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In this photo taken Feb. 1, 2019, Bill and Melinda Gates pose for a photo in Kirkland, Wash. From their perch as the "unofficial deans" of big-ticket philanthropy, it's business as usual for the Gates amid questions about whether altruism by the wealthy is a force for good. They are speaking out as their annual letter reviewing their work and vision is released. This year's note focused on 2018's surprises in the areas where the Bill and Melinda Gates Foundation are involved, including global health and development and U.S. education and poverty. (AP Photo/Elaine Thompson)