Bill Gates on AI, aid cuts and the fear of speaking out

In a Financial Times Rachman Review transcript, Bill Gates discusses rising child mortality amid falling aid budgets and describes a Gates Foundation–OpenAI pilot to bring AI tools into 1,000 African clinics starting in Rwanda.

Bill Gates spoke with Gideon Rachman at the World Economic Forum in Davos about global development, artificial intelligence and questions about his public profile. He highlighted a recent uptick in child deaths after decades of decline and linked that to disruptions in primary health services and donor cuts. Gates described how the Gates Foundation plans to spend its resources over the next 20 years while engaging governments and partners. He also outlined an early pilot with OpenAI to introduce AI tools into clinics in Rwanda and discussed past meetings with controversial figures and with President Trump. Key facts: - Gates reported that global child deaths aged 0–5 rose from about 4.6 million in 2024 to about 4.8 million in 2025 and said distribution disruptions and donor cuts contributed to the increase. - He cited significant reductions in public aid budgets as part of the broader context, mentioning changes in the United States and cuts reported in several European donors. - The Gates Foundation intends to spend its funds over the next 20 years but said its projected annual spending is smaller than large sovereign aid budgets and cannot fully replace government aid. - Gates described Horizon 1000, a mutual $50m commitment with OpenAI to pilot AI tools in 1,000 African clinics starting in Rwanda, and said the project addresses language and connectivity by gathering local data. - He acknowledged past meetings with Jeffrey Epstein and said he was embarrassed about that, and he said he has met with President Trump several times to discuss global health. Summary: Gates warned that recent aid cuts have coincided with a reversal in a long-term decline in child mortality and said the foundation will continue its planned spending over the next 20 years. He presented the Horizon 1000 pilot as an early effort to use AI in clinics, with pilots beginning in Rwanda, while broader outcomes and the scale of government responses remain undetermined at this time.