The Gates Foundation has outlined three major ambitions it hopes to achieve over the next two decades: end preventable maternal and child deaths, eliminate deadly infectious diseases and help hundreds of millions of people escape poverty.
In his 2026 Annual Letter titled The Road to 2045, the foundation’s Chief Executive Officer, Mark Suzman, said the foundation would spend $200 billion over the next 20 years before closing its doors in December 2045.
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Mr Suzman described it as an accelerated push to “save and improve lives” at a time when global health progress is slowing, and foreign aid is shrinking.
“In 2025, for the first time this century, it’s almost certain that more children died than the year before,” Mr Suzman wrote. “That’s a sentence I hoped I’d never have to write. It’s not as if the world forgot how to save children’s lives. It just wasn’t prioritised.”
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For Nigeria, the foundation’s priorities align closely with long-standing health and development gaps. The country consistently ranks among those with the highest maternal and child mortality rates globally and continues to face major burdens from malaria, tuberculosis, and HIV.
According to the World Health Organisation (WHO), Nigeria is among the top contributors to maternal, neonatal and child deaths worldwide.
If the Gates Foundation’s final 20-year push is about reducing maternal and child mortality, eradicating malaria, controlling TB and HIV, and reducing poverty through agriculture and education, Nigeria sits at the centre of that agenda.
Ending preventable maternal and child deaths
The foundation’s first goal is: “No mother or child dies of a preventable cause.”
Mr Suzman writes that the aim is to bring maternal and child mortality rates in the global South in line with those in the global North by 2045. That would require halving child mortality again within two decades.
Maternal deaths in Nigeria are largely driven by preventable causes such as haemorrhage, infections, pre-eclampsia, and complications during childbirth. Access to skilled birth attendants remains uneven, especially in rural and conflict-affected areas, while many primary health centres face staffing shortages and equipment gaps.
Data from the 2024 Nigeria Demographic and Health Survey (NDHS) show that only 46 per cent of live births in Nigeria were attended by skilled birth personnel.
To address these issues, the Federal Ministry of Health and Social Welfare launched the Maternal and Neonatal Mortality Reduction Initiative (MAMII) in 2024 and began refurbishing more than 1,400 PHCs. As of December 2025, the National Primary Health Care Development Agency (NPHCDA) revealed that 2,125 PHCs have been fully revitalised across the country.
Under-five mortality in Nigeria is closely linked to pneumonia, diarrhoea, malaria and malnutrition. Malnutrition alone is an underlying factor in nearly half of global child deaths, and Nigeria continues to struggle with high rates of stunting.
The Gates Foundation says it will continue investing in vaccines, nutrition and maternal health care, areas where it has historically focused. Mr Suzman describes vaccines as “the best buy in global health” and points to investments in maternal immunisation, obstetric care, nutrition and innovation in women’s health.
One example he highlights is pre-eclampsia, a major contributor to maternal deaths. Doctors still do not fully understand its causes, and treatment options are limited.
The foundation says it is supporting innovations like a screening tool that helps healthcare workers spot risk early, a quick and affordable blood test that lets clinics diagnose and manage cases without having to send the blood to a separate lab, and promising new drug candidates that could finally move treatment beyond symptom management.
Mr Suzman acknowledges that “a breakthrough innovation can’t change lives unless it reaches the people who need it – and that often comes down to cost and access.”
Infectious diseases: Nigeria at the centre of the fight
The second goal is that “the next generation grows up in a world without deadly infectious diseases.”
The foundation believes malaria and polio can be eradicated by 2045, and that TB and HIV can be brought under control as manageable conditions.
Nigeria was declared free of wild poliovirus in 2020 after years of coordinated vaccination campaigns, but maintaining that status depends on sustained immunisation and surveillance, both of which require consistent funding.
Malaria remains Nigeria’s biggest infectious disease burden. The country recorded the highest number of malaria cases and deaths globally, with an estimated 68,466,000 cases, according to the 2025 World Malaria Report.
Despite long-running donor-supported programmes, malaria continues to overwhelm households and health facilities.
Tuberculosis remains underdiagnosed, and Nigeria is among the countries with a significant gap between estimated and detected cases. HIV prevalence has declined over time, but treatment and prevention efforts rely heavily on external funding.
Following a reduction in international funding, the Nigerian government intensified efforts to combat malaria, aiming to eliminate the disease by 2030. Recent actions focus on increasing domestic funding, accelerating vaccine deployment, local production of commodities, and expanding preventive treatments.
The Gates Foundation says it is supporting a new generation of tools: malaria vaccines, mosquito-targeting innovations, improved TB vaccines such as the M72 candidate currently in trials, and advances in HIV prevention and potential cures.
It is also investing in generative artificial intelligence to strengthen primary healthcare systems. Through partnerships like Horizon 1000, the foundation aims to bring AI tools to clinics across sub-Saharan Africa to support patient intake, triage and follow-up care.
In theory, such tools could help overstretched Nigerian health workers manage large patient loads. In practice, their effectiveness will depend on electricity supply, internet access, data systems and trained personnel.
Poverty, agriculture and the economic question
The third ambition extends beyond health: “Hundreds of millions of people break free from poverty.”
While more than 70 per cent of the foundation’s funding will focus on health, agriculture remains central to its poverty strategy in low- and middle-income countries.
Mr Suzman noted that growth in agriculture is two to three times more effective at reducing poverty than growth in other sectors. At COP30, the foundation committed $1.4 billion over four years to help smallholder farmers adapt to climate change.
Nigeria’s economy makes this goal highly relevant. Small-scale or smallholder farming is the backbone of the national food supply and a primary source of livelihood for millions of Nigerians.
Climate shocks, flooding, desertification and insecurity have disrupted agricultural productivity. Improved seeds, climate-resilient crops and better market access could boost productivity, but structural constraints like land tenure issues, rural insecurity, poor transport infrastructure and limited credit could complicate development.
Aid decline and Nigeria’s responsibility
Mr Suzman further notes that wealthy countries have withdrawn tens of billions of dollars from health and development funding, with foreign aid falling by more than 25 per cent. He admitted that low-income countries face mounting debt burdens that constrain spending on health and social services.
The Gates Foundation’s proposed $200 billion investment over the next 20 years globally, including in Nigeria, could help accelerate progress, but its impact in Nigeria will depend largely on government ownership, policy consistency and accountability.
Nigeria has repeatedly fallen short of the Abuja Declaration target of allocating 15 per cent of its national budget to health, and state-level commitments vary widely. Health financing remains heavily reliant on external partners for HIV, TB, malaria and immunisation programmes.
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If global aid continues to shrink, Nigeria will need to expand domestic health financing, improve budget execution and strengthen accountability mechanisms.
A 20-year window
The Gates Foundation plans to close in 2045. That deadline gives the world a 20-year window.
Mr Suzman says he hopes future generations will look back at 2025 as “a small spike, an almost forgotten moment when progress hung in the balance before the world got back on track.”
Whether that proves true may depend on countries like Nigeria. The foundation can invest in vaccines, nutrition, maternal health innovation, malaria tools, TB vaccines, AI systems and climate-resilient agriculture, but lasting change will require accountable and reliable public institutions, stable financing and leadership.
