Bill Gates says recent breakthroughs could save millions—but only if governments maintain support. Photo by Arun Sankar/AFP via Getty Images
Funding for global health is shrinking rapidly amid steep foreign aid cuts by the Trump administration. At the same time, however, scientific breakthroughs are making today’s health innovations more promising than ever. These two realities amount to “the paradox of this moment,” Bill Gates wrote in an op-ed for Time Magazine published yesterday (Sep. 18).
At such a critical juncture, the Microsoft co-founder is doubling down on global health through the Bill and Melinda Gates Foundation—while urging governments not to abandon their commitments. “The choices they make now—whether to go forward with proposed steep cuts to health aid, or to give the world’s children the chance they deserve to live a healthy life—will determine what kind of future we leave the next generation,” wrote Gates.
Gates has repeatedly criticized the Trump administration’s pullback from global health programs, including cuts to the U.S. Agency for International Development (USAID) and HIV relief initiative PEPFAR. Earlier this year, he denounced the role of Elon Musk, then head of the cost-cutting Department of Government Efficiency (DOGE), for contributing to “the deaths of the world’s poorest children.”
The retreat comes at a time of unprecedented progress. In 2000, more than 10 million children died before the age of five, Gates noted in the op-ed. That number has since fallen by half, and the philanthropist believes it could be halved again within two decades—if funding is sustained or increased.
The Gates Foundation is committing heavily to that future. In May, Gates announced the foundation, with an endowment of $77 billion, will wind down by 2045 after distributing $200 billion in grants. Much of that money will target preventable maternal and child deaths, as well as diseases like polio, malaria and guinea worm. Since its launch in 2000, the foundation has already given away more than $100 billion, much of it to health initiatives.
But philanthropy alone can’t replace government support. “The fact remains: we won’t get there without rich countries giving a small fraction of their budgets,” said Gates.
He has spent much of this year lobbying lawmakers and the Trump administration to protect aid programs. In recent testimony to Congress, he warned that a sharp reduction in U.S. funding could cause the deaths of an additional eight million children by 2040. He has also personally met with Trump, urging him to scale back the severity of cuts. “If you make a very modest cut, we’ll make sure that the money is well spent and there’s no additional deaths,” Gates told TIME in an interview, which was also published yesterday. “But if you have the kind of cuts that are, in fact, the reality today… there will be millions of additional deaths.”
The urgency will soon be tested. In November, the Global Fund, a financing partnership founded in 2002 to fight AIDS, tuberculosis, and malaria, will hold its next replenishment conference. The U.S. has contributed $27.6 billion to the fund to date, making it its largest donor. Gates said his foundation will announce its own contribution next week.
The upcoming conference will show “just how high of a priority this is for countries,” Gates wrote. “I’ll be interested to see what governments bring to the table.”
