You are assuming that the information that is publicly available is a representative sample of how Bill Gates spends his money. That may or may not be true.
Except most of those tens of billions haven't gone anywhere and are still held by a foundation fully controlled by bill gates. The amount of it that drips down to actual charities is a small percentage of these tens of billions each year.
Perhaps not all at once, but there are plenty of problems with underfunded solutions.
A few years back, I was fortunate to have a random conversation with a reknown researcher from Princeton Plasma Physics Laboratory. He was lucid and blunt: if we had more money we could solve fusion.
A couple days later there was news of China having done the longest running fusion reactor burst (?) to date. Two-plus minutes.
I keep thinking about that conversation and his "promise."