Friday Notes, May 9, 2025
Dear Friends —
It’s 2045 and we’re all in Seattle, Washington, at the Gates Foundation capstone ceremony. The world has changed in the two decades since Bill Gates, now 89 years old, accelerated his foundation’s grantmaking to spend down more than $200 billion.
The global population has reached 9.5 billion, a net increase of 16 percent; most of that growth has been in sub-Saharan Africa. In Europe, half the population is older than 50 years; in most African countries, half the population is younger than 25. China has the largest economy, having surpassed the U.S. in 2030. And while the world has warmed perilously close to the 2 degrees threshold that climate scientists have feared, adaptation to weather extremes has prevented the worst impacts.
What are we about to celebrate, as we play the Gates Foundation off the stage?
Are we celebrating the development of technological innovations like nutrient-rich and climate-resistant food crops, improved vaccines that simultaneously prevent malaria and other parasite-borne illnesses, or treatments that make contaminated water potable? Are we congratulating American and European scientists along with a parade of aid workers with specialized knowledge who have earned Gates-funded salaries while working for ministries of agriculture and health in parts of Africa and South Asia? Are we tallying up the numbers of children who lived to their fifth birthday and being wowed by the math?
If so, are we at the precipice of a cliff, unsure of who is going to buy the vaccines and the fertilizer, and who is going to pay the people required to make sure they’re used? Are we looking for the next good-hearted American billionaire (trillionaire?) — or hoping that China is ready to step into the breech? Are we fretting that the outside help has propped up politicians who spoke eloquently at international conferences but left their people disenfranchised at home?
Or maybe we’re at a different type of celebration, where the main characters are a set of government, multilateral, and civic leaders who — supported in different ways by the largesse of the Gates Foundation — have successfully championed the idea that the benefits of economic growth should be widely shared. These women and men have figured out how to enable human capabilities across their societies through sound stewardship of their economies, fair taxation, and allocation of public treasure for public good. At the national level, they have built a strong compact between citizens and their government, so that policies and public programs are aimed at fostering good health and education, along with food, housing, and economic security. At the regional and international level, partnerships of mutual respect are strengthening peaceful cooperation and learning across what used to be called the Global North and the Global South. The R&D that has created new health and agricultural technologies has prioritized affordability and user acceptance — and the funding behind it has strengthened the scientific and technological capacity in centers of excellence throughout Africa and Asia. It is a celebration of solidarity not saviorism.
Okay, I know. We’re not really in 2045 — but we will be soon enough and what happens in the next year or so will set the course for what the future will look like. As the Gates Foundation develops its pathway toward spending down the resources available, I am hopeful that key decision makers are thinking hard about the celebration they truly want to be a part of.
With the U.S. Government is cutting funding for global health and development programs, it must be tempting to play the hero and respond with a lifeboat to save the people so badly affected by the brutal new policy direction. It also must be tempting for someone who made his fortune in technology to believe in scientific solutions — and to count on the familiar brilliance of people who model disability-adjusted life-years or create multi-year action plans (with multimillion dollar budgets) for eradicating disease. But it would be a mistake to decide to follow that path without thinking backwards from the future, and making the most of the lessons of aid (as well as the lessons of spend-down foundations).
Many others are far smarter than I am about the lessons of aid, but here are the ones I think are most useful for the Gates Foundation to consider:
Context matters. Few programs are transferrable from one place to another. Each place has its own history, social dynamic, politics, culture, and economic trajectory. The people who know it best are the people who live there.
Think affordability from the start. Many aid programs are built for speedy results and supported by deep pockets. They are very hard or impossible to adapt to a lower-cost mode of operating.
Think sustainability from the start. If governments are to take up a particular program or cause, they need to demonstrate from the beginning that they see it as a priority. Too often, aid agencies have prioritized support for programs, like child health, that are popular (or at least relatively uncontroversial) at home. They’ve failed to reinforce or respond to the preferences of citizens in partner countries, and governments have — rationally — used their resources elsewhere. That’s a recipe for disaster when the outside tap is turned off.
Focus on people not programs. Read Amartya Sen’s Development as Freedom — and then read it again as you think about what work needs to be done to develop human capabilities. It will be in messy places, like schools, voting booths, courts. But there is no tidy path to progress.
Design from the margins. Nothing is more predictable than elite capture, so you have to mitigate that risk in multiple ways. If policies and programs are not designed to serve those who are furthest from power, those people’s needs will never be met.
In 2045, I will probably not be invited to Seattle for the Gates Foundation celebration. But I hope that I’ll be around to watch from afar — and I will be cheering loudly if the remarkable and dedicated team at that organization has done their best work.
Have a good weekend,
-Ruth