There is no question that it has been a tumultuous year for global health. Foreign aid has fallen by more than 25 percent, rich countries are making 11 per cent cuts in health and development funding, and low-income countries are seeing their limited resources continue to be burdened by debt. However, in the face of such challenges, the Gates Foundation does not back down from global aid but doubles down—and urges others to do the same.
“These are real challenges—but they’re not permanent,” said Mark Suzman, CEO of the Gates Foundation, in an annual report published today (Feb. 3). “And while these conditions will have a major impact on global health and development in the next few years, priorities can change. Debt can be restructured. Generosity can return.”
Seeking global cooperation is a key element of the Gates Foundation’s plan for the next two decades as it prepares to accelerate progress in areas such as global health, education and economic prosperity. The organization, founded by Bill Gates and his wife at the time, Melinda French Gates, in 2000, last year revealed plans to spend the money allocated to it before it ends in 2045.
The foundation’s goals have taken on added urgency amid cuts in global aid led by high-income countries like the US. In the past year, the US has cut funding to agencies like the US Agency for International Development (USAID) and withdrawn support for the Gavi vaccine coalition—despite pledging $4.5 million in Global Funding, AIDS, and tuberculosis funding.
Such budget cuts have been linked to a worrying shift in child mortality trends around the world. For the first time this century, child deaths are estimated to have increased in 2025 compared to the previous year, increasing from 4.6 million to 4.8 million, according to the Gates Foundation.
“It was not prioritized,” said Suzman. “Funding and attention was diverted elsewhere, even though we know more about how to save lives now than at any other time in human history.”
The Gates Foundation knows it cannot fill the global aid gap alone. This is why in the next twenty years there will be an emphasis on strengthening existing alliances and building new ones. “What the world needs now is a new era of cooperation focused on saving and improving lives,” said Suzman, who outlined the foundation’s goal of mobilizing other donors and working with governments in low- and middle-income countries to extend resources in a sustainable manner.
The road to 2045 will also bring a sharper focus on fundamental priorities. Going forward, the organization will use 70 percent of its resources to reduce maternal and child mortality in the Global South and eliminate deadly infectious diseases such as polio and malaria. Its third goal will focus on improving economic prosperity through investment in education and agriculture.
AI will play a role in all three areas, Suzman said, noting that the Gates Foundation has already entered into strategic partnerships such as Horizon1000, a $50 million collaboration with OpenAI to strengthen AI-enabled health care in African countries.
The Gates Foundation is well aware of its influence as the largest private foundation in the world. Given $86 billion since July, the organization has already distributed more than $100 billion since its inception. And it plans to double spending between now and 2045.
Despite its many resources, the foundation will need to streamline operations to maximize the impact of its grants. Last month, it announced its largest ever annual spending budget of $9 billion, and plans to cut its workforce by 500 roles over the next five years. Some of the affected positions will be tied to programs that have closed or will soon end, including the Inclusive Financial Systems program and the US Economic Mobility and Opportunity program.
As the Gates Foundation moves forward with its sunset mission, it remains hopeful that its priorities can cross borders and attract broad support. “These are the principles that I hope people of all backgrounds, religions and political beliefs can agree on,” said Suzman.
