Gates CEO on what the next 20 years hold, and what it means for partners

Devex readers sent over 100 questions to ask Mark Suzman, CEO of the Gates Foundation, during our one-on-one briefing with him on Wednesday. Some were broad, others specific, but many could be distilled into the one burning question development organizations are dying to know in this age of diminished aid: How can we partner with Gates? That question is all the more timely and complex given the Gates Foundation’s announcement that it will double its giving over the next 20 years by a staggering $200 billion before shutting its doors in 2045. So, how will sunsetting affect the foundation’s strategy, both today and tomorrow? In some ways, it will change it, Suzman said, but the fundamentals that have driven billionaire philanthropist Bill Gates over the last quarter of a century remain solid. “Our primary lens on everything we do is outcomes,” Suzman said. “It’s impact measured in terms of lives saved and opportunities provided for the poorest and most vulnerable. The core animating mission of the Gates Foundation is a commitment that every person deserves the chance to a healthy and productive life. For us, that's not just a saying.” “I expect if you look at the makeup of our partners five to 10 years from now, I would expect probably there will have been some significant turnover and change,” he added. “But again, we're not doing anything for the sake of itself. It's all going to be very focused on the end.” And that endgame is not about reinventing the wheel. Rather, it’s about reinforcing the business model and doubling down on what works, especially innovation. “It’s forcing us to be much more rigorous about what is our true comparative advantage,” Suzman said. That means even amazing ideas may not make the cut, given the foundation’s focus on practical, achievable results. “If there isn’t a way to make this at a price point and at a timeline that's going to be useful and usable within low- and middle-income countries, I don't care how good the idea is, we're not going to be funding this,” Suzman said Ideas also have to gel with the priorities the foundation has set out for the next 20 years. Suzman said these fall into three broad categories: maternal and child health, and minimizing preventable deaths; eradicating or bringing under control infectious diseases such as polio, malaria, tuberculosis, and HIV; and economic mobility and opportunity. In the U.S., the latter means focusing on education, while globally, it means bolstering agricultural productivity to help rural farmers who tend to be among the world’s poorest. “So we're trying to map concrete goals at that 2045 level that we can work back from,” Suzman said, although he stressed that even with the “incredible generosity” of Bill and Melinda Gates and supporters such as billionaire philanthropist Warren Buffett, “our money is finite.” And having an end in sight forces you to make the most of those finite resources. To account for the fact that resources aren’t endless, the organization did what Suzman described as a “conservative calculation” of how it can continue to give roughly $9 billion to $10 billion a year into the future to ensure that the foundation “is going to be a stable, predictable, reliable funding partner for anything we're committed to,” he said. “We're going to have the resources, we're going to be able to follow through. But that also means the money will run out.” And when that happens, the hope is that Gates has laid the groundwork for partners to continue the effort. “If there's one word which I know it's used a lot, but it's truly what we aspire to be, it's catalytic. Can we use our innovation to capitalize a different way of doing things that is going to be sustainable without us? And by putting that stake in the ground, saying we're not going to be here in 20 years, we're saying that all of the stuff that we work on, the problems that we haven't solved … that's work that's going to have to have to continue after we've gone, so you have to capitalize other actors [who are] going to drive that work forward in the future.” And Suzman is clear that nurturing other partners to take over is an intensive, hands-on process. “If you're going to be a partner with the Gates Foundation, expect us to be a very engaged partner. We are not a hands-off partner, and we'll just be transparent and honest about that. We think that can still be a very trust-based healthy dialogue … but that's our nature and model.” That model very much involves Bill Gates engaging directly and deeply in pilot projects, down to a level of detail that might surprise many, Suzman said. “I've got meetings later today on wastewater surveillance, looking at models from Pakistan, South Africa, a few others. And believe me, [with Bill], you will learn more about wastewater surveillance than you thought was possible,” Suzman said, though he added that the organization tries to strike the right balance by not being “naively top-down.” That gets to a common criticism of the foundation, which is that its financial firepower gives it the heft to dictate the priorities countries should be addressing — even when governments may not agree with those priorities. But Suzman countered that governments are key partners in the process. He noted that a significant portion of the foundation’s portfolio revolves around products, whether it’s a vaccine, an HIV antiretroviral treatment, or improved seeds for smallholder farmers. But he insisted that doesn’t mean “we are naive, silver bullet-believers who think that this product is somehow going to be transformative on its own.” Rather, Suzman said Gates relies on “a full ecosystem” of health systems or food systems, and for that, you need to engage with fiscally capable governments. In fact, Suzman said the foundation’s goal is not to be the most financially influential voice in the room, especially in multilateral settings, because that means the rest of the world isn’t doing its part. Take the World Health Organization, for example. “We're currently one of the largest funders since the U.S. withdrew. And as I like to say — and I say it to many European partners who occasionally wonder what our disproportionate goal is — this is a crazy world if a philanthropic foundation has become the largest funder of the most important multilateral health agency. This is a world that is not allocating its resources appropriately compared to need.” Suzman also noted that in terms of influence, while the foundation serves on the boards of some of the entities it created, such as Gavi, the Vaccine Alliance, it doesn’t sit on the boards of the WHO or the food research network CGIAR, “which we’ve also just become, by default, the largest funder of with the U.S. withdrawal.” Multilateral withdrawal is a running theme under the Trump administration, but as Suzman and other philanthropic leaders often point out, the sector cannot pick up the slack for what was once the world’s largest aid donor. The aid cuts by the U.S., as well as many other donor countries in Europe, have forced the foundation to wade into policy work and political advocacy to restore at least some of those cuts. And while Bill Gates has been vocal about the short-sightedness and cruelty of those cuts, he’s been more reticent to directly criticize President Donald Trump — a caution echoed by Suzman. “We've been able to declare with conviction and accuracy that the issues we work on are nonpartisan, that when it comes to saving kids lives, or helping HIV-positive people get on treatment, there is a broad consensus on both sides of the aisle in the United States and across most traditional donor countries that these are good things to do,” Suzman said. But the Gates CEO admits that’s not the case right now, as donors retrench. As a result, the foundation is pursuing both short-term advocacy to address the immediate impacts of the cuts, but also long-term advocacy to do the painstaking work of rebuilding what’s been lost. “A lot of our thinking is, as we look over the next 20 years, how do we recreate a context, a political context, where there is broader support for these kinds of health and development interventions, which I strongly believe are truly universal values,” he said. “We may win the occasional battle, but at the moment, we're losing the war of our hearts and minds. So something needs to shift and change. And exactly what that is, we don't know, but we're taking a hard look at how we're deploying our resources in that space.” So what would Suzman like to see accomplished in those next 20 years, besides rebuilding collective support for foreign assistance? He said he'd like to see progress in areas “where the world's very poorest are most disproportionately affected compared to the world's richest, and that is still in preventable maternal and child health care, death, and infectious diseases. And we hope that the world will look very different, transformed — not solved, but transformed — which means there should be much less need for traditional development resources to focus on those core issues.” That in turn will allow the world to focus on the next set of pressing issues — aided by the next generation of philanthropists. “We are, at the moment, the world's largest philanthropy by payout … but we don't want that to remain the same. … There is huge scope right now for energized, engaged philanthropy from some of the world's very wealthiest people,” Suzman said. “And I do think philanthropy will never operate at the scale and scope of government, of private sector, but I hope that our work and our model will have helped build a strong, exciting ecosystem of new, engaged philanthropists able to operate at scale and scope on these issues of human health and development, and that will be a big complementary force to whatever the traditional development ecosystem looks like in 2045.”