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Welcome to Asking for a Trend. We're learning that the Gates Foundation has some new and ambitious goals going forward. The foundation plans to close in 2045 with Bill Gates saying he will donate 99% of his remaining fortune earlier than previously planned. Mark Suzman is here with us now. He's CEO of the foundation. He's here with us in the studio. Mark, thank you so much for being here.

Thank you for having me.

So this is quite an acceleration. The foundation spent $100 billion in its first 25 years and now is going to double that in the next 20 years. And it's a time when the stakes are pretty high, right? I was reading today there was an analysis in the journal Nature that estimated that 25 million more people could die within the next 15 years specifically because of the pulling of aid from the United States. And I was struck by something that Bill wrote in his note discussing this announcement. He said, quote, "None of this progress that the foundation has made is possible without partnership from governments." Was the closure of USAID and the pulling of some of this funding a catalyst for this move on the part of the foundation?

Uh, not directly. The truth is this is something that Bill and I and the board have been discussing for over a year. We knew we were coming up to our 25th anniversary, which is this year. We were founded in 2000 and we were trying to really look back and say, "Where have we made the greatest impact and where and how could we make the even bigger impact going forward?" And looking back, we've spent $100 billion to date, which is by far the largest amount of any philanthropy. $43 billion of that has come from the generosity of Warren Buffett. And when we looked at what we did, we saw we'd made amazing progress against goals like reducing preventable child mortality. Deaths have been cut in half from over 10 million deaths a year to under 5 million deaths a year today. We've seen big cuts in mortality for the infectious diseases which still kill many more people in the global South among the poorest than any others. HIV, TB, malaria. And so we were already looking ahead and saying, "We think by 2045 we could potentially almost solve these problems." By solve, I mean, we would bring them down to rates that are equivalent to what we have in the United States today, death rates from big diseases like HIV or TB. You don't know anyone who's suffering from TB, I think.

Right.

You know, we tend not to see it, but it's still the infectious disease that kills more people than any other. So we were going to make that commitment regardless, and Bill decided that he wanted to bring forward the date of his commitment. He was always going to commit to spend the bulk of his fortune to the foundation, but it was going to be spent within 20 years of his death.

Right.

And now we brought that forward and said it's actually it's going to be within 20 years from today, because at our current budget levels, which are about to reach $9 billion a year, which is a record, we want to be able to stay steady and consistent and reliable, and as you pointed out, this is at a moment now where there are significant cuts happening, from the US but not just the US alone, into areas that have traditionally supported our work. And so we felt it was more important than ever that we put a stake in the ground and say, "Actually, we are fully committed to this and we think these are goals that are still achievable."

So does that mean, Mark, that the foundation has to do more to fill those gaps, that it might not be able to meet some of its most ambitious goals because it is doing the things, funding some of the activities that governments used to step in and fund?

Uh, well, partially, but not exactly. So, it is true that the successes that we've seen over the last 25 years have come through huge support from governments, especially the US government. The US is by far the largest funder of global health. I said, our budget is nearly $9 billion a year. The USAID budget used to be $44 billion a year. Total USAID a year used to be $69 billion a year. That's being cut. Clearly, neither we nor any combination of philanthropies can fill a gap of that size. Also, philanthropy does things that's different from government. We fund innovation. We fund, we can take risks. So we'll fund big vaccine trials. We have a $700 million trial going on to look for a new tuberculosis vaccine. That may or may not work. That's a risk a government can't take. We think our biggest strength is funding innovation, new tools for farmers, new ways to use AI to help education. That's where we can make a difference. And then we have to work. Governments working with the private sector and civil society are how these products get to reach the people who need them, whether it's school children in the US, whether it's people who need access to HIV treatments or malaria bed nets globally. And that's why we still want to make the case that hopefully the US and not just the US, other countries that are also looking to cut back like the United Kingdom or France, really halt those cutbacks and focus what remains on what we believe are the most impactful investments. Those are the investments that really we can prove save lives, are not wasted and do it very cheaply and effectively.

Um, one of the forces behind the cuts here in the US, maybe the main one, was Elon Musk with his work at Doge. And Bill Gates in interviews has not minced words when it comes to Musk. So one of the things he said in the New York Times was "the world's richest man has been involved in the deaths of the world's poorest children." Now, I'm not going to ask you to opine specifically on Musk unless you really want to, but I would ask you about the broader attitude amongst the wealthy, because this sort of decline in giving, it's not new to this current moment, right? You and I have talked about it before. What's going on there? Why aren't we seeing that philanthropy in the same way we were before?

Yeah. Well, let me take it in two parts, because the first part is, do we think government could be more efficient? Do we think that areas that work on international aid or others could be more efficient? Absolutely, we do. That's something we work on and we make sure when we partner with what used to be USAID or other partners, we make sure that our dollars are being used as efficiently as possible. We drive down costs. We've helped bring down the costs of global vaccines 10 to 20 fold over the last two decades. And so when we talk about looking for efficiencies in government, we wanted to be fact based. Really do the detailed analysis. Some programs don't work and are expensive and should be cut. Some programs do work, work really well. And our belief is strongly, if you could go to a US taxpayer and say, "We can show you how a single dollar of your taxpayer dollars are going and literally saving a mother's life in childbirth and allowing that kid to survive, and not just survive but thrive. Do you think that's a worthwhile use of your tax dollars?" I am confident that 99% of them would say yes. And I think that's also part of the challenge with philanthropy writ large that you talked about. The one group of people that have got much wealthier over the last half decade are the world's very richest. The number of billionaires has actually increased significantly. But the number of very generous philanthropists has not increased at the same rate as the number of billionaires. And so certainly with today's announcement, what we're hoping at both as the Gates Foundation and I know Bill personally is hoping that he can help inspire and encourage both existing philanthropists, because we do have some great partners who do work. We just had at the event we just held at Carnegie Hall, we had Mike Bloomberg was there, who's an amazing partner, there are other global leaders. But we hope we can encourage many more to give, to give at scale and to give to today's problems. That's the other thing with our timeline. We don't want to do it for some hypothetical future. The needs are here now, the opportunities are here now, and you can make a really amazing impact.

Something else I want to ask you about specific to this administration, just to give an example. You mentioned TB before, and there is a TB vaccine that's in the works, that's in trials. Do you have any concerns about approvals of a product like that in the United States under this current regime?

Well, we hope, and in this particular case, we carry out the trials in a very robust and thoughtful and thorough way. We actually support the Gates Medical Research Institute, which is overseeing that trial. It uses the best of modern best practice global standards to make sure that everything we're doing is very effective. And we believe the evidence dossier that we'll be able to provide is something that we believe the FDA in the US, the European health authorities, who are traditionally the gold standards of assessing regulatory, will look at and will make a fact-based decision based on to approve.

So during your tenure at the foundation, I'm curious, what is the innovation that has stood out to you the most, that has been most impactful, and what next innovation are you looking ahead to the most?

Yeah. Well, there's so many to choose from. So I'm going to cheat and I'm going to do two looking back, and then I'll do one big umbrella one looking forward. And looking back, it really has been in that power of both vaccine technology, where you've been able to actually increase the range and scope of different childhood vaccines, which are the most effective ways to save lives. So, new vaccines against rotavirus which tackle diarrhea, against meningitis, which used to kill thousands of people, primarily in Africa. And the power of vaccines is extraordinary when they work, because they do save lives. That's an amazing prevention. We've also seen it in other areas like agricultural development. We've been developing some amazing new tools, seeds and crops that can grow in drought and flood resilient contexts. So in the face of climate change, where it's the smallholder farmers, mostly in Africa and Asia, who did the least to cause climate change, did not contribute to any greenhouse gases, but we're able to provide them tools, resources, training, ways to access markets, ways to understand markets. This is a private sector self-sustaining solution in the future. So those are two really extraordinary things we're proud of that we think we'll keep building on. And really, I know it's overhyped, but in this case, very concretely, we believe the potential of AI in many of the spaces we work at is extraordinary. It has to be AI intentionally used to focus on the needs of the poorest. So to take education and health care, AI can help a teacher, an overstretched teacher understand much better what bit of a math problem is a ninth grade student struggling with. How can they adapt? Can the student have better interactions? We've got some great pilots underway which are showing both here in the US and globally, some very extraordinary early results. And the same thing in health care, we think it's going to be an amazing force multiplier, but it requires an intentionality of trying to get the use cases that are going to help serve the poorest, because naturally the market will go to the wealthy.

Right, definitely.