Washington CNN Business  — 

Bill Gates sounded a note of caution this week on Elon Musk’s $44 billion acquisition of Twitter, saying the Tesla CEO “actually could make it worse” despite a strong track record with his other business ventures.

While Gates did not precisely define what he meant by “worse” in remarks at the Wall Street Journal’s CEO Summit on Wednesday, he questioned whether Musk is committed to preventing the rapid spread of public health misinformation and vaccine skepticism on social media.

“How does he feel about something that says vaccines kill people, or you know, that Bill Gates is tracking people — is that one of the things he thinks should be spread?” Gates asked.

“If all you need is money and hiring great engineers, he’s probably as good a person as any” to guide Twitter through its next chapter, Gates added, but said he doesn’t expect Musk to replicate Tesla and SpaceX’s “mind-blowing” performance.

“I kind of doubt that’ll happen this time, but we should have an open mind and never underestimate Elon,” Gates said.

Public attention has zeroed in on Gates’ relationship with Musk in recent weeks after Musk tweeted an unflattering picture of Gates and accused him of shorting Tesla’s stock.

On Wednesday, Gates said that Musk’s tweeting “doesn’t bother me” and declined to say whether he has bet against Tesla.

“It’s possible that the stock went down and whoever shorted the stock made money, I don’t know,” Gates said, seemingly with a small smile. “Did it go down in the last month? I don’t know. I don’t think whether one is short or long Tesla is a statement about your seriousness about climate change. I’m putting billions of dollars into climate change innovation; I applaud Tesla’s role in helping with climate change.”

Gates also characterized misinformation on social media as being more than a technology problem, highlighting how people in positions of trust — from religious leaders in Africa to politicians in the United States — play a major role in whether people embrace vaccines or turn instead to “insane” beliefs about alternative, unproven therapies.

“When you don’t have the trusted leaders speaking out about vaccines, it’s pretty hard for the [tech] platform to work against that, so I think that we have a leadership problem and we have a platform problem,” Gates said.

While Musk may bring sweeping changes to Twitter’s product, Gates said he is hopeful that policymakers will develop their own changes to “the legal framework, which he’ll have to follow … there’ll be hopefully innovation in that in parallel with whatever he’s doing on the engineering side.”

Asked to expand on his tweet this week criticizing the leaked Supreme Court opinion overturning Roe v. Wade, Gates called the draft decision “pretty disappointing from my point of view.”

“It’s weird to think of the US going backwards, because mostly what we’re trying to do is get other countries to catch up with the rich countries where the right to choose has been pretty well established,” Gates said. “After 50 years, something feels like it is part of the history of the country and it’s strange to say, ‘No, let’s reverse that.’”