THE Chief Executive Officer (CEO) of the Gates Foundation, Mark Suzman, has warned that the recent reversal in global health progress raises urgent moral choices and outlined a 20-year agenda to accelerate impact.

Suzman observed that, after years of stalled progress, foreign aid has fallen sharply by more than 25 per cent, with low-income countries also facing mounting debt that constrains investment in their people.

In his yearly letter, titled “The Road to 2045”, Suzman noted that for the first time this century, more children died in 2025 than the year before. “It’s not as if the world forgot how to save children’s lives. It just wasn’t prioritised.”

Suzman stated that while recent setbacks driven by declining development assistance and growing debt burdens are serious, they are not permanent and can be addressed through renewed political will, sharper prioritisation, and sustained investment.

He emphasised that the setback shouldn’t be permanent and unveiled a roadmap to reclaim momentum and accelerate progress through 2045 amid significant financial constraints globally.

“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 said.

Suzman observed that the foundation has moved to accelerate its work and sharpen its focus at a moment when global needs are growing. “Building on Bill Gates’ May 2025 announcement committing the Gates Foundation to spend a total of $200 billion over the next 20 years before closing in 2045, Suzman reaffirms three core goals that will guide the foundation’s work to include that no mother or child dies of a preventable cause, the next generation grows up in a world without deadly infectious diseases and that

Hundreds of millions of people break free from poverty, putting more countries on the path to prosperity. Suzman noted that achieving these ambitions is possible if resources are focused where they save the most lives, adding that the foundation will concentrate its accelerated spending on scaling proven interventions such as immunisation, nutrition, and maternal health care, while investing in new tools to combat malaria, tuberculosis, and other infectious diseases.

He cited the foundation’s recent announcement of a historic $9 billion yearly payout as evidence of both urgency and disciplined stewardship. Suzman highlighted how responsibly deploying innovation, including generative AI, can help limited resources go farther by strengthening delivery systems, improving decision-making and expanding access to care.

Suzman noted the foundation’s recent investment to expand access to AI tools in global health and development, including new partnerships focused on strengthening primary health care systems in Africa. He emphasised that technology must be paired with equity, strong public institutions, and local leadership to deliver lasting impact.
He underscored that progress at this scale depends on deep partnerships. “None of the progress of the last 25 years would have been possible without our partners,” he added.

Suzman emphasised the foundation’s role as a catalyst that takes risks others cannot or will not take and works alongside governments, businesses and communities to ensure solutions last long after its funding ends.
Looking ahead, Suzman frames the coming years as a pivotal time. “I hope 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.”

“When the foundation closes its doors,” Suzman added, “I’m confident that where a child is born will no longer determine whether they live, learn, and thrive.”