Investing Bill's and Warren's money

For Dr. Regina Rabinovich, the director of the program for more than three years, it's with great care and strategy. She's in charge of a $1.5 billion fund to fight infectious diseases like HIV, malaria and bird flu--a mounting threat around the world.

"We're trying to create a 'global access strategy.' That means if (a potential vaccine) is funded, what is the plan to deliver access to the developing world," said Rabinovich, speaking here Tuesday at the Dow Jones Venturewire Healthcare Innovations conference.

Rabinovich's talk comes less than three months after Berkshire Hathaway's Buffett announced he would give the lion's share of his estimated $44 billion net worth to the Gates Foundation, in a gesture of generosity and longtime friendship with Microsoft co-founder Bill Gates. Rabinovich said during her talk that the day after the announcement, the Gates Foundation received as many as 300 e-mails and faxes an hour, asking for grants or offering congratulations. At least 25 percent of those communications were asking the foundation if it needed more donations, she said.

"That just reflects the amazing and untapped potential (out there), if we could only figure out how to engage it," she said.

She said Buffett's donation hasn't meant immediate change to the Gates Foundation because the money is on a gradual investment schedule. The first major installment came last month in the form of Berkshire Hathaway shares worth roughly $1.6 billion. But she said the Gates Foundation has already been in a rapid growth phase that could only be furthered by Buffett's charity.

In the six years since the Gates Foundation was established with $100 million of his own money, it has doled out grants in the amount of $9 billion--$6 billion of which has gone toward global health. The other grants have gone toward education and economic development.

Yet she acknowledged the hurdles of growth: "It is a challenge to keep up the quality of the program and double resources," she said.

The program's strategy is to invest in high-impact areas of the developing world that are neglected when it comes to funding, such as Nigeria, Rabinovich said. The foundation looks especially hard at investing in ways to ensure that medical breakthroughs--such as a new vaccine--have a pathway to reach the people who need it. Plenty of vaccines are developed, but never reach the needy. Part of the distribution equation is a better use of technology, she noted.

Talking to a group of health care investors and U.S. start-ups, Rabinovich turned her focus to whether private industry can do more for global health than governments. Rabinovich said that everyone can do more and that partnerships between private and public entities could prove beneficial to the cause. The Gates Foundation doesn't invest in private start-ups, but rather in universities, medical research groups and nongovernmental organizations that can partner with industry to bring better health care to the developing world.

So far, Rabinovich said she has made between 160 to 180 grants, mostly in the range of $10 million to $50 million. She acknowledged some jealousy of VCs that can jump into the finances of a start-up, invest quickly and chart the companies' course by joining the board of directors. Resources at a foundation like hers don't lend to that kind of relationship.

"We do fewer grants but they take a lot of work. That said, (the foundation) can move quickly when incentives are driven by the need," she said.