In their 2018 annual letter (, 16 pages, ), reflect on their 's focus, impact, and outsize influence, as well as some of the lessons they have learned over the last decade.
In their tenth annual letter, the Gateses each address "the ten toughest questions [they] get," ranging from "Why don't you give more in the United States?" to "Why are you really giving your money away — what's in it for you?" In the letter, Melinda Gates explains that the foundation spends more in developing countries because those investments can have a disproportionate impact — the $15.3 billion disbursed over eighteen years in support of vaccines has helped halve child mortality globally, for example — while Bill Gates highlights the foundation's work with the , which is studying ways to improve economic mobility for millions of Americans.
And while Bill Gates acknowledges the challenges the foundation has faced in scaling its education reform efforts in the U.S., Melinda points to recent changes at the foundation that reflect some of the lessons they have learned, including an initiative aimed at building collaborative school networks.
In response to the question, "Are you imposing your values on other cultures?" the couple notes that they have become better listeners and that understanding the needs of the people they are trying to help and refining the foundation's strategies accordingly "is not only more respectful — it's also more effective." "We aren't interested in making choices for anyone," writes Melinda Gates. "We invest in family planning, for example, not because we have a vision of what other people's families should look like, but because parents around the world have told us they want the tools to make their vision of their own family come to fruition."
Similarly, when asked, "Is it fair that you have so much influence?" Melinda Gates writes, "No. It's not fair that we have so much wealth…that our wealth opens doors…[and that] cash-strapped school districts are more likely to divert money and talent toward ideas they think we will fund" — but that they "do this work, and use whatever influence we have, to help as many people as possible and to advance equity around the world." Bill Gates notes that "[t]here's another issue at the heart of this question. If we think it's unfair that we have so much wealth, why don't we give it all to the government? The answer is that we think there's always going to be a unique role for foundations," because they can be flexible with their investments and take risks that governments and corporations can't or won't.
As for how the policies of the Trump administration have affected the foundation's work, Bill Gates expresses concerns about proposed cuts to foreign aid, adding: "More broadly, the America First worldview concerns me. It's not that the United States shouldn't look out for its people. The question is how best to do that. My view is that engaging with the world has proven over time to benefit everyone, including Americans, more than withdrawing does. Even if we measured everything the government did only by how much it helped American citizens, global engagement would still be a smart investment."
"I would also say," writes Melinda Gates, "that I believe one of the duties of the president of the United States is to role-model American values in the world....The sanctity of each individual, regardless of race, religion, sexual orientation, or gender, is part of our country's spirit."