Presented by Foreign Affairs Open House
There’s never a shortage of attention when it comes to the Gates Foundation. While the world’s largest philanthropy is constantly under the microscope, it’s been thrust even more into the limelight by a confluence of factors, including global aid cuts and the announcement that the foundation is closing up shop in 2045. What does this mean for the future of Gates, both today and 20 years from now? We have the inside take from the foundation’s CEO.
Also in today’s edition: Funds for global health plunge, and how economic resilience programs are helping to support HIV patients.
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The end’s in sight
The Gates Foundation is giving away $200 billion over the next two decades before sunsetting in 2045. The question on everyone’s minds — though they may be too diplomatic to say it out loud — is how they can get their hands on some of that money.
While there’s no secret playbook (at least that we know of), Gates Foundation CEO Mark Suzman did share his insights on what the organization hopes to achieve in the next 20 years and what it will take for partners to help them achieve that vision.
While of course some things will inevitably change, Suzman said the bedrock principles that have driven the foundation for the past quarter of a century will remain — though on steroids. That means doubling down on what’s worked, tapping into innovations such as artificial intelligence, catalyzing investments, and nurturing a new generation of philanthropists and partners to ensure decades of progress live on when the foundation moves on. And Suzman isn’t shy about touting that progress.
“[We’ve seen] the greatest progress for the greatest number of people over the largest and most diverse group of countries in human history,” he said during a one-on-one interview with Devex on Wednesday. “We saw a halving of preventable child mortality, a halving of preventable maternal mortality, a halving of deaths from HIV and TB and malaria.”
But paradoxically, “this will be the first year of the Gates Foundation’s life where the global rates of preventable child mortality and the infection rates and death rates from those big diseases I talked about — HIV, TB, and malaria — will all likely go up,” he added. “And so … you're celebrating 25 years of progress in a year of the greatest setbacks and political headwinds that we have [seen], and that's really at the core of what we're hoping our announcements can help us do — weather this moment and really map a pathway to a future which actually still has massive, accelerated progress for people across the world.”
And what would that progress look like? He cited advances in areas “where the world’s very poorest are most disproportionately affected compared to the world's richest, and that is still in preventable maternal and child health care, death, and infectious diseases. And we hope that the world will look very different, transformed — not solved, but transformed — which means there should be much less need for traditional development resources to focus on those core issues.”
Read: Gates CEO on what the next 20 years hold, and what it means for partners (Pro)
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Unhealthy drop
Before the United States withdrew from the World Health Organization, the Gates Foundation was already its second-largest funder. Suzman warned this is a sign that donors aren’t doing their jobs. “This is a crazy world if a philanthropic foundation has become the largest funder of the most important multilateral health agency. This is a world that is not allocating its resources appropriately compared to need,” he told us.
In fact, as my colleague Jenny Lei Ravelo reports, official development assistance, or ODA, for health may hit a decade low, WHO warned at the Asian Development Bank-hosted INSPIRE forum earlier this month.
Health aid is projected to decline by up to 40% in 2025 compared to 2023 levels, from over $25 billion to around $15 billion, according to WHO. This is even below the health ODA funding in 2015, which was over $18 billion.
The culprit? No surprise — donor cuts by the United States, the world’s largest sovereign donor to health, as well as several countries in Europe.
The victim? No surprise there either — many low-income countries heavily reliant on external aid for their health. It also means more out-of-pocket spending by patients, which could push many into poverty.
In the African region, for example, out-of-pocket spending accounted for more than 50% of the total health spending in 11 countries, including in Equatorial Guinea, which is classified as an upper-middle-income country by the World Bank.
“This means … countries need to spend more on health. Full stop. They need to prioritize domestic public spending on health,” said WHO’s Kalipso Chalkidou.
Read: WHO projects up to 40% cut in health aid in 2025
🎧Listen: For the latest episode of our podcast series, Devex’s Adva Saldinger and Colum Lynch sit down with Shari Spiegel, chief of the Financing for Sustainable Development Office at UNDESA, to discuss the U.S. decision to claw back more than $1 billion in funding to the United Nations, and other top global development stories from the week.
Resilient neighbors
In the wake of the steep U.S. cuts to HIV/AIDS programming worldwide, communities are having to get creative — and resilient.
World Neighbors is among the many nonprofits making this urgent pivot. In Africa’s Lake Victoria basin, what began as a program to address stigma and get bedridden HIV/AIDS patients back on their feet has evolved into building economic resilience — helping people access treatment, improve nutrition, and regain independence.
In 2020, World Neighbors expanded its program to provide people living with HIV and AIDS with economic support to access care during emergencies such as the COVID-19 pandemic. Now, that same resilience is helping groups navigate shocks such as the cuts to the U.S. flagship global HIV/AIDS initiative PEPFAR, says Chris Macoloo, the regional director for Africa at World Neighbors.
Through the programs, participants receive training in entrepreneurship, business development, and record-keeping to prepare them for microfinance schemes such as village savings groups and table banking — a group-based financial model where members contribute savings and loan the pooled funds to each other — which provide them with ready cash flow and access to loans at 5% to 10% interest to cover health care needs.
“People who thought they were too poor and vulnerable now realize that they can mobilize local resources to continue getting ARVs [antiretroviral medication] and good nutrition. We help them establish themselves through training and support groups with the funding we mobilize from private donors, church organizations, and individuals,” Macoloo says.
Read: How economic resilience projects are helping HIV patients survive aid cuts
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In other news
France will recognize a Palestinian state and will make the announcement at September’s United Nations General Assembly, while the U.S. will skip next week’s summit aimed at finding a two-state solution between Israel and Palestine. [The Guardian and The Hill]
Democratic Sen. Jeanne Shaheen has voted to advance Mike Waltz’s nomination as U.S. ambassador to the United Nations in exchange for a commitment to release $75 million in foreign aid for Haiti and Nigeria. [Reuters]
Thailand has evacuated at least 100,000 people from areas along the border it shares with Cambodia, as tension between the two countries escalates. [Financial Times]
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About the author
Anna Gawel
Anna Gawel is the Managing Editor of Devex. She previously worked as the managing editor of The Washington Diplomat, the flagship publication of D.C.’s diplomatic community. She’s had hundreds of articles published on world affairs, U.S. foreign policy, politics, security, trade, travel and the arts on topics ranging from the impact of State Department budget cuts to Caribbean efforts to fight climate change. She was also a broadcast producer and digital editor at WTOP News and host of the Global 360 podcast. She holds a journalism degree from the University of Maryland in College Park.
