Exclusive: Melinda French Gates reflects on the Gates Foundation’s greatest achievements—and what she’s focusing on next

At a time of government-aid cuts, internationally, and domestically under the Trump administration, French Gates told Fortune in an exclusive sit-down, “people need to see that this is not a pie that is only so big.”

“When I have seen the rollbacks in this country, and I know that only 2% of philanthropy goes to organizations that work on gender,” she added, “this is the time for me to step in and to use my resources.”

French Gates was the cofounder, with her then-husband, of the Bill & Melinda Gates Foundation in 2000, and spent over two decades traveling globally to understand the world’s most significant health challenges, and how to best utilize their multibillion-dollar fortune to address them. 

And they saw considerable success: In that time, the number of children dying before their fifth birthday was halved. Their support and advocacy for vaccination and treatment programs in the poorest nations have limited the spread of the world’s deadliest infectious diseases, including tuberculosis, malaria, and HIV. And more women are receiving lifesaving care and access to contraceptives. 

Today, the Gates Foundation announced a move unprecedented in the world of philanthropic giving. It will double spending to $200 billion in a tight 20-year timeline and spend every last dollar before shutting down in 2045. In a February interview, French Gates (who stepped away from her official role at the foundation in 2024) told Fortune that this was a “fantastic” decision.

As for what’s next for her, the philanthropist said, there is more to do at home than ever before. French Gates is dedicating her resources to improving the lives of women and girls in the U.S. through her company, Pivotal Ventures, founded in 2015. 

“I want this world to be better in the United States for my granddaughter than it is today,” French Gates told Fortune. “Right now, she has less rights than I had growing up.”

Fortune spoke with French Gates about her perspective from outside the foundation; her most significant accomplishments; what’s next for her company; and the responsibility of the world’s wealthiest to address global inequities as the public sector pulls back funding. 

This interview has been edited for length and clarity. 

Twenty-five years ago, you read an article highlighting just how many childhood deaths were happening from preventable causes around the world. It propelled the mission of the Bill & Melinda Gates Foundation. And now, we’re here to celebrate the 25th anniversary of the foundation. What is it like to think back on those early days?

Melinda French Gates: It’s kind of remarkable when you think back. The article that caught our attention was about children dying of diarrhea. I kept thinking, in our own country, when a child has that, you go down to the pharmacy, and you pick something up over the counter. I was aghast to think that children in this day and age were dying of diarrhea. 

To think how far we’ve come in the foundation’s 25 years is kind of, in a weird way, almost daunting, even though I was there for every single piece of it. We started with two employees over a pizza parlor in Redmond [Washington]. Literally, you’d smell pizza cooking below. 

Can you talk about how the global health scene has changed since 2000?

The truth is, there has been a lot of progress. And had it not been for COVID, that progress was sticking. We were building momentum year after year after year. You could see it in the numbers. You could see it in the childhood deaths. You could see it by the children vaccinated. You could see it by the number of moms hanging malaria bed nets, which then meant the childhood death numbers were going down. You could see it in the number of HIV cases. 

We know so much more about the diseases that affect the poorest. Back then, we knew kids were dying of diarrhea. But it turns out, children are dying of other things, too, and they’re dying of different types of diarrhea, not just one type.

So over that time, we’ve been able to take that problem apart, piece by piece, and then tackle different pieces of it. That’s been remarkable, and that’s very different than when we started. 

DESHAKALYAN CHOWDHURY—AFP/Getty Images

In your book, The Moment of Lift, you write, “It took us years to learn that contraceptives were the greatest lifesaving, poverty-ending, women-empowering innovation ever created.” Data on women’s health is harder to come by. How did you grapple with that? 

I felt it was so important to be on the ground, to listen to what was happening to families. Women were coming over and over to this point about contraceptives—that they needed them. They knew about them. 

I came back to look at the numbers, and there was a number. What the data suggested was that contraceptives were stocked in. Well, it turned out that the only thing really stocked in places around the world, because of HIV/AIDS, were condoms. But women will tell you all over the world, they can’t negotiate a condom in their marriage, because they’re either suggesting he’s been unfaithful or she’s been unfaithful. 

I had to learn to say, “No, no, we need to go build the data system to understand what contraceptives women have access to. What do they want?” We learn from country after country that you have to have a range of options, because women use different contraceptives, even here in the United States.

I learned over and over again about women that we just hadn’t collected the data. We needed to have the numeric data, but we also needed to have the qualitative data. It’s not enough to look at the numbers. Behind every one of those numbers is a person’s life, and you have to understand her life to know, will she even be able to access a contraceptive? Can she leave the home? Who would she go to? Where would we give her those messages?

One story that you’ve told stayed with me: The story of Meena, a woman in India who was really open and vulnerable with you about her fears around the future of her children, to the point where she even asked you to take her children and raise them. What feelings does that bring up sitting here today?

Sadness. Deep sadness. I really don’t think there’s a woman who wants to give up her children. There’s a bond there that’s biologically so strong, and yet, she knew that if an American took her children home, the chance of those children growing up healthier and being able to thrive was just higher than in her community. She had nothing. Her husband was out of work. 

I just thought, how tragic that you would be at that point. And yet, I’ve met many men and women who are barely making a living in these places. That’s why working on global health and development is so vitally important.

The Gates Foundation is announcing that over the next 20 years, it’s going to commit $200 billion, roughly double what has been given in the past 25 years, and it will be spending the last dollar by Dec. 31, 2045. What’s your reaction to this news?

That’s been the plan, that the vast majority of those resources were to go back to society. I think it is fantastic that there’s now a public pledge to do that. This particular decision was made after I left. It was made between Bill and Mark [Suzman, the foundation’s CEO] and the board, and I think it’s a fantastic decision.

What would you say is the foundation’s most impactful achievement?

Honestly, there are many. But I would say the Global Alliance for Vaccines and Immunization, Gavi, that we were part of founding. There are literally children alive because of that program. 

Over a billion children have been vaccinated. The childhood death rate has been cut in half. When I go around the world and I meet mothers and fathers, they walk miles for their kids, or they save up the bus fare to get those lifesaving vaccines. 

 I’d be remiss to not ask about some of the threats that we’re seeing facing global health policy today. The new U.S. administration moved immediately to dismantle USAID. What was your reaction to this?

Lives have been saved because of the grants from USAID, and it will be devastating what will happen in some of these communities. The other thing that just seems quite bizarre about it is the U.S. has built up lots of infrastructure around the world, like labs and making sure we have nurses trained. We have infrastructure out there, so we’re going to pull back and let all of that crumble? 

I’m not saying the organization was perfect. Yes, there were some things that needed to be looked at. Yes, there probably were some trimmings that needed to happen. But what I know and what I have seen on the ground are mothers and fathers who benefited from that. 

And guess what? If they can prosper in their own community, they can have good health, their kids can have good health, they can feed their family—they’re going to stay where they are. 

I will say, I took a group of Republican senators many years ago out in the field in Africa. And they were blown away by the end of the trip. Many of them said, “I just had no idea how much these small investments in these communities help families lift up their children.” They started to see what I see when I’m in these countries, which is that people, by and large, want the same thing for their children. They want them to grow up healthy, and they want them to thrive. 

What would you say to people who would frame foreign aid as fundamentally not an American interest? 

I would say, I wish you could go out and see what I’ve seen. I’ve seen bags of food that say “USAID” all over them. Communities know that they’re being fed by the American government. People don’t want continuous handouts. They want to be able to have their own income. So if they can get seeds and plant their farm and get a good yield of their crop, feed their children, put a little bit on the market, they’re grateful.

But if we now just suddenly, in a big whoosh, pull back on that, can you imagine what they’re going to think about Americans and the American government? We’ve built up trust. Trust takes a long time to build, but you can take it away so quickly. I think we need to be much more careful as a nation.

There’s been a lot of conversation around the world’s richest man, Elon Musk, and his role in influencing our country. If you had the chance, what would you say to him about how the U.S. should be delivering foreign aid?

I would say, before you move on an action, go out and actually see what’s going on in the world today. Go travel. Then decide what you’re going to do. 

I can’t speak to his values. I can only speak to my values. We are the wealthiest nation in the world. Yes, we are hurting. Yes, people in our own country are hurting. We need to do things about that. But people are really hurting around the world, and I don’t think we want more poverty and more disease when we have a program that’s working. 

How does philanthropy fit in with the pullback in government funding?

You can never fill the gap if the public sector pulls back. You just can’t. 

You’ve talked about how important it is to let our hearts break a little bit. And I think a lot of people would argue that we’ve collectively lost some of this connection and love and empathy. Where do we go from here?

I’m not sure we’ve lost it. I really am not. I see a lot of great, great, great work happening at the community level. All of that community work adds up to something bigger, and something bigger than that. What I know to be true is that people want connection. They don’t want to be in conflict, even with their neighbor. I’m looking forward to a day when we see more of those values coming back in society. 

And you’re optimistic about that?

I am. Sometimes you have to go through deep change. Sometimes it’s quite troubling in the moment, but it doesn’t mean what wins out in the end isn’t the light.

Is there a moral responsibility for billionaires in this day and age?

If you’re a billionaire in the United States, you benefited from this country. You benefited from good roads. You probably benefited somewhere along the way from the health sector. You probably benefited because maybe it was a good business climate, and you could start your business. People in other places don’t have those things. So yes, we owe something back to society, and there are lots of ways to do it. 

I’ve always believed, to whom much is given, much is expected. Anyone who is lucky enough to be wealthy in society—like I’m unbelievably privileged to have the resources I have—has something to give back. We should. 

Even if you don’t have great means, if you have a little bit, you can still give back your time. You can tutor a child, work in a soup kitchen, give away clothes and things you don’t need anymore, or buy a Christmas present or birthday present for a kid who’s in a homeless shelter.

Is there anything keeping you up at night? 

What’s keeping me up at night is that the strings of our institutions, the threads, are being pulled out. It’s one thing to say, this institution hasn’t been as effective as it should be. Let’s go in and do a reboot of it. But to pull the strings from so many institutions and create chaos, I don’t think that helps anybody.