Melinda Gates and her husband, Bill, the Microsoft co-founder, pause before being honored for their philanthropic work in France this April. (Kamil Zihnioglu/AFP/Getty Images)

SEATTLE — Melinda Gates is calling on world leaders to step up global aid funding, saying “a loss of U.S. leadership” is resulting in “confusion and chaos” in some of the most vulnerable corners of the planet.

The billionaire philanthropist and her husband, Bill, who spoke in separate interviews at the offices of their charitable foundation last week, have deep concerns about the global repercussions of the federal budget debate in Washington. The Trump administration has recommended that the United States — which contributes $12 billion out of the $34 billion spent on foreign assistance for health each year — reduce its support in almost all areas, including infectious diseases and family planning.

Although lawmakers have said they would reject some cuts, especially if they raise national security concerns, this “mood of retrenchment” has the potential to undo the world's significant progress over the past few decades in public health and anti-poverty programs, the couple said. HIV rates would rise again. Women’s access to contraceptives could disappear in some areas. And fewer children, they fear, would get a chance to live long enough to reach their full potential.

“No one can fill in that kind of money,” Melinda Gates said. “And it's a loss of U.S. leadership. People are saying, 'Well, what is it that U.S. stands for? What are your values? You've always believed in the past in helping other countries come along, come out of poverty.'”

The Gateses are pushing back against the administration's proposed funding cuts with a global effort to raise awareness of what is at risk. They will officially launch their campaign next week with an event in New York City that will be attended by U.N. Deputy Secretary General Amina J. Mohammed, Nobel laureate Malala Yousafzai and former president Barack Obama, who championed foreign assistance programs while in office.

The Gates Foundation has long been a pioneer in setting measurable goals for its work. Program directors there talk about “investment cases” for each initiative and carefully track the “returns” (usually lives saved) for every dollar expended. It is taking the same approach in the new campaign, with a focus on data and accountability for progress — or the lack thereof. 

The centerpiece of the effort will be a series of charts, based on data being published in the medical journal the Lancet, that tracks the story of world health over time by focusing on 18 key indicators. Those include child mortality, HIV deaths and “stunting,” which is children grow up shorter than they should because of malnutrition. The report is being produced by the same team that works on the highly regarded Global Burden of Disease, the world's most comprehensive epidemiological study.

The data show extraordinary progress — child mortality, for example, was essentially halved in recent years — as well as the potential for a catastrophe by 2030 as a result of a pullback in funding. The projections about HIV are the most alarming. They show that a 10 percent cut in funding would cause mortality to rise sharply, resulting in 5 million more deaths.

Bill Gates said the goal is to “really highlight that these things hang in the balance.”

“If we don't get new innovations, if we don't get the funding, if we don't get countries to adopt the best practices … then in some cases not only will the progress stop, but we'll actually in absolute [terms] get worse,” he said.

For HIV and other infectious diseases, he said, “every case you don't avoid is a case that has the potential to create more cases. So infectious diseases tend to be either exponentially growing or exponentially decaying.”

(The 2017 Goalkeepers report, Bill & Melinda Gates Foundation/Institute for Health Metrics and Evaluation, University of Washington)

While neither Gates mentioned President Trump by name, and program directors at their foundation emphasized that the couple is not seeking to pick a political fight, the ideological chasm between the Gateses and the president is clear. Bill Gates, who co-founded Microsoft, and Melinda Gates are geeks at their core, with worldviews based on scientific principles and data. The president, who has criticized childhood vaccines and suggested that climate change is a hoax, despite years of contrary evidence, has a different mind-set.

The guiding principle behind the Bill & Melinda Gates Foundation, which had $41 billion in assets as of last December, is that every life has equal value. But foreign assistance on purely humanitarian grounds alone “wouldn’t get these things ranked as highly in this administration as in past administrations,” Bill Gates said.

Calling the political atmosphere challenging, Melinda Gates said that she and her husband had been spending much time in Washington in recent months trying to talk about these issues with members of Congress and Trump's inner circle. “We want people to understand that the progress isn't inevitable,” she said, “but it's totally possible.”

She said she believes the administration's proposed cuts “send completely the wrong message” when it comes to women and their rights, resulting in “confusion and chaos” in the development community. And while optimistic that some of the funding for global health overall will be restored in the federal budget, she is pessimistic about the outlook for family planning. In May, Trump issued an executive order — known as the “Mexico City policy” — restricting foreign aid to groups that counsel or provide referrals about abortion. The order could imperil nearly $9 billion for programs dealing with AIDS, malaria and child health.

“It's a hard political space for people to stand in inside the United States,” Melinda Gates said. “And that's been true for a long time.”

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