鈥淭he wealthy have a responsibility to return their resources to society.鈥 鈥 Bill Gates, describing the concept behind Andrew Carnegie鈥檚 essay 鈥楾he Gospel of Wealth鈥.
WILLIAM Henry Gates III, commonly known as Bill Gates, is an exceptional man of our times. A dropout from Harvard, he cofounded the software company Microsoft in 1975. By 1987, at the age of 31, he had become the youngest-ever billionaire. He remained the wealthiest person in the world for 13 consecutive years. In 1999, his net worth briefly surpassed $100 billion. Along with his wife, he also established the world鈥檚 largest private charitable organisation, the Bill & Melinda Gates Foundation. It has been called the Gates Foundation since they divorced in 2021. In the last 25 years, the Foundation has spent around $100bn on health, education, energy and other development issues, and made a huge impact at scale in these areas and saved millions of lives.
The Foundation鈥檚 contributions include, among other things, support for development and deployment of lifesaving vaccines for diseases like rotavirus, pneumococcus and meningitis. The Foundation has also helped establish new models for procurement and funding, like Gavi, the Vaccine Alliance as well as the Global Fund to Fight AIDS, Tuberculosis and Malaria. It played a catalytic role in global health research and innovation, including through the Grand Challenges in Global Health initiative. The list is very long.
On May 8, 2025, Gates wrote a blog on his website titled 鈥楳y New Deadline: 20 years to give away virtually all my wealth鈥. He wrote, 鈥淒uring the first 25 years of the Gates Foundation 鈥 we gave away more than $100 billion. Over the next two decades, we will double our giving 鈥 to the cause of saving and improving lives around the world.鈥 That is, $200bn will be spent in the next 20 years 鈥渁nd on Dec 31, 2045, the foundation will close its doors permanently鈥.
This scale of giving is mind-boggling. He wrote movingly: 鈥淧eople will say a lot of things about me when I die, but I am determined that 鈥榟e died rich鈥 will not be one of them. There are too many urgent problems to solve for me to hold onto resources that could be used to help people.鈥
This is phenomenal. Bill Gates draws his inspiration for giving from his parents, and philanthropists like Warren Buffet and Chuck Feeney. His mother, Mary Maxwell Gates, was a believer in the idea 鈥榯o whom much is given much is expected鈥, and she taught him that he was just a steward of any wealth he gained. He talks about his father, Bill Gates Sr, who shaped the values of the foundation; Warren Buffet who introduced him to the idea of giving everything away; and Chuck Feeny, another billionaire and Bill Gates鈥檚 big hero, with his philosophy of 鈥榞iving while living鈥. Feeny is also known for giving away billions anonymously. These influences have shaped Gates鈥檚 thinking about philanthropy.
Gates has listed three aims he wants to pursue in the next two decades with his wealth, an announcement that sparked discussions in the global health and development community. His three key aspirations for the next 20 years include, in his own words: 鈥渘o mom, child, or baby dies of a preventable cause鈥; 鈥渢he next generation grows up in a world without deadly infectious diseases鈥; and 鈥渉undreds of millions of people break free from poverty, putting more countries on a path to prosperity鈥.
There can be many perspectives about how Gates should spend $200bn over the next 20 years to have a maximum and sustainable impact. As a prelude to this discussion, however, it is not possible to impact things that last without a close and committed partnership with governments. Coun-try leaders have to lead and put resources, including philanthropic resources, to their best use.
Peter Singer has many distinctions. He is a professor of medicine, a bioethicist, and an active player in global health. He wrote with Abdallah Daar, The Grandest Challenge: Taking Life-Saving Science from Lab to Village 鈥 a must read. He established Grand Challenges Canada with the support of the Bill & Melinda Gates Foundation and remained its CEO for 10 years. He was also a key adviser to the current director general of the World Health Organisation, Dr Tedros Adhanom Ghebreyesus. He was a colleague at the WHO, and I have seen him in action from close.
Based on his rich experience in global health, in a recent blog, Singer has laid down five priority ideas for the Gates Foundation to consider to make a sustainable impact. First and foremost, he promotes the idea of investing strategically in the local production of medicines, vaccines and medical devices. In an increasingly chequered world, countries have to become self-sufficient to meet their essential public health needs. Secondly, he proposes redesigning the Gavi and Global Fund in terms of developing clear sun-setting strategies in recipient countries. Thirdly, he calls for supporting a 鈥楪rand Challenge鈥 on 鈥渢urning innovations into successful local companies鈥 in low- and middle-income countries (L&MICs). Systematic support and approach are needed to find local solutions to local problems through promoting research and innovation and commercialising them. Fourthly, he stresses strengthening innovative financing to increase resources for countries in a sustainable manner. Lastly, he recommends fostering a result-oriented WHO that can serve its member countries much more effectively.
Of course there can be a lot of debate on these ideas, especially when seen from the perspective of the countries themselves. However, governance failure in L&MICs can drown all grand ideas and plans, and billions of dollars. The grandest challenge is how to firewall human development from bad governance. If we come up with innovative ideas to achieve this, the rest would follow. This is where we need to drill deep. With full respect and profound appreciation for Gates鈥檚 decision and aspirations, this is a point to ponder by the Foundation over the next two decades.
The writer is a former health minister and currently a professor of health systems & population health at the Shifa Tameer-i-Millat University.
Published in Dawn, June 27th, 2025