Bill Gates is worried that "millions" of lives are on the line if U.S. foreign aid funding isn't reinstated.

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• Bill Gates says if U.S. foreign aid spending doesn’t get back on track soon, millions of lives are at risk. He added it could also present an economic problem as aid presents a gateway for diplomatic and economic conversations with foreign nations.

While the end result of Elon Musk’s cost-cutting crusade through government remains to be seen, Microsoft cofounder Bill Gates has warned millions of people could suffer in the meantime.

The philanthropist warned that if aid funding out of the world’s largest economy continues to dwindle, millions of lives will be on the line, and he hopes that some of the Department of Government Efficiency’s (DOGE) measures will be rolled back.

Speaking to PBS in an interview released yesterday, Gates was asked about the 180-degree turnaround between action being taken by the White House and a conversation the billionaire tech titan previously had with Trump.

Earlier this month, Gates said that President Trump seemed open to hearing his thoughts on continued foreign aid.

But with Musk and President Trump halting USAID’s work—be it placing staff on leave, freezing spending, or reducing its headcount to a mere 300 workers from thousands—that conversation seems to have been forgotten.

“I’m hopeful that some significant portion of that can be reversed and preserved,” Gates said. “Elon, of all the elimination he’s done, 99% of it is these employees at the USAID who work overseas in very tough circumstances and they allow the U.S., in addition to our military power, get out there and help out with famine and HIV medicines.”

Gates also spoke specifically about PEPFAR—the President’s Emergency Plan for AIDS Relief—which so far has saved more than 26 million lives through HIV and AIDS prevention courtesy of $110 billion in funding since its inception more than 20 years ago.

“I know a lot of those workers, I know that work,” Gates continued. “A very, very high percentage of it is stuff every taxpayer would be proud of.

“Elon I think said ‘Yeah, we made a mistake, we went overboard,’ but … what is the equilibrium? How many of those people can be kept so we can continue to save tens of millions of lives?”

Gates’s anecdote is partially correct. Musk has indeed admitted he has, and will, make mistakes during his work at DOGE.

This was in response to a question from a journalist last week, who asked if a $50 million aid payment toward condoms in Gaza had been blocked for the wrong reason.

The reporter pointed out that the payment, which would have purchased around a billion condoms, is likely to have been intended for HIV prevention in the Gaza region of Mozambique, and not the war-torn region currently controlled by Hamas.

Such slip-ups could prove costly, warned Gates, who was asked how many lives are at risk if funding for these sorts of health organizations are not reinstated.

“It’s definitely in the millions,” Gates responded. “PEPFAR has kept over 20 million alive with HIV drugs, started by President Bush and continued on a bipartisan basis literally up to the day Elon decided it wasn’t a good organization.”

DOGE and the White House did not respond to Fortune‘s request for comment.

“Keeping people alive from HIV, the U.S. has done a great job, and even if we have to reduce that sum, an abrupt withdrawal is a terrible thing,” Gates added.

Motivation for foreign aid

When the White House announced its 90-day pause on foreign aid, it pointed out that the U.S. government spends some $40 billion a year on such funding.

However, this is a fraction of the administration’s spending—it has spent $2.44 trillion since October.

Therefore, the yearly spending on foreign aid represents 1.6% of the government’s spending in less than five months.

Gates, worth $168 billion per the Bloomberg Billionaire Index, pointed out that as well as the obvious moral and ethical benefits of supporting humanitarian crises, there is also an economic benefit.

“There is the uplifting element that if these countries can get out of the poverty trap, then they participate in doing business with the U.S., they have gratitude to the U.S., so even beyond the moral reason—maintaining stability, reducing illegal immigration—we have something in common that we can help these countries,” Gates explained.

“There’s a little bit of a ‘do they favor China over us’ but because of PEPFAR they’ve been very much positive to the United States,” Gates added.