“[David Wallace-Wells] Were you surprised by the cruelty?
[Bill Gates] The reductions to U.S.A.I.D. are stunning. 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. We will do our best to get these things changed. I will be an advocate. But those are real headwinds.
And what’s Congress going to do? My history with Congress is that they’re very supportive. We’ve had cases during Trump’s first presidency, when he and Russ Vought at the Office of Management and Budget said, We’re going to cut PEPFAR. And Congress didn’t give it the time of day. But these are different times. And the cuts are so dramatic that even if we get some restored, we’re going to have a tough time.
I don’t think we’re going to have administration after administration who cuts and cuts and cuts and cuts these things. I see it as a four- to six-year interruption. And if we zoom out and think about 20 years from now — I do think we’ll cut childhood deaths, despite all this, because the Golden Rule was not repealed. [..]
[Wallace-Wells] One thing that worries me is that this is not just happening here. The U.S. has been a very large share of global humanitarian aid, and so the Trump cuts are devastating. But there has been a rollback almost everywhere in the world.
[Gates] Yes, in the U.K., their aid budget was up at 0.7 percent of G.D.P., then it went to 0.5 percent under the conservative leadership, and now — stunningly, as part of going to see President Trump — it’s gone down to 0.3 percent. Germany is proposing to cut its aid budget. France has big budget problems. So aid is getting squeezed. [..]
[Wallace-Wells] I’ve heard this described as a “bolus dose” approach — the medical term for an injection that gets meds into the patient’s system rapidly.
[Gates] Normally we’re saving lives for $2,000 or $3,000. But given the problems that are out there, we’re actually now saving lives for less.
And this is a miraculous time. A lot of the hundred billion we’ve spent is to build a pipeline, and the most important stuff the foundation is doing is the stuff that’s in the R.&D. pipeline right now. The tuberculosis stuff — compared with what we’ve done in the last 25 years, our TB stuff is mind-blowing. We will have a genetic cure for H.I.V., and we should spend whatever it takes to get that done, because that changes the world permanently. We’ll be able to take A.I. into our drug-discovery efforts.
The tools are so phenomenal — the way we’re going to put A.I. into the health-delivery system, for example. All the intelligence will be in the A.I., and so you will have a personal doctor that’s as good as somebody who has a full-time dedicated doctor — that’s actually better than even what rich countries have. And likewise, that’s our goal for the educational tutor. That’s our goal for the agricultural adviser. And so given that I have these resources, what can we achieve? It makes a big difference to take the money and spend it now versus later. [..]
[Wallace-Wells] I think it was 2013, when Google was rolling out a program to deliver the internet via balloons to the developing world. Was it called Project Loon? And you suggested they were sort of too focused on the technology and not enough in terms of the real problems demanding attention on the ground: “When you’re dying of malaria, I suppose you’ll look up and see that balloon, and I’m not sure how it’ll help you,” you said. “When a kid gets diarrhea, no, there’s no website that relieves that.”
[Gates] Well, the way to think of A.I. is that it’s essentially free intelligence, and in no sense does that mean it will naturally be made available to people in poor countries. It helps rich people — that’s where the market will take it. And that’s why having a big nonmarket actor like us who’s sophisticated about A.I. is so important. It’s incredible what we will be able to do.
And so you can accuse me of being by nature an optimistic person. But I just think I’m being realistic. I think it’s objective to say to you that things will be better in the next 20 years.
In any case, let’s say somebody convinced me otherwise. What am I going to do? Just go buy a bunch of boats or something? Go gamble? This money should go back to society in the way that it has the best chance of causing something positive to happen.”
Full article, D Wallace-Wells, New York Times Magazine, 2025.5.8