In the face of aid cuts, Gates Foundation narrows its priorities and defends global health funding

The Gates Foundation will not change course in the face of massive foreign aid cuts, holding out hope that the U.S. specifically will return to funding the global health projects the foundation has long championed, its CEO said Tuesday.

Instead, the foundation — one of the largest in the world — 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 will divide its work between U.S. education and agriculture in poorer countries.

“We are saying not only will we not be taking on new priorities, we’re actively narrowing our priorities against three core North Star goals,” Mark Suzman said in an interview with The Associated Press as the foundation published an annual update on its plans Tuesday.

In May, Bill Gates, who started the foundation with his ex-wife Melinda French Gates in 2000, announced it would close in 20 years, earlier than planned.

In the letter Tuesday, Suzman gave more details about what work would end and what would continue. He also affirmed that the foundation would not rethink its plans given the cuts to foreign assistance by donor countries around the world.

“While these conditions will have significant repercussions for global health and development for the next few years, priorities can shift. Debt can be restructured. Generosity can return,” Suzman wrote in the letter, referring also to the significant debt burden that many low- and middle-income countries carry, which eats into their public health budgets, for example.

The foundation will renew its campaign for donor countries to fund global health, specifically, Suzman said, even as he acknowledged that overall funding levels were unlikely to return to pre-pandemic levels.

“We definitely have not lost hope that the U.S. will stay engaged over the medium and longer term as a champion of global health,” Suzman said.

The foundation will renew its advocacy with campaigns that argue for saving the lives of pregnant women and young children.

“We think that is powerful and evocative,” Suzman said.

The U.S. has historically been the largest funder of global health. It's not yet clear how much funding Congress and the Trump administration will ultimately allocate toward foreign assistance or global health this year, but the State Department has said foreign assistance going forward will look extremely different. This year, the U.S. refused to fund Gavi, which offers vaccinations to children around the world, but it did pledge to contribute to the Global Fund to Fight AIDS, Tuberculosis and Malaria, of which it has historically been the largest supporter.

What Gates Foundation programs will end?

The foundation will wind down its program that aimed to give more people in sub-Saharan Africa and South Asia access to digital financial services, with Suzman saying they think that goal will be met by 2030.

The foundation also has planned the end of its program to help people move out of poverty in the U.S., which it launched in 2022 with a $460 million commitment.

In 2023, Ryan Rippel, the head of the program, said they aimed to improve economic mobility for 50 million people in the U.S. who earn 200% of the poverty level or less, which was $29,160 in annual income for an individual at the time. The foundation said it hadn't assessed the program's impact against that goal specifically.

The economic mobility work will continue in a modified form as a partnership announced in July to develop AI tools that benefit frontline workers.

For the next five years, the foundation plans to hold its budget steady, spending $9 billion annually, regardless of market changes, Suzman said. They then anticipate increasing that amount as they seek to meet Gates’ commitment to spend the vast remainder of his fortune through the foundation by 2045. The foundation said in January that it would cap operating expenses at 14% of its annual budget and anticipated reducing its workforce by 2030.

The proposed changes were developed before the U.S. government released files on Jeffrey Epstein that include mentions of Gates and unsubstantiated claims that a spokesperson called false.

Betting on AI to make big gains in multiple areas

The foundation is also betting on the potential of artificial intelligence tools in other areas, including U.S. education and agriculture, where it's funded projects delivering information like weather conditions to small farmers.

While U.S. education was an early focus for Gates and French Gates, Suzman said looking back, those efforts did not deliver the desired impact. However, they think AI applications could help a large number of students, teachers and schools.

In January, the foundation 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. When the foundation works with corporations, it requires them to offer what they develop without any markup to poorer countries.

"Wherever possible, we’re looking for things that are going be interoperable and open source to allow for these very new public goods," Suzman said, meaning users aren't locked into working with a specific company.

John Halamka, a physician and president of the Mayo Clinic Platform, who has worked at the intersection of health care and technology for many years, said these types of projects need to empower the local municipality to develop and fine tune the AI model for their population. Halamka, who has previously worked with the Gates Foundation on projects but is not involved in this initiative, said interventions also need to meet patients at their level of comfort and trust with the technologies.

“How do you ensure these kinds of tools will be used, trusted, adopted?" he asked. "And what are you doing to make the population comfortable with the use of these new technologies?”

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