The Boom Years of Global Charity Are Over. What Comes Next?

New York Times

14-05-2025

Will anyone ever give like this again? When Bill and Melinda French Gates established their world-shaping Gates Foundation in 2000, you could say it marked the peak of a certain era of starry-eyed optimism among the world's private-jet elite.
This month, when Bill Gates celebrated the foundation's 25th anniversary by announcing he was putting it on a glide path to closing, he pledged that he would be spending even more aggressively, distributing 99 percent of his astronomical wealth in just two decades. But the announcement looked nevertheless like a turning of the page, even a passing of the baton. I spoke with Gates about the decision over two days last month outside Palm Springs, Calif., and to me it felt like a trip in a time machine to a throwback era not so distant in years but disorientingly foreign in mood.
Sometimes called the end of history, sometimes the time of globalization and sometimes the age of neoliberalism, that era was defined by new levels of extreme wealth, technocratic confidence in the human capacity to transform the world and a somewhat miraculous — and often underappreciated — wave of improvements in the lives of the least well off. One benefit of truly extreme wealth is that it allows one to sail into the future somewhat unperturbed by the choppiness of the cultural waters. But for someone tallying the achievements of a generation of global giving, it is hard not to worry about the direction of change and the way the winds are blowing.
There were blind spots to that old worldview, to be sure, not to mention missteps and blunders when its evangelists brought the new developmental gospel to the front lines. In 2018, an evaluation determined that one of the Gates Foundation's central educational initiatives had been a failure — perhaps a sobering sign for future endeavors focused on artificial intelligence in schools. In 2021, the foundation funded an audit that concluded that its agricultural initiatives in Africa had been a mixed bag — a gentler critique than those that advocates on the ground had been making for years, both on the basis of limited returns and in explicitly anticolonialist terms. In the midst of the pandemic, Gates argued against releasing intellectual property to accelerate the global distribution of Covid shots, leaving shortfalls in the global south, which critics there called 'vaccine apartheid.'
But the period also produced enormous dividends: huge improvements in extreme poverty globally, as well as maternal mortality and childhood death rates, to name just a few metrics. Western philanthropy was far from the sole driver of these gains; a large part of the poverty reduction, especially, took place in China. And yet just through its work with Gavi and the Global Fund to Fight AIDS, Tuberculosis and Malaria, two programs it also helped establish, the Gates Foundation has a plausible claim to helping save more than 80 million lives. That is an absolutely staggering achievement, one that places the Gateses in the philanthropic pantheon right next to the robber barons whose Gilded Age giving first inspired them.
Not everyone saw this work as charitably as did globalization's leadership class, who sometimes cheered development philanthropies as a way of affirming the justice of a world system on whose top they proudly sat. After all, even as extreme poverty fell by three-quarters in what were often called the miraculous decades of the 1990s and the 2000s, the wealth gap between the world's poorest and the world's richest didn't decline; it ballooned, with the income gains flooding to the globe's top 10 percent hundreds of times as large as those going to the bottom 10 percent. As skeptics of foreign aid have been pointing out for quite a while, adjusted for inflation, the average income in sub-Saharan Africa has barely grown since 1970 — more than 50 years and several distinct lost decades ago. Developmental aid has probably produced as many cautionary tales as economic boom success stories, and to bring all the world's people out of poverty, the World Bank recently estimated, would take more than a century; to bring them up to the poverty level of rich nations would take far longer. 'G.D.P. is magic stuff,' Gates told me. 'But you also want your interventions to help out even before that growth kicks in.'
And they have: Rates of childhood death and maternal mortality remain much higher among the world's poor than the world's rich, but each has also been cut roughly in half in just a few decades. Smallpox has been eradicated globally, and Guinea worm and polio appear to be on their way out. This isn't the work of one man or one couple or one foundation, however large. But that one foundation and its billions of dollars have played an outsize role.
A decade ago, it would have been easy to look at those improvements and trust that the trends would continue wherever the growth rates or political currents went — the project of global health so deeply embedded in international institutions that it had begun to seem almost like the basic compensatory infrastructure of an outrageously unequal world.
Today, it's less clear how interested the world's richest are in offering such compensation, with that infrastructure looking much less secure as a result. President George W. Bush's PEPFAR program to deliver H.I.V. treatment globally has been credited with saving an estimated 25 million lives, but instead of confirming its value beyond any public doubt, the opposite seems to have happened. In just a few months, the Trump administration's attack on U.S. foreign aid has already been blamed, by some trackers, for the needless deaths of more than 200,000 people abroad. In 2021, JD Vance called the Gates Foundation and its breed 'cancers on American society,' and Stephen Miller, a top adviser to President Trump, has criticized it for promoting 'the most hateful, toxic and Marxist ideologies.' You can even see some Trump-y accelerationist types mocking Gates online for having sold so much of his Microsoft stock, because holding onto it over the decades would have meant that he never had to relinquish the title of world's richest man — as though wealth itself would have been a more lasting monument than the millions of lives he saved.
And what of global health? Last year, acknowledging that the boom years for progress had ended, Gates wondered publicly how long the slowdown would last. Now he describes his speed-run approach less in the language of shortfalls or crises than through the logic of opportunity. Others at the foundation talk in terms of imagining a future in which, by making enough progress toward its headline targets, the organization could also make itself unnecessary. Many in the developing world would like to imagine that, too, some of them for somewhat different reasons. But in the near term, the influence of the Gates Foundation isn't heading for a sunset but a sunrise.
In recent years, the foundation has been the second largest donor to the World Health Organization. With the United States' withdrawal, it will become the largest single supporter of what is now a much more vulnerable institution. Probably the same pattern will repeat elsewhere: If we are genuinely entering a fallow period, the relative influence of the biggest donors will only grow. Already there are those asking, somewhat in desperation, why Gates isn't doing even more.
And the years ahead do look fallow. The United States has been responsible for one-third of all funding for global health, and the cuts to basic science and R. & D. may prove just as gutting. For decades now, money flowed from the world's rich to the world's poor partly to meet fundamental needs that could not be met locally, and the world's exploding debt crisis has made the problem only more acute: Forty percent of the planet lives in places that spend more money paying interest on their debts than on health or education; the number of African countries where debts have passed 60 percent of G.D.P. has doubled in a decade; and it costs roughly 10 times as much to borrow money south of the Mediterranean as it does north of the Alps. Violence and warfare have grown globally, particularly across the poorer world, and relatedly, there are now nearly 200 million more people living with food insecurity than before the pandemic.
Perhaps it isn't enough to torpedo comforting narratives of global progress or materially undermine all those global health gains. But if it looked for a time as though the turn of the millennium had initiated a new phase of developmental history, it's a lot less clear where things are heading next.