Donald Trump is the face of these cuts, but the cruelty of his administration is not the only story. After leaping upward in the 2000s, global giving for health grew very slowly through the 2010s. The culture of philanthropy has changed somewhat, too, with the age of the Giving Pledge — in which hundreds of the world’s richest people promised to donate more than half of their great fortunes to charity — yielding first to the upstart movement called Effective Altruism and then to a new age of extreme wealth defined less by altruism than by grandiosity. After the Gateses’ divorce in 2021, Melinda eventually left the foundation to establish her own philanthropy; Warren Buffett, a longtime supporter, recently announced his plans to leave most of his remaining fortune in the hands of a charitable trust his own children will administer, and to give no additional money to the Gates Foundation beyond his death. After a few years of slow post-Covid decline, this has been the year that foreign aid — as the Gates Foundation’s chief executive, Mark Suzman, wrote recently in The Economist — “fell off a cliff.”
On the ground, progress has been bumpy, too, particularly in the aftermath of the pandemic emergency, when many routine vaccination programs were paused and the world’s poorest countries were thrown, en masse, into extreme debt distress. The share of the world’s population living in extreme poverty fell by almost three-quarters between 1990 and 2014, but it has hardly shrunk since.
To hear Gates and his team tell it, this is the time to go all in — given the yawning gaps produced by post-pandemic setbacks and the Trump assault, and given the promise of biomedical tools and other lifesaving innovations now in the development pipeline, and given A.I., a subject Gates returns to again and again. They even talk excitedly about a world in which the Gates Foundation has made itself unnecessary. That world sounds tremendously appealing. But — given the obstacles — can it be built?
Over two days in late April, I spoke with Gates about the state and legacy of his philanthropic endeavor, its achievements and disappointments thus far and what lies ahead. What follows is an edited and condensed version of those conversations, in which he was sunny, detailed and confident, sometimes to the point of brusque certainty, that the next few decades would yield even more radical improvements in global development than what he called, in retrospect, “our miraculous period.”
I. ‘Millions of Additional Deaths of Kids’
Let’s talk about the very present tense, with the Trump administration completely turning its back on foreign aid and leaving not just many millions of people but also most of the world’s global institutions in the lurch. How bad is it?