Gates, 69, declared that the foundation he started with his former wife, Melinda French Gates, will officially shut down at the end of 2045 after spending the vast majority of its endowment. According to him, the goal is to solve “urgent problems” such as preventable diseases, child mortality, and poverty in the poorest regions of the world. Yet it’s unclear why one tech billionaire should be so deeply embedded in decisions that shape public health systems, particularly in nations that never elected or invited him to do so.

“People will say a lot of things about me when I die, but I am determined that ‘he died rich’ will not be one of them,” Gates wrote in a personal post. But critics point out that this kind of centralized, privately directed giving can blur the line between philanthropy and influence.

Gates also made thinly veiled criticisms of governments—including the United States, United Kingdom, and France—for cutting foreign aid budgets, arguing that public-sector funding remains essential for tackling diseases like polio and malaria. He singled out the U.S. in particular, noting the importance of its continued investment, and referenced past discussions with President Donald Trump about the issue.

It’s not the first time Gates has taken a strong public stance on matters of health policy, often stepping into roles typically reserved for elected officials or medical experts. His foundation has already spent $100 billion on global initiatives and plans to spend another $100 billion by 2045. It has also played a central role in shaping the priorities of global health bodies such as Gavi and the Global Fund—two organizations with massive influence over vaccine distribution and disease response.

Joined over the years by billionaire investor Warren Buffett, Gates has built a foundation with an annual budget set to reach $9 billion by 2026. That level of spending gives the organization unmatched sway in the global development space—yet it is still ultimately accountable to no one but its founders.

The question isn’t whether Gates is capable of generosity. It’s why so much control over the world’s most vulnerable communities should rest in the hands of one individual, especially one whose expertise lies in building tech empires, not public health systems.