Does our foundation have too much influence? Here’s how I see it.

Our work in response to climate change is a great example of how we seek to prioritize the needs of the most vulnerable—and do all we can to get others to, as well.

It’s a harsh reality that the communities that have contributed least to the climate crisis are already facing its most severe consequences. Nobody knows that more than smallholder farmers in sub-Saharan Africa and South Asia, who are experiencing devastating floods and drought, shrinking growing seasons, and in some places even famine.

We’ve focused on agricultural development for 16 years, because it’s one of the most effective ways to help large numbers of people lift themselves out of poverty. I recently announced at the 2022 United Nations Climate Change Conference that we are accelerating that work with a $1.4 billion commitment over four years to help provide farmers with innovative tools and build more resilient food systems.

For years, leaders in sub-Saharan Africa, South Asia, and other affected regions have been calling for dramatic funding increases for adaptation—that is, ways to adjust to changes in the climate, as opposed to preventing or mitigating climate change. These calls have been largely ignored. While US$632 billion was spent globally to combat climate change in 2020, just 7% of that went toward climate adaptation.

It’s not that the world hasn’t invested in agricultural innovation. It certainly has, with incredible advances in crop productivity over the last half-century. But shockingly little money has been spent to meet the needs of farmers in low-income countries—even by donor nations that have made public commitments to do so.

For instance, the vast majority of research and development has targeted the major crops common in wealthy nations rather than crops that millions of African families depend on. Rich countries will invest in better approaches to producing the crops that their populations rely on whether or not the Gates Foundation gets involved. But that’s not true for cowpeas, millet, cassava, or direct-seeded rice.

We fund a huge volume of research—in particular through CGIAR, a network of research centers around the world—on how these crops can be produced and livestock reared more reliably, prolifically, and sustainably. We also make investments to make sure that innovations meet the needs of smallholder farmers—for example by answering low-income countries’ call for better data and modeling to predict climate events.

One important component of our agricultural adaptation strategy is to prioritize the needs of women. Gender equality is a Sustainable Development Goal of its own—but it’s also a vital path to meeting all of the other goals. Diseases can’t be eradicated if researchers don’t understand the unique ways they impact women and girls; innovative sanitation technologies won’t effectively serve a community unless people of all genders are comfortable using them; anti-poverty measures won’t make a dent unless they capture the millions of women earning a living outside the formal economy.

With this in mind, several years ago we made a commitment to design strategies and investments to effectively serve women and girls. Nowhere is this more relevant than in agriculture, since women comprise half of smallholder farmers worldwide. We are using our influence to put women farmers at the heart of solutions—whether that means equal access to credit and markets, farming implements tailored to them, or training to equip them to be mentors and leaders in their communities.

Perhaps most importantly, we’re doing our agriculture work in partnership with regional and local institutions. While we’re sometimes accused of advancing corporate interests or pushing technologies that countries don’t want, in fact we work at the request of national governments and regional bodies like the African Union (which has developed a continent-wide climate strategy) and the African Adaptation Initiative (which helps governments get climate financing and coordinates advocacy efforts). We invest a lot to build up institutions, so that they can lead the work altogether. And we’ll use our influence to press others to step up too.

By the turn of this century, malaria had been eliminated in wealthy nations yet still killed nearly a million people a year—mostly young children—in poorer countries.

So we joined with other organizations working to reduce the burden of this preventable disease, dedicating billions of dollars to the effort. This past September, the foundation announced a US$912 million commitment over three years to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Our biggest contribution over the years, though, may not have been the money. In 2007, Melinda posed a challenge to the global health community: Rather than merely reduce the threat of malaria, why not totally eradicate it? From there, we plotted backwards: What actions would get the world to zero cases? Of those, which would be unlikely to happen if we didn’t play a role?

Our influence hasn’t really been about what we can make happen. (Our contribution to the Global Fund, after all, is only about 6% of what it raises from all donors.) It’s about how we help others make a huge impact.

We have funded R&D for and gotten private-sector companies to focus on not just the next generation of diagnostic tools, bed nets, and medicines, but also the generation after that. That includes work agreements we’ve reached with pharmaceutical companies so they produce drugs that benefit low-income populations, even though those products don’t have high profit margins. We’ve helped some countries export their knowledge—like China, which eliminated malaria within its borders and now lends its expertise to African countries—and helped others strengthen measurement systems and analytic capacity so they can use data to tailor malaria interventions to local needs. And we fund the training of African entomologists and national malaria program staff, so that there will always be a vibrant community of experts to see the fight to the end.

All along, Bill, Melinda, and I have spent a lot of time trying to convince leaders to dedicate more money to fighting malaria and other diseases that disproportionately affect people living in poverty.

By all accounts, the fight has been a big success. While malaria deaths have increased during the pandemic, from 2000 to 2020 the death rate dropped by nearly 50%. We’re optimistic that cases could fall even more over the next few years, thanks to several promising innovations in the works, including a preventive therapy that uses monoclonal antibodies and ways to rid areas of the most deadly mosquitos (by killing them with sugar bait traps or using genetic technology to stop disease transmission).

Despite this progress, people have raised good questions about our work. They ask whether resources spent on specific diseases would be better spent on improving overall health systems. They suggest that eradication is an unrealistic goal. And they critique the foundation for playing what they see as an outsized role.

We agree that funding health systems is important, so we do that too, in Ethiopia, India, and other countries. We agree that calling for malaria eradication is audacious, but we knew that any lesser goal would mean continued suffering.

On the size of our role, I agree, in a way: It’s not right for a private philanthropy to be one of the largest funders of multinational global health efforts. Countries should fully fund them. But consider the example of the World Health Organization. Where we share common goals, like eradicating malaria, we fund WHO programs. As countries have decreased their contributions, we’ve become the second-largest donor. I’d love it if many more governments would pass us on that list—because that would mean more lives saved.