On Thursday, Bill Gates announced a new, faster timeline to give away his fortune — and close the doors of the Gates Foundation, one of the world’s leading global-health philanthropies.
Over two days last week, he spoke to me for an exclusive interview to explain his decision — and why it made sense to him, at a critical moment in public health, when the Trump administration’s steep cuts to foreign aid have thrown many global-health priorities into jeopardy.
Here are some of the key takeaways from that conversation.
Before the foundation shuts down in 2045, Gates has committed to it spending $200 billion, beginning now.
All told, the foundation has spent $100 billion over 25 years. It now intends to double that over the next two decades, focusing on three key goals: that “no mom, child or baby dies of a preventable cause”; that “the next generation grows up in a world without deadly infectious diseases”; and that “hundreds of millions of people break free from poverty, putting more countries on a path to prosperity.”
These are astronomically ambitious goals, but Gates and his team believe they can be achieved in a compressed timeline — just 20 years, instead of an original vision that would have lasted for decades longer — and he is pouring nearly all of his remaining fortune into making it happen.
In the next 20 years, Gates believes, progress will be ‘incredible.’
“This is a miraculous time,” he told me, with the most exciting work the foundation has ever done sitting in the R.&D. pipeline now, waiting to be delivered.
It was almost hard to keep up with his survey of breakthroughs: on H.I.V., on tuberculosis, but also on more obscure and neglected diseases like lymphatic filariasis and visceral leishmaniasis. He predicts that maternal-mortality rates in the developing world could be brought into rough parity with those in the rich world, and that childhood deaths could be cut in half.
But in the short term, Gates predicts that childhood mortality will increase in Trump’s term — and not by a little.
Given the various cuts imposed by the Trump administration, Gates says he expects childhood mortality to go up by a million additional deaths per year.
He was stunned by the breadth of the foreign-aid cuts and puts future childhood deaths in Elon Musk’s hands.
“The world’s richest man has been involved in the deaths of the world’s poorest children,” Gates told me, exhibiting a rare burst of real anger about the cuts to U.S.A.I.D. “He put it in the wood chipper, because he didn’t go to a party that weekend.”
Those cuts, he says, were much larger than he anticipated:
I thought there’d be, like, a 20 percent cut. Instead, right now, it’s like an 80 percent cut. And yes, I did not expect that. I don’t think anybody expected that. Nobody expected the executive branch to cut PEPFAR or polio money without the involvement of Congress. What’s going on with H.I.V. research and trial networks, I didn’t expect that either.
It isn’t just America: Other leaders of rich nations are squeezing their aid budgets.
“Take Keir Starmer,” Gates told me.
A day before he’s supposed to fly and see Trump, and he’s like, Oh, my God, I’ve got to show that we’re serious about defense spending. He’s in some meetings saying, OK, how do I increase defense spending from 2.1 percent to 2.3 percent? And somebody says, We could cut the aid budget from 0.5 percent to 0.3 percent. Nobody says, Hey, what about those kids who won’t get vaccines?
Gates calls A.I. a ‘magic wand.’
Throughout our conversation, he returned again and again to the promises of A.I. — not just in the area of drug discovery, but as part of a better delivery mechanism, to make sure that those in need can actually access the world’s most powerful tools.
“The way to think of A.I. is that it’s essentially free intelligence,” he says, “and in no sense does that mean it will naturally be made available to people in poor countries.” But if it is made available? “It’s incredible what we will be able to do.”
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