The education of President Trump by Bill Gates, global health advocate

In these early days of Donald Trump’s administration, Americans and the rest of the world have been watching the education and evolution of a new president. Foreign policy is tricky. Replacing the Affordable Care Act isn’t so easy.

On the global health front, too, the new administration is on the steep part of the learning curve. And people worried about its understanding of and appreciation for the benefits of US global health spending — worries exacerbated by proposed to-the-bone cuts in the president’s budget blueprint — are hoping to fast-track that education process.

Among them is billionaire Bill Gates, the cofounder of Microsoft and the world’s richest man.

Gates, who with his wife, Melinda, runs the enormously influential Gates Foundation, met last month with Trump at the White House, his second meeting with the 45th president since Election Day.

In a recent interview with STAT, the philanthropist talked about how he made the case for global health — and vaccines — to Trump. Though the meeting took place several weeks ago, Gates didn’t speak publicly about the most recent meeting after it took place.

“Absolutely!” Gates answered emphatically, when asked if he raised the topic of vaccines with the new president. Vaccines “are miracles and have done great things, and when we get new ones, we can do a lot. That definitely came up.”

Trump has raised concerns about vaccines, repeating discredited claims that vaccination can trigger autism. Prominent vaccine skeptic Robert Kennedy Jr. reported late last year that Trump had asked him to chair a commission exploring vaccine safety. So far, Trump has been publicly silent on whether he intends to proceed with that panel.

Gates said he tried to impress upon the president the danger of confusing the messages around vaccines. He knows his comments registered with Trump, because the president repeated them later when he met with a delegation from the pharmaceutical industry.

“I heard when he saw pharma guys he said he was still wondering about vaccines, but he did mention to them that I’d said to him that I’d looked at it and that they were completely safe and that we shouldn’t raise any doubts about that.”

Still, Gates isn’t certain that means Trump has been persuaded to drop the idea of a vaccine safety inquiry. “There’s a rumor that he is going to do something in that area,” Gates said. “But maybe I and others will convince him that that’s not worthwhile.”

Gates said he also pushed hard for foreign aid during the meeting, trying to make the point that programs that would likely be targeted for deep cuts under his proposed budget are actually a highly valuable way to spend US money.

“As I was talking to people in the executive branch, including President Trump, they probably were a little surprised by how much I said that the $8.6 billion — which is the global health piece in the State Department budget — or the $1.5 billion, which is the agriculture piece, or even some of the other pieces that help fund World Bank or the UN agencies that are our partners, that I do view those as quite effective and I do view them as quite strategic,” Gates said.

The administration proposed a cut of 28 percent cut to the budget for the State Department and the US Agency for International Development.

Rob Nabors, the Gates Foundation’s director of policy, advocacy, and communications, knows where global health spending money nestles in the budget and sees this large cut as endangering those programs.

“Something is going to take much more than a whack. It’s going to take a deep, deep cut to something that either works or something that is incredibly popular or most likely both,” he told STAT.

“What I can’t tell you right now is who is going to be upset. But what I can tell you is that there are going to be a lot of people that are upset. And it’s going to be … because people are cutting programs that have had a tremendous amount of success alleviating development problems abroad and making the world a more secure place.”

Gates, however, said he believed that Congress would use a more measured approach to crafting next year’s budget. Many of the elected representatives there have traveled to distant parts of the world to see how US aid money changes lives. The Gates Foundation has organized many of those trips; Gates calls those efforts “the most valuable thing we’ve done.”

“And it’s partly why, when you get a new administration in, it’s not that surprising that they think, ‘Hey, foreign aid, what’s in there? There must be a lot of stuff that’s not all that impactful or strategic,’” Gates said, noting he’s “quite optimistic” Congress understands the value of programs like PEPFAR (the President’s Emergency Plan for AIDS Relief) and the polio eradication program.

“But we are having to articulate how these programs have become smarter over time and why we choose to put literally billions of dollars of the foundation’s money into these causes,” he noted.

It’s “an education process. … It’s mostly new people. And I think some of the things that were in the mini-budget — like the idea of substantially reducing PEPFAR — I don’t think that will end up being what the government chooses to do.”

Does he hope to get Trump to see firsthand how US global health funding is spent? Perhaps a trip to see the work being done to finally rid the world of Guinea worm, an effort led by former President Jimmy Carter’s foundation?

“It’s a good idea,” said Gates, whose foundation helps fund the Guinea worm eradication program. “We should get him out there. [But] it’s pretty far away from Trump Tower.”