventures.

The goal was to find a way to provide safe, clean water to a community within the slum, Elias said. The two partners came up with a device that runs on little more than salt, water and electricity from a car battery.

It works by producing a chlorine solution that kills dangerous microbes, making the water safe to drink, he said.

PATH hired a local contractor to build a building with electrical power and a water tank, and a kiosk where the water and chlorine solution could be sold. Three local health workers were trained to operate the electro-chlorinator and six local women to dispense the chlorine solution and instructions.

In December, "the first customer bought ten jerry cans of the treated water, at a price of one Kenyan shilling per liter," he said. "That's a little more than a penny apiece--affordable even in Korogocho."

Elias said he hopes to test the prototype in other locations and expand the model to many parts of the world lacking water treatment systems.

COURTESY OF PATH

An electrochlorinator device made by Seattle-based Cascade Designs with the global health non-profit PATH as a cheap water purifier.

Another of the non-profit's milestones was helping distribute mosquito bednets to two-thirds of homes in Zambia. PATH expects to reach the whole population within the next two years, he said, making Zambia the first country in Africa to meet the global targets for malaria control.

As a result, malaria prevalence in children has gone down by more than half, and the number of children dying of malaria in Zambia has been cut by a third, Elias said.

Looking at health care from another angle, PATH Nicaragua country manager Margarita Quintanilla talked about programs for adolescent girls and boys aimed at reducing violence against women in a country where one out of three women is abused.

PATH also focuses on heavily on vaccines, such as a new meningitis vaccine for sub-Saharan Africa, where about 450 million people -- more than the populations of the U.S. and Canada -- are at risk from the disease each year.

The first wave of young people will get the vaccine by the end of this year, Elias said, adding "It's the beginning of the end for a disease that has devastated Africa's poorest communities for more than a century."

The Bill & Melinda Gates Foundation is giving its annual million dollar award for global health to the London School of Hygiene & Tropical Medicine.

The school was created more than a century ago to treat far-flung British citizens dying of tropical diseases that were new to colonial doctors.

Now, as Britain's national school of public health, it's being honored for cutting-edge research and a commitment to training health workers in poor countries and post-conflict situations.

It's the first academic institution to win, and it plans to use the money to train more people around the world to work in public health.

Interesting that one of the experts it trained was David McCoy, the main author of the recent article in The Lancet critical of the Gates Foundation. He received his Ph.D. from the school.

The award to the London School will be presented May 28 during the Global Health Council's annual conference in Washington, D.C.

(This post was co-written by Sandi Doughton)

Low-key grumbling from critics for some time has suggested that the Bill & Melinda Gates Foundation lacks sufficient transparency and accountability and places too much emphasis on high-tech solutions.

Now one of the world's premier medical journals is drawing some of the same conclusions after an analysis of the foundation's health spending over 10 years.

"The foundation's emphasis on technology... can detract attention" from the basic causes of health problems and can skew the health spending priorities of poor countries, the main author, David McCoy, writes in one of a series of articles coming out Friday in the medical journal The Lancet. McCoy is senior clinical associate at University College London.

As the largest private foundation in the world, the Gates Foundation itself defies precedent in its ability to influence global health. The foundation's spending on global health was nearly equal to the World Health Organization's annual budget in 2007.

Yet the Gates Foundation is not held accountable, nor is it open about the way it sets priorities and awards grants, according to the Lancet analysis.

"What are the foundation's future plans?" asks an editorial. "It's hard to know for sure."

The world's biggest philanthropy is upfront about being "driven by the interests and passions of the Gates family," but that's a "whimsical" way to exert such enormous power on the world stage, says an editorial accompanying the analysis.

"We think it's important that he (Bill Gates) hears some of the perspectives from others," said Robert E. Black, chairman of the department of international health at the Johns Hopkins Bloomberg School of Public Health, and the lead author of a commentary published along with the Lancet analysis. "He can choose to ignore it, if he wants, but honestly, I think he cares about doing things that really matter."

Black is in Seattle this week, attending a Gates-funded program on stillbirths and premature births, and said he hopes the Gates Foundation won't react defensively.

"I hope they take it in the constructive way in which it was meant," he said.

The analysis finds that more than half of the philanthropy's $9 billion in spending went to just 20 organizations. Among universities, about 60 percent of the foundation's research funding went to eight institutions in the U.S. and the U.K.

As a result those organizations and universities now have "privileged status" and are able to exert huge influence over global health policies worldwide, the articles say.

Gates Foundation spokeswoman Karen Lowry Miller said the foundation welcomed the article and its findings.

"We're totally open to this and will take all of this into consideration," she said. "Our strategy is constantly evolving."

Tadataka "Tachi" Yamada, president of the foundation's global health program, plans to meet with McCoy in the future, she said. The foundation is also preparing to publish more information on its Web site about its approach to grants, decision-making process and strategy, Miller said.

Over the past decade, more than a third of the funding went to research and development or basic sciences, "a technological bias that reflects the priorities of Bill Gates himself," McCoy writes.

Most childhood deaths result from a lack of access to basic needs such as food, housing, water and safe employment. Rather than looking for a clinical solution, "a better approach might be to view it as a public health problem that needs a social, economic or political intervention to ensure universal access to clean water and sanitation," McCoy writes.

"We think we have a strong global health strategy that really gets to the problems of the developing world," Miller responded. "We're not trying to be everything. We're trying to be where we can have the most value."

Black, of Johns Hopkins, has received Gates funding. And though he joked that he may not receive anymore, he said he's convinced that Bill and Melinda Gates are committed to improving health around the world.

"I know their motivations are good, and I hope their responsiveness is, too," Black said.

In his commentary, he said the foundation's emphasis on future solutions, like new vaccines and drugs, ignores the fact that treatments and health strategies that are known to work are not being implemented.

By promoting new vaccines, for example, the foundation puts pressure on developing nations to adopt those vaccines -- even though they may be expensive. As a result, countries may neglect things like basic treatment for pneumonia or promotion for breastfeeding.

The foundation could see a quicker payoff if it would instead focus on research on ways to improve delivery of health care, and the best ways to get people to take simple steps that boost health, like breast feeding their babies, he said.

"Two-thirds of global child deaths could be prevented if existing interventions were fully implemented," the commentary says.

The journal was not without praise.

"The Gates Foundation has added renewed dynamism, credibility and attractiveness to global health," the Lancet said in an editorial.

But McCoy's analysis concludes that grant making by the Gates Foundation seems to be largely managed through an informal system of personal networks and relationships rather than by a more transparent process based on independent and technical peer review.

The article singles out Seattle-based PATH, which was awarded nearly $1 billion, saying the amount "raises the question as to whether some organizations might be better characterized as agents of the foundation rather than as independent grantees."

It also brought up the question of accountability in grants to the International Finance Corp. and World Bank.

"The promotion of the private sector, including for-profit companies, raises a more fundamental question about the mandate and role of a foundation in promoting and shaping policies on core health systems issues... to whom is the Gates Foundation accountable for the promotion of such policies?"

Where do swine flu, avian flu and potential influenza viruses of the future find a rich breeding ground? In the production sites of industrial agriculture, some disease experts say.

Industrial poultry and swine production can foster the mixing of flu viruses such as the new influenza A (H1N1) strain, commonly called swine flu, which has components of human, bird and pig viruses.

Disease experts are starting to see links between conditions in industrial food animal production and public health, but the risks are not well measured, said Dr. Ann Marie Kimball, professor of epidemiology at the University of Washington's School of Public Health and a specialist in emerging diseases.

ALEXANDRE MENEGHINI / ASSOCIATED PRESS>

Pigs on a farm in Mexico's Veracruz state.

Kimball was among a panel of Seattle experts speaking at the University of Washington on swine flu Monday evening as part of the Washington Global Health Alliance Discovery series. TVW will televise the panel at 8 p.m. tomorrow.

Kimball said the globalization of travel, trade and extended chains of food production all represent risks for influenza as animals and people are transported across borders more than ever before.

She pointed out that people won't catch swine flu by eating pork or traveling on planes. With modern filtration systems in airplane cabins, people are unlikely to contract a virus through the air unless they're sitting next to a person coughing or sneezing.

Yet air transportation has played a central role in global transmission, since travelers exposed to viruses can carry them within hours to other countries.

Kimball said influenza surveillance may be missing the "sentinel populations" working close to animals, such as farmers, veterinarians and meat packers, particularly in places like Iowa where much of the country's pork is produced.

A report by the Pew Commission on Industrial Farm Animal Production found chronic overuse of antibiotics in animals and other problems with industrial farming has led to antibiotic resistance and become a threat to public health. More interesting commentary on that is here.

Commercial agriculture has experienced a boom in China, and most of it of takes place in urban areas, said Kimball, who directs the APEC Emerging Infections Network.

Just as avian influenza (H5N1) and SARS had connections to human contact with animals, reports in the Mexican press and elsewhere point to an influenza epicenter around a huge hog farm in Veracruz.

Around the world, global defenses are uneven, with poor and middle-income countries lacking enough resources to monitor and respond to a pandemic.

"You don't worry about countries reporting cases," she said. "You worry about countries that are very silent."

Seattle's global health expertise is being called upon to study the body's immune response to the swine flu virus.

Alan Aderem, co-founder and director of the Institute for Systems Biology, was tapped by the National Institutes of Health (NIH) this week to apply his current research to unlocking the mysteries of the H1N1 "swine flu" virus. Aderem had already received a $20 million NIH grant to study immune response to avian flu.

Aderem and a team of 25 ISB researchers are comparing the swine flu virus with the avian flu virus and the seasonal flu virus. They hope to determine not only how dangerous the current virus could be, but how to treat and prevent it.

The 1918 flu killed millions of people because it produced an overly active immune response. He'll examine proteins in the lung to determine whether the swine flu virus elicits a similar response. I had a conversation with Aderem about his project late Thursday.

JOHN LOK/SEATTLE TIMES

Alan Aderem, at work in his Seattle office, specializes in immunology and cell biology.

How did this come about?
Two days ago we had started moving in the direction of applying what we were doing in our big NIH grant to this problem. NIH called this morning and asked specifically to apply what we were doing to this flu, so it was both on our own initiative and NIH.. I won't say commanded but strongly supported us to do this.

How exactly do you study it?
Infect many mice with the virus and then take fluid from the lung. We measure proteins with a very sensitive mass spectrometer and essentially are able to quantify every one of the proteins in the lung. It's important because for a few immune proteins, the way they are secreted is the way the 1918 flu killed the host.

What makes this more serious than seasonal flu?
Usually diseases that are viral or any infectious diseases co-evolved with the host generally are relatively mild. Human flu co-evolved with humans is mild because it's not in the interest of the virus to kill the host. When viruses become very dangerous is when they jump from one species to another. That's why bird flu is so dangerous. Humans have not developed immunity.

Generally speaking bird flu cannot infect humans. There's protein on the surface of bird flu which allows flu to infect a cell that has a very specific protein in the receptor. Human flu has protein that recognizes the human receptor and allows human virus to enter the human cell. The bird virus has a different protein that can't enter humans. But if you have an intermediary like a pig, where human virus can infect it, and bird virus can infect it, when the virus reassembles in the cell, you have more than one type of flu in the cell. It can reassemble and the human gene can go to the bird and vice versa. Now the virus coming out has components of humans, allowing it to infect humans with the bird virus. This virus has some components from bird, some components from pig. Because of that it's a very dangerous. It can get into human cells, has dangerous components from other species and can spread to other humans.

Bird flu is clearly very dangerous. It produces a cytokine storm -- hormone molecules produced by immune cells used to signal other immune cells. If you produce too many, essentially an over exuberance in immune response, that causes severe damage.

What expertise can ISB bring to bear on this problem?
Our main focus is systems biology -- what that does is take global measurements. We measure all of the proteins. We measure all the genes, all the RNA and all the proteins then use very powerful computational tools to understand how the system works holistically.

There are complicated webs of information produced in immune cells when they interact with viruses. One thing we do very well is measure large numbers of proteins very accurately. Those two capacities allow us in this case to examine these immune cells in context of how they respond to flu. how they can compare to other flus and proteins in the lungs and their capacity to do damage.

The idea is they give us the opportunity to find better drug targets and generate more effective vaccines. Drug targets are particularly important because right now Tamiflul is the only drug that's working. One needs to find more targets.

Are people overreacting to this?
I think better safe than sorry. Maybe one day in hindsight people will say they might have been overreacting For right now, it's potentially dangerous, and it's worthwhile to respond with these kinds of measures. I don't think we are panicked from where I'm sitting. I live in Madrona and they closed Madrona Elementary. I think that is the right thing to do.

Why is the virus causing more deaths in Mexico than in the U.S.?
It isn't that it's a different virus, rather the health conditions are different. Other social factors are influencing the outcome of infection, such as if people live more closely or people are malnourished.

How quickly can you develop a vaccine?
I think we'll get results pretty quickly and deeper understanding quite quickly, but what one can do about it is another matter. It takes time to interpret and collate information. It's hard to say how long it will take. Vaccines are made in eggs. For 300 million dosage, right now that's 300 million eggs. That's a huge ship you've got to turn around to do that. This virus appears to grow very slowly in eggs. That of course also impedes vaccine development.

It's World Malaria Day, and this year everyone from celebrities to CEOs to the President of the free world is stumping for the cause... actually I was ready to bet that Ashton Kutcher had already forgotten about it, but I see he's still Tweeting away.

How much impact are these good intentions and money spent on malaria prevention efforts actually having?

Earlier this year, the statistics the Gates Foundation was using to promote its success in reducing malaria, based on WHO data circulating at the time, were questioned as inflated.

The claim was that African countries have made rapid progress against the disease using low-tech methods such as insecticide-treated bed nets and indoor spraying.

In less than three years, for example, Zambia has seen a 50 percent drop in the number of children infected by malaria parasites and a 29 percent drop in overall child deaths, the Gates Foundation said.

William Easterly, a professor at New York University, traced the claims back to Dr. Arata Kochi, the former WHO malaria chief, reporting 50 to 60 percent reductions in deaths of children in countries such as Zambia and Ethiopia to celebrate the victories of the anti-malaria campaign.

A more recent World Malaria Report made no such claims, saying that in most countries, "the links between interventions and trends remain ambiguous."

In African countries "where a high proportion of people have access to antimalarial drugs or insecticidal nets, such as Ethiopia, Gambia, Kenya, Mali, Niger and Togo, routine surveillance data do not yet show, unequivocally, the expected reductions in morbidity and mortality," the report said. "Either the data are incomplete, or the effects of interventions are small."

COURTESY OF PATH

Kent Campbell, a veteran of the U.S. CDC, is director of the Malaria Control Program at PATH.

I asked Kent Campbell, who is in charge of malaria control efforts at PATH, what he thought of the discrepancies. He could not entirely explain them, but he said the difficulty in measuring malaria is related to diagnosis.

For an officer at a clinic in Africa seeing 200 children every morning and trying to keep a tally of their problems and treatments, "the question is what is malaria? ... you don't have a laboratory. You don't know who has parasites."

Some things like pneumonia also cause fevers and can look indistinguishable from malaria.

In Ethiopia, it's hard to pinpoint trends because 2007 was the first survey done there, and malaria incidence across the country was patchy, he said. Some improvements should be seen after a massive distribution of bednets since then.

But Campbell knows the data well in Zambia, a country he says can clearly show the relationship between steps to prevent and treat malaria and positive results. PATH's MACEPA program has partnered with the Zambian government for four years to try to demonstrate that even in one of the poorest countries in Africa, where malaria causes about 20 percent of childhood deaths, the right strategies can cut that rate dramatically.

Based on more recent data in Zambia "malaria has dropped by over 50 percent, absolutely," Campbell said. "There's no question about it."

But Zambia (and other places making consistent progress, like Rwanda) borders countries that might not be so aggressive with prevention measures, and malarial mosquitoes know no national boundaries.

Another reason to continue bednet campaigns: according to the World Malaria Report, only six countries in Africa had sufficient nets to cover at least half of the people at risk: Ethiopia, Kenya, Madagascar, Niger, Sao Tome and Principe and Zambia.

PATH received two major grants this week for work on HIV/AIDS prevention and treatment programs.

One is a $35 million three-year contract to help Ethiopian communities respond to the HIV/AIDS epidemic. The Seattle global health non-profit received the grant from the US Agency for International Development (USAID) to help nongovernmental organizations improve and coordinate their efforts to provide services for people affected by HIV/AIDS.

SIEGFRIED MODOLA / AFP/GETTY IMAGES

Ethiopians crowd a rural road as they line up to be examined at a Medecins Sans Frontieres (Doctors Without Borders, MSF) outreach center in southern Ethiopia.

About 2 percent of people in Ethiopia are living with HIV, according to UNAIDS. Ethiopia has a relatively low level of the disease, particularly when compared to sub-Saharan Africa where HIV affects more than 20 percent of the population in some countries.

But in urban areas of Ethiopia, as much as ten percent of the population is affected, and the epidemic which has undermined the workforce, reduced life expectancy and weakened health systems. Further background on the situation in Ethiopia is here and here.

The USAID project aims to improve access to HIV/AIDS treatment and services, strengthen community and home-based services, and raise awareness and demand for high-quality affordable services. PATH is targeting more than 900,000 people in 300 towns.

MARK HARRISON/SEATTLE TIMES

PATH, the global health non-profit, is moving its headquarters from Ballard to the 2201 Westlake Buildling.

Partners include Dawn of Hope Ethiopia Association, Hope for Children Organization, International HIV/AIDS Alliance, International Relief & Development, International Training & Education Center on HIV, Mekdim Ethiopia National Association, Organization for Social Services for AIDS, and Westat.

PATH also received a US$17 million grant from the Canadian International Development Agency to strengthen HIV-prevention efforts through research and evaluation of the effectiveness of different strategies. The program's objective is assess how best to avert HIV infections among high-risk populations.

PATH is expanding and moving its Seattle headquarters from Ballard to South Lake Union, where many of its partners working in biotechnology are clustered.

The malaria eradication efforts of Seattle-based PATH are moving ahead today with the first human trials of one of its vaccine candidates -- a "whole parasite" vaccine made by Sanaria.

MIKE SIEGEL/SEATTLE TIMES

PATH's Malaria Vaccine Initiative, a global nonprofit consortium supported by about $450 million in grants from the Gates Foundation, is working with drug companies such as Sanaria to advance studies on various vaccine candidates.

"Initiation of this trial expands the spectrum of malaria vaccines in clinical development today," said MVI Director Christian Loucq. Conducting early trials with volunteers allows scientists to weed out vaccines that don't work and accelerate those that do, he said.

The PfSPZ vaccine is made in Sanaria's Maryland lab from P. falciparum parasites harvested by hand from the salivary glands of infected mosquitoes.

This trial will assess the vaccine's safety and efficacy by vaccinating more than 100 volunteers and then allowing malaria-infected mosquitoes to bite them, testing whether the vaccine offers protection. Malaria kills nearly a million people a year, mostly small children in Africa.

Another malaria vaccine supported by PATH, RTS,S developed by GlaxoSmithKline (GSK), is the most advanced, beginning its final phase of clinical trials this year in Africa.

Sanaria founder and CEO Stephen L. Hoffman was part of a team of military doctors trying to develop a malaria vaccine in the 1980s at the Walter Reed Army Institute of Research. There he worked with W. Ripley Ballou, who now heads malaria vaccine research for GSK.

Ballou's RTS,S malaria vaccine has proved effective in adults and children, reducing the risk of infection by about 35 percent. But Hoffman said that level of protection is too low.

"That's not a vaccine that could ever be considered for use in the developed world," he told Scientific American in an interview last year.

In the 1990s, Hoffman exposed himself to bites of 3,000 mosquitoes -- irradiated to weaken the malaria parasites they were carrying -- to infect himself with malaria, eventually becoming immune from the disease.

That early experiment formed the basis of Sanaria's approach, which is unique in deploying a weakened form of the whole malaria parasite harvested from the saliva of irradiated mosquitoes instead of using small portions of the parasite.

While the challenges associated with a vaccine based on live parasites had been widely viewed as insurmountable, Sanaria says it has developed new technologies and manufacturing capability.

The trials will be conducted by researchers at two sites in Maryland: the US Naval Medical Research Center in Bethesda and the University of Maryland School of Medicine in Baltimore.

Scientists from Seattle Biomedical Research Institute (SBRI), meanwhile, are working on a vaccine that uses genetic engineering to render malaria parasites harmless. SBRI is preparing its first vaccine candidate to enter clinical trials at Walter Reed this year. SBRI, which as about 100 researchers dedicated exclusively to malaria, will also open its own Malaria Clinical Trials Research Center later this year at its South Lake Union lab, where volunteers are paid to get bitten.

Today is game day for the Seattle Sounders FC, and I'm eager to see how the team integrates philanthropic messages into its ads and announcements at Quest Field. The team supports four charities: Seattle SCORES, Boys & Girls Clubs of King County, Washington Youth Soccer and Save the Children.

KEN LAMBERT/SEATTLE TIMES

Seattle Sounders FC forward Nate Jaqua (left) stands with SPU coach Cliff McCrath, co-founder of Soccer Saves (center), and Charles MacCormack, president of Save the Children.

Non-profits are coming up with creative ways to market their messages using popular culture and commercial partners. The question is how do you distinguish between those campaigns that serve their humanitarian causes well and those that simply use the cause to polish the image of a corporate brand. Or is it possible (and ethical) to achieve both at the same time? Either way, the trend to merge brand and cause is growing.

I did a short interview with Sounders forward Nate Jaqua, which my story about Soccer Saves yesterday didn't have the space to include. Jaqua, a native of Eugene, is friends with Diego Gutierrez, who asked him to be a spokesman for Nothing But Nets in Los Angeles. (Nothing But Nets is the campaign to raise money for bednets in malaria prone countries). Jaqua was traded from the Galaxy before he got started, but he told me he was very interested in ways Major League Soccer might help impoverished kids.

Pop culture events such as American Idol or World Cup soccer do grab the attention of people who might not otherwise notice problems outside their own backyard.

"Probably the single greatest common denominator in the world that cuts across every culture and language is sports, and the greatest global events are the Olympics and the World Cup," said Charles MacCormack, president and CEO of Save the Children. "Those are probably the one time where 3 or 4 billion people are all thinking about the same thing."

Gary Wright, who oversees business operations for the Sounders, summed it up like this:
"Kids are going to listen to an athlete, sometimes more than they might even their parents. That's not to say that's right. That's kind of reality."

What a difference a decade makes. One of the companies that sued South Africa to block distribution of low-cost drugs to fight AIDS now says it's cutting drug prices and funding health clinics in poor countries.

Last week drug maker GlaxoSmithKline said it would slash prices to the 50 poorest countries in the world and use 20 percent of its profits from them to build health clinics. Prices for the poorest countries would be no higher than 25 percent of the price in developed countries, CEO Andrew Witty said.

GSK's revenue from those countries is about $43 million a year, so it would generate $1.5 million to $2.5 million for the clinics, according to the Wall Street Journal.

Witty proposed that drug companies and non-profits create a common pool for intellectual property, donating patents related to neglected tropical diseases to speed development of new drugs.

It's an interesting model that might apply in other cases where patents on technology make prices prohibitively expensive. GSK is the company with the most advanced vaccine candidate for malaria, a project backed by the Gates Foundation.

On Friday, GSK said it would not donate patents on HIV drugs, however, because they're sold at not-for-profit prices and there is enough competition to drive innovation.

Doctors Without Borders responded today: Thanks for the Valentine; now show us some real love.

The group welcomed GSK's new stance, saying patent pools offer new ways to stimulate research, but added that more details are needed about licensing terms and "promises now need to be turned into action."

GSK must include in its patent pool drugs for HIV, a field where the gap between what is needed and what is available is large, Doctors Without Borders contends.

A bit of history: GSK was among a group of 39 pharmaceutical companies that sued the government of South Africa in 1998 for enacting an amendment to WTO rules, which allowed it access generic versions of patented HIV drugs. The companies later dropped the suit , facing international public pressure.

But the impact of trade policies on disease remains an ongoing issue, says Health Alliance International, a non-profit based at the University of Washington that addresses disparities in health.

Few know better than the Gates Foundation how important results are to mobilizing people and money to tackle a problem such as malaria.

But those results are hard to pinpoint accurately, it seems. William Easterly takes a look at some of the recent malaria success claims and finds some of them to be overstated.

KATHY WILLENS/ASSOCIATED PRESS

Bill Gates announced $168 million in funding toward malaria vaccine research at a UN Millennium Development Goals Malaria Summit in September.

Here's what the Gates Foundation said, and we reported, last September:

Several African countries have made progress against the disease using low-tech methods such as bed nets and indoor spraying. In Ethiopia, for example, 70 percent of households in high-risk areas now have at least one insecticide treated bed net and indoor spraying, and effective medicines are available nationwide to treat malaria.

In less than three years, Zambia has seen a 50 percent drop in the number of children infected by malaria parasites and a 29 percent drop in overall child mortality, which experts say is almost certainly due to the wider distribution of insecticide treated bed nets.

Now Easterly cites this more recent WHO malaria report, which takes a step back. The effects of malaria control in Zambia were "less clear," and in Ethiopia, "the expected effects" of malaria control are "not yet visible," he says, quoting the report.

Indeed, other than four countries with small populations -- Eritrea, Rwanda, Sao Tome and Principe, and Zanzibar (in Tanzania) -- in many other cases "the links between interventions and trends remain ambiguous," the report concludes.

In an interview from Davos recently, Bill and Melinda Gates repeated "numbers that have already been discredited," Easterly says.

He traces the claims back to Dr. Arata Kochi, the former WHO malaria chief, reporting 50 to 60 percent reductions in deaths of children in Zambia, Ethiopia, and Rwanda to celebrate the victories of the anti-malaria campaign. Kochi had rushed conclusions from a preliminary report that was never verified, Easterly says.

Easterly admits to his own philosophical differences with Gates, who he says hated his recent book. The NYU economics professor jokes he recovered from the criticism only after "months of intensive psychotherapy."

Easterly has dismissed foreign aid and "creative capitalism" as solutions to help the poor in developing countries, which he says could benefit more from plain old capitalism in the form of foreign investment. One of the other main differences seems to be that Easterly is basically a pessimist and Gates an optimist.

As for evaluating malaria control progress, this could be a key task for the UW's Institute for Health Metrics and Evaluation and its director, Christopher Murray. While financed by the Gates Foundation, the institute has not held off from reporting critical results.

Washington state is in the soft power business. Dozens of local organizations involved in global affairs have a stake in defining the U.S. role in the world, and they're calling for an overhaul of some basic principles.

They're hoping to influence policy in the other Washington to focus on more equitable, efficient and sustainable development as the Obama Administration sets its budget and priorities.

One area that needs changing most is foreign aid, participants at a Global Washington forum on Monday agreed.

WALLY SANTANA/ASSOCIATED PRESS

The U.S. foreign aid program needs a thorough overhaul to be more effective, many NGOs say.

The current Foreign Assistance Act, all of 417 pages, contains programs to attack the Soviet threat and address disasters in Nicaragua and Pakistan that ended in the 1970s, said Jenni Rothenberg, field director of the U.S. Global Leadership Campaign. With 140 priorities and 400 directives, it's complex and cluttered without any clear road map.

The campaign, whose leadership includes local charities such as PATH, Mercy Corps and World Vision, along with Boeing and Microsoft, is advocating for a strong international affairs budget. The administration's current international affairs budget proposal for fiscal 2009 is $39.8 billion, about 1.3 percent of the total budget request, according to the campaign.

As the U.S. has been involved in two wars, the military role in development has grown significantly, said U.S. Rep. Adam Smith (D-Tacoma).

The Defense Department "moved into what was traditionally the State Department's lane," Smith said. Now it's in over its head in some places and needs to work cooperatively with more civilian experts in a broader mission. But as for getting the military out of the business of development entirely, "it's not going to happen and it's not desirable," Smith said.

Foreign investment and trade will play a key role, but the U.S. needs a new approach to that as well, he said.

"We have learned an enormous amount about how to not make it work," Smith said. "Foreign investment comes in, keeps separate from local populations, sucks money out, pays shareholders somewhere else, pays no taxes and flees."

JOHN MOORE/GETTY IMAGES

As the U.S. military has expanded its role to include more international development, it has stretched beyond its capability and needs more civilian involvement, local leaders say.

Bill Clapp, a Seattle businessman and philanthropist who launched the Global Washington network, suggested that the mission of the U.S. trade representative should be redefined.

Rather than simply negotiating the best deal for U.S. companies, "there has to be a change in priorities, or an additional priority on the trade arm, that says economic development is also one of the outcomes we are looking for," Clapp said.

Speakers debated the role of corporate involvement in economic development.

Foreign aid, originally used to bring foreign countries in line with Washington and promote U.S. economic interests, has fostered a sense of mistrust of U.S. programs, some said.

Margaret Willson, international director of Bahia Street, a Seattle non-profit that aids impoverished girls in Brazil, said her organization refused money from the U.S. Agency for International Development. "All the construction materials had to be brought from the States, supervisors had to be from the States. No money was going into the community. They did not own it, they did not supervise it." In addition, USAID "wanted dossiers on every person involved in the organization," she said.

Simeon Karanja Waidhima, a businessman from Kenya, pointed out that while many criticize U.S. foreign investment, almost none has actually gone to Africa. He also argued that foreign aid has done some good.

"I'm a product of foreign aid," he said. The aid that came in the 1960s and 70s was visible on the ground in the form of teachers and machinery, he said. But in recent years "what we received is not visible," he said. "It's packaged in democratization, but this has no effect on the local population."

Aaron Katz, senior lecturer at the University of Washington School of Public Health, said business interests can be a positive force for development if the focus is on creating economic opportunities for families.

"If there is an intersection between the interests of some corporations and expanding opportunities for those families, I say great," he said. "It's not the companies' interest or U.S. interest that should be paramount. It's the economic well being and opportunity to expand one's freedom that should be paramount."

Since foreign debt consumes up to 70 percent of the budgets of some countries, it has to be addressed to make resources available for health, education and other services, Katz said. An audience member from Ethiopia, however, was quick to chime in that governments often don't use those resources appropriately, and the savings from debt relief does not go to the poor.

Katz and Willson put forth what they called "A Modest Proposal" for U.S. foreign aid, based on the following principles: Do no harm, support public institutions and transparent decision making, invest locally, serve local agendas and priorities, and foster equitable relations.

The great Gates vacuum keeps pulling them in from points far and wide, with news today that the former director of the U.S. National Institutes of Health (NIH), Dr. Elias Zerhouni, is now a senior fellow at the Gates Foundation. NIH is the country's largest funder of biomedical research.

Zerhouni served under the Bush Administration from his appointment in 2002 until he left in October. There he helped "enhance synergy between all 27 NIH institutes and centers and fund compelling research initiatives of potential high impact," says the Gates Foundation. In 2006 Congress institutionalized many of his reforms.

Zerhouni also became controversial for banning NIH scientists from consulting with drug and medical device makers, and during his tenure, the NIH budgets stagnated. The New England Journal of Medicine noted that funding doubled between 1998 and 2003, but flattened afterward. In 2007 the budget was the first real reduction in NIH support since 1970.

Born in Algeria, Zerhouni came to the United States at age 24 with a medical degree from the University of Algiers School of Medicine and finished his training at the Johns Hopkins School of Medicine, where he worked as chair of Radiology Department, vice dean for research and executive vice dean.

Besides being a member of the Institute of Medicine of the National Academy of Sciences, he will serve on the board of King Abdullah University of Science and Technology in Saudi Arabia.

His task now is to "spur innovative solutions" as he advises the foundation on its global health programs, particularly the Grand Challenges in Global Health initiative.

For more innovative solutions, maybe they should just hire this company.

It's a sign of the times that whenever a Gates Foundation employee speaks in public, the question and answer session becomes an audition for would-be job candidates. You can save the world and still wear Prada, too.

MICHEL EULER/ASSOCIATED PRESS

Shaping the post-crisis world with an economy on edge.

Gates Foundation CFO Alexander Friedman spoke to the Trade Development Alliance in Seattle this week, offering such a clear, detailed and unvarnished analysis of the market it's amazing there was no run on banks.

The talk came after Bill Gates revealed his foundation lost 20 percent of its assets in 2008 but vowed to push ahead this year, and just before Gates headed to Davos to urge other non-profits, businesses and governments to do the same.

In Friedman's analysis, the roots of this crisis date back a long time. In the 1980s, the current account balance flipped as the U.S. began importing more than it exported. At the same time, Americans started saving less.

Interest rates came down from the ultra-high levels of the late 1970s and early 1980s; largely as a result, home ownership surged from the mid-1990s until 2007. Subprime loans grew from about 6 percent of all loans to 20 percent. And most mortgages, rather than being held by the banks that made them, increasingly were packaged together and sold as securities.

FABRICE COFFRINI/AFP/Getty Images

Davos: a spectacle of wealth, power and debate... but less caviar.

With money so cheap, investment banks borrowed more to increase their profits. Consumers went on a debt-fueled spending spree, borrowing against their homes and loading up their credit cards. When the bubble finally burst and defaults started rising, mortgage-backed securities went from 100 cents on the dollar to 15 cents on the dollar. About $2 trillion in securities were downgraded.

How much could it all cost to fix? To shore up the financial system, U.S. government agencies have committed almost $8.5 trillion, even before the $819 billion stimulus package. That's about half of the U.S. GDP, and the single largest expenditure in American history.

Looking at various financial crises over the last 30 years, the minimum losses from this one appear to be far more severe -- almost double the losses from Japan's banking crisis of the 1990s and triple those of the Asian financial crisis.

Global markets have fallen in tandem with the U.S. What's the net result? Poverty is likely to rise sharply, especially in the poorest countries.

The World Bank estimates 20 million more people will go into extreme poverty for every one percentage point drop in developing countries' growth rate. Overall growth rates of developing and emerging economies are projected to fall from 8 percent in 2007 to about 5 percent in 2009. Robust African growth rates of 5 or 6 percent are almost certain to drop, too. Add at least another 60 million to the 100 million people pushed into poverty by the food crisis

So back to Gates' mission. Poor countries, especially in Africa, depend on foreign aid, which typically makes up 10 to 25 percent of their GDP. Aid has disproportionately gone into education and health, so those programs will be hit hard if it falls.

The prospects for aid look fairly grim throughout much of the world, said Friedman.

United States: Could be reduced or stretched out over longer period.
Japan: Flat or falling, unless aid becomes part of an anti-deflationary package.
Italy: Threatened 50% cut in bilateral aid program..
France: Official intent is to flat-line aid, but internal discussions indicate cuts.
United Kingdom: Holding firm -- so far.
Canada: Flat to negative.
Gulf states: Falling oil prices and financial contagion likely to minimize their role.
Nordic countries and Netherlands: Maintaining aid targets for now, but ministers say that's politically unsustainable if big donor countries cut theirs.

Gates is holding a press conference Friday to call on global leaders to maintain their commitments.

Meanwhile, Friedman thinks consumer debt, commercial real estate and private equity could be the next trouble spots in the U.S. economy. Big commercial banks may not be prepared for much higher unemployment levels and the related defaults, he said. Still he's trying to stay optimistic.

"When you're in a crisis, you tend to think the sky's falling," he said. "When you look at a 5 or 10-year horizon you adopt a more positive frame."

"We're trying to address diseases that are essentially Biblical..." Friedman said. "They've been around thousands of years... so the time frame of two or four years is something we can't let distract us."

During the recent floods this winter, I couldn't help but think of Marla Smith-Nilson. If only we could take all the excess water creating havoc in the Northwest and pipe it over to the places she's trying to reach. Smith-Nilson is an engineer who founded Water 1st, a Seattle non-profit working to relieve poverty by starting with the most basic necessity: safe water.

There's nothing fancy or high-tech about the group's work. They work on the simplest kinds of wells or distribution systems from local springs that can be built and maintained by communities, one village at a time. Water 1st works with local partners in four countries: Honduras, Ethiopia, Bangladesh and India.

One problem with past projects built by outside organizations like the World Bank is that they are complex and expensive, but not regularly maintained or repaired, Smith-Nilson said. Locally no one can agree who is responsible for the well, so half of them fail.

ALAN BERNER/SEATTLE TIMES

A farm is totally surrounded by flood waters in the Snoqualmie Valley.

Water 1st decided to enlist local residents to plan and build the projects.

"If you've invested half a year of labor, there's no way you're going to let that system fail," she said.

Progress is especially important for women and girls, who are usually the main water bearers. If they don't have to walk miles every day to collect water, they can spend more time in school. Water 1st also focuses on training in food preparation and hygiene and building latrines.

In Seattle Smith-Nilson raises money mostly by word of mouth through her network of friends, enlisting help from local schools and businesses.

ALAA AL-MARJANI/ASSOCIATED PRESS

A man sows a crop on a dry field on the outskirts of Najaf, south of Baghdad.

On Friday evening Water 1st is holding its fourth annual Water 1st - Beer 2nd event at the Lake Union Park Armory, including a presentation about the world water crisis.

Another event on the calendar is a unique combination of water causes and the trendy microblogging phenom of Twitter. On Feb. 12 Twestival Seattle, a grassroots effort to raise money and awareness for charity, will kick off with a focus on water.

One person in six, or more than a billion people worldwide, has no access to clean water, according to the group. More than 4,500 children die each day from dehydration and water-borne diseases.

One of charity:water's solutions is to donate 100 percent of profits from the sale of a $20 bottle of water to help build wells. Founder Scott Harrison said he had to rethink his lush life in New York after a trip to Liberia, where he could feed four people for the price of one $16 margarita he consumed in Manhattan. That's nice. But maybe he should rethink those plastic bottles... no sense helping one problem only to contribute to another.

Grim financial news has made raising capital almost anywhere a challenge. But a relatively new kind of investment with a social payoff is expanding this year -- vaccine bonds.

The bonds offer retail investors a fixed rate of return along with the opportunity to use their money to help immunize children in poor countries.

The bonds are offered by the International Finance Facility for Immunisation Co., (IFFIm) a UK-based charity and subsidiary of the GAVI Alliance, a global partnership to expand vaccines that was one of the Bill & Melinda Gates Foundation's first major health initiatives.

Since introducing the bonds first to institutional investors in 2006, GAVI has raised about $1 billion. The organization seeks to raise an additional $500 million this year, beginning next month when the bonds go on sale to retail investors in Japan. Based on their success so far, they may be offered in other markets in the future, says Gargee Ghosh, senior program officer for development finance at the Gates Foundation.

JACQUELINE M. KOCH

Researchers are closing in on a successful vaccine against malaria in Mozambique, .

They're backed by long-term government aid commitments over one or two decades from donors such as the United Kingdom, France, Norway, Spain and other countries. Based on those pledges, the IFFIm board issues bonds as needed. The donor countries make annual payments toward their commitments, covering the interest on the bonds.

"What this essentially does is create predictable on-call funding for vaccines," says Ghosh.

The previous bond, issued in March 2008 to Japanese institutional investors, pays 9.9 percent a year with a two-year maturity. This year's bond, arranged by Daiwa Securities SMBC, pays 6.6 percent interest over three years.

Their triple-A rating makes the bonds solid enough to appeal to the gun-shy, Ghosh says.

"IFFIm has really tapped a market we thought but weren't sure existed," she said. "People talk so much about social investing. This is such a great example. It's a completely viable financial structure. People don't need to care about kids in Africa at all for this to make sense in a portfolio. But if they do, they can track the impact of their funds."

(The University of Washington's Institute for Health Metrics and Evaluation recently questioned some countries' reporting methods, which may influence the way GAVI measures progress.)

GAVI uses the funds for big upfront investments such as buying trucks and stockpiling polio vaccines. In the future it may call upon bonds to help finance a malaria vaccine.

The innovative financing is creating a new kind of asset class, one that could work for other kinds of investments supporting humanitarian projects. It could also attract socially motivated investors in the U.S.

"We've just scratched the surface of understanding the social investment market," she said. "The U.S. is a deep market we just haven't really tapped."

As the crisis in the Gaza Strip occupies UN and world leaders, the situation on the ground eased enough to get two truckloads into the territory, Mercy Corps reported. Still humanitarian workers said food and medicine is moving at a snail's pace, and they've had to resort to buying limited supplies inside Gaza at exorbitant prices.

These photos taken by Saleh Jadallah for Mercy Corps show the state of affairs in Gaza City. About 5,000 people signed an online petition urging immediate access for aid shipments.

If you've been feeling a strong gust blowing toward the Northwest, it's probably the suction from the Gates Foundation vacuum, which seems to draw every expert from around the world into its lucrative doorway, from the World Bank and the UN to the government of Mexico and the former Clinton Administration.

UNAIDS

Peter Piot will work for the foundation through April.

Tom Paulson at the PI has an interesting interview with UNAIDS founding director Peter Piot, who will work for several months at the Bill & Melinda Gates Foundation, advising the non-profit about its global health strategy. Piot is also known for discovering the Ebola virus.

Under Piot, the UN once assessed the HIV/AIDS epidemic at nearly 40 million people worldwide infected and more than 4 million new cases a year. Later, it revised those numbers downward, slashing its estimate of total cases by about 7 million and lowering the estimate of new infections 40 percent. Some critics had accused the agency of deliberately inflating the numbers, but Piot said it was a matter of using new methodologies to assess the situation.

Here's the story mentioning problems with world health data, and here's one in which Piot comments on the Gates Foundation's plan to address HIV/AIDS in China.