Reflections On My First Year as CEO of the Gates Foundation


When you walk into the Bill & Melinda Gates Foundation in Seattle, you see the words All Lives Have Equal Value etched into glass.
What a powerful belief that is. Simple. Inspiring. And bigger than any one person.

I was hooked by that belief the day Bill and Melinda offered me the job of CEO. They gave me the opportunity to work with a team of incredibly talented people and world-class partners to help create a more equitable world for millions of people, especially the most vulnerable.

A year later, I am so thankful I said “Yes.” The experience so far has been thrilling at times, often sobering, and always rewarding.


Some people used to see philanthropy as not especially rigorous or not willing to throw elbows to make good things happen.

Bill and Melinda wanted to do something different. They wanted a foundation that focused on clear goals and measurable results. They wanted to identify the world’s most important problems — and solve them.

Fundamentally, our goal is to level the playing field for people who may be left behind without access to healthcare, education, or pathways to escape extreme poverty.

We aim for nothing short of changing the world. You can’t do this until you’ve first opened people’s imagination to consider how much more is possible.

I think the biggest achievement in the foundation’s first 15 years is the extent to which its approach has changed expectations. No problem that leaves a person mired in suffering should be considered unsolvable.

“Nothing makes me grumpier than the thought of the poorest people missing out on the best the world has to offer simply because they’re poor.”

The single most important thing for me as CEO is taking the drive, power, and intellect of our people and partners, and uniting them to use every resource we have as effectively as possible.

I see firsthand what can happen when brilliant, passionate people are pointed in the same direction. Clarity of purpose emerges. Boundless creativity is unleashed.

Passion like this unlocks something in all of us. It is a joy to witness it coming together to enable people to be great at doing good.

Educational opportunities such as the Prerna School seen here empower girls to build better lives. (Bihar state, India, 2015)


Bill and Melinda speak regularly in public about the work of the foundation. It is a huge asset to have their passion and intellect guide our work.

What I didn’t appreciate prior to joining the foundation is the influence of two other individuals.

Bill Gates Sr. — Bill’s father, and co-chair alongside Bill and Melinda — has been a source of inspiration since the beginning. He encouraged them to begin their involvement in philanthropy.

One of my favorite stories from the early days of the foundation occurred when Bill and Melinda read Nick Kristof’s article about the staggering number of kids dying of diarrhea around the world. Their first reaction was to send a note to Bill Sr. saying, “Dad, maybe we can do something about this.”

Bill Sr. has a way of getting to the heart of the matter with deceptively simple questions like: “At the end of the day, did we help people?” The degree to which he helps to keep all of us grounded is invaluable.

Bill Gates Sr. spending time with kids at a care center for HIV-positive children. (New Delhi, India, 2004)

I draw similar inspiration from Warren Buffett, who has donated a significant portion of his wealth to the foundation and serves as a trustee. Warren cautions against succumbing to the ABCs of business decay: arrogance, bureaucracy, and complacency.

This advice is just as crucial when running a philanthropy as it is when running a company. In fact, it can be even more difficult when you don’t have forcing mechanisms like quarterly earnings reports or shareholder meetings to hold you accountable.

I’ve realized we need to continually ask ourselves if — given our resources and our bold mandate — the foundation is as strong and effective as it should be. To answer that question truthfully, we need to look at ourselves with a candid eye.

To live up to the expectations for what we can accomplish, we have to be a learning organization at our core. That means we must have clear goals, objectively measure how we’re doing, communicate openly, and course correct when things aren’t going as planned.

Open communication isn’t always easy, but I respect when people disagree with me. Creating space for constructive conflict allows you to learn from other perspectives to find unexpected solutions. As someone who considers herself a lifetime student, I find this absolutely essential.

The bottom line with our mission is this: If we allow ourselves to get gummed up because we lack self-awareness and discipline, we lose precious opportunities to reduce human suffering.

Professor Adrian Hill and his team work on vaccines for malaria, HIV, and tuberculosis at the Jenner Institute. (Oxford, United Kingdom, 2014)


Despite having nearly 1,400 employees, we are very small when compared to the problems we are trying to solve, many of which are centuries old and incredibly complex. That’s why everything we do is arm-in-arm with others. We forge partnerships across sectors and industries and geographies to change the way the world thinks about and tackles big problems.

I heard a great African proverb when I started at the foundation, and it has stuck with me: “If you want to go fast, go alone. If you want to go far, go together.”

Five-month-old Tesfahun Tekilo receives an oral polio vaccine at the Dalocha Health Center. (Kebet, Ethiopia, 2013)

We want to help the world go further than ever before. Partnerships are the only way to make that happen. When they work well, when they allow for constructive conflict, partnerships have a way of adding up to something greater than the sum of their parts.

Recently, I heard global-health legend Bill Foege describe lessons he learned while working to eradicate smallpox. He talked about the importance of “consilience” — the phenomenon of independent pieces of information and evidence converging into a stronger whole — as a prerequisite for making dramatic improvements in health.

I love this idea. I like to think of our partner network as a hub of innovation. When NGOs, researchers, and advocates come together with unique vantage points and evidence, powerful ideas can emerge to help make the world a better place. We all win.

“In my view, there are no bigger or better bets we can make than those which have a chance to improve our collective well-being.”

We highlight our partnerships whenever we can. Gavi, the Vaccine Alliance rightly earns kudos for having built a global collaborative that has inoculated nearly half a billion kids worldwide, and saved 7 million lives.

Students at the Miami Dade College Wolfson Campus learn 21st-century skills during a computer course. (Miami, Florida, 2013)

A partnership I particularly love, given my time as chancellor of the University of California, San Francisco, is the University Innovation Alliance, a consortium of public research universities helping to make college degrees more attainable for low-income students. It’s an innovation hub in action — universities experimenting and working together in new ways to help more students succeed.

Other partners are changing entire business models for how we tackle complex issues like fighting disease. A recent one is a German company called CureVac, which is working on a new vaccine-manufacturing technology that allows the body to create its own medicine to fight disease. It’s still early stage, but if it pays off, our partnership will allow this cutting-edge technology to be applied to diseases that disproportionately affect the world’s poorest people.

How cool is that?


I am a firm believer that the well-being of our world is trending in the right direction. It’s feasible that in the next 15 years we will see historic gains in improving the lives of the poorest people faster than at any other time. Bill and Melinda are betting on it.

In the not-too-distant future, I believe we’ll see a series of wins for humanity — a combination of incremental changes and monumental achievements.

Some will grab headlines. Several diseases will dwindle to the point where they are no longer a significant health burden. Others — like polio and Guinea worm — will disappear entirely, thanks to the culmination of decades-long eradication efforts.

Other wins may be less visible, but equally miraculous. More students in the United States will be able to earn a good education; more mothers and their babies will survive pregnancy and childbirth. More people than ever before will have opportunities to thrive and build better lives.

This is the hardest work I know of. The ambitions feel daunting on a good day, ridiculous on a bad day. Nothing makes me grumpier than the thought of the poorest people missing out on the best the world has to offer simply because they’re poor. In my view, there are no bigger or better bets we can make than those which have a chance to improve our collective well-being.

The payoff? An equal chance for everyone to live a healthy and productive life.

The foundation’s core belief etched on the wall of the office lobby. (Seattle, Washington, 2015)