Based on actual evidence, what does the Gates foundation actually do with it's money?

1. Where the money goes: program areas and big-ticket projects

Annual reports and the foundation’s committed grants database make clear that the bulk of spending is concentrated in a few programmatic areas—global health (vaccines, disease eradication like polio, R&D and delivery), global development (agriculture, financial inclusion, water and sanitation), and U.S. education—each broken down in the foundation’s public financials and grant listings ^{[4] [5] [6]}. The foundation explicitly highlights long-running, high-dollar commitments such as polio eradication and vaccine scaling partnerships, and reports working with manufacturers to increase vaccine supply when needed ^{[6] [4]}.

2. Scale and strategy: budgets, endowment, and the payout plan

The foundation operates at an unprecedented scale—reporting an endowment/trust value in the tens of billions (Foundation Trust Endowment reported $77.2 billion as of Dec. 31, 2024, and an unaudited $86 billion as of July 31, 2025) and annual charitable support of about $8.0 billion in 2024 ^[1]. Leadership has signaled an intentional “spend-down” posture: the board endorsed a roughly $9 billion annual payout for 2026 as part of a plan that intends to accelerate grantmaking ahead of a planned closure of the foundation in 2045 ^{[3] [2]}. Reporters have also documented operational moves tied to that shift, including plans to reduce staff headcount over several years to align with the spend-down ^{[7] [8] [9]}.

3. How the foundation accounts for and publishes spending

The foundation publishes audited consolidated financial statements, Form 990-PFs, and annual reports; it states that its online committed-grants database lists grant commitments back to 1994 and that audited filings are posted as they become available ^{[10] [11] [5]}. Annual reports disclose what’s included in headline numbers—for example, 2024 figures are rounded to the nearest million and include grant payments, direct charitable contracts, and operational expenditures but exclude program‑related investments (PRIs)—so some investment activity is reported separately ^[4].

4. Influence, criticism, and areas of debate

Public commentary and critiques focus less on opacity of dollars than on the foundation’s influence and strategic choices—arguments that a few large private funders can shape research agendas, policy priorities, or education reform without the same accountability mechanisms as public institutions appear in external coverage and encyclopedic summaries ^[12]. The foundation itself defends its stewardship strategy and argues that large, targeted investments can create market tools and accelerate solutions in low-income settings ^{[4] [6]}. Both viewpoints are visible in the public record: critics raise concerns about outsized influence ^[12], while the foundation points to audited results, long-term partnerships, and outcome-focused spending as justification ^[4].

5. Limits of available evidence and what remains unclear

The public documents supplied by the foundation provide granular line items for grants and audited totals, but they also disclose that certain instruments—like PRIs and some internal stewardship decisions—are reported differently or excluded from headline totals, which limits a single-number view of all capital deployed ^{[4] [11]}. Independent assessments of long-term causal impact, or comprehensive mapping of how grants changed recipient countries’ systems over decades, are referenced in program narratives but require external evaluation studies beyond the foundation’s financial filings to confirm; those studies are not comprehensively assembled in the financial reports themselves ^{[4] [6]}.