Co-chair of Gates Foundation, Bill & Melinda Gates Foundation
Q&A on Healthcare Innovations with Nick Kristof, Bill Gates, and Dr. Bosede Afolabi
Nick Kristof sits down with Dr. Bosede Afolabi and Bill Gates to discuss the priority of adopting healthcare innovations across the globe.
#Goalkeepers2030
About Bill Gates
Bill Gates, co-chair of the Gates Foundation, faced renewed scrutiny in February 2026 following the release of Justice Department documents related to Jeffrey Epstein. The documents included draft emails, apparently written by Epstein to himself, containing graphic and unverified allegations about Gates. Gates denied the claims in interviews, stating that he only attended dinners with Epstein, never went to Epstein's island, and never met any women through him. He said he regretted every minute spent with Epstein and apologized for the association. His ex-wife, Melinda French Gates, said in response to the documents that questions about the allegations were for her ex-husband to answer, not her. At the World Economic Forum in Davos in January 2026, Gates focused on global health and artificial intelligence. He announced a $50 million partnership between the Gates Foundation and OpenAI called "Horizon 1000," which aims to deploy AI tools in 1,000 primary healthcare clinics in Africa, starting in Rwanda. Gates described the initiative as a way to improve healthcare quality and efficiency by using AI to reduce paperwork and help patients communicate in their local languages. He also warned that global health funding cuts had led to an increase in childhood deaths for the first time in 25 years, with 4.8 million children under five dying in 2025 compared to 4.6 million the year before. Gates said the U.S. aid cuts were "abrupt and cruel" and expressed hope that funding would be restored.
Transcript (14 segments)
✨ AI-enhanced transcript with speaker attribution
N
Nick0:03
Go ahead. Okay. Thank you very much, and I'm very proud of that article way back in 1997, but it has been downhill in terms of impact ever since. Let me start with you, Bosede, and thank you for that amazing show and tell that you offered earlier. And I think one of the lessons of that show and tell, and more broadly of this session, has been that we have the knowledge to make a huge difference in saving lives, and we have the toolbox, and so much of what we lack is a combination of political will and resources. And of course part of that is the resources in the West, it's also a question of resources in the global south. I think in sub-Saharan Africa, it is not only that less money is spent per capita on healthcare, which we might expect, but only about half as much as a share of GDP, 6% compared to 12% in the rich world, or substantially more than that in the US. So how do we get developing countries to actually prioritize health in ways that these innovations can be scaled up?
B
Bosede1:18
Thank you very much, Nick. First of all, that budgetary allocation has to be done. It has to be increased. For the past, I think between 2017 and 2021 in Nigeria, for example, less than 5%, maybe an average of about 3.5%, has been spent annually on health. I mean, it's not enough. That's without doubt. And that needs to be increased. Other ways of getting the resources there, I think, includes getting the private sector to be more deliberate in their care and investment into healthcare and making the society generally connect the dots between good healthcare and economic wellbeing. Because without that, they're not going to do better, generally.
N
Nick2:14
And Bill, we have the same problem connecting those dots here in the US. I mean, I think the best thing Congress ever did was PEPFAR, and now it's in jeopardy of being reauthorized. The first 10 years or so of the Gates Foundation, people were thrilled at the idea of engaging in these tasks. That seems no longer true. In fact, Ukraine has sucked the oxygen out of so much interest in international issues. How do we regenerate that magic so that these things can be scaled up?
B
Bill Gates2:44
Well, I think the moral imperative of it is so strong that we will find our way back to getting a lot of attention. When we set the goals for the SDGs 2015 to 2030, we looked at the incredible success of 2000 to 2015. Of course we didn't have a pandemic then. We didn't have these interest rates. Even the stability in Africa in many locations was better than what we see today. So the distraction of attention, the distraction of financial resources, those are all a big challenge. Innovation can help. We're not saying that we're going to buy that intubation capability everywhere. We're going to get it to be low cost. And in the case of Gavi, which buys the vaccines, we've done such a good job bringing the cost of the existing vaccines down that it makes room to buy new ones. So for example, we can buy HPV vaccine for cervical cancer with the money that we freed up by always driving the costs further down. But political tension in the rich countries, political attention in the developing countries will be important. Even in Nigeria, there's quite a variation. The south, many of the states there do a pretty decent job with limited resources. Up in the north, we have death rates still above 15%, which is tragic.
N
Nick4:23
And we in the media, frankly, have dropped the ball on these issues. But Bosede, it's not just a question of resources. And I want to ask you a little bit about the cultural obstacles if I can. And I remember this visit to Chad and a teenage girl who was suffering, she was in a coma from eclampsia, and the response of her family had not been to rush her to a doctor but to take her to a TBA who burned her chest as a traditional remedy and poured holy water in her mouth. And by the time she was actually brought to somebody who might help her, she was almost dead. And so often I've seen this with moms with children, I can't help thinking that part of it is that those traditional healers may not have the skills in some cases, but they have a great bedside manner. And that the medical establishment often comes across to people as condescending, as unhelpful, not speaking local languages, for example. Is that true? You're on the front lines of this, if that is an obstacle, then how can we address it?
B
Bosede5:44
Thank you for that. So there is that issue where women want to deliver amongst loved ones. They want respect during delivery. They want care, they want to be sure that they're in good hands. And unfortunately, in places where healthcare is not great, especially for women like my country, you sometimes have the issue, a lot of the time women don't want to go to the healthcare system. The trust isn't there. They want to stay home and deliver or go to the person who their mother-in-law said delivered all her five children. But the thing is, because deliveries would always, six out of 10 would be fine without any problems, that's why that person delivered their mother-in-law well. But for those four out of 10 that would have problems, it's difficult to know. And that's why every woman needs skilled healthcare. So to get the healthcare system, we in the healthcare system to bridge that divide, to know, to appreciate the fact that women want to deliver with respect and with care and take all these innovations to them as much as possible. Even in the West, women want to deliver at home, but they have the benefit of skilled healthcare. So bridging that gap, making us understand that from a high level, hospitals would, I think, make that difference.
N
Nick7:09
The one of the things that I worry about, Bill, is that in this issue, in this period of scarce resources where the magic has faded to some degree, that all these folks with the best of intentions who care deeply about these issues become warring saints. And the nutrition people say, oh, you can't solve these problems without nutrition, maternal health people, it's all about maternal health, neonatal, it's nutrition, and so on. How do we actually get everybody in this room and who cares about these issues to pull together so that it doesn't just become a competition over a fixed pie?
B
Bill Gates7:53
Yeah, even within health, you have that little bit: TB versus malaria versus neonatal type care. And then as soon as you get to, okay, global education needs more resources, super important. I put it right after health, but other people would put it even before. And now we have the cause that gets great visibility for good reasons, which is climate. And yet buying less vaccines so you can do climate interventions would net be a huge step backwards. And so, keeping in mind, okay, how do we improve governance? How do we get these medical things done? It is a very rich world. We should be able to deal with a complex set of issues. Hopefully the generosity of the rich world to the developing world goes up. Also, countries are going to have to collect more domestically. If we get their economies growing, of course that becomes very possible. And you hope in a democracy which politician can do a good job on healthcare gets more resonance. In Nigeria, there's a new president. He seems to be putting more attention so far into health than in the past. So he's off to what hopefully will be a promising start. But each area has to decide what the most effective interventions are and make sure that that's what they're taking the very limited resources to do.
N
Nick9:35
A last very brief question for each of you. I sometimes think that one of the reasons why that magic has faded is that we in the media community, and folks in the nonprofit community, and maybe in the foundation community, that collectively we have so emphasized all the problems that we haven't adequately focused on the progress and the potential. And so what gives you that sense of hope, and success, and pride, and accomplishment, and transformation that we can evangelize about, Bosede?
B
Bosede10:12
I see light at the end of the tunnel, and the reason I do that is because I know that the fire I have in my belly is not just from me alone. And I have a lot of colleagues, and junior colleagues, and assistants, and people in the policy making business that are actually interested in doing this. The only important thing is coordinating all those efforts and making sure that we can get to the women where they need their care. So if that concerted effort is done where we connect all the dots, we make sure that we see the women's point of view, and we prioritize women as being birthing the nation, as Melinda alluded to earlier, I think that definitely things are going to happen and a lot of us have that concerted desire to make it work. So I see light at the end of the tunnel, basically.
B
Bill Gates11:14
Yeah, I'll just briefly mention, Hans Rosling taught us that we can be amazed at the progress and still horrified at what still has to be done. And in health, you saw the possibility of what we can do here. Just the despair doesn't work. Even in climate now the despair message might be too high because people aren't seeing the progress.
N
Nick11:40
Well, thank you for the work you do. You're both engines of hope and progress. So thank you for both for all you do.
B
Bosede11:45
Thank you.
B
Bill Gates11:46
Thank you.