Twenty-five years ago, Bill Gates, then the world’s richest man, announced that he would start giving away his fortune to save lives and reduce poverty abroad and at home. Since then, the Bill & Melinda Gates Foundation, which the Microsoft co-founder established with his then wife, Melinda French Gates, has donated more than $100bn to global health, development and education.
Now Gates, who turns 70 this year, is doubling down. Over the next 20 years the Gates Foundation, renamed last year after his 2021 divorce, will give away a further $200bn. On December 31 2045, by which time Gates would be 90, it will shut down permanently. By then, Gates has committed to have spent 99 per cent of his fortune, leaving himself enough money, as he once quipped, “for my tennis racket”.
In a letter announcing what he called “the last chapter of my career”, Gates quotes Andrew Carnegie, the 19th-century steel magnate and philanthropist, saying: “The man who dies thus rich dies disgraced.” People might say many things about him, Gates writes. “But I am determined that ‘he died rich’ will not be one of them.”
Gates has generated nearly as much criticism as praise over his quarter of a century of philanthropy, with people accusing him of everything from shielding his wealth behind a tax shelter and buying influence to implanting chips in people’s brains. He has stuck to his guns. He argues that by spending his money more urgently, he can now help solve once and for all some of the world’s biggest health problems.
Among his many lofty goals for the next two decades are to eradicate polio (and perhaps malaria and measles), come up with a cure for HIV and halve child mortality from levels that have already halved since 2000 — partly thanks to programmes he catalyses or bankrolls.
The new strategy is better, he argues, than drip-feeding money and prioritising the longevity of the foundation over the problems it is trying to solve. “It gives us clarity,” he says in an interview with the Financial Times. “We’ll have a lot more money because we’re spending down over the 20 years, as opposed to making an effort to be a perpetual foundation.”
Gates reckons accelerated spending can “put the world on a path to ending preventable deaths of moms and babies”. More rapid progress is possible, he says, partly because of advances in AI.
But Gates’ intention to turbocharge his global health drive could be undermined by current political reality, with the US and other western governments drastically cutting back on foreign aid. That risks setting back huge advances in global health that no private philanthropy, not even one the size of the Gates Foundation, can achieve alone.
The attack on aid spending has been particularly fierce in the US where Elon Musk boasted in February that he was putting the US Agency for International Development “into the woodchipper”.
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Full story: Gates accuses Musk of ‘killing children’ with USAID cuts
If Gates has spent the past 25 years championing work on treating Aids or childhood vaccinations, Musk has emerged as a sort of anti-Gates, branding those causes as “globalist” and somehow anti-American. Musk, who superseded Gates as the world’s richest man, prefers to seek solutions for humanity’s problems through commercial products, such as Tesla’s electric cars, and in space rather than on Earth.
The Gates Foundation, which spent nearly $9bn last year, is the biggest philanthropic organisation in the US by some distance. But its spending does not come close to the erstwhile $44bn budget of USAID, at least four-fifths of which faces the chop. Other governments, including the UK, France and the Netherlands, are also implementing swingeing cuts to foreign aid, leaving Gates swimming against the tide.
Without US funding, Gates says his dream of eradicating polio — now tantalisingly close — will fail.
Gates stresses that innovations in areas such as TB, malaria and child-killing diarrhoea can only reach the people who need them with the help of governments, particularly the US, which has alone historically provided more than 40 per cent of international funding for global health.
“Obviously, none of this is stuff we do on our own or could possibly do on our own,” says Mark Suzman, chief executive of the Gates Foundation. “We are not the primary delivery providers. Service delivery ultimately has to be from the governments and multilateralism.”
Beyond the cuts to aid spending, there is another potential Trump-related threat looming over Gates’ plans. His foundation, like others, risks being stripped of its tax-free status.
Trump has said he will scrap the tax exemption enjoyed by Harvard University, an institution his administration considers too progressive. Similar moves against Gates have long been telegraphed. As far back as 2021, vice-president JD Vance, then a Senate candidate, called both Harvard and the Gates Foundation “cancers on American society”.
Last month, the Gates Foundation, along with several others, was braced for a potential executive order removing its charitable status. “There were rumours to that effect,” Gates says, though he adds that Trump’s legal basis for doing so might be on shaky ground. “Congress created rules under which foundations exist, including the definition of charitable purpose. It’s not at all clear that an executive order could override that.”
Gates, who contributed $50mn to Kamala Harris’s unsuccessful presidential campaign, has long striven to present his foundation’s work as scrupulously non-partisan. It has sought to meet objectives that, at least until recently, nearly all Americans could get behind.
These included reducing child and maternal deaths, tackling infectious diseases, trying to improve poor farmers’ yields and lifting educational standards, mainly abroad but also in America. These aims were couched as being in line with the UN’s 17 sustainable development goals adopted in 2015, the successor of the earlier Millennium Development Goals.
But in the Trump era, such policy aspirations, which include “gender equality”, “no poverty” and “climate action”, have suddenly become controversial. At a speech at the UN General Assembly in March, Edward Heartney, a senior official at the US mission to the UN, said the Trump administration “rejects and denounces” the SDGs, which “advance a programme of soft global governance that is inconsistent with US sovereignty and adverse to the rights and interests of Americans”.
Gates is blunt in his view of Musk, who he says will be responsible for “killing the world’s poorest children” through his demolition of USAID. But he is much more reluctant to criticise Trump directly. Last December, Gates flew to Mar-a-Lago for a three-hour dinner with the then president-elect, after which he told The Wall Street Journal that he was “frankly impressed” with Trump’s interest in innovation in vaccines and HIV.
Since then, Gates has maintained this position despite the evidence that Trump fully backs the assault on global health. After Musk’s decision to gut USAID, Trump said the organisation had been run by a bunch of “radical lunatics”. The president may not fully understand the impact of cuts, Gates implies, suggesting that, with persuasion, they might be partly reversed.
“I don’t know that President Trump is aware that these cuts will, in the case of HIV, mean that hundreds of thousands of babies are infected and literally over a million people [will die],” he says. “Both with the executive branch and with Congress, we’re going to be advocating for restoration of substantial amounts of this money.”
If Gates is cautious about antagonising Trump, he is unwilling to concede that the goals of global health and equality he has long championed are no longer shared by the American people.
“America didn’t get dramatically poorer or, hopefully, less morally enlightened,” he says. “By and large, I make the assumption that it’s OK to save children’s lives outside the United States.”
Gates was born in Seattle in 1955. His father, Bill Gates Sr, was an attorney, and his mother, Mary Maxwell Gates, a banker and civic activist. Gates dropped out of Harvard in 1975 to co-found Microsoft.
As chief executive over the next 25 years, he became known for the single-mindedness with which he turned Microsoft into the world’s most valuable company. Microsoft became such a dominant force that a federal judge in 1999, the year before Gates stepped down as chief executive, labelled it a “predatory monopoly”.
Over the first 25 years of this century, Gates has applied himself to the cause of giving away his money with the same rigour with which he accumulated it.
From spending an initial $1bn, the foundation gradually expanded. That was partly thanks to Warren Buffett, the legendary investor, who launched the Giving Pledge with Bill and Melinda Gates in 2010, encouraging several billionaires, from Sam Altman to Mark Zuckerberg, to give more than half their wealth to philanthropy. To date, Buffett has contributed more than $43bn to the Gates Foundation.
As the scope of the foundation’s mission expanded, the Seattle-based organisation added offices in India, China, Europe and several countries in Africa. Staff numbers have risen from 20 to more than 2,000.
Under Gates’ direction, it has moved ever more decisively in the direction of global health, where there have been some quick wins through sustained spending on proven interventions, says Ian Goldin, professor of globalisation and development at the Oxford Martin School. “Gates has been good about plugging holes and not changing focus,” he says. “That makes him more important than ever, with public funding at a 25-year low.”
The foundation’s modus operandi has been consistent: to use technology; to measure the efficacy of interventions; to partner with the private sector; and to address market failures.
Among Gates’ biggest bets was on Gavi, the Vaccine Alliance, to which he gave an initial $750mn grant, and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Both organisations set out to pool resources and create market incentives for the procurement and distribution of childhood vaccines, antiretrovirals and other treatments to people who otherwise could not afford them.
Gavi itself reckons that, by getting vaccines for preventable diseases such as cholera, measles and diarrhoea-causing rotavirus to more than 1bn children in lower-income countries, it has saved an estimated 18.8mn lives, more than died in combat during the first world war.
“Kids used to die at the rate of 200 per 1,000,” says Seth Berkley, former Gavi chief executive. “Now we are at the lowest level in history. What he did at Gavi was worth the Nobel Prize alone.”
By championing innovations, and often paying for the randomised controlled trials to prove they work, the foundation has scored some notable successes. One small example is the deployment of a blood-collection drape for women giving birth, a simple intervention that allows nurses to quickly diagnose post-partum haemorrhage, the leading cause of death during childbirth. They can then be treated with cheap drugs also developed with Gates’ money.
The foundation’s single biggest spending item has consistently been on polio eradication. Though stamping it out has proved fiendishly complicated, paralysis in children has dropped dramatically. Since the late-1980s, worldwide cases have fallen from 350,000 to a few hundred new cases in 2024.
As Gates points out, if polio can be added to the roster of eradicated diseases — the only other one is smallpox — then spending on prevention and treatment would fall to zero, freeing up resources to tackle other problems.
Gates says the foundation will continue to spend in proven areas, particularly in health, as well as education, and seek ways to further lower costs of life-saving medicines. He will also continue to spend money on Alzheimer’s research.
Massive cuts to aid funding could set back progress by years, he says, adding that their “abruptness” would have immediate negative impacts as well as long-term ones. “You have HIV medicine sitting in warehouses . . . food sitting in warehouses, you have demographic health surveys that are halfway completed.”
The foundation has said that, depending where cuts finally land, it may adjust spending to try to plug some gaps. But Gates makes clear it was in no position to undo all the damage. “It’s a tragedy and if we don’t get reversals [of US government cuts], then we’ll have literally millions of deaths as a result.”
When Gates set out to spend his fortune 25 years ago, he probably had little inkling of how controversial his philanthropic endeavours would become. Long before Musk and Trump had him in their sights, many from the other end of the political spectrum attacked him for being what they saw as the epitome of the influence-peddling, know-it-all billionaire.
Journalist Tim Schwab excoriating 2023 book The Bill Gates Problem accused him of using the foundation as “political tool, tax break and PR machine”. Schwab told one interviewer: “His influence in world affairs only really makes sense if you believe that the richest guy deserves the loudest voice.”
Even admirers have been uncomfortable with the idea that one man — however clever or well intentioned — should have such a profound influence over global priorities.
Gates’ reputation as a do-gooder has also been tarnished, first through an acrimonious divorce with Melinda — who now runs her own philanthropy, Pivotal Ventures — and even more damagingly by an association with Jeffrey Epstein. Gates has said meeting Epstein was a mistake, but insists he had no business relationship or friendship with the convicted sex offender.
Gates says he is open to the questions raised by Schwab and others about whether billionaires should pay more tax. He supports a strong estate tax to short-circuit the accumulation of “dynastic wealth”, he says. But he stops short of agreeing with more radical proposals. “Bernie Sanders thinks there should be no billionaires at all,” he says of the senator from Vermont. “And you know, maybe I’m biased, but I disagree.”
For Gates, the biggest outrage has been the backlash against vaccines, which he calls a “fantastic tool” and which many health experts regard as perhaps the single most cost-effective health intervention. “Would you have expected the US government to have as leader of its health system somebody who’s attacked vaccines and specifically my role . . . with a lot of falsehoods,” Gates says, referring to Trump’s appointment of Robert F Kennedy Jr, a vocal vaccine sceptic, as US health secretary.
Health experts say that the attack on development aid leaves the world vulnerable to an upsurge in infectious diseases, from measles to polio, an impact that will be felt first in poor countries but one that could eventually rebound on the west. Pandemic preparedness could be another casualty, warns Suzman, the foundation’s chief executive.
Hassan Damluji, a former Gates Foundation employee and director of think-tank Global Nation, says Gates has studiously avoided politics, but that politics has engulfed him anyway. “They picked saving kids’ lives precisely because who could have a problem with that?”
Suzman says: “We continue to believe that, when it’s explained clearly to both political leaders and US citizens or UK citizens that their marginal dollar or pound . . . is going to save a kid’s life, they’re very comfortable spending that.”
It is a conviction that, over the next months and years, will be severely tested.
Data visualisation by Jana Tauschinski
