The Gateses after an interview with Fortune in Seattle in March.

IT WAS MARCH 2018, AND ONCE MORE BILL GATES found himself behind a podium. In the previous few months, he had given one keynote address after another—in San Francisco, he’d urged drugmakers to focus on diseases that affect the poor as well as the rich; in Andhra Pradesh, India, he had preached the value of smallholder farms; in Abu Dhabi, he’d enjoined the Crown Prince and other princelings to continue their financial support for global health initiatives; in Cleveland, he’d promoted investment in better schools.

Now the world’s second-richest man and foremost itinerant advocate for the poor was in Abuja, Nigeria, talking about the same theme that had underlain all of these speeches: the need to invest in “human capital.” Among those gathered at the conference center, in the shadow of the Aso Rock Presidential Villa, was the Nigerian President himself, Muhammadu Buhari, and what seemed like the entire seat of government, from legislative mandarins to a full house of governors and business leaders—all primed to hear from a man who had, so far, lavished the country with $1.6 billion in grants through his eponymous foundation.

Two months earlier, the Bill & Melinda Gates Foundation had taken the unusual step of absorbing a $76 million IOU Nigeria owed to Japan, for money Nigeria had borrowed to fund a polio eradication effort. The progress there had been striking. In 2012 the country had more than half of the worldwide cases of this paralyzing disease; that number had since been cut to zero.

But Gates wasn’t there to deliver a keep-up-the-good-work speech. He was there to say the opposite: to tell his hosts that their nation—Africa’s richest and most populous, with 190 million residents—was on a knife’s edge. The country was facing an “epidemic of chronic malnutrition,” with one in three Nigerian children chronically malnourished, Gates told his audience. Nigeria had the fourth-worst maternal mortality rate on the planet, making it “one of the most dangerous places in the world to give birth.” More than half of rural Nigerian children could not adequately read or write. The primary health care system was “broken.”

The harsh litany went on. On the basis of per capita GDP, oil-rich Nigeria was “rapidly approaching upper-middle-income status, like Brazil, China, and Mexico,” Gates said. But by every meaningful measure, it still resembled an impoverished nation: Life expectancy was a meager 53 years—nine years lower, on average, than its low-income neighbors in sub-Saharan Africa. Nigeria was headed for a perilous future—unless it changed course, that is, and began to substantially

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