LIVE: The Gates Foundation makes an announcement about its future

Well, good morning. You know, I'm not one for looking back much, but we've got such incredible anniversaries this year and particularly the 25 years of the Gates Foundation. During the 1990s, Microsoft was doing very well. And so that's when I was thinking, okay, what am I going to do with this wealth? How much should go to the kids? How much do I want to consume? And how should the bulk of it go back to society? And I was trying to figure out if there was anything dramatic, anything that would be significant that could be done. Obviously I was spoiled by the computer revolution and how digital tools, including the software from Microsoft, had made a big difference. And it made me think about innovation, surprising innovation that could do big things. And so as I was studying foundations from the past and the work they had done, one of the articles I ran into in 1997 by Nick Kristoff, who's here with us today, talked about deaths from diarrhea. And I wrote a note on it to my dad saying, hey, this could be something we could help with. And it was through that journey that I came to understand that there was a rotavirus vaccine, which is the cause of most real deaths, and it was being given to the rich kids but it was not available to the rest of the kids in the world. So it was deeply ironic that we'd invented this thing and yet it was far too expensive and there was no funding to get it to all the world's countries. And so that was the kind of opportunity that made me super enthusiastic. So it was in the year 2000 that I made the first big gift to the Gates Foundation. It became the largest foundation in the world. I can't say enough how my parents drove my values and specifically pushed me to be philanthropic. My mom talked about to whom much is given, much is expected. Tragically, she died 32 years ago, but she really shaped me in a very strong way. My dad was also quite amazing, not only encouraging me but also he was around to help out. In fact, my dad and Patty Stone is here, did amazing work getting the foundation going while I was still full-time at Microsoft. This picture of my dad with Nelson Mandela and Jimmy Carter holding babies infected with HIV is part of a trip they made to Africa. It's one of my favorites. They were attacked at the time by the ANC as being agents of the pharmaceutical companies because Thabo Mbeki was sort of denying that HIV was caused by the virus. And so it was a very controversial thing. The person other than my parents who influenced me a great deal is of course Warren Buffett. Warren influenced me before I met him in 1991. He wrote an article about giving all your money away and how leaving large sums to kids sometimes wasn't even a favor to them. And so people should think in a generous way like he was. I learned so much from Warren, both his advice to me and his example. Of course in 2006 he decided that some of his wealth would be given away through the Gates Foundation, probably the most generous gift ever given by somebody to someone else's foundation. We've received over $43 billion in stock from Warren. And he continues to be very generous. Of course it was very poignant last Saturday when at his 60th annual meeting he discussed that he'll be stepping down as CEO of Berkshire, but he's still as wise as ever and had fantastic messages as part of that annual meeting that I was on there with them. So the foundation so far during the 25 years has given away a little bit more than a hundred billion dollars.

We started in 2001 giving a bit over a billion. You can see that it grows, including particularly after the Buffett gift in 2006, and then you can see what it's been spent on. We picked two big causes, education and health, would be our main ones. Health here we've split into two categories. Our health work is both discovery where we create new tools and make them very very inexpensive, and then healthcare delivery where with partners we finance these tools so they can get out to everyone in the world. The discovery piece, we can fund a lot of that ourselves. Areas like malaria, TB, we're big funders. We invite other people in. But the place that we're not nearly large enough to achieve what should be done is in the delivery piece. And that's where we've had other philanthropies but also rich world governments that have given between 1 to 2% of their budget for these global health causes. And the work in global health in terms of measuring the results, making sure we're having impact, from the year 2000 to today we've come a long ways. A lot of this can best be summarized in terms of saving lives. Now it's daunting when you talk about saving millions of lives or tens of millions of lives. It's somehow not as evocative if I put up one person's picture and said we saved that person. But in fact we can think of the parents and the communities and how impactful this is. In fact we got a short clip that hopefully will bring that home.

Two very specific memories for me are one is being in a malaria ward in Kenya with over 40 children and being told that half of those kids would not survive because of the malaria they were experiencing. Another experience was in South Africa where I was meeting with the parents of a child that had died and they had been asked for permission for us to do a what we call a minimal invasive autopsy which allows us to see exactly what caused the death. And the parents talked about how they were proud to give permission because it would mean that less parents would have to go through what they were going through. So the overall picture is the graph that's my favorite ever showing this progress. Childhood deaths have been coming down for hundreds of years, but the period by far of the greatest progress reducing childhood deaths is the last 25 years. It was almost 10 million at the turn of the century and now a bit below 5 million. Now, how do we do it? That's something to wish for, but how do you achieve it? Well it turns out children die of a pretty modest number of things. Two of the diseases are pneumonia and diarrhea and as I said there were great vaccines but only available in rich countries. And so we funded the creation of new vaccines for pneumococcus and rotavirus and we got the price of the rotavirus vaccine down to a dollar. This is a pneumococcus vaccine. We got that down from over $30 down to now $2 and we have a roadmap to get it down to a dollar. And so there was a lot of upstream work that we did but the key partner was Gavi that we played a role in creating at the very beginning of the foundation and it pays for these vaccines for the poorest country and it's just miraculous the role that they've played. Another big disease, somewhat of children but also adults, is HIV. And it was soon after the turn of the century that President Bush created both the bilateral program PEPFAR and had the US be the most generous participant in the multilateral Global Fund that also works on malaria and tuberculosis. And the work of the Global Fund has been unbelievable. We've made sure there's new drug regimens that are safer and cheaper and made advanced purchase commitments to those and then Global Fund takes and works with each of the countries to come out with a plan of how to get those delivered. We have incredible HIV tools that are recently discovered. Lenacapavir from Gilead is a shot that if you get you're protected for six months and we're going to drive the price of that down. Merck is far along in a trial on an oral just a pill which we'll be able to make very cheap that also is a protective and further out is a way of using gene editing not only to cure sickle cell but also to cure HIV. And so we're going to turn that into a single shot that can be very inexpensive. The progress on malaria is not quite as dramatic as the other diseases. This is a tough disease. COVID was a setback in terms of delivering these tools. Also with malaria you constantly get resistance. For a while a drug called chloroquine worked but then chloroquine resistance spread throughout Africa and that was a huge setback. Even the bed nets that we created, that first generation of pyrethroid bed nets, the mosquitoes evolved around it and so we had to move to what we call the dual insecticide bed net. That's this one here. By making big advanced purchase commitments now the cost of this net is down at about $5 which is same as that first generation net was. We have incredible tools in the pipeline. One of them is called gene drive which is a way of either making it so mosquitoes can't carry malaria or that we reduce that mosquito population. So even though it's been a tough one, we do think there's a real chance in the next 20 years to eradicate malaria. One thing that whenever you look at these statistics important to remember is that the portion of the babies born in Africa is going up quite substantially. At the turn of the century it's like 15%. Now it's over 25%. And so we wish the babies would choose to be born in Scandinavia but in fact somehow they're choosing to be born in northern Nigeria which makes it a challenge to make sure we give them what they deserve. The last global health thing that I'll mention is the work that we do on polio. Polio eradication started in 1988, before we were involved in any way. And that's Rotary International and other partners going after it. And as you can see here, they made very very rapid progress to get the numbers down. But the inset shows you recently, even though we're down at a small number of cases, it's been very hard. We have cases in Pakistan and Afghanistan that we've never gotten to zero. We have cases in Africa where a so-called vaccine derived type two form of the virus has gotten out and it's affecting a lot of children there. So we have to solve Pakistan, Afghanistan, Africa and we have to continue to raise the money for this effort so that we can take it all the way to zero.

I mentioned that education was also a big focus. We don't have the same miraculous result like twice as many people getting college degrees but there are some exciting important things that have been done. This shows you college completion rates going up. We've been able to back a lot of exemplary institutions, some great charter schools. A lot of the big universities, ASU, SNHU, WGU have been increasing their enrollment and doing very high quality work. We work on curriculum partners like Zearn, Illustrated Math, Carnegie, Khan Academy, which is now bringing AI tools into the classroom and showing great progress there. Over 20,000 students who've gotten scholarships that we provided going on to do incredible work. And another area for us has been agriculture and that might be surprising and yet when you study what the poorest in the world do and how you can lift them up, making sure that their crops are more productive or they suffer less seasons where they have a crop failure, it's a very big deal and in fact these crops are very challenged by climate change. Africa is a net food importer. But even despite the population growth and climate change, we think by improving the seeds, getting them better advice, better access to fertilizer, Africa can become a net food exporter and we can get more nutritious foods to the children. We do things like take chicken genetics and crossbreed to have chickens that lay more eggs, a lot more healthy. And we have over 200 million of those chickens that have gone out to raise women's income.

Well, I won't be able to touch on all the areas the foundation works in. Here I list some of the others. Our work on pandemics, the creation of the Giving Pledge, early work to get computers into libraries and have access there. Tuberculosis, the largest infectious disease killer where we have an incredible vaccine trial outstanding. Sanitation, digital finance, family planning where we have new tools like very low-cost hormonal IUD that will be very impactful. So there's a huge pipeline of innovations in all the areas that we work in. As Mark mentioned, in a way this is a surprising time to come together and state our optimism about what can be done because we are in an incredible crisis. The funding cuts, the money that's been cut off from the US in a very abrupt way. The pressure on Europe where partly to raise their defense budgets, they're cutting their aid budgets where they've been the most generous over time. It is tragic and what it's going to mean is that for the first time in a long time, that childhood death number is going to go back up. And so what we're facing is millions of additional deaths. Now I believe that the case we'll make to the rich countries to restore this money where we ask for somewhere between 1% to 2% of their money to save these tens of millions of lives, to create stability and growing economies and to create the capacity to avoid pandemics emerging and sweeping worldwide, that proposition will get these resources restored over time. Also on our side of course is an increase in very generous philanthropists. We have a number of our great philanthropic partners here today. Tobacco is one of the programs that there's been great progress and we're not the large funder there. Actually Bloomberg who works with us in many areas has been the leader in all of that. So you're going to hear more from us on this crisis. In late June we have a Gavi fundraising in Brussels. And I'm afraid it probably won't be very good news. The metric is can we raise as much as we did 5 years ago or is it going to be 50 or 60% as much and that's going to mean not being able to buy vaccines that we've been able to in the past. The pipeline of innovations, I'll just mention a few that I'm thrilled about. We're finally getting to the bottom of malnutrition. We're getting new tools that babies that are born prematurely, we can help their lungs develop so that they don't die of asphyxiation. I mentioned the malaria gene drive, the HIV gene edit cure. Some of our interventions are not as complex and technical as those. One of the ones that's had miraculous results is using this drape which you put under a mother while she's delivering and it's got a little cup in it that'll show you how much bleeding has taken place. And so we showed that with a very low threshold you can save over 70% of the lives where tragically a woman would bleed to death because once you see that then you give these $2 of drugs that absolutely stop the bleeding. Our innovation pipeline is being accelerated substantially by the use of AI. AI tools to understand biology in the cell. But what many people probably don't appreciate is how dramatic the use of AI will be for equity. We're going to use AI for delivery and so everyone talking their local dialect with their cell phone will get fantastic health advice. Every farmer will hear about the weather, understand their soil, what seeds they should plant, what the prices are, and so they'll get advice that's better than what even a rich farmer gets today. And AI tutors, things like Khanmigo and being done by many partners, are already showing great promise to help in education. So these are some of the reasons we say the next 20 years can be more impactful. As part of this, something I've been thinking about for several years is being announced today, which is my commitment to put virtually all my wealth into the foundation. This is a pretty simple chart that just shows my wealth has gone up and now will go down. It doesn't go all the way to zero, but 98% of the way there.

And to close, what's it all about? What are the values? What are the dreams? It's about ending the scourge of infectious disease. It's about having mothers survive, kids be well-nourished, great education that can lead people to prosperity. Now, we won't achieve all of these things completely in the next 20 years. But I think we can with the kind of partnerships and support from people here we can go a long ways and I'm very excited about that. Thank you.

Well, I'll be 90 by the time it's all given away and I'll make sure I have enough to buy pickleball rackets, tennis rackets, various things. I'm mostly taking care of supporting my kids in a generous way. So the money's there for the foundation and it's the combination of that money plus the money that's already in the foundation trust with pretty modest assumptions about returns that makes us confident that we'll have over 200 billion of resources during the 20-year period.

This year is pretty unusual for me. My dad would be 100. I'll be 70, which seems like a very old age. Microsoft celebrated its 50th anniversary and I got to do that with Steve Ballmer and Satya just a few weeks ago. And I'll be 90 in 20 years and I want the Gates Foundation, which has great people, great partnerships, to be able to go full speed ahead. There will be other rich people alive and energetic and they'll understand the geopolitics 20 years from now. They'll understand what AI has done or not done 20 years from now. So I'm not that worried that as we increase our partnerships during this 20-year period, whatever remains of this work can be done. So it's not some notion that the Gates Foundation would be around forever. There never was, but it was much further out in time. It was like 20 years after I died was going to be the sunset date before.

Well, the legacy I dream about is that when people see the word malaria, they go, 'What was that?' I remember as a kid reading Dickens books and they talked about consumption and I had no idea what was consuming these people. And of course that was tuberculosis, which although it's gone in rich countries it's still killing 1.3 million people a year. So there is no goal that the Gates Foundation would have any particular legacy. And there's no desire for your name then to live on? I mean not everybody's so modest. No, but there's nothing special about that. I'm very lucky to have the fortune I have. There's a lot of other people contributing to these things. Maybe I'll be remembered for my software prowess at a young age but I think doubling down so people know that we can spend at an even greater rate than we are today, that's the best possible choice.

Well, I had a really good dinner with him December 27th and then a short meeting on February 5th where I said that what was going on with USAID was way beyond any elimination of waste, and even that case where the money to prevent children getting HIV in Mozambique was misconstrued as condoms for Hamas, which just kind of shows how much thought the group that did that put into their work. So given what he said to me in the dinner, I'm very hopeful that we won't get this scale of HIV cut, that we'll get a continued commitment to Gavi for vaccines and polio. I admit there's budget pressures and there's other voices talking to him. But I think I'll get a chance to talk with him and the Congress and if we were able to get to something like a 15 to 20% cut then we can be smart about which things were the lowest impact and it won't be a tragedy. We won't have to see that death number go up. With something like HIV where you just abruptly cut off the medicines, very quickly people's viral load goes up and not only does their health worsen, but they start to infect other people. And so we could see literally in the worst case get back to the death level that we haven't seen for over a decade.

Well, I think when it comes to knowledge of USAID, as brilliant as Elon is, I actually know more about it than he does. I've been in Nigeria, met the people who worked for USAID, I've been in DRC. These are heroic people. Probably other than the military, the most heroic people who work for the US government. And the work they do makes a huge difference. So his characterization of it as a criminal enterprise or it's worms or it belongs in the wood chipper, I think was not based on having much data, just like the condoms for Hamas. Or he said in a cabinet meeting that he had accidentally cut off the Ebola prevention work but put it back on. Well, that's not true. He canceled all the Ebola work. They're all fired. They're all gone. And so objectively, I think the people who are there full-time, including the Congress, need to look at this. We may not get every program back, but the benefit to the world, the United States particularly, for people who have religious values, I think is unarguable.