The Gates Foundation is pledging to spend at least $1 billion over the next two years on artificial intelligence for health workers, farmers and teachers, largely in the world’s poorest countries, funding AI tools for people the market would otherwise overlook.

The bet is that AI can help reaccelerate the world’s progress against child mortality, poverty and disease, which has slowed sharply as governments cut global health funding.

The Seattle-based foundation’s new financial commitment, released Monday evening in conjunction with its 10th annual Goalkeepers Report, illustrates the double-edged sword of AI at a moment when the U.S. in particular is preoccupied with what the technology might damage or destroy.

Bill Gates, who issued his own AI warnings in an essay three weeks ago, writes in the new report that the risks “are real and deserve serious attention.” He adds, “AI could be a great equalizer — or widen the gap. This is not a long-range prediction. It’s a present-tense choice.”

In this case, Gates writes, he’s focusing on “the possibility that AI, if shaped well, could expand who has access to solutions, opportunities, and knowledge that has too often been out of reach.”

The window is short, he writes: “I believe that the decisions made in the next 12 to 18 months — about how AI is built, funded, and deployed — will determine whether this technology primarily benefits the people who already have the most or reaches those who have the least.”

Gates Foundation CEO Mark Suzman, in an interview with GeekWire, called the $1 billion a “down payment,” saying he expects the figure to grow significantly after the first two years.

For this first installment, 40% of the money will go to education, 40% to health care, 10% to agriculture and 10% to digital infrastructure, including datasets in languages the models don’t handle, according to the foundation.

More than 90% of the data used to train early large language models came from English-language sources, according to the report. Leading AI speech recognition systems make errors less than 6% of the time in English and more than 60% of the time in Yoruba, a West African language spoken by tens of millions of people, for example.

Most people in Africa use feature phones rather than smartphones, Suzman said, so the tools have to work by voice. That means collecting recordings of speech, not just written text, in local accents and including children’s voices. He said the foundation works with Google and Microsoft on AI language initiatives.

Winding down: Gates announced in May 2025 that he would give away virtually all his wealth and close the foundation in 2045, which requires doubling its spending over those 20 years. The foundation had previously planned to close 20 years after his death.

As part of that plan, the foundation will need to give away $200 billion before it shuts down. Its budgeted payout is $9 billion this year, the largest in its history. Suzman said the $1 billion over two years comes out of its core budget.

Goals for its final two decades include cutting preventable child deaths in half again, eradicating polio and malaria, and bringing tuberculosis and HIV under control.

The report’s data section shows how far off the pace the world is. Child mortality, neonatal mortality and HIV are all projected to miss their 2030 targets. HIV incidence is on track to fall only to 0.22 new cases per 1,000 people, more than 10 times the target of 0.02.

Early AI results: The report makes the case that AI could change those trajectories. It points to a number of tools already in use in different settings:

• Penda Health, a network of affordable clinics in Nairobi, Kenya, where an AI tool built into patient records has raised diagnostic accuracy by 16 percentage points.
• In the U.S., seventh graders using a tool called Kiddom Atlas across 21 middle schools gained the equivalent of six extra months of learning in a single year.
• In India, the state of Maharashtra runs a free AI advisory service called MahaVISTAAR that has signed up more than 740,000 farmers, with 70,000 more joining every month.

The foundation has supported all three, according to the report’s endnotes. The endnotes also cite OpenAI’s account of its work with Penda Health on the clinical copilot.

One caveat: the evidence behind the examples is early. Suzman said the education work is “still on a relatively small scale,” and pointed to agriculture as the area already operating at size.

Suzman said the foundation spent years experimenting with AI without committing at this scale, wary of getting ahead of what the technology could actually deliver in its areas. Progress in the models over the past year, and results from early investments, convinced him otherwise.

“We now can state with a pretty high degree of confidence there are real deliverables that we can see across health, across education, across agricultural development,” he said.

What AI won’t fix: Asked whether AI can substitute for the money the U.S. and other governments have cut from global health, Suzman said: “Sadly, no.” The cuts run to “tens of billions of dollars,” he said, and they are hitting basic services now. He cited the purchase of bed nets and antiretroviral drugs, and care for mothers before and after birth.

“That’s affecting families right now with a real impact,” he said. “Ideally, you combine the two [AI and aid funding], and that’s how you get hugely accelerated progress.”

Suzman said the foundation will keep pressing the U.S. to remain a leader in global health. Despite the cuts, he said, it has been encouraging to see the country stay a partner in programs such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, and he noted that Congress has moved to fund these areas more fully than the administration has.

“We believe that currently reflects the U.S. public’s broad view and support for these areas, when you can see the concrete results,” he said.

The Epstein review: Asked how the scrutiny of Gates’ ties to Jeffrey Epstein has affected the foundation’s work, Suzman pointed to the external review the foundation released in July.

Conducted by the law firm WilmerHale, it found no evidence that Epstein received foundation money or that the foundation knew of his crimes. It counted roughly 30 meetings from 2011 to 2014, involving Gates and nine other foundation leaders and staff, and found that staff had repeatedly raised concerns about associating with him.

The board adopted the recommendations that followed, among them centralized vetting of brokers and co-funders and tougher conflict-of-interest rules.

Suzman expressed optimism that the review has cleared the way for the foundation to keep working across the full range of governmental and philanthropic partnerships. “Hopefully it’s full speed ahead,” he said, “and with these AI shifts, that’s more important than ever.”

The Gates Foundation broke its own record at the University of Washington with the largest charitable gift in university history: $540.2 million for the Institute for Health Metrics and Evaluation.

The commitment, announced Monday, will fund a 10-year expansion of IHME’s Global Burden of Disease study, increasing the number of locations it covers from about 925 to nearly 5,000. For many countries, the study is the only source of comparable data on causes of death and disease, according to IHME.

It will also support the institute’s health forecasting and its tracking of health spending worldwide.

The funding “will allow us to provide high-quality evidence at a much more local level and help leaders understand not only where health is improving or worsening, but which decisions can make the greatest difference for people,” said Dr. Christopher Murray, IHME’s director and a professor of health metrics sciences at UW, in a statement announcing the grant.

Roughly 60% of IHME’s budget comes from the Gates Foundation, according to the institute. The rest comes from federal grants, projects with other countries and other philanthropies.

IHME describes the new commitment from the Gates Foundation as a core grant that keeps the institute at a “steady state.” The previous core grant, $279 million announced in 2017, ramps down in December, and the new one begins in January.

IHME employed 425 people in fiscal 2026, down from 469 the year before, the institute said. No significant additional hiring is planned.

The institute became widely known during the COVID-19 pandemic, when its projections of cases, hospitalizations and deaths were used by the White House coronavirus task force and cited around the world. It drew criticism from statisticians who said its early forecasts understated the U.S. death toll and that its uncertainty ranges were too narrow, prompting revisions by IHME.

The Gates Foundation helped create IHME at UW in 2007 with a $105 million grant, then the largest in UW history. It has repeatedly set UW’s donation record since then, including $210 million in 2016 for the building that now houses the institute and $279 million to IHME in 2017.

The latest grant comes as global health funding falls sharply. IHME’s own tracking found that development assistance for health dropped 21% between 2024 and 2025, driven by a 67% decline in U.S. spending. Britain, France and Germany also cut their contributions.

It also comes at a tough moment for UW, which is facing a budget crisis driven by funding cuts. KUOW reported in April that NIH award money promised to UW dropped 50% from fiscal 2025 to fiscal 2026, with funds in hand down 74% because of slow federal grant processing.

The foundation is going through a transition of its own. It announced in May 2025 that it would spend $200 billion over 20 years and close on Dec. 31, 2045. Its board approved a record $9 billion budget for 2026 and a plan to cut up to 500 of its roughly 2,375 staff positions by 2030.

The new grant will run into 2036, about a decade before the foundation closes.

Updated after publication with additional information from IHME.