Mark Suzman CEO of the Gates Foundation.PHOTO; Courtesy
The head of the Gates Foundation has warned that the world is at risk of losing decades of progress in global health, as falling aid budgets and rising debt levels place renewed pressure on low-income countries.
In his 2026 Annual Letter, The Road to 2045, Mark Suzman, CEO of the Gates Foundation, describes the current moment as one of profound moral choice, one that will determine whether recent setbacks become a temporary pause or a lasting reversal in the fight against preventable deaths and poverty.
Suzman’s reflections come as foreign aid has declined by more than 25 percent, even as global health needs rise.
Many low-income countries are also facing mounting debt burdens that are limiting public investment in health systems, nutrition, and basic services.
“In 2025, for the first time this century, it’s almost certain that more children died than the year before. That’s a sentence I hoped I’d never have to write,” Suzman says.
“It’s not as if the world forgot how to save children’s lives. It just wasn’t prioritized.”
A setback that can still be reversed
While acknowledging the seriousness of the current decline, Suzman argues that the slowdown in progress is not inevitable.
He writes that with renewed political commitment, sharper prioritisation and sustained investment, global health gains can be restored.
“Over the years, I’ve held fast to the conviction that poverty is not a sad inevitability but a solvable problem, one we have a moral obligation to take on,” he writes.
The letter builds on Bill Gates’ May 2025 announcement that the foundation will spend $200 billion over the next two decades, before closing in 2045.
According to Suzman, the accelerated spending reflects urgency, but also confidence that proven solutions already exist and simply need to be scaled.
Three goals guiding the road to 2045
Suzman outlines three long-term goals that will guide the foundation’s work over the next 20 years:
Ensuring no mother or child dies from a preventable cause
Ending deadly infectious diseases for the next generation
Enabling hundreds of millions of people to escape poverty, putting more countries on a path to prosperity
He argues that achieving these ambitions depends on focusing resources where they save the most lives.
As a result, the foundation plans to scale up proven interventions such as immunisation, maternal health care and nutrition, while continuing to invest in new tools to fight malaria, tuberculosis and other infectious diseases.
Innovation, AI, and delivery systems
Suzman points to the foundation’s recent commitment to a historic $9 billion annual payout as evidence of both urgency and accountability.
He also highlights the growing role of innovation, including generative artificial intelligence, in helping limited resources reach more people.
The letter notes investments to expand access to AI tools in global health, including partnerships focused on strengthening primary health care systems in Africa.
Suzman stresses, however, that technology alone cannot deliver change: it must be paired with equity, strong public institutions, and local leadership.
Partnerships and local leadership
Suzman repeatedly underscores the importance of collaboration, describing the foundation not as a replacement for governments but as a catalyst that supports risk-taking, innovation, and long-term sustainability.
“None of the progress of the last 25 years would have been possible without our partners,” he writes, emphasising collaboration with governments, communities, researchers, and local organisations.
Looking ahead, Suzman frames the coming years as decisive for the future of global development.
“My hope is that future generations will look back on this period as a small spike, an almost forgotten moment when progress hung in the balance before the world got back on track,” he writes.
“When the foundation closes its doors,” Suzman adds, “I’m confident that where a child is born will no longer determine whether they live, learn, and thrive.”
Relevance for Africa
While Suzman does not specifically mention Africa in his letter, the continent remains central to the global health challenges he highlights.
Child mortality, infectious diseases, and gaps in primary health care remain pressing issues across the region.
By emphasising investments in primary health care, maternal and child health, infectious disease control, and the use of AI to strengthen delivery systems, the Gates Foundation’s accelerated 20-year agenda has direct implications for African countries.
How governments, donors, and local partners respond now will shape whether the continent’s health and development gains continue, stall, or accelerate over the next generation.
