Early in my conversation with Bill Gates, in a small, windowless room at the Peninsula hotel in London, the lights went out. There was an initial surprised silence before Hannah Cockburn-Logie, Gates’s consigliere and a former Foreign Office mandarin, stood up and attempted to reactivate the lighting by swaying slightly and waving her arms in a kind of restrained English parody of the Trump dance craze sweeping social media. As my recording device on the table before us glowed in the darkness, and as Hannah searched without luck for a light switch, and though we could scarcely see each other, Gates and I simply continued our conversation, his jaunty voice emerging as if from the void.

This would happen several times over the next 45 minutes. The effect of the interruptions was to darken the room but lighten the mood. Gates relaxed. We shared a few jokes. He opened up, although he would not discuss the forthcoming US election (we met before the vote but as Elon Musk had declared his support for Donald Trump – “Musk is quite unique. I mean he’s very involved in politics, I read today,” Gates said, smiling.)

Gates was in London for 24 hours on his way back from the World Health summit in Berlin. The next day he would meet Keir Starmer and Rachel Reeves in Downing Street. He and Starmer had spoken before by telephone after the general election and he’d previously met David Lammy, the Foreign Secretary, in New York. He hoped to nudge Labour into reaffirming the UK’s commitment to spend 0.7 per cent of national income on international aid and development, as it did during the New Labour years.

The UK is one of six original donors to the Global Alliance for Vaccines and Immunization (Gavi), co-funded by the Bill and Melinda Gates Foundation, and the largest sovereign donor to its core programmes.

“We’re saying to the UK now,” Gates said, “‘Hey, you know, Labour’s back and please maintain, despite all these pressures on that [overseas aid] budget – including this refugee thing but all sorts of things – maintain your leadership in Gavi.”

This was before the Labour Budget, however. Boris Johnson dissolved the Department for Overseas Development, or DFID, in 2020, but Gates points out that even in the early years of the Conservative-led coalition, the UK maintained its commitment to spending 0.7 per cent of national income on international development. “They were confused, so they wouldn’t talk about it,” he said. “And then they cut the budget to 0.5 per cent. Labour’s got a challenge to renew the leadership.”

He acknowledged the UK’s economic plight: stagnant growth, dismal productivity, diminished state capacity, a health and social care crisis. “I mean, which is more important, fixing the NHS, helping Ukraine, climate change, which there’s a lot of domestic spending and very ambitious goals on that. Fortunately, we’re asking for a few per cent of the budget. It’s tough to be a politician, because of the willingness [he meant the reluctance of people] to pay higher taxes. The amount rich countries spend on old people is very high: people don’t like to say that, but if you say, ‘OK, of the incremental tax collection, how much has gone to elderly health, elderly pensions?’ It’s a very high percentage, and so people are a little dissatisfied about the investments in the young. And our men, how are they feeling, how are they succeeding? The non-urban areas – there’s plenty of problems. But it would be tragic to move away from something that’s worked so well.”

In the event, Gates was frustrated by the Labour Budget. On 31 October, he issued a statement in which he described the decision to cut the overseas aid budget as “a disappointing outcome for the world’s most vulnerable people”. The UK was withdrawing from its overseas aid leadership role and this “leaves us all at greater risk”.

Here, then, is the optimist’s dilemma in microcosm: the world is not as Bill Gates wishes it to be or believed it once was or would like to imagine. History does not move progressively forward in a linear way. In a world in turmoil the gains of progress can be reversed or lost. His priorities – as one of the world’s richest men and greatest philanthropists – are increasingly not shared by nation states committed to national exceptionalism and to spending more of their GDP on defence and security. The potential for technological innovation, Gates believes, is boundless, and yet something has been lost, the spirit of transnational and multilateral collaboration that illuminated the early years of the century. How do we encourage every nation to do what it can to help the poorest in a zero-sum world? Gates seeks light but darkness is visible everywhere.

As the founder of Microsoft, Gates believes in the inevitability of progress – this defines his optimism – and the transformative power of technology, especially AI, to solve humanity’s greatest challenges. He doesn’t say this explicitly, but he believes in his own capacity to change the world. He has already done it twice – through Microsoft, which created accessible computing for the masses, and the Gates Foundation, with its transformative investment in immunisation, women’s education and children’s health in the poorest parts of the world. We have developed climate resistant seeds, Gates says, and are close to the near eradication of polio. His moonshot is that no child should die of a preventable disease.

He showed me a small AI-enabled ultrasound “birth predicator device” which can be attached to a mobile phone. “You scan the pregnant woman’s belly, using this, and then a piece of AI software asks will this be a difficult pregnancy, and then, if so [you act]. To get the information takes a few seconds. We have a pipeline of things like that, if the financing stays strong – and we can talk about why it might not, because rich-world budgets are very tight.”

The Bill and Melinda Gates Foundation was created in 2000. It has an endowment of $75.2bn, which is $22bn more than Harvard University’s, and is the world’s third largest charitable organisation. Professor Michael Barrett, a leading British infection biologist whose research into the eradication of sleeping sickness benefited from several Gates grants in the early years, spoke to me of how the original launch of the Foundation “catalysed a whole new approach and idea of philanthropy”, and led the fight against malaria, TB, polio and Aids as well as neglected tropical diseases: “It was not just the cash he injected but other impacts, such as bringing the CEOs of big pharmaceutical companies around the table to commit their resources to help the fight.”

Yet as the Foundation prepares for its 25th anniversary in 2025, Gates and his team believe the world is at a “crossroads” – or has reached “a tipping or inflection point”. They couldn’t quite decide on the best metaphor to encapsulate their anxieties. But key public health indicators and development goals are going into reverse.

The data his team shares with me shows the global debt crisis, for instance, means that 25 of the world’s poorest countries are now spending more on debt than on education, health and social protection combined. The Sustainable Development Goals (SDGs) – with a deadline of 2030 – are slipping further out of reach. International development spending isn’t keeping pace with where it’s needed most. And the Covid-19 pandemic showed how a health crisis somewhere can become a health crisis everywhere.

“The big wildcard is the global political thing,” Gates told me. “Wars are the way to go backwards most efficiently. Can we avoid both local and big wars? US-China is a big concern. Both sides seem to be getting better at irritating each other. But I remain optimistic.”

He said the “footnotes” to his optimism were bioterrorism, nuclear weapons and the disruptive potential of AI, for good and ill. “When [Steven] Pinker says things have gone well, he doesn’t say they’ll necessarily stay that way. We had World War I, World War II, we did use nuclear weapons, amazingly only twice and not since then, but there’s no guarantees. People of my age, in the 1970s, we were thinking, ‘Oh, my God, nuclear weapons!’ I feel like this generation doesn’t worry enough about it, and yet I admit you’ve got to worry about how we adapt to AI and bioterrorism and geopolitics at the same time – and climate change, although there I think the innovation will mean we avoid having a major disaster.”

The measurable gains in global health outcomes – especially in the Global South, made between 2000 and 2020 when the Global Fund for Aids, TB and Malaria saved 59 million lives, child mortality and rates of infectious diseases were halved and Gavi immunised more than 1.1 billion children and helped low-income families prevent more than 18.8 million future deaths – are stalling or reversing.

“The pandemic was a huge setback,” Gates said. “Rich countries became more indebted, the health service stuff. Our vaccine coverage levels in many countries are still not back to the pre-pandemic level.”

Later, after the third time the lights came back on in the room, he returned to why it is imperative for rich countries to do more to support poorer states, especially in Africa. The population of Africa and the Middle East is predicted to increase from 1.7 billion to 4.4 billion by the end of the century, when 40 per cent of the world’s population will be African.

“We have moral clarity that we are all humans,” Gates said, “and we owe it to the developing countries, particularly the low-income countries, to help them out. Whenever something bad happens – Ukraine, Middle East, political polarisation, US-China – this focus on Africa goes down. We now have 25 per cent of the aid, down from 40 per cent, going there, and we do look nostalgically back on 2008, when at the G8 meeting all the leaders came and signed and said: ‘OK, we are going to maintain this moral commitment.’ The UK deserves a lot of credit, but not just the UK. I’d say at the top of my list are the people I learn from like Bob Geldof, Bono. Today you have Jamie Drummond talking about, ‘OK, how do we recreate that visibility, that moral clarity’ [of 2008]. The financial crisis became something that distracted people. Now, the UK stayed true, and every year less children die, but you could say that was our peak. We went down somewhat from there.”

In a 2015 TED Talk, Bill Gates warned of the threat to the world of a pandemic caused by an airborne SARS-like virus. “Unfortunately, 90 per cent of the viewing of my TED Talk was after the pandemic hit, not before it hit,” he said ruefully. But his prescience had been noted.

“In that case, yes, but some people said that I must have made it happen to be able to say I predicted it!”

Gates is reviled by vaccine-sceptics even though, because of the success of vaccination programmes, polio is down to just a few reported cases in the world (Nigeria, South Sudan, Afghanistan) and Guinea worm has fallen from more than 3 million cases in the 1980s to just a few dozen cases today. These are diseases that could be completely eradicated, as smallpox was before them.

Online conspiracy theorists believe Gates is part of a corrupt global cabal that controls the world. That he was an associate of Jeffrey Epstein, the convicted sex offender who died in prison, only inflames the conspiracists.

I asked Gates how he felt to be the subject of so many ugly online rumours – what does it to do to his morale to be entangled in vast webs of conspiracy?

“The pandemic certainly heightened this distrust of health authorities, and that’s very unfortunate, because it causes a lot of people not to seek out the [Covid] vaccine,” he replied. “In fact, if you were over 60 or had certain health conditions, the vaccine was very dramatic and so literally millions died because they didn’t seek out the vaccine. We have a little bit less of a problem with vaccine integrity in developing countries, because the diseases we’re protecting against are prevalent enough that you see deaths, and a measles death is a very ugly death.”

I pushed him on the conspiracy theories and the abuse he endures. He is aware of it but is also protected by the power of his worldwide team; the Gates Foundation is like a quasi-state with its executive decision-making authority, its huge R&D budget and, in effect, its own foreign policy.

“If you’re asking for me personally,” he said, “the world has treated me well enough that overall, I don’t go around and say, ‘You bastards, how could you say these things about me?’ I mean, I have to take it with a sense of humour. You worry that some crazy person might attack me, or, even worse, [attack] members of my family or something, but fortunately, I’ve had people yell at me, and vague threats, but nothing where anything’s happened.”

He paused to reflect more on social media, its advantages but also its toxic effects and the wider degradation of public discourse. “I thought digital tools that made information available were an unadulterated good. [But] the exact tactics of how you have free speech and yet also certain pernicious things [being widely shared] about health or conspiracy theories about politicians and so on, how we balance that… I hope somebody else is very innovative, because in the political realm it’s making democracies a little less stable.”

He has spoken to his daughter, Phoebe, about how one might best regulate social media while preserving free speech. “She understands way better than I do. She says, ‘Dad, don’t send me an email!’ She wants me to send her more texts. My three children, one is on no social networks at all, one is a little bit, but Phoebe, the youngest, is quite active and expects me to see every post she makes.”

(In recent days, I tried to contact Gates again through his London office. I wanted to know what he thought of Trump’s crushing victory and the proposed appointment of a notorious vaccine-sceptic, Robert F Kennedy Jr, as the next US health secretary. The return message was that he did not want “to provide any further reflections”.)

A cliché of corporate away days and management theory is to ask: what keeps world leaders and  FTSE 100 CEOs awake at night? Gates is used to being asked this question, so I reframed it. Is he introspective, I wondered – he is 69 and a grandfather: what has he learned about himself?

“Well, I hope I’m introspective. I mean, self-improvement is pretty important. As [the late Richard] Feynman says, the easiest person to fool is yourself.”

Back when he was in his twenties, after he had dropped out of Harvard, Gates “picked one thing, which was being the leader in software and being monomaniacal. I didn’t believe in vacations, didn’t even let myself read all these scientific things that, once I got into my thirties, I let myself go back to being polymathic. Now most of the work I do is by picking teams and reviewing teams. I’m not writing code, I’ve never gone into the lab and made a vaccine. I still write quite a bit and of course I like to read a lot and enjoy learning all the health stuff.”

Unlike his former wife, Melinda, who is a committed Catholic, Gates is not religious. He does not share Silicon Valley’s obsession with human longevity, with the 100-year life, with cryogenics, and so on. He keeps fit by playing tennis and, in a recent Netflix docuseries, was filmed doing push-ups at his desk at home in Seattle. “The AI told me to do that,” he said. “I’m hoping my cognitive contribution goes on 20-plus years, because then I’ll have a chance to see malaria eradication and huge, huge progress.”

He does not believe in the great-man theory of history nor that today’s tech titans are world-historic figures whose actions define the spirit of the age, contemporary Napoleons no less. “I’m a kind of innovation person, that until electricity got invented, I don’t care how many great men were born: what did they do? Then we invented electricity, and so the Industrial Revolution – when did lifespans go from average 30 up to over 70? That’s really energy intensification and then the academic tradition, scientific traditions, understanding health. The last 200 years of all man’s existence has been incredible. So there were incredible people born [before], but so what?”

The new Trump administration is determined to embrace Silicon Valley disruption and innovation – to build, as Dominic Cummings put it in a recent talk in Oxford, “like Silicon Valley does – ie super-fast and optimised for speed and engineering”. Peter Kyle, Secretary of State for Science, Innovation and Technology, has described what he calls the world’s changing balance of power. “If you look at the big five tech companies [Apple, Alphabet, Amazon, Meta and Microsoft], each spends more on R&D than Britain does,” he told the Times. “So we are dealing with companies that can innovate on a scale that the state can’t and none of them is accountable to general populations – they’re accountable to their customers and shareholders.”

Observing the billionaires and oligarchs gathering around Trump – Musk has been appointed to lead the Department of Government Efficiency (DOGE) – it can feel as if we are returning to a kind of baronial system, where super-wealthy individuals aspire to have the power to fulfil the traditional functions of the state. Perhaps this is already happening. Gates’ philanthropy is international development; Musk has provided Starlink for free to those affected by recent hurricanes in the United States; Google is buying its own small nuclear power stations. In this new era, the tech titans do not fear monopoly but seek it. Gates was a determined monopolist, and Microsoft became embroiled in a landmark American antitrust case.

He has spoken about how robotic AIs can act as tutors, carers and mental health professionals. But who should own those robots? A private company or the state? Again, is he comfortable with people’s basic needs being dependent on private companies? After all, as Peter Thiel, another tech titan, says, “Competition is for losers.”

“Ah, he’s kind of a cynic who says a lot of strange things,” Gates said of Thiel. “It is true that if your only goal in life is profitability, you’d prefer not to have much competition, but the AI space is very, very competitive.”

Gates favours “estate taxes” (“I’m stunned that more countries don’t have estate taxes, China for instance”) as well as higher income taxes: “I would tax more progressively and then whatever you have left after you pay your taxes, hopefully you take your energy, prominence and resources and give back to society… With these tech titans – under my rules – we’d still have a lot of money. Bernie Sanders would outlaw billionaires: that’s not the right answer. But I’m a big believer that if you have a large fortune, you should be quite philanthropic: you should not spoil your kids too much and each person has to figure out what that is, and then beyond that you have an obligation to give back.”

Gates and Warren Buffett established the Giving Pledge and among those he encouraged to sign it was Sam Bankman-Fried, the now disgraced and imprisoned cryptocurrency geek and former self-styled effective altruist (EA). Gates is not an EA but, like them, he and the Foundation operate by an ultra-utilitarian calculus: “In the world I work in, we set numeric goals.”

Before we parted, I asked Gates what had surprised him most about human nature, and he said: “I’m very positive about human nature. The human condition is better today than at any time in history, and people don’t step back and see that!”

But he paused, as if a dark shadow had fallen across the room. The optimist’s dilemma was framed like this by Colin S Gray, author of The Geopolitics of the Nuclear Era: “Optimism and pessimism can be perilous attitudes that undergird policy. But of the two, optimism is apt to kill with greater certainty.” “I am an optimist,” Gates repeated. “But I’m worried about polarisation, I always worry about bioterrorism, I worry about nuclear weapons, I worry about climate change, and now I would add AI; although it’s the most positive innovation, it happens so quickly that it will be quite disruptive.”

That’s a lot to be worried about, then.

Bill Gates knows that the world of the so-called global health boom he is nostalgic for, of the early 2000s when global political and economic integration was accelerating, has fragmented. Today we live in a world of competing civilisations. Conspiracists and anti-vaxxers will be prominent in the second Trump administration. JD Vance, the vice-president-elect, has described non-profit organisations, including the Gates Foundation, because they are tax-sheltered and seek to perpetuate power and wealth, as “cancers on American society”, champions of “well-endowed leftism”.

Anupreeta Das, author of Billionaire, Nerd, Savior, King: Bill Gates and His Quest to Shape Our World, wrote that the launch of the Bill and Melinda Gates Foundation “completely refurbished the image of Gates, the jagged edges of the monopolist softened by the halo of the philanthropist”. But one wonders now if Gates feels his influence waning as the new national populism hardens against him and his philanthropic and liberal globalist ethos. He complains about the collapse in state capacity in the West but doesn’t draw a connection with the rise of the billionaire class and the hollowing out of the state and a sense of mass disaffection.

Gates pushed back against the notion the Foundation occupies a space beyond democratic accountability. He welcomes criticism – so long as he considers it to be constructive, not ad hominem. “Take malaria,” he said. “We are such a big funder in malaria that if we mess up our malaria strategy, will somebody tell us that they have a different idea? I wish there were more people doing serious criticism, like saying: ‘Oh, you say you’re about saving lives: why aren’t you investing in this? Why did you miss that?’ If you just say, ‘Nobody should have that much money!’ OK, fine, maybe, but as long as I have it, isn’t this the best way for it to go back to society?”

This is the cover story of the 29 November – 5 December 2024 issue of the New Statesman magazine