Marco della Cava

USA TODAY

SUNNYVALE, Calif. — The evolution of Bill Gates has seen the Microsoft cofounder master both technology and philanthropy. Now he just may need to conquer diplomacy.

For the first time since creating the Bill & Melinda Gates Foundation in 2000, the billionaire and his foundation co-chair wife find themselves in the role of convincing governments that funding global health initiatives is in the national interest.

In interviews with USA TODAY, both expressed concern over the inward-looking nature of nationalist movements.

“If you interpret America First (the stated doctrine of President Trump) in certain ways, it would suggest not prioritizing the stability of Africa and American leadership” on African issues, Gates, 61, told USA TODAY during a visit to Silicon Valley, just weeks after arguing that very point in a private meeting with the then president-elect.

"With this new crowd, and with some of things they want to do fiscally, it just means we’re going to have to tell the story of how amazing this work is," he said.

The Gateses note that big foreign aid donors such as the U.S. and its U.K., which contribute $30 billion and $16 billion respectively and combine forces with the foundation's $40 billion endowment, are critical to preventing deaths in poor countries.

The foundation’s latest annual letter, out Tuesday, lays out the concern bluntly: “We hope this story will remind everyone why foreign aid should remain a priority, because improving lives abroad is in our own national interest as well as the world’s.”

The pointed reference to the new political climate is a detour from Foundation's typical letters — a sign of how the shake-up in administrations both in the U.S. and the United Kingdom, which has voted to leave the European Union, is rippling across many sectors, from manufacturing to philanthropy.

The reactions have ranged from supportive — take the steel industry and Trump's promises for more trade protection — to the guarded (autos) and criticized (tech and the travel ban.) Facebook COO Sheryl Sandberg has said a Trump decision to withhold funding from overseas care providers that provide abortion counseling could have "terrible consequences."

“Governments have to look outward,” Melinda Gates said by phone. “The message we are giving is, we are a global community. Ebola came here. When we help the world, peace and security also shows up on our doorstep.”

Melinda also noted that the purposes of big government and private sector donations isn't to create an infinite loop of charity.

"You don't make these donations forever," she says, alluding to the fact that she and her husband hope to give away their wealth within their lifetimes. "We are starting countries on a path. When you do the right thing for people in terms of health and agriculture and banking, you lift people out of poverty. South Korea used to be a recipient of aid from the world, and now they're a donor country to the world. So, we need to make these investments."

While the Gates’ don’t hesitate to show their heart — the foundation’s letter features photos of Melinda with Asian sex workers and Bill at the autopsy of an African boy — they lean on numbers to make their case.

Those include: 122 million (the number of children’s lives saved through vaccines and nutrition), 300 million (the number of women in the developing world using modern contraceptives, up 50% from 2003), 35 (the number of polio cases) and 0 (the target the foundation has for cases of AIDS/HIV, malaria, tuberculosis and other killer diseases).

“If you want to improve the world meaningfully in aggregate, with 2 billion very poor people, you have to think numerically,” says Gates, comfortable in slacks and a sweater as he sits on a couch in a small windowless hotel room.

“If you say, I helped this guy and that guy, well that’s wonderful and connects to your heart, but given the size of our resources, we had to try and dramatically raise the health of all poor children in the world,” he says. “So that 122 million (lives saved since 1990), that’s the biggest impact we’ve had.”

Last summer, politicians on both sides of the aisle of Theresa May's anti-European Union-leaning U.K. government voted to maintain the country's $16 billion foreign aid package.

Here in the U.S., Gates is concerned that the new administration’s agenda could jeopardize a historically bipartisan commitment to global health.

That troubles him because “when you commit to bring low-cost HIV drugs to people (under a program started by President George W. Bush, PEPFAR, President’s Emergency Plan for AIDS Relief), there’s kind of a promise you’re not going to cut it off,” he says.

Gates reports that during his meeting with Trump in the weeks before the inauguration, the New York businessman was attentive.

“He admires people who are successful, so he couldn’t have been nicer and he listened,” he says. “But he has a lot of people around him” who could influence his policies.

In some ways, Gates sounds pessimistic about his ability to sell Trump and other officials on the importance to the U.S. of a stable and healthy Third World population.

“The budget is particularly tight, people are talking about increasing defense (spending), lowering taxes, interest costs will be higher,” he says. “So when you look at it mathematically you say, ‘Will the saving of millions of lives for less than $100 a year of drugs, will the U.S. continue to do that?’ It’s not clear where we’re headed.”

But the tech titan cautions against misreading that sober calculus.

“I’m certainly optimistic,” he says. “We have the benefit of science. We will create an HIV vaccine, even it’s likely a decade from now. We’ll get a malaria vaccine, a TB (tuberculosis) vaccine. So all this scientific stuff we’re doing doesn’t go backwards. An election does not cause our vaccines to stop working all of a sudden. It’s all accretive.”

Follow USA TODAY tech reporter Marco della Cava on Twitter.

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