The Gates Foundation will shut its doors. Fortune sat down with Bill Gates and Melinda French Gates about the decision and the commitment to spend $200 billion over the next 20 years.
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00:00If you're a billionaire in the United States, you benefited from this country.
00:03We owe something back to society.
00:05Unless the rich countries stay generous, then the progress is going to stop and may even go into reverse.
00:13Over a billion children have been vaccinated.
00:15We cut the childhood death rate, came down in half.
00:19The Gates Foundation is one of the world's biggest, richest, most influential private philanthropic organizations.
00:26It prides itself on being practical, asking questions others weren't asking, and creating solutions.
00:34How can a disease that kills millions of children have so few people involved in it?
00:40The basic criticism is they're too big and powerful.
00:44The Gates Foundation has decided that we will commit to spending $200 billion over the next 20 years.
00:52We will then close our doors.
00:53So with the U.S. and other countries increasingly pulling back on foreign aid...
00:59Trust takes a long time to build, but you can take it away so quickly.
01:05Can the Gates Foundation achieve their lofty goals over the next 20 years?
01:10You know, at the end of the 20 years, there will be many other rich people.
01:14The vast majority of those resources were to go back to society.
01:18The Gates Foundation will shut its doors in 20 years.
01:25Since the pandemic, foreign aid from governments of rich countries has been declining.
01:30And that's the base on which private philanthropy builds.
01:34Our biggest question, will philanthropy be able to function with a weakening infrastructure?
01:39Bill Gates and the Foundation have made a huge pledge of $200 billion, but will that pledge go the distance?
01:47I mean, I think sort of conveying the scale of this is one of the big challenges.
01:52Like, how do we get across how momentous this decision is?
01:56I mean, it almost seems like a kind of tech mindset, right?
01:59Like, it's like they're 10X-ing it, probably a legacy of Bill's background.
02:04The total devotion to data, which he had to have developed because nobody else in the world was developing it.
02:12It's the idea of doing something that hasn't ever been done before or seen before.
02:16Right.
02:17Yeah.
02:19We've always believed in having a limited lifetime, but we've actually now made it specifically 20 years
02:26that we'll spend all of our resources.
02:30And so between the additional money that I'll put into the Foundation and the money that's there,
02:36over these next 20 years, we'll spend a bit over $200 billion.
02:40And so we'll be able to spend at a pretty high rate, and that'll give us a chance to make a great deal of progress,
02:47we think, on the key issues.
02:50I'm not aware of any significant Foundation that has named an end date 20 years in the future.
02:59And the other thing that I think is unprecedented is simply the amount that you will have disbursed.
03:05Is that correct?
03:07There have been spend-down Foundations.
03:10Most of the largest have had sort of indefinite timeframes.
03:14Rockefeller Foundation and others, you know, were created a long time ago, and they're still doing great work.
03:23So for a Foundation our size, this is unique.
03:26And, yes, it sets some records in terms of the amounts involved.
03:31You know, other people could later beat it.
03:33I hope they do.
03:34So you mentioned the Rockefeller Foundation, there's the Carnegie Foundation, both over 100 years old and still, as you say, giving money to worthy causes.
03:43So why not do that?
03:45Well, the Gates Foundation is fairly operational.
03:48That is, you know, we built teams that are experts on malnutrition, malaria, contraception,
03:56and we fund both the research to create new products and get them to be very inexpensive.
04:02And then we partner with governments and other philanthropies to actually deliver those to where they're most needed.
04:10By spending the money sooner than later, it allows us to be very ambitious about getting polio eradication done.
04:20We hope in this time frame that malaria is either done or almost done.
04:26And we can kind of clarify, okay, here's what we've got, you know, and say to other people, okay, we can't do these other things, so let's work together.
04:37Because certainly both of our key areas, health and education, you know, our resources are nowhere near enough to achieve what everybody should want the world to do.
04:48Would it be fair to say that the Foundation is very data-driven?
04:54Yeah, we're very data-driven.
04:56I mean, what other ways is there to be?
04:58I mean, you know.
04:59Well, but maybe others don't do it as much as you do, or so I have heard.
05:02Sure, but you only need, you don't need everyone to go off and do the analysis.
05:09But, you know, when I was asking in the late 90s, what do children buy of, you know, there were only sketchy answers.
05:20Before the Gates Foundation, many public health decisions were based on educated guesses.
05:26That led Gates to spend $75 million in 2015 to start CHAMPS, a global network to accurately map the causes of death in children under five.
05:38That information helps organizations like Gavi, also a Gates partner, to assess vaccination needs worldwide.
05:46But 90% of Gavi funding has come from governments.
05:50If you think about philanthropy, philanthropy is a catalytic wedge, sitting alongside business, government, and civil society.
06:00We were writing about the 25th anniversary and this big announcement, but now we're also writing about whether or not the Gates Foundation can really fill the gap that foreign aid is now diminishing.
06:13And people would be surprised, I think, that even the Gates Foundation, even one of the richest people on this planet, isn't rich enough to do everything that needs doing to get these vaccines where they need to be.
06:27When I was in South Africa traveling for the story, it was actually the same week that President Trump announced that he was going to be dismantling USAID.
06:36We're going to the Desmond Tutu Foundation to learn all about HIV prevention methods in the community.
06:42I got to see firsthand where the Gates money goes and speak with some of the recipients of the funding on the challenges they face ahead.
06:51When we were seeing these clinics in a certain village right outside of Cape Town, they were saying we would never go to a clinic that had HIV right on the sign.
07:00And that it's so important to think about how delivery is done to break some of those stigmas.
07:05Another thing the Foundation is up against is growing health misinformation and vaccine skepticism.
07:10It's so much more than just the production of the vaccine, because there's tons of community work that goes into building trust.
07:17I am here in Parle, South Africa.
07:20This research center has a huge youth initiative component.
07:23When the global health ecosystem is so complex, it makes it clear just how much eradicating HIV, malaria, and TB will cost.
07:32People, I don't, when they see the Gates Foundation, I don't think they understand the nuance of just, of the scale of ambition.
07:40This is actually a sculptural exhibit in honor of Bill Gates Sr., our chairman emeritus, really, in many ways, the heart and soul of the foundation.
07:50He helped start it, helped drive it through his lifetime.
07:52And he passed away five years ago, and actually during the COVID pandemic, this sculpture was put up in place and was awaiting everyone when we came back to the offices.
08:03And it symbolizes Bill Sr. is indeed the lead crane and taking us towards the future, the aspirational future of the foundation.
08:11We think, based on the lessons we've learned over the last 25 years of the foundation, that we can make a transformative impact over these two decades.
08:23Tuberculosis, HIV, and malaria make up the three largest infectious disease killers that, you know, disproportionately affect poor countries.
08:31And we'd love to see a world where all of those are eradicated.
08:34But we understand for both tuberculosis and HIV, it likely will be a bit more of a stretch by the deadline that we're giving ourselves of what can we do by under 2045.
08:44I think our hope is more that we can control those diseases and bring mortality and incidence rates down in, you know, low-income countries to where they are in a country like the United States today.
08:55And so this gets to what I think is the central question for the foundation, or any foundation, which is, okay, you have a wonderful goal.
09:05There are a million ways to reach it, and you have to decide what's the best way.
09:09What has been the way you've done that so far?
09:12What is the appropriate role of philanthropic capital, as opposed to private or public capital?
09:17It's a very specific, it's tax-privileged, it's an advantageous thing, how can it be put to its best use?
09:25And the first thing is it should never substitute for either public or private capital.
09:29It should be looking to fill the gaps that either those forms of capital won't fill.
09:35An example would be, and one of the big examples, is in research and development and innovation for many of the diseases that disproportionately impact the poorest.
09:43Malaria is often a classic example of that, but global malaria research and development is a fraction of what it could and should be, given that mortality volume.
09:53And yet we're able to come in and be extremely large catalytic funders in that space, working with the private sector, because we work with private sector partners, pharmaceutical companies and others, to catalyze the innovation the private sector provides,
10:07and then working with the public sector, government, multilaterals, to help deliver those services.
10:13As with malaria, the Gates Foundation saw an opportunity with tuberculosis, a preventable disease that killed more than 1.3 million people in 2023.
10:25The foundation responded by funding a vaccine accelerator program that could help lower the cost of the vaccine.
10:33But as vaccination rates fall around the world, the Gates Foundation will need to do much on-the-ground work to get results.
10:44I still think a large part of the story is still the future of philanthropy and the urgency we're seeing right now.
10:51Because right now we're sitting down and, you know, we're thinking about the threats we're seeing to foreign aid and how the private sector plays a role.
10:58So I think we're trying to sort of balance the reflections of the last 25 years and what this means going forward.
11:07What would you say is the foundation's most impactful achievement?
11:13I will say there are, honestly, there are many.
11:16But I would say the fact that, you know, because of this global alliance for vaccines and immunizations that we were part of founding,
11:22there are literally children alive because of that program, you know, it touched over a billion children have been vaccinated.
11:33And, you know, we cut the childhood death rate, came down in half, in half, you know, since the beginning of that.
11:41So when I go around the world and I meet mothers and fathers, they walk miles for their kids or they save up the bus fare to get those life-saving vaccines.
11:51What have you learned about how the world's most fortunate should be giving back?
11:57Well, I've always believed to whom much is given, much is expected.
12:02And so anyone who is lucky enough to be wealthy in society, like I'm unbelievably privileged to have the resources I have.
12:12But anyone who has resources has something to give back, right?
12:18And we should.
12:19And even if you don't have great means, if you have a little bit, you can still give back your time.
12:25You can tutor a child.
12:26You can work in a soup kitchen.
12:28You can give away clothes and things you don't need anymore or buy a Christmas present or birthday present for a kid who's, you know, in a homeless shelter.
12:36I've learned so much from philanthropy, but it's more and more reinforced for me that we ought to do more.
12:45We ought to do more for our fellow neighbors.
12:47And so in your perspective, there is this moral responsibility for billionaires in this day and age.
12:53Yeah, we look, if you're a billionaire, let's just say if you're a billionaire in the United States, you benefited from this country.
13:00You benefited from good roads.
13:02You probably benefited somewhere along the way from the health sector, I hope.
13:06You probably benefited because maybe it was a good business climate and you could start your business, right?
13:11People in other places don't have those things.
13:14And so, yes, we owe something back to society.
13:18And there are lots of ways to do it.
13:20You don't have to do it in any one way, but sure, we were lucky.
13:24So we're talking a lot about progress around global health, but I'd sort of be remiss to not ask about some of the threats that we're currently seeing facing global health policy today.
13:34The new administration nearly immediately is trying to dismantle USAID.
13:39What was your reaction to this?
13:41Lives have been saved because of the grants from USAID, and it will be devastating what will happen in some of these communities.
13:50The U.S. has built up lots of infrastructure around the world, labs for things, making sure there are nurses trained or midwives trained.
14:01But we have infrastructure out there, so we're going to pull back and let all of that crumble.
14:07And I'm not saying the organization was perfect.
14:09Yes, there were some things that need to be looked at.
14:12Yes, there probably were some trimming that needed to happen.
14:14But what I know and what I have seen on the ground are mothers and fathers who benefit from that.
14:21And guess what?
14:22If they can prosper in their own community, if they can have good health, their kids can have good health, and by and large, most of them are farmers.
14:30They can feed their family.
14:32They're going to stay where they are.
14:34People don't want continuous handouts.
14:37They want to be able to have their own income.
14:39So if they can get seeds and plant their farm and get a good yield of their crop, feed their children, put a little bit on the market, they're grateful.
14:50But if we now just suddenly, in a big whoosh, pull back on that, can you imagine what they're going to think about the Americans and American government?
15:00Trust takes a long time to build, but you can take it away so quickly.
15:06And I think we need to be much more careful as a nation.
15:09Unless the rich countries stay generous, then the progress is going to stop and may even go into reverse.
15:17And so, you know, telling these voters, hey, you should be proud of this.
15:22It is moral.
15:24It serves a lot of benefits.
15:25You know, I'll be doing my best to articulate that.
15:28That uncertainty means that how much we'll achieve in the next 20 years, that's probably the biggest unknown, is do our fellow travelers stay generous or do they kind of tune out these millions of deaths and turn inward?