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Today, Gates Foundation CEO Mark Suzman released his 2026 Annual Letter, The Road to 2045, warning that the recent reversal in global health progress raises urgent moral choices and outlining a 20-year agenda to accelerate impact as the foundation works toward completing its mission.
Mr Suzman’s reflections come at a consequential moment for global health and development and for the foundation itself. 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 is constraining investment in their people.
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Against this backdrop, the Gates Foundation has moved to accelerate its work and sharpen its focus at a moment 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,” Mr Suzman says.
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“It’s not as if the world forgot how to save children’s lives. It just wasn’t prioritised.”
Mr Suzman notes 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.
Reflecting on what is at stake, Mr Suzman 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.”
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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, Mr Suzman reaffirms three core goals that will guide the foundation’s work. These are, “No mother or child dies of a preventable cause, The next generation grows up in a world without deadly infectious diseases, and hundreds of millions of people break free from poverty, putting more countries on the path to prosperity.”
Mr Suzman’s Annual Letter makes the case that achieving these ambitions is possible if resources are focused where they save the most lives.
He writes 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.
Mr Suzman points to the foundation’s recent announcement of a historic $9 billion annual payout as evidence of both urgency and disciplined stewardship.
His letter also highlights 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.
As one example, Mr Suzman highlights 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 emphasises that technology must be paired with equity, strong public institutions, and local leadership to deliver lasting impact.
Mr Suzman underscores 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 writes.
He emphasises 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, Mr Suzman frames the coming years as a pivotal time. “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.”
“When the foundation closes its doors,” Mr Suzman adds, “I’m confident that where a child is born will no longer determine whether they live, learn, and thrive.”
The full 2026 Annual Letter is available here
About the Gates Foundation
Guided by the belief that every life has equal value, the Gates Foundation works to help all people lead healthy, productive lives. In developing countries, we work with partners to create impactful solutions so that people can take charge of their futures and achieve their full potential.
In the United States, we aim to ensure that everyone—especially those with the fewest resources—has access to the opportunities needed to succeed in school and life. Based in Seattle, Washington, the foundation is led by CEO Mark Suzman, under the direction of Bill Gates and our governing board.
Media contact: [email protected]
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