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The Rachman Review
Bill Gates: AI, aid cuts and the fear of speaking out
00:20:38
US philanthropist on his new partnership with OpenAI
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- [00:00]
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Gideon Rachman
Hello and welcome to the Rachman Review. I'm Gideon Rachman, chief foreign affairs commentator of the Financial Times. My guest this week is Bill Gates, co founder of Microsoft and chair of the Gates foundation, the world's largest philanthropic organization. Gates is under some pressure at the moment. He has a tricky relationship with President Trump. And his connection to the late sex offender Jeffrey Epstein has also been under intense scrutiny. We talked about both of those issues when we met in Davos last week. But the main focus of our discussion was global development and artificial intelligence. So, with official aid budgets falling around the world, can AI help to fill.
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Schwab Announcer
The gap from disaster relief to fighting world hunger? The United States Agency for International Development, or usaid, was at the center of it all. But now, a chilling warning from several medical researchers. They say people around the world, millions of them, could die in the next five years because of the Trump administration's cuts to humanitarian aid.
- [01:32]
Gideon Rachman
The closure of USAID by the Trump administration was met with real horror by many of those who are trying to combat global poverty and disease around the world. As global aid budgets fall, some people hope that private philanthropists can fill the gap and that the Gates foundation in particular can take the lead.
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Bill Gates
Horizon 1000 is the Gates foundation and OpenAI coming together on a pilot initiative. It's bringing AI literally into the clinic.
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Gideon Rachman
I met Bill Gates at the World Economic Forum in Davos last week. We began our conversation by talking about the recent increase in child mortality around the world.
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Bill Gates
Well, many people aren't aware of of the miracle that took place since the turn of the century. The fastest decrease ever in history of childhood death was from 2000 to 2024. So 25 years. The biggest single cause was vaccine. Economic growth always helps. Better sanitation always helps. But we went from over 10 million deaths a year down to below 5 million. So 2024 was actually 4.6 million. In 2025 was an increase to 4.8 million.
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Gideon Rachman
Sorry, what's the age range we're discussing?
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Bill Gates
0 to 5. It's the big thing that we track. And, you know, it's because the bed nets weren't distributed, the vaccines weren't distributed. There were a lot of disruptions to primary healthcare because of donor cuts last year.
- [03:06]
Gideon Rachman
Donor cuts being USAID particularly.
- [03:09]
Bill Gates
Well, you know, the UK under David Cameron was at 0.7% and then you went to 0.5 and then to 0.3. And the 0.7 had no refugee costs in dedicated ministry, so it was a pure 0.7. So now what you have is 0.3 minus refugee costs with an impure set of goals. So that is the fastest decrease in the history of foreign aid and the first one by a center left government just boom, 0.5 to 0.3 on a plane flight to see the President of the United States. So you can't say it's just the United States that's cutting their aid budgets. You know, we don't know what the French aid budget will be. You know, probably a 15, 20% cut. The German was a 15% cut. And we don't have much in the way of offsets anyway. It's challenging.
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Gideon Rachman
Yeah. So are you worried that this uptick is not just going to be a blip? That trend that you spoke of is now to go into reverse?
- [04:06]
Bill Gates
Well, we're certainly not going back up to 10 million. You know, we have the pneumococcus vaccine, we have the cheap rotavirus vaccine, but the question is, can we get back on the path we were on? And so, you know, the foundation will spend all its money over the next 20 years. And our goal is to try to convince voters and governments to stabilize their aid generosity, which is a key enabling thing that would let us get from below 5 million to below 2.5 million during that 20 year period. So we're going to have three or four years here that'll be slightly up and then it hangs in the balance. Depending on how disrupted things get. I mean, things could get worse. That is, if the US pulled out of World bank ida, then you would see a gigantic collapse. We also have very high African debts. And traditionally like at the turn of the century, when they've gotten this high, there's a set of debt relief that then gives them a clean balance sheet. So they have 20 years to go and have a little bit of flexibility there. But if you look at like Kenya, it's not clear how you ever get out of the debt cycle they're in because there aren't donors who are coming up and saying, okay, we'll do debt relief.
- [05:31]
Gideon Rachman
And how much of the gap can organizations like the Gates foundation fill? I mean, you've got a lot of cash, you put a Lot of cash into development. Do the numbers stack up remotely?
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Bill Gates
No. You know, our number is not the result of anyone else's number. So we're spending 100% of my money, both what I have personally and what's in the foundation over the 20 years. And that's true whether aid budgets go up or down. So it's not in any sense making up for the fact that the US Government is trying to save money. We are a large giver, but the US total aid budget was 40 billion a year. Our total foundation spend may get up as high as 12 billion a year, but we're not in that same level. And that counts our R and D spending to create new products as well as our delivery spending. Whereas the 40 billion doesn't count the US R&D stuff. That's their humanitarian aid delivery and all that. So that number is unique. The UK was at 24 billion per year. So sovereigns have a lot of resources. If you got all the billionaires in the world to be giving to poor countries, okay, then you can get significant numbers. But there's no big move in that direction.
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Gideon Rachman
I mean, I know you spent quite a lot of time trying to persuade other billionaires to sign the giving pledge and so on. And I think you have a new partner in sort of philanthropy and development, which is OpenAI. Can you tell me what the two of your abilities are going?
- [07:03]
Bill Gates
Yeah. So in the long run, OpenAI's almost certainly going to do a lot, but this is their first push in this direction. So this is just a 50 million mutual commitment between OpenAI and the foundation to go into a thousand African healthcare clinics starting in Rwanda. It's called the Horizon 1000.
- [07:25]
Gideon Rachman
And it is what? To help enable medical care through the use of AI?
- [07:30]
Bill Gates
Yeah, that's right. So the AI, as you're talking to the patient, it's transcribing it. The foundation takes all the medical data that's unique. You know, malaria data wouldn't be in the general OpenAI model. And we do a lot of work on African dialects and OpenAI ingests, all of that.
- [07:48]
Gideon Rachman
I was going to ask about that. At least they're a language issue, because obviously OpenAI, the one I know is in English. I know it does plenty of languages, but as you say, there's lots of African dialects. Can it cope with that?
- [07:57]
Bill Gates
Right now, the two key dialects in Rwanda does a pretty good job on. And the more we use it, the more data we gather and we feed that back into the OpenAI training over time. There's over 40 African dialects that were benchmarking. And we spent money to get data to give to all the big model companies, you know, because we make it free. And for all of them, it's trivial when they do retraining to crawl the data we provide. India did that for the Indian languages. The Indian government just funded that. In the case of Africa, you get a little bit of government support. But we're the main funder of gathering the language data. And we have a benchmark for education, we have a benchmark for agriculture, and we have a benchmark for health. And we make sure before we deploy it that it's performing at that level. But these things are so cheap nowadays. I mean, we'll spend like 4 million per language to gather the data and then it's done.
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Gideon Rachman
And what about connectivity? Because I doubt that you want to go up to the remotest areas where the need is greatest, but then they need to stable into that connection.
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Bill Gates
There's two ways to interact with this thing. One is through a pure voice connection, where if you have a feature phone voice connection, the thing you're talking to is the multimedia AI. And so, no, it doesn't work if you can't make a phone call. But there are very, very few health clinics that don't have voice connectivity. Slightly more demanding is to have a data connection so that you have a smartphone that's connecting over data protocols. And then you're not only getting voice in, voice out, but you're also getting the screen interaction as well. And that's much preferred. In fact, I don't think we're going to pilot in any clinics that are voice only because the interface is just way more cumbersome.
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Gideon Rachman
And I assume the idea is that it means that in areas where there are not that many medical doctors, a practitioner has access to the information that fully trained doctor would.
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Bill Gates
Yeah, the majority of Africans never meet a real doctor. So these are sort of what we might think of as more nurse practitioners. So, like, I'm a pregnant woman and I'm having a difficult delivery, you know, the question is always, should I escalate up? And if you eventually get to a hospital, there'll be a doctor there, but that's the first place you'll run into what rich countries would call a doctor. So this is to do clinical record keeping, clinical symptom evaluation. It's to make the workers both more productive, that is to see patients more efficiently and to make better decisions.
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Gideon Rachman
And you're doing it in Africa. But is it potentially applicable to the richer parts of the world as well. Do you think AI should play a much bigger role in medicine in the West?
- [10:44]
Bill Gates
Yes, I'm a huge optimist about what this can mean. I mean, what you really want is the patient to be talking to this virtual doctor on a regular basis. And so when you come into the clinic, instead of filling out a piece of paper and, you know, having to go through that with the doctor, the AI has been listening to what you've said. And the AI creates a summary for the doctor that he can look at very, very efficiently. So there's no paperwork. Ideally, you time the person coming to the clinic when the doctor is available. Not this thing where you have everybody just sitting for hours at a time and you're getting things explained to you whenever you want. Two of our first scenarios we're going to make sure we do a super good job on are people living with HIV and pregnant mothers so that even when they leave the clinic, they can talk on a regular basis about the symptoms they're having and exactly what's going on. But yeah, in a certain sense, what we're talking about here is free intelligence. And so the ability to take lots of complex data and understand that the amount of information you have to know to diagnose patients is sort of superhuman. Now, in an African context, you're not going to assess a rare disease because it really wouldn't matter. You wouldn't have the capacity to treat it. So we're dealing with a smaller set of things than an American or UK clinic that's trying to catch even, you know, very rare conditions and make sure you get the right treatment for them.
- [12:20]
Gideon Rachman
So that's the very optimistic case for AI. But obviously there's this other debate going on about could AI destroy humanity or do something terrible. Short of that, where do you stand on the kind of AI doom versus AI optimism debate?
- [12:35]
Bill Gates
Well, all the positive things that AI can do are clearly correct. And anybody who thinks we're reaching a plateau or that our errors can't be dealt with, they're wrong. It's very complex to characterize these systems in terms of, okay, if you need to do everything in a job, when can they do everything in a job? But the ability to learn, to improve, it's incredible. And it's hyper competition in terms of the US firms, the Chinese firms, and the other firms in this space. In terms of downside, one is that AI will be used by bad people and it will make bad people have free intelligence. So designing a bioterrorism weapon the way that war Works will be utterly different. When you can have free intelligence out and all these different sensors bringing things together. And so current weapon systems will be obsoleted by these things. You'll have people trying to influence the public doing fraud. Every bad activity, the one that sort of stands out in terms of a potentially huge event is the bioterrorism one. Then you'll have the just plain old disruption. Particularly when the blue collar robot humanoid stuff gets good. There's quite a disagreement between say Elon, who says tomorrow and Rodney brooks who says 10 years from now. But particularly because of the amount of manpower the Chinese have on that. I'd say it's in the four year time frame. It's very disruptive to labor markets, both white collar and blue collar. And that brings a level of turmoil in society. You could say, well, why should it be a bad thing? Because you've raised the production frontier and if it's really making things worse, you just, you're like the Amish, you decide, hey, I don't want to use this thing. But we've organized our society around certain scarcity, scarcity of labor, scarcity of medical knowledge, legal knowledge, drug design knowledge. And that scarcity, when it goes away, the whole purpose of human work and how they organize it's massively disrupted like no technology ever in history.
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Gideon Rachman
Here's how to stay alive longer so you can enjoy Boost Mobile's unlimited plan with a price that never goes up. Do not mistake a wasp nest for a pinata. Stay alive and switch now at boost mobile after 30 gigs, customers may experience lower speeds. Customers will pay $25 a month as long as they remain active on the Boost Mobile unlimited plan. One thing that was a huge story a month ago, now nobody is talking about that much was the Epstein files. You have been accused of being close to Epstein. You've had to ask plenty of questions about it. How do you feel about the release of those files?
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Bill Gates
I have no issue. I think every meeting I have with Epstein is known. I had dinner with them, the people who were there. His saying to me that he could help raise money for global health.
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Gideon Rachman
So you're not sitting there thinking, oh my God, that email, you know, because they've been easily taken up by emails.
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Bill Gates
Well, I'm embarrassed that I spent any time with Epstein. And so you know, of his emails, the ones that connect to me will be 0.1%. But the fact that it's not zero, it'll remind people that I went to dinner with Larry Summers and all sorts of other people and I never went to any island. There were never any women at anything I ever did with him. But there was a period from 2011 to early in 2014 where I did talk to him and have dinners with them.
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Gideon Rachman
Trump himself. I mean, maybe this is just my impression. He seems to be becoming even more out of control, if I'm allowed to say that.
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Bill Gates
I was at a conference where they said, how many of you are afraid to speak out? And only, like, four people raised their hands. And I said, wow, this is even worse than I thought. People are afraid to speak out about being afraid to speak out. I mean, because everybody in the room should have raised their hand. Are you kidding? So, hey, you know, he was elected President of the United States. I've been talking to him about restoring the money for global health. I last saw him on December 12. I hope we can get money restored. The Doge people cut it to zero and fired all the USAID people. About half of it has been restored. But there's a disparity between what the Congress budgeted for PEPFAR and Global Fund and all these things and what's being spent. Some of it is being spent. It's on. Down in Searle, they made a really good commitment to Global Fund. They're doing these country compacts. But, wow, you always think, okay, this is the height of the US President keeping people surprised and not understand why he's doing what he's doing or why he picked what he picked. But I think this year sets a new record for what's next.
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Gideon Rachman
Yeah, I mean, remember this time last year, there were a whole load of tech bros, if I can use that phrase, your contemporaries sitting in the front row at the inauguration. And you actually skipped that. You were here. I remember seeing you here. Given the range of your interests in business, in philanthropy, you have to have a relationship with the president, don't it?
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Bill Gates
Actually, I have. For someone who's been more associated with the other party, including the Harris campaign, I've gotten more time than you would expect. I had a long dinner with him on December 29, 2024, and I'd been in to see him at the White House four times. Most recently, as I said December 12, I had 80 minutes, of which 40 minutes were on the topic of global health.
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Gideon Rachman
And can you get any sense out.
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Bill Gates
Of him on Glenn will help. He likes the idea of finishing polio. He has this strong relationship with the Pakistani field Marshal. And you probably know that Pakistan and Afghanistan are the only two countries we've never gotten to zero. We have cases in Africa, but We did get to zero there, and then it spread back. And actually, Trump's connection to the field marshal has meant that the attention we've gotten from the Pakistani army has been helpful. You know, South Khyber Pashtun, we miss kids because to go in and vaccinate, the army has to escort them. And we've been trying to get that number down. We've got it down somewhat, so that's actually been constructive.
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Gideon Rachman
So, last question, I mean, to your fellow CEOs, how do you think it's the best way of dealing with Trump? Do you get as close to him as you can so that you can always have a word, or do you need to really keep your distance, or some strange combination of the two?
- [19:24]
Bill Gates
Well, for the work that I do, the US Government as the biggest funder of medical research and still, even with these cuts, one of the biggest funders of global health stuff, the foundation always seeks to engage. I met with Secretary Kennedy. He and I disagree about vaccines, and he wrote a book saying, I kill millions of children, and I have not agreed to that proposition. Quite the opposite, I think. You know, when you have governments that are doing unexpected things, you have a lot of people who want to cozy up and make sure that they're the ones benefiting or they're not the ones coming under attack. And so it leads to all sorts of desire to make sure that you get to tell your story. So I'm sure the demand to go and spend time with Trump must be infinite. But this conference I was at, somebody said, oh, my advice is you should just go talk to Trump if you have an issue. Well, that's not a very scalable solution. It is for the large tech guys, because I was at a dinner in September where he had us all at the White House. And as I said at that dinner, I'm not in the money making phase of my career. I'm in the giving money away phase. So I was there to try to talk more about the global health spending. They're all there in their business modes, trying to advantage their businesses and saying things, some of which I thought were more to curry favor than totally accurate. But, hey, it's hard. They're in a hard position.
- [21:05]
Gideon Rachman
That was Bill Gates ending this edition of the Rachman Review. I'll be away next week, but the show goes on. So please tune in for another edition of the Rachman Review, Thinking long term about your investment career. Hear stories, advice and lessons from seasoned leaders at Capital Group on the Capital Ideas podcast. Subscribe and start listening today, published by Capital Client Group Inc.