Bill Gates: Don't expect charities to pick up the bill for Trump's sweeping aid cuts

Bill Gates has warned that organisations like his are “absolutely not” prepared to plug the yawning gaps in development aid that will result from funding cuts, including those proposed by President Trump.

Speaking to the Guardian ahead of the UN general assembly meeting, which opens for general debate next week, the billionaire philanthropist said simply: “There’s no way to balance a cut in [a] rich country’s generosity.”

Although it is is the world’s largest private philanthropic organisation, the Bill & Melinda Gates Foundation, founded in 2000, spends just over $3bn (£2.25bn) a year on development assistance, Gates said, which is about one-tenth of the US aid budget and almost one-fiftieth of the global aid budget, which stands at $143bn.

“We don’t have some special stash that we keep in case some government is less generous,” he continued. “We’re spending at our maximum capacity because we know that every $1,000 we spend, we’re saving an additional life. So if net, from all governments as a whole, you get big cuts, there’s no other sector that has fair capacity to step up.”

The US is the largest global aid donor, but earlier this year, President Trump proposed cuts to the foreign aid budget of roughly 32%, including a $1bn cut to the President’s Emergency Plan for Aids Relief (Pepfar) programme, which funds HIV and Aids treatment, testing and counselling for millions of people worldwide.

Gates indicated that rather than focusing on Trump, he has instead approached Congress, as well as individual members of the US government’s executive branch, to stress to key players just how vital foreign aid spending is to global health and stability.

“The uncertainty about what the US government will do remains very high,” he said, adding that funding gaps were still unknown but unlikely to be anywhere near as high as the cuts envisioned by Trump.

He pointed to key conversations he had had with the national security adviser, General HR McMaster, as well as the secretary of defence, James Mattis, regarding global security and polio: how combating the disease is affected by the stability of Pakistan and Afghanistan, and the situation in Syria.

“We’ve got three tough areas in polio. We’ve got Nigeria with Boko Haram. We’ve got Syria with all the things going on there. And then in Pakistan/Afghanistan, obviously the challenge is with the Taliban. So I think that dialogue has been constructive. And as you get people on a more executive level – like people running USAid – there we’re constantly talking about what’s going on with HIV, or talking with the National Institute for Health about the research budget.”

But the most promising dialogue, Gates said, had been with Congress, which seemed aware of the significance of maintaining the US aid budget as much as possible.

“We increased the amount of time we’re spending talking with Congress, because things very much hang in the balance,” he said. “I don’t want to create the notion that there’s real certainty here, but the idea that these investments can be defended by the Republican party is beneficial to American citizens. That’s stronger than people might expect. The legislative view of [development aid] is stronger than you would expect if you just listened to the executive branch.”

New research from the Gates Foundation and the Institute for Health Metrics and Evaluation, published on Wednesday, has found that remarkable progress has been made in reducing extreme poverty and child deaths by half within the last few decades. Yet the report also warned that such advances will only continue if governments maintain aid programmes, and shows how progress will decrease if aid tapers out.

A cut of just 10% in global donor funding for HIV treatment, for example, could result in over 5 million more deaths by 2030.

“We don’t have to say that aid is just about stopping a complete regression. HIV is the most dramatic [example], where even a modest [funding] cut leads to a huge number of additional deaths,” Gates said.

“HIV is a particular problem in that if you underfund the delivery system and people aren’t getting their medicines, or they’re only getting it like two-thirds of the time, the health benefit is almost zero. So if you don’t get up to about 90% compliance, the viral loads escalate and therefore side effects and deaths go up dramatically.”

The report – which the foundation plans to publish every year until 2030 – tracks 18 indicators from the UN sustainable development goals, including child and maternal deaths, stunting, access to contraceptives, HIV, malaria, polio and extreme poverty.

In April, Gates warned Theresa May that failure to commit foreign aid spending to 0.7% of the budget would result in diminished global influence as well as millions of deaths across Africa. The pledge was included in the Conservative party’s manifesto ahead of this year’s election.