As Elon Musk champions aggressive cost-cutting within the U.S. government through the Department of Government Efficiency (DOGE), Bill Gates is raising red flags about the human cost of that mission.

The billionaire philanthropist warned that dismantling the U.S. Agency for International Development (USAID) could result in millions of preventable deaths globally.

This follows moves by the Trump administration to wind down USAID’s operations and halt its foreign aid efforts, a shift Musk celebrated by boasting he had fed the agency to the “woodchipper.” Since then, many NGOs have reported terminated contracts or inconsistent funding, though a few have seen limited reinstatements amid outcry from humanitarian groups.

“When Elon went into government, if his thing really was about efficiency or using AI, you know, of course we need to make the government more efficient. If that’s what it had been, then it’s a praiseworthy thing to put his time and expertise (into),” Gates told CNN’s Fareed Zakaria in a recent interview. “The fact that it turned into slashing these people, I didn’t expect that and some of that should be put back in place.”

Gates warned that global health efforts are entering a critical phase, as the U.S. and European nations reduce funding for essential health initiatives.

The Microsoft cofounder made the comments just one day after announcing that the Gates Foundation would spend down its endowment—giving away $200 billion, including nearly all of his personal wealth—over the next two decades before shutting down the organization. The decision, he said, reflects urgent concerns over stagnating and reversing gains in global health.

“I think if you show up and say, in two months, you can cut $2 trillion out of a $7 trillion budget, you’re not going to succeed,” Gates said. “So you go for the softest things and things that are overseas, that you can mischaracterize… people that he hasn’t spent any time with.”

Gates also called out Musk for spreading misinformation, specifically a fabricated claim that the U.S. was spending $50 billion on condoms for Gaza, an assertion Musk later admitted was false. Gates pushed back hard on Musk’s rhetoric about USAID workers, whom Musk has described as “radical lunatics” and “anti-American.”

“Other than the military, these are about as honorable and, you know, they’re the face of America to people who we want to be alive with us, and we want their health systems to be tracking potential pandemics,” Gates said. “Demonizing them is deeply unfair.”

Since 2000, the Gates Foundation has invested over $100 billion in global health efforts, working alongside governments and nonprofits to create vaccines, diagnostics, and innovative treatment solutions for the world’s most vulnerable populations.