Why is the Bill and Melinda Gates Foundation going extinct?

The prestigious medical magazine The New England Journal of Medicine has published an article announcing and arguing the reasons that have led Bill Gates to extinguish his foundation (Phillips S. N Engl J Med 2025). Reading the text leaves no one indifferent.

Health and prosperity

After World War II, the Marshall Plan in Europe allowed for a rapid recovery from the devastation of the continent. West Germany, one of the most destroyed areas, was rebuilt in a few decades. Its transformation into an industrial power is known as the “German miracle”. Later, social prosperity in the rest of the surrounding countries was fundamental to the foundation of the European Union. Today, life expectancy and health indices in Europe are the highest in the world. A simple interpretation of the phenomenon is that prosperity leads to better health (“wealth to health”).

In 2001, economist Jeffrey Sachs and the WHO postulated that strategic investments in health – especially in Third World countries – could spur economic recovery and social prosperity. This new model (“health to wealth”) is precisely the one chosen by the Bill and Melinda Gates Foundation (BMGF) for its grants.

Goals of the gates foundation

Since its inception 25 years ago, BMGF-funded projects have mostly focused on the control of three diseases: HIV/AIDS, tuberculosis, and malaria.

Other aid programs have been to improve the health of children and pregnant women, neglected tropical diseases, and biomedical research. One of the latest major grants has been for the Vaccine Alliance, GAVI, including COVID-19 vaccines (Storeng et al. Glob Public Health 2023).

Since the beginning in 2000, the Gates Foundation has invested $62 billion in health projects around the world. It represents 15% of all global health aid in the last 25 years. As the article acknowledges (Phillips S. N Engl J Med 2025), many have questioned the legitimacy and transparency of a private organization to influence global public health decisions.

Do health benefits promote the prosperity of a society?

Data from the Global Burden of Diseases (GBD) and UNICEF studies have shown an extraordinary drop in infant mortality and mortality among pregnant women since the beginning of the new millennium, especially in the Third World (GBD. Lancet 2025). Mortality has also been significantly reduced for AIDS (Lu et al. BMC Public Health 2025), tuberculosis (GBD TB cols. Lancet Infect Dis 2024), and malaria (Bhatt et al. Nature 2015).

In this encouraging scenario, a decade ago, Bill Gates even predicted that “by 2035 there may be no poor countries left in the world” (BMGF. Annual letter 2014). However, great advances in health have not been followed by significant economic improvements in the countries that have received aid. This disconnect is particularly recognizable in Sub-Saharan Africa, where the average increase in the gross domestic product has been only 1.5% in two decades, according to the World Bank.

Disenchantment with the governments of underdeveloped countries

The New England article (Phillips S. N Engl J Med 2025) stresses that there is widespread skepticism regarding the benefit of aid to poor countries. There is a growing feeling of “philanthropist fatigue.”

The disconnect between health benefits and social prosperity can be caused by poor management of human resources, ranging from scarce education to precarious industriousness, with bad organization and distribution of resources. All these tasks are the responsibility of national governments.

The article suggests that the lack of commitment of country rulers to the common good and high corruption may account for the poor prosperity of some nations, despite great improvements in the health of their citizens with external aid programs.

Date of extinction: year 2045

The announcement of closure is for 20 years from now. Until then, 200 billion dollars will be invested. That huge amount is more than a third of the annual budget of Spain, a country with about 50 million inhabitants.

The notification of the extinction of the Gates Foundation by 2045 is very surprising. The justification for the closure in view of the health-prosperity dissociation data raises doubts. Perhaps a more active and committed involvement of local people and institutions could have allowed the progress made with external aid to take root in greater depth. In other words, teaching how to grow wheat is better than giving bread.

Of course, for this to happen, the objectives of donors and recipients must be aligned. In many developing countries, there is a perception of manipulation by some philanthropic organizations. There are important issues that affect the cultural identity of people, such as sexual and reproductive health, that seem to be violated. The promotion of contraception, abortion, or alternative family models by some of these organizations is interpreted as an abuse or imposition. Help is given in exchange for… Local cultural values are disregarded.

The crisis of values that Europe and North America are experiencing should not be exported with solidarity aids. Concerns in developing countries are justified when their traditions and cultural identity are not respected. The recognition of diversity and equity in a global world is a call for a true human ecology (González et al. AIDS Rev 2025).

Western organizations that finance health aid programs to developing countries must have local citizens as protagonists. Attending to the principle of subsidiarity can avoid intrusion and the risk of abuse in solidarity aid programs.