The Blubber

Bill Gates has reportedly cautioned President Donald Trump’s administration that his philanthropic work cannot substitute for the U.S. government’s funding of global health initiatives.

According to Reuters, citing two anonymous sources, the Microsoft cofounder and billionaire philanthropist is urging the Trump administration to maintain support for international health programs. Gates has raised his concerns in meetings with lawmakers and members of the National Security Council.

The administration has effectively dismantled the U.S. Agency for International Development (USAID), the primary government agency responsible for major public health campaigns — including large-scale measles vaccination efforts. Last month, the White House slashed 90% of USAID’s foreign aid contracts, placed most of its staff on leave, and dismissed 1,600 employees. In fiscal year 2023, USAID distributed $43.8 billion in aid, according to Pew Research.

“President Trump will support policies that bolster our public health, cut programs that do not align with the agenda that the American people gave him a mandate in November to implement, and keep programs that put America First,” White House deputy press secretary Anna Kelly said in a statement to Fortune.

Public health officials are sounding the alarm, warning that eliminating USAID’s global reach could result in dire consequences — including increased deaths from malaria, and the resurgence of HIV and tuberculosis (TB).

“Without immediate action, hard-won progress in the fight against TB is at risk,” said Dr. Tereza Kasaeva, director of the World Health Organization’s Global Programme on TB and Lung Health, earlier this month.

Founded in 2000 by Bill Gates and Melinda French Gates, the Gates Foundation has a projected 2025 budget of nearly $9 billion and has funded efforts ranging from malaria vaccine research to global childhood immunization through the Gavi Alliance.

The foundation declined Fortune’s request for comment but told Reuters: “Bill was recently in Washington, D.C., meeting with decision makers to discuss the lifesaving impact of U.S. international assistance and the need for a strategic plan to protect the world’s most vulnerable while safeguarding America’s health and security.”

Foundations Push Back

As Trump seeks to scale back U.S. foreign aid, pressure is mounting on private foundations to fill the gap — a role they say they cannot fulfill. Gates met with Trump at the White House in early February, urging continued support for USAID. The Gates Foundation has made it clear that no private entity can replace the capacity or impact of government-funded aid.

“There is no foundation—or group of foundations—that can provide the funding, workforce capacity, expertise, or leadership that the United States has historically provided to combat and control deadly diseases and address hunger and poverty around the world,” said Rob Nabors, the Gates Foundation’s North America director, in comments to the media earlier this month.

The Novo Nordisk Foundation — one of the world’s wealthiest charitable organizations — has also declined to expand its role in global aid. Instead, it will continue focusing on non-communicable diseases like heart disease and diabetes.

“Of course, more people are contacting us,” said Flemming Konradsen, scientific director of global health at the foundation, in a February interview with Reuters. “We don’t have plans of stepping in, of filling gaps.”