B

ill and Melinda Gates’ annual letter about the work of their philanthropic foundation is styled as a report to Warren Buffett, the business tycoon who has donated billions to their endeavor.

But reading between the lines of the report, which was released Tuesday, leaves the impression these philanthropists — among the world’s wealthiest people — are making a subtle effort to influence the Trump administration’s thinking on the value of global development and international aid.

The letter stresses the importance of vaccines, calling them one of the best deals in global health spending. It also emphasizes how critical it is that women around the world have access to effective contraception, saying family planning lowers child mortality and enables countries to emerge from poverty.

advertisement

Both could be areas of contention with the new administration.

Before he took office, President Donald Trump indicated he believes vaccines are linked to autism, a claim that is not supported by science. And one of his first moves after taking office was to reinstate a policy banning the use of taxpayer funds for abortion services. The so-called Mexico City policy — enacted by a series of Republican presidents and lifted during Democratic administrations — freezes government funding to international aid agencies that include abortion counseling among their services.

There have been few signals from the administration on how Trump will approach issues of global health. However, on other issues involving multilateral cooperation, including the NATO military alliance, Trump has made clear he feels the United States has for too long borne an excessive share of the costs.

“We hope this story will remind everyone why foreign aid should remain a priority — because improving lives abroad is in our own national interest as well as the world’s,” Bill and Melinda Gates wrote.

“By preventing the spread of disease, we save lives in other countries and at home. By stimulating economic development, we open new markets for our countries’ goods. By making conflict less likely, we advance our own national security. And by lifting up the poorest, we express the highest values of our nations.”

In an interview with STAT last summer, Gates said he approaches “any new administration with a positive, open mind” and a desire to work together on issues such as polio eradication, HIV prevention, and the fight against malaria. But he also said that it was “a concern” when candidates didn’t trust the science on vaccines.

“There’s a lot of people out there who don’t give science the benefit of the doubt,” he told STAT.

The chatty note from the Gateses was inspired by a letter — published in the report — that Buffett wrote to the couple in December. He noted 10 years had elapsed since he had pledged to give away, in his lifetime, the bulk of his massive fortune. The Gates Foundation is one of the major beneficiaries of Buffett’s decision.

He asked the couple to assess how the foundation’s work had gone and where they saw it going. “I…believe it’s important that people better understand why success in philanthropy is measured differently from success in business or government,” Buffett suggested.

The Gateses took up the challenge, noting in the opening of the report that dramatic political transitions are underway in the world, including in the United States and Britain.

The general tone of the letter is optimistic, celebrating steady and substantial declines over the last quarter century of the number of children worldwide who die in early childhood and a sizable increase in the number who are receiving basic childhood vaccines.

The gap between vaccination coverage rates in high income countries (96 percent) and low income countries (80 percent) is the smallest it has ever been, the report noted. On average, 86 percent of children receive three doses of the diphtheria, tetanus, and pertussis vaccine, it said, citing UNICEF data.

The report also appeared to try to counter some of Trump’s dire warnings about surging urban crime.

Bill Gates noted violent crime has actually dropped dramatically, referencing Harvard scholar Steven Pinker’s 2011 book The Better Angels of Our Nature, which argued the modern world is far less violent than times past.

“That’s startling news to people, because they tend to think things are not improving as much as they are. Actually, in significant ways, the world is a better place to live than it’s ever been. Global poverty is going down, childhood deaths are dropping, literacy is rising, the status of women and minorities around the world is improving,” Bill Gates wrote.

Melinda Gates noted that while it can feel like the world is becoming more fragmented, “[t]he larger historical trends are toward greater inclusion and caring. We definitely see it in global health. Governments are prioritizing it. Citizens are supporting it. And scientists are migrating to it.”

The couple concluded on a hopeful note, saying they feel certain the long fight to eradicate polio will soon be completed, that malaria will be conquered in their lifetimes and that AIDS will no longer kill.

“We can’t put a date on these events, and we don’t know the sequence, but we’re confident of one thing: The future will surprise the pessimists,” the couple said.

Sign up for Morning Rounds

A daily dose of health and medicine news — and a finalist for Digiday’s best email newsletter.

Recommended Stories