Bill Gates has launched a scathing critique of Elon Musk and his involvement with the U.S. government’s foreign aid policy, warning that millions of the world’s poorest children could die as a result of dramatic funding cuts spearheaded by Musk’s Department of Government Efficiency, known by the acronym DOGE.
In interviews with The New York Times, Financial Times, and The Times of London, Gates accused Musk of accelerating the dismantling of global health programs previously supported by the United States Agency for International Development (USAID), a federal body responsible for administering civilian foreign aid and development assistance.
The End of an Era for USAID
DOGE, created under the Trump administration with support from Musk as part of a broader “government efficiency” drive, has reportedly slashed approximately 90% of USAID’s programs globally. According to Gates, this includes the near-total elimination of critical health programs in sub-Saharan Africa, including HIV prevention and treatment efforts in countries like Mozambique.
“Boxes of HIV medication and testing kits are now sitting expired in warehouses. Health workers are gone. Clinics are empty,” Gates said. “A decade of progress has been erased in less than two years.”
USAID, established in 1961 by President John F. Kennedy, has long been a cornerstone of American soft power and global health. The agency played a central role in PEPFAR—the President’s Emergency Plan for AIDS Relief launched in 2003, which has saved over 25 million lives, according to the U.S. Department of State.
But recent changes driven by DOGE have led to widespread project closures, leaving vulnerable populations without medical care. Gates estimates that child mortality could rise by over one million deaths annually if funding and services are not restored quickly.
The Musk-Government Nexus
Gates’ remarks also reflect growing concern over the level of influence wealthy individuals like Musk now wield over public institutions. Elon Musk, CEO of Tesla and SpaceX, was tapped by the Trump administration in 2023 to oversee DOGE’s digital transformation and cost-cutting efforts, initially pitched as a way to streamline bureaucracy.
However, critics argue the department has gone beyond efficiency measures and has effectively gutted essential humanitarian functions.
According to documents reviewed by The Financial Times, DOGE used an AI model to evaluate “return on investment” for every international aid project. Projects in low-income, rural regions were deemed “non-viable” and terminated.
The official DOGE website claims the department has saved over $80 billion since 2023 by “eliminating redundant, outdated, and low-impact federal programs.” But it offers no transparency on its project evaluation methodology or metrics for humanitarian success.
Global Reaction and Political Fallout
The backlash against DOGE’s actions has intensified in recent weeks. Several international NGOs, including Save the Children and Doctors Without Borders, have issued joint statements condemning the cuts. The World Health Organization has warned that disruptions to vaccine delivery and disease control could lead to the resurgence of malaria, measles, and cholera in regions that had previously made significant health gains.
Gates also voiced alarm over Musk’s increasing involvement in foreign political movements, particularly in Europe. He singled out Musk’s public support for Germany’s far-right Alternative für Deutschland (AfD) party as “insane nonsense” and warned that “this kind of political meddling by billionaires is dangerous.”
Musk has not publicly responded to Gates’ remarks. The White House also declined to comment on the accusations when contacted by multiple outlets.
Philanthropic Acceleration
In response to what he calls a “global emergency,” Gates announced a major acceleration in philanthropic spending. The Bill & Melinda Gates Foundation will disburse $200 billion over the next 20 years, doubling its previous commitment, and plans to shut down by 2045.
“We’re giving it all away now. There’s no time to wait,” Gates told the Financial Times. “If governments won’t act, then philanthropy must step up.”
The foundation will focus on restoring stalled health programs, particularly in maternal and child health, infectious disease prevention, and food security sectors most affected by USAID’s pullback.
For more information on the Gates Foundation’s global health programs, visit gatesfoundation.org.
A Turning Point for Global Aid?
Gates’ warning highlights a broader shift in the landscape of international development aid. As wealthy technocrats reshape public institutions according to private-sector logic, questions of accountability and ethics have come to the fore.
The U.S. used to be a beacon of global leadership in public health,” Gates said. “Now, it’s risking its moral authority and millions of lives because a few rich men think they know better.
The debate over DOGE’s role is likely to intensify as Congress re-evaluates the agency’s charter later this year. Several bipartisan lawmakers have already signaled concerns about its overreach.
In the meantime, health workers on the ground continue to grapple with the fallout.