Global Health at Risk, Yet Recoverable as Gates Foundation Presses for Urgent Collective Action

For the first time in a generation, the world is moving backwards on global health. More children are dying, foreign aid is shrinking, and debt is tightening its grip on low-income countries just as needs are rising. In this moment of reversal, Mark Suzman, Chief Executive Officer of the Gates Foundation, is calling for urgency rather than retreat. In the foundation’s 2026 Annual Letter, The Road to 2045, Suzman confronts the moral and practical consequences of stalled progress, lays out a 20-year plan to accelerate impact before the foundation closes, and argues that proven interventions, innovation and partnership can still ensure that where a child is born, including in countries such as Nigeria, no longer determines whether they live, learn and thrive. Chiemelie Ezeobi reports 

For the first time in more than two decades, global health progress has gone into reverse. It is a moment Mark Suzman, Chief Executive Officer of the Gates Foundation, describes with visible gravity, and one that frames his newly released 2026 Annual Letter, “The Road to 2045”.

Released on February 3, 2026, the letter arrives at what Suzman calls a consequential moment, not only for global health and development, but for the foundation itself. After

 years of stalled gains, foreign aid has fallen sharply by more than 25 per cent, while low-income countries face rising debt burdens that are constraining investment in their people. Against this backdrop of tightening resources and growing need, Suzman warns that recent losses threaten hard-won gains.

“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 prioritised.”

The reversal marks a sobering break from a 25-year period during which child mortality declined sharply and infectious diseases were pushed back through sustained global investment.

A Crisis Driven by Aid Decline and Debt

Suzman’s letter directly links the current setback to declining development assistance and mounting debt pressures across developing economies. Foreign aid cuts and fiscal constraints, he notes, are limiting governments’ ability to invest in health, nutrition and social services at a time when needs are rising.

Yet Suzman is clear that the situation is not irreversible. He argues that progress can be reclaimed through renewed political will, sharper prioritisation and sustained investment, even in a constrained global financial environment.

Reflecting on what is at stake, he writes, “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.”

A 20-Year Mission to 2045

At the heart of The Road to 2045 is a long-term commitment that builds on Bill Gates’ May 2025 announcement that the Gates Foundation would 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 over that period: that no mother or child dies of a preventable cause; that 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.

He argues that achieving these ambitions remains possible if resources are directed where they save the most lives. To that end, the foundation will focus 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.

The Stakes for Nigeria, Africa 

For Nigeria and Africa at large, the overarching question is.. what does it mean for the health systems even with the continuous investments over the years by the foundation aimed at strengthening primary health care systems across the continent. Undoubtedly, these efforts include expanding access to new tools, including artificial intelligence, to improve service delivery, decision-making and access to care.

For countries such as Nigeria, where primary health care, maternal and child survival, infectious disease control and health system financing remain central development challenges, the priorities outlined in the letter directly intersect with national health outcomes. Suzman stresses, however, that technology alone is not enough.

He emphasises that innovation must be paired with equity, strong public institutions and local leadership to deliver lasting impact, a point that underscores the importance of government capacity and community ownership in translating global investment into measurable progress.

Funding, Innovation and Partnership

The Gates Foundation’s recently announced $9 billion annual payout, described by Suzman as historic, is presented as a response to urgency rather than a departure from disciplined stewardship. The letter also highlights how responsibly deployed innovation can help limited resources go further at a time when global funding is under strain.

Equally central to Suzman’s vision is partnership. “None of the progress of the last 25 years would have been possible without our partners,” he writes. He describes the foundation as a catalyst, one that takes risks others cannot or will not take, while working alongside governments, businesses and communities to ensure solutions endure beyond its funding.

Looking Beyond the Reversal

Despite the gravity of the current moment, Suzman frames the coming years as a pivotal opportunity rather than a period of decline. He expresses hope that the present setback will ultimately be remembered as temporary.

“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.

As the foundation looks towards its planned closure in 2045, Suzman ends with a statement of confidence fused with hope in what sustained global effort can achieve. “When the foundation closes its doors,” he adds, “I’m confident that where a child is born will no longer determine whether they live, learn, and thrive.