Mark Suzman

My annual letter is a window into how the @gatesfoundation is approaching the next two decades, at a moment when global health is facing its first reversal in a generation, but progress is still possible. Our end goal remains clear: achieving a future where a child’s opportunities, and even chance of survival, are not determined by where they are born. To get there, we’re focusing our efforts on three concrete—though certainly ambitious—priorities. If you haven’t had a chance to read what we’re working toward through 2045, I encourage you to take a moment to view it here: gatesfoundation.org/ideas/articles….

Every year, I look forward to sharing my thoughts on our progress as a foundation and my vision for the work ahead. This year feels more significant than those before it—the world has changed dramatically since my last annual letter. The @gatesfoundation was built on a simple but powerful promise: everyone deserves the chance to live a healthy life and reach their full potential. More recently, that promise has been tested in very real ways. In 2025, global childhood deaths rose for the first time this century, and millions of these deaths were preventable. Declines in health funding have left low-income countries with increasingly fewer resources to invest in their people. It wouldn’t surprise me if some readers wondered whether my outlook has grown bleak. I can say with confidence: it hasn’t. These constraints are significant, but they aren’t permanent. Every day our partners around the world are proving progress is possible. And new innovations from AI-enabled ultrasounds to next-generation vaccines are expanding and accelerating what we can achieve together. Our compressed timeline simply gives us a mandate and a deadline to maximize our impact and solve the problems we were founded to address. In this year’s annual letter, I explore what we’ll prioritize in our next chapter and how we plan to help progress rebound. I hope you’ll take a look here: gatesfoundation.org/ideas/articles…

Over the past two decades at the @gatesfoundation , I’ve had the privilege of learning from many extraordinary leaders in global health. Few have shaped our field — or our institution — as profoundly as Dr. Bill Foege. Bill was a pioneer whose work helped eradicate smallpox and accelerate childhood immunization. But what set him apart was not only his scientific brilliance, it was his belief that public health is, at its core, an expression of human kindness. Bill advised the foundation from the very beginning. His ideas helped shape our strategies. His mentorship shaped generations of global health leaders. And his moral clarity shaped the way many of us think about service, humility, and long‑term impact. Millions of people are alive today because of his work. Countless more will benefit from the institutions, partnerships, and ways of thinking he helped build. We will honor him by continuing the work, learning from what doesn’t go right, pushing toward what’s possible, and keeping those we aim to serve at the center of everything we do. Thank you, Bill, for showing the world what determined, hopeful leadership can achieve. nytimes.com/2026/01/24/us/…

Across sub-Saharan Africa, many frontline health workers are responsible for the care of millions of people—often with limited resources and too few specialists available for support. That’s why the @GatesFoundation and @OpenAI are collaborating on Horizon1000, a pilot initiative to support countries in Africa as they apply AI to strengthen national health systems. Together, we're committing $50 million in funding, technology, and technical support to strengthen care across 1,000 primary health care clinics and their surrounding communities by 2028. AI won’t replace health workers, but it can support vital functions like patient triage and administrative support. Success isn’t about the technology itself—it’s about meaningful support for health workers and better care for patients. gatesnotes.com/home/home-page…

Fewer children are reaching their fifth birthday—and that’s something we can and must change. For the first time in decades, child mortality is rising. As I write in this @forbesme op-ed with Acting Director General of the @mbz_foundation, Her Excellency Dr. Shamma Khalifa Al Mazrouei, we have the tools to get back on track. While the data from our @GatesFoundation 2025 Goalkeepers Report is staggering, I know that we can reverse this trend. But we need more investment in these solutions to do it. Where we go from here depends on all of us. Read more: forbesmiddleeast.com/leadership/opi….

Today, our board approved a historic $9B annual payout for the @gatesfoundation—part of a deliberate plan to save and improve more lives by 2045. Building on @BillGates's commitment to invest an additional $200B before our spenddown in 2045, we’re concentrating on three priorities: preventing maternal and child deaths, ending deadly infectious diseases, and helping millions break free from poverty—so progress reaches those who need it most. Read more: gatesfoundation.org/ideas/media-ce…

I’m delighted to share several appointments that strengthen the @gatesfoundation efforts to improve lives. Dr. Sri Mulyani Indrawati joins our Governing Board, bringing experience from the World Bank, IMF, and as Indonesia’s longest-serving Minister of Finance. Internally, @MHariMenon is elevated to President of our Global Growth and Opportunity Division and our CSO @AnkurVora1 also takes on the role of President of our newly-created Africa & India Offices Division. At a moment of both urgency and opportunity across global health and development, these leaders strengthen our connection to local work and bring critical international perspectives. I’m grateful to Sri, Hari, and Ankur for stepping into these roles, and I look forward to working together as we continue advancing the foundation’s mission. gatesfoundation.org/ideas/media-ce…

One of 2025’s brightest moments: our announcement in August to commit $2.5B through 2030 to transform women’s health. Critical issues that affect millions of women around the world have been chronically under-researched and underfunded. As we sharpen our focus on ending preventable maternal and child deaths, eliminating deadly infectious diseases, and creating pathways to economic prosperity, investing in women’s health is essential. Our investment supports the advancement of over 40 innovations spanning five areas that have an outsized effect on women in low- and middle-income countries. I’m proud to work with @AnitaZaidi, @GatesFoundation’s President of the Gender Equality Division, whose team is dedicated to creating a world where all women and girls have access to a full range of opportunities—through better health, economic power, and a voice in decision-making. As Anita shared when she made this announcement, the foundation’s commitment is important, but it’s not enough. Real progress requires collaboration. Only by working together—governments, philanthropies, the private sector—can we make bold ideas go further, faster. I’m optimistic that we will see more of this collaboration take shape in 2026. gatesfoundation.org/ideas/media-ce…

As 2025 comes to a close, I keep coming back to a moment backstage at Carnegie Hall at our 25th Anniversary event in May. That morning, @BillGates made his historic commitment—to give virtually all of his wealth away through the @GatesFoundation over the next 20 years—and I was first to speak. Looking out at so many people who’ve been part of the foundation’s history, I felt both the weight and possibility of the work still ahead. Our message that day, and what we’re carrying forward, is simple: as others step back, we’re stepping up. We will double down on our investments within our new timeframe and focus on three critical goals: ending preventable deaths of mothers and babies, eliminating deadly infectious diseases, and lifting millions out of poverty. It’s easy to admire the scale of problems in front of us. We’re choosing to stay focused on solving them, so millions more people can live healthy lives and reach their full potential. This spirit carried us through a challenging year, and I’m proud of the foundation and our partners across the world for navigating complexity with grace, creativity, and commitment to our shared goals. Bill’s announcement gives us a once-in-a-generation opportunity to make transformative progress—and over the past seven months, we have begun to lay the foundation for what comes next. Thank you to our global partners for your collaboration this year and your commitment to achieving great things together in our next chapter. And, of course, thank you, Gates Foundation team members, for the impact you’ve made and everything you’ve done this year to further our mission. None of this happens without you. I’ll be taking the next few weeks to rest and prepare for what’s sure to be a meaningful 2026. Wishing you all a wonderful holiday season and a bright new year. I look forward to reconnecting in January.

While many conversations I’ve had over the year have left an impact on me, one interaction during my trip to South Africa in February continues to resonate: meeting Nandipha Titana, Community Liaison Officer at Be Part Yoluntu Centre during my trip to South Africa in February. Nandipha has dedicated her life to connecting her neighbors at high risk for tuberculosis with critical testing and treatment, along with other essential health services like contraception, pregnancy testing, and STI and HIV testing. As she showed me around the clinic, I was struck by the vast offerings and opportunities available to her neighbors because of people like Nandipha. But it’s more personal than that. She has built deep-rooted trust in her community. She referred to Be Part as “a helping hand.” There’s a strong sense of responsibility that Nandipha and her colleagues feel in creating a safe and nurturing environment for those they serve. While the services themselves are critical to driving change, I truly believe that the care in how they are delivered makes all the difference. That’s one lesson I’ll be bringing with me into the new year.

Our lives are a series of decisions. Some are easy, like grabbing a coat before walking out the door. Others—like moving across the world, or going into business with someone—are much harder. As I reflect on the past year at the @GatesFoundation, one decision stands out: the one @BillGates made to close the foundation’s doors in 2045. It wasn’t a decision he made lightly, and it’s one I fully support. It reflects a shared conviction that increasing our investment over the next two decades gives us the best shot at ending preventable deaths of mothers and babies, eradicating deadly infectious diseases, and putting millions of people on the path to economic prosperity. In this moment of global pullback, we chose to double down. We’ll invest $200 billion through 2045, twice what we spent in our first 25 years, to focus on what matters most: lives saved and opportunities created. This decision has reshaped how I think about leading the foundation. With a fixed horizon ahead, my responsibility now is to be clear about the goals we’ve set out to accomplish and how we'll achieve them together with our partners. As I look ahead to 2026 and beyond, I'm struck by what an incredible opportunity and responsibility the foundation's sunset represents. It's both an opportunity to save millions of lives and the responsibility to stay focused on areas with the greatest potential for impact. As I’ve shared before, philanthropy can’t fill the gap left by shrinking government funding. But it can take risks, invest in innovations, and move with urgency. And that’s exactly what we intend to do. gatesfoundation.org/ideas/articles…

From the foundation’s earliest days, Bill Gates Sr. believed our responsibility extended equally to our neighbors here in Seattle and to communities around the world. “Think globally, act locally.” That principle helped shape the foundation’s “good neighbor” grant programs, and it continues to guide our work closer to home. This year, our 25th anniversary, the foundation is in a noticeably different place than it was when it began. We have a campus in the heart of Seattle, 13 global offices, and partnerships with organizations in communities all over the world. Our local partners have been essential in furthering our growth. I’m proud to recognize 25 local partners who have played an important role in our story. Some have been by our side for decades, while others represent newer collaborations. Each one reflects the spirit of partnership and progress that Bill Sr. championed. Please join me in thanking these partners for their persistence, everyday leadership, and unwavering dedication to improving their communities. Seattle is a stronger, more equitable place because of it. I look forward to continuing our work together in the foundation’s next chapter.

One of the most powerful moments tied to Goalkeepers Abu Dhabi was the @ADFinanceWeek announcement earlier that day: a US$1.9 billion financing package dedicated to the Global Polio Eradication Initiative (GPEI). This is partnership at its best—leaders from government, philanthropy, business, and civil society coming together to build a future where deadly infectious diseases are eliminated for good. At the @GatesFoundation, we believe emphatically that no child should die from a disease we know how to prevent—and our own contribution of US$1.2 billion reflects our deep commitment to making that vision a reality. Much of this new funding will go toward making vaccines more widely available, protecting newborns, and supporting immunization programs in areas facing instability and conflict. Polio eradication—currently at 99.9%—is well within reach. It’s up to all of us, as a global community, to close the final gap. Children’s lives are on the line.

As a child, @XtalBirungi’s life was changed by a global health program, @GlobalFund. Now, as an entomologist at @TargetMalaria, she’s working to eliminate malaria, the disease that once devastated her community in Uganda. With the right tools—like dual-insecticide bed nets and spatial repellents—we can save more lives. But without continued investment, health funding cuts could lead to 12–16 million more preventable child deaths in the next 20 years. Our goal is for no children to die from diseases we know how to prevent. We can’t stop at almost. Hear more from Krystal about the tools and innovations that can help us reach a world without malaria, and read our 2025 @gatesfoundation Goalkeepers Report, out today: gatesfoundation.org/goalkeepers/re….

Today, global leaders stepped up to pledge $11.34 billion for the @GlobalFund to Fight AIDS, Tuberculosis and Malaria. At a moment when funding for global health is declining, this is an important sign of continued global support. My thanks to @GovernmentZA and @GOVUK for bringing the world together around this shared goal. We also expect more pledges to come in the near future. Still, not reaching the Global Fund’s target means fewer bed nets will reach communities, fewer treatments will reach people who need them and fewer lives will be saved from these preventable diseases. The @gatesfoundation is proud to support the Global Fund as one of the most effective engines in health. With millions of lives on the line, we urge governments and private sector partners to continue to step up to support the Global Fund and help those affected by AIDS, TB, and malaria, while supporting economies and our collective global health security.

Addressing climate change should start with people. Smallholder farmers across Africa and South Asia have contributed almost nothing to create the climate crisis, but are facing daily threats to their lives and livelihoods. They are the people at the heart of the @GatesFoundation’s new $1.4 billion commitment to help bring agricultural innovations to the people who need them most. Climate-resilient crops and AI-powered weather forecasting are proven solutions, but unless farmers can access them, they won’t have the transformative impacts on lives that they could have. More on the 'why' behind our investment here: reuters.com/sustainability…

Across Africa and South Asia, smallholder farmers—those who’ve contributed the least to climate change—are being hit hardest by its effects. Extreme weather is causing more food shortages, loss of income, and pushing more families into poverty. But tools like AI-powered weather forecasts and mobile apps offering planting advice can help secure a more resilient future. The @GatesFoundation is committing $1.4 billion over 4 years to support agricultural innovations like these that help smallholder farmers navigate and adapt to a changing climate. Let’s invest in the people who feed us all. gatesfoundation.org/ideas/media-ce…