The foundation has spent a total of $53.8 billion over the last two decades in support of global development (45 percent of grant dollars), global health (29 percent), programs and initiatives in the United States (16 percent), and other charitable programs (10 percent). According to the letter, the organization has "focused on improving health around the world and [on] strengthening the public education system in the United States, because...[d]isease is both a symptom and a cause of inequality, while public education is a driver of equality."
The couple further notes that when Warren Buffett pledged the bulk of his fortune to the Gates Foundation, he urged them to "swing for the fences." "The goal," they add, "isn't just incremental progress. It's to put the full force of our efforts and resources behind the big bets that, if successful, will save and improve lives." That said, twenty years ago, they "would have guessed that global health would be our foundation's riskiest work, and our U.S. education work would be our surest bet. In fact, it has turned out just the opposite."
One area of undisputed success for the foundation has been the increase in global immunization rates — a development achieved in part through GAVI, the Vaccine Alliance, which was launched in 2000 by the foundation in partnership with the World Health Organization, the World Bank, and UNICEF and has helped vaccinate more than seven hundred and sixty million children, resulting in the prevention of some thirteen million deaths. The foundation also helped launch the Global Fund to Fight AIDS, Tuberculosis, and Malaria in 2002. While the foundation initially invested in HIV drugs that needed to be taken every day — drugs that either proved to be ineffective in preventing transmission or that local health programs in low- and middle-income countries had difficulty delivering — the effort is now focused on providing longer-lasting medications and preventatives such as injections and implants as well as non-biomedical interventions, with the aim of addressing factors in HIV transmission such as stigma, poverty, violence, and gender norms.
In the area of K-12 education, the Gateses write that "we're not yet seeing the kind of bottom-line impact we expected" in terms of high school graduation and postsecondary enrollment and completion rates, especially for African-American and Latinx students. "Bill and I have always been clear that our role isn't to generate ideas ourselves," adds Melinda Gates. "[I]t's to support innovation driven by people who have spent their careers working in education: teachers, administrators, researchers, and community leaders. But one thing that makes improving education tricky is that even among people who work on the issue, there isn't much agreement on what works and what doesn't....The process is so cumulative that changing the ultimate outcome requires intervention at many different stages."
The letter does mention a number of foundation-supported programs that have generated encouraging results — including the Gates Millennium Scholars Program, which has provided full college scholarships to twenty thousand students of color; EdReports, which helps teachers determine whether a textbook is high-quality and aligned with Common Core standards; and recent efforts to support locally driven solutions tailored to the needs of teachers and students in specific communities such as Networks for School Improvement and the Network for College Success.
The letter also highlights two issues that have become priorities for the foundation: the climate crisis and gender equality. "Tackling climate change is going to demand historic levels of global cooperation, unprecedented amounts of innovation in nearly every sector of the economy, widespread deployment of today's clean-energy solutions like solar and wind, and a concerted effort to work with the people who are most vulnerable to a warmer world," writes Bill Gates. In addition to mitigation and adaptation efforts, "[t]he best thing we can do to help people in poor countries adapt to climate change is make sure they're healthy enough to survive it."
In closing, Melinda Gates notes that while 2020 marks the twenty-fifth anniversary of the Beijing World Conference on Women, the pace of progress for women and girls has been "glacial" as a "direct result of the fact that...the world has refused to make gender equality a priority." In response, the foundation has stepped up its commitments to family planning in recent years and has invested in efforts "to close data gaps, strengthen advocacy, and support women's economic empowerment." Melinda Gates herself recently announced a $1 billion commitment in support of Pivotal Ventures, an "investment and incubation company" focused on accelerating work to advance gender equality in the U.S. over the next decade. "My message is simple: Equality can't wait."
(Photo credit: GAVI/GMB Akash)