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The Gates Foundation said it will hold to its long-running global health focus even as countries reduce foreign assistance, and it plans to narrow—rather than expand—its priorities through its next phase of funding. In an annual letter released Tuesday, the foundation’s chief executive, Mark Suzman, said donor cutbacks would have “significant repercussions” but that priorities can still shift and that “generosity can return.” He said the foundation is renewing its push for continued global health financing, with an emphasis on saving the lives of pregnant women and young children.
The foundation said it will not add new priorities in the face of aid reductions, and it described the change as a narrowing tied to three “core North Star goals.” It said it will concentrate at least 70% of its funding over the next 20 years on ending preventable maternal and child deaths and controlling key infectious diseases. A third goal focused on poverty, the letter said, will split the foundation’s work between U.S. education and agriculture in poorer countries.
Suzman said the foundation will renew advocacy efforts even though he acknowledged that overall global health funding is unlikely to return to pre-pandemic levels. He added that the foundation has “not lost hope that the U.S. will stay engaged over the medium and longer term as a champion of global health,” and he said the foundation’s advocacy would argue for saving the lives of pregnant women and young children because it is “powerful and evocative,” according to the letter.
The letter also set out how foreign aid dynamics could affect global health programs in coming years. The article said it was not yet clear how much funding Congress and the Trump administration will allocate toward foreign assistance or global health, but it cited that the State Department has said foreign assistance would look “extremely different.” It also said the U.S. refused to fund Gavi, which provides vaccines to children around the world, while pledging to contribute to the Global Fund to Fight AIDS, Tuberculosis and Malaria.
In the foundation’s plan for what would end, the letter said the Gates Foundation would wind down a program designed to help people in sub-Saharan Africa and South Asia gain access to digital financial services, adding that the goal would be met by 2030. It also said the foundation would end a U.S. program aimed at helping people move out of poverty that it launched in 2022 with a $460 million commitment.
The article said the economic mobility program was led by Ryan Rippel, who in 2023 said the foundation aimed to improve economic mobility for 50 million people in the U.S. who earn 200% of the poverty level or less—a figure the article said was $29,160 in annual income for an individual at the time. The Gates Foundation said it had not assessed the program’s impact against that goal specifically, and it said the work would continue in a modified form as a partnership announced in July to develop AI tools that benefit frontline workers.
For near-term planning, the foundation said it plans to hold its budget steady for the next five years at $9 billion annually, regardless of market changes, Suzman said. After that, the foundation said it expects to increase the spending as it seeks to meet its commitment to spend the vast remainder of Bill Gates’ fortune through the foundation by 2045. The foundation said in January it would cap operating expenses at 14% of its annual budget and anticipated reducing its workforce by 2030.
The foundation also said it is betting on artificial intelligence tools in multiple areas, including U.S. education and agriculture. It said that looking back, U.S. education had been an early focus of Bill Gates and Melinda French Gates and that those efforts did not deliver the desired impact, but Suzman said AI applications could help many students, teachers and schools. The article said the Gates Foundation in January announced a new $50 million partnership with OpenAI’s for-profit subsidiary, to develop ways for primary health clinics in Rwanda and potentially other countries to use AI to amplify the reach of health workers and improve outcomes for patients.
Suzman said that when the foundation works with corporations, it requires that what they develop be offered without markup to poorer countries. He also said the foundation is seeking projects that will be interoperable and open source so that they function as “very new public goods,” meaning users are not locked into working with a specific company. John Halamka, a physician and president of the Mayo Clinic Platform who previously worked at the intersection of health care and technology but said he is not involved in the initiative, said such projects need to empower local municipalities to develop and fine-tune AI models for their populations and must also build patient trust.
“What are you doing to make the population comfortable with the use of these new technologies?” Halamka asked in comments included in the article, also asking how to ensure that tools like these will be used, trusted, and adopted.
The article also noted that the foundation’s proposed changes were developed before U.S. government files on Jeffrey Epstein that include mentions of Gates and “unsubstantiated claims” cited by a spokesperson described as false were released.