Seattle — Mark Suzman has warned that recent reversals in global health progress pose urgent moral choices but insisted the setback need not be permanent, outlining a 20-year roadmap to reclaim momentum and accelerate gains through 2045--even amid severe global financial constraints.
In his 2026 Annual Letter, The Road to 2045, released on Tuesday, the Gates Foundation chief said the world is at a consequential moment for global health and development, as foreign aid has fallen by more than 25 per cent and mounting debt in low-income countries is constraining investment in people.
Against this backdrop, Suzman said the foundation is accelerating its work and sharpening its focus at a time when global need is growing.
"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 said. "It's not as if the world forgot how to save children's lives. It just wasn't prioritised."
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While acknowledging that declining development assistance and rising debt burdens have driven recent setbacks, Suzman said these challenges are not irreversible and can be addressed through renewed political will, sharper prioritisation and sustained investment.
"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 wrote.
The letter builds on Bill Gates' May 2025 announcement committing the foundation to spend $200 billion over the next 20 years before closing in 2045. Suzman reaffirmed three core goals guiding the foundation's work: ensuring no mother or child dies from a preventable cause; enabling the next generation to grow up without deadly infectious diseases; and helping hundreds of millions escape poverty, putting more countries on a path to prosperity.
Suzman said achieving these ambitions is possible if resources are focused where they save the most lives. He noted that the foundation will prioritise scaling proven interventions--such as immunisation, nutrition and maternal healthcare--while investing in new tools to fight malaria, tuberculosis and other infectious diseases.
He cited the foundation's recent announcement of a historic $9 billion annual payout as evidence of urgency and disciplined stewardship, and highlighted the role of responsibly deployed innovation, including generative AI, in stretching limited resources by strengthening delivery systems, improving decision-making and expanding access to care.
As an example, Suzman pointed to recent investments aimed at expanding access to AI tools in global health and development, including partnerships focused on strengthening primary healthcare systems in Africa. He stressed, however, that technology must be paired with equity, strong public institutions and local leadership to deliver lasting impact.
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Suzman also underscored the importance of partnerships, describing the foundation as a catalyst that takes risks others cannot or will not take, while working alongside governments, businesses and communities to ensure solutions endure beyond its funding.
Looking ahead, he framed the coming years as pivotal. "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 wrote.
"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."
