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World in microcosm Hyderabad, the capital of Andhra Pradesh, is like much of India -- a land of extremes. It is both an ancient center for Islamic culture and India's "most wired city." Dubbed "Cyber-abad," it is home to Microsoft Corp.'s largest software-development center outside the United States, and the source of nearly one-quarter of India's software production -- a huge export. "This is where it's happening," said Swain Porter, a former Microsoft executive who moved here several years ago to launch his own high-tech company, Catalytic Software. Porter offers all his Indian employees a modern home as well as a job. On the rugged, rocky outskirts of Hyderabad, he has founded a company town producing low-cost software. New Oroville, named after Porter's hometown in Eastern Washington, looks like a sci-fi novelist's vision of a Martian outpost, with space-agelike white concrete domes dotting the landscape like giant puffball mushrooms. "This is a visionary part of India," Porter said. "I'm excited to be a part of it." The experiment took shape in 2000, when Gates met Chandrababu Naidu, Andhra Pradesh's chief minister, at the World Economic Forum in Switzerland. Gates was about to launch one of the biggest endeavors in the history of world health -- the Global Alliance for Vaccines and Immunization, or GAVI. Naidu had come to the forum to talk to Gates about information technology. But the Microsoft chairman quickly turned the conversation from software to disease. GAVI would soon be getting basic vaccines to millions of kids in Africa, Asia and other poor regions of the world. Gates, well aware of the international community's short attention span and tendency to lose interest in "chronic" health needs such as immunization, decided it needed proof that the approach can work. Andhra Pradesh, home to 75 million people, is an intriguing choice as the laboratory. Beyond the state's promising urban centers are some of India's poorest and least-developed communities. Most of those occupying hospital beds in Hyderabad have come from outside the high-tech city, from villages where few have running water or electricity. "It is rich and poor, making progress here and moving backward there -- the world in microcosm," said James Cheyne, an immunization specialist who left the World Health Organization to join the Program for Appropriate Technology in Health, or PATH, and help run the Andhra Pradesh project. "It's a perfect place to test the Gates strategy." Hepatitis B vaccine had never before been offered to the general public in India. When the project started, Cheyne said, remote parts of the state had some of the lowest immunization rates in southern India. Naidu and other officials questioned why -- with all of the country's other more basic health needs -- this project was focused on introducing a new vaccine. "We had to sell them on why we felt the hep B vaccine should be given such high priority," said Madhu Krishna, head of PATH's office in India. "We were asking the government to put money into this project as well, but it's not a disease with a high profile. There was some political opposition to it." The vaccine was attractive to PATH and the Gates Foundation because it is desperately needed, with studies indicating that one out of every 25 people in India (40 million) are already infected. Most will die as adults, of liver failure or cancer. 'It can be done' By almost any measure, progress over the past few years has been stunning. Working with the government, PATH has trained more than 30,000 health workers at thousands of clinics, reached more than a million newborns with the vaccine and strengthened the basic public health system. These Gates-funded "special ops" health teams have fanned out across Andhra Pradesh, attacking weak links in the "cold chain" vaccine-refrigeration system; most vaccines need to be kept cool. In one case, PATH dumped 140,000 doses of bad vaccine and either brought in new vaccine refrigerators or fixed the old ones. PATH also worked with medical colleges to encourage faculty members and students to supervise care at rural clinics. The organization introduced a number of methods and devices to make immunizations safer, such as PATH's lead invention -- the single-use, "auto-destruct" syringe. The Seattle organization also helped local officials develop a system for investigating problems with immunization, such as adverse reactions, to ensure public confidence. In addition, PATH helped an Indian biotechnology company launch a vaccine-research project aimed at encouraging local control over the supply and reducing dependency on Western drug companies