Ankur Vora: Bill Gates' strategist on global health and local innovation

Ankur Vora, Bill Gates’ top strategy adviser at his foundation, gave a behind-the-scenes look at how the Gates Foundation tackles the world’s toughest challenges — from child mortality to poverty and global health. Describing his role as "the coolest job on the planet," Vora spoke to Devex Editor-in-Chief Raj Kumar during a Devex event on the sidelines of the United Nations General Assembly, and emphasized the importance of strategizing, measuring progress, and course-correcting to meet the foundation’s ambitious goals. Central to his work is addressing challenges related to maternal and child mortality, especially in the aftermath of setbacks caused by the COVID-19 pandemic. The Gates Foundation “focuses on surviving, thriving, lives and livelihoods,” Vora explained, highlighting that it works to ensure mothers and babies don’t die from preventable causes. Although the philanthropic landscape has shifted — thanks to figures such as Melinda Gates, MacKenzie Scott, and the Buffett family launching their own initiatives – Vora said governments still dominate global aid. The Gates Foundation, however, continues to focus on innovation, catalyzing government, and private sector investments to create sustainable impact, he noted. “Governments are just by a huge margin larger than anything that foundations do. So philanthropy's role is to focus on things that governments can't do and private sector won't do,” he added. Despite global development funding cuts by the U.K., France, and Germany, Vora remains optimistic. He highlighted India’s emergence as a hub for health care innovation, particularly in the development of affordable tuberculosis diagnostics, which he sees as a key example of how local solutions can drive global change. “The pie is getting divided into many more issues — Ukraine takes a chunk, climate change takes a chunk, and migrant issues take a chunk. So yes, the pie is shrinking, especially for African countries,” Vora acknowledged. But India is “a game changer … They’re breaking the cost curves and the people who are innovating are the people who are actually interested in making sure that it gets scaled,” he said, noting that these innovations are not only reducing costs but also scaling rapidly to benefit communities worldwide. Localization is a crucial element of the Gates Foundation's approach, said Vora, who previously served as director of programs at the Children’s Investment Fund Foundation in London. He emphasized that communities most affected by global challenges should be at the forefront of creating solutions. He again pointed to India's local scientists, who are spearheading cost-effective health care developments, as proof that this strategy works. “You want to make sure that the agenda setting is done by people who know the most about the context on the ground,” Vora stated, underscoring the importance of community-driven solutions. Vora championed the transformative potential of digital public infrastructure, calling it the “operating system” for governments. He highlighted India's success with digital IDs and payment systems, which has made it a model for other countries looking to improve efficiency and reduce costs in public services — a concept the foundation hopes to scale globally. As Vora wrapped up, he reflected on his day-to-day role, “a fun day,” which involves reviewing strategies and assessing global health initiatives. “We'll feel proud about the progress that the world is making, we’ll be impatient about the fact that we're not making enough progress,” he said. He is driven by the belief that philanthropy, particularly through the Gates Foundation, plays a critical role in solving global challenges through innovation, localization, and strategic partnerships. Despite the growing pressures of climate change and health crises, Vora remains hopeful that local innovations will lead to scalable, impactful solutions.