Gates Foundation CEO Mark Suzman says cuts in health funding are driving a preventable rise in child deaths and calls for renewed global investment alongside stronger African leadership.
In an in-depth conversation with Teresa Clarke, Executive Editor at Africa.com, Mark Suzman, CEO of the Gates Foundation, issued a clear warning that global health is entering a dangerous new phase, requiring short term and long term interventions. After 25 years of steady gains in child survival, the world is likely to see the first increase in preventable child deaths since the turn of the century.
“This year is almost certain to see the first increase in preventable child mortality this century. Two hundred thousand additional lives,” Suzman said. “And that is completely preventable.”
The Gates Foundation’s 2025 Goalkeepers Report captures the scale of the setback and outlines the urgent steps required to preserve two decades of progress. Global child mortality has fallen from more than 10 million annual deaths in 2000 to 4.6 million today. Much of that progress has come from improved health outcomes across Africa.
The report’s title, “We can’t stop at almost,” conveys the core message that global efforts must not stall when the finish line for preventable child deaths is finally in sight.
Why Children Remain at the Center of the Gates Foundation’s Work
Suzman explained that children remain the foundation’s focus because they represent both the moral and economic future of societies.
“Children at many levels are the future. They are the human capital of tomorrow,” he said. “Preventable child mortality is, for us, a key indicator of how a society thinks about its own people.”
The expected increase in deaths is not caused by scientific setbacks or new health crises. Instead, Suzman attributes it directly to the steep withdrawal of donor funds from major economies.
“The biggest cause of this increase in child mortality is the cut in aid coming from large donors across Europe and the United States,” he said. “Many governments are struggling to invest in healthcare and innovation that benefits the poorest and most vulnerable.”
A Financing Gap Too Large for African Governments to Fill Immediately
Pressed on whether African governments have the capacity to make up for the tens of billions of dollars removed from global health budgets. His answer was unequivocal.
There is no way the short-term gap can be filled right now,” he said.
The consequences are already visible. Tens of thousands of health workers have been laid off. Clinics have reduced services or closed temporarily. Essential supplies have run out in some areas.
He pointed out how governments in Nigeria, Kenya, Uganda, Rwanda and South Africa have taken steps to soften the blow, but added that these measures cannot restore the scale of investment that has been lost.
Suzman was also clear that even Bill Gates’s commitment of the Gates Foundation’s 200 billion dollar commitment over the next two decades cannot replace the need for consistent international partnership.
“In the short term, the cuts are creating exactly these consequences. Preventable child deaths,” Suzman said. “But over time, African governments and African philanthropists will take on increasing responsibility. Aid should not be forever. It is supposed to help countries build the infrastructure and institutions to address the problems of their own citizens.”
100 Dollars to Save 90 Percent of Child Deaths: The Economic Case for Primary Health Care
One of the strongest arguments in the Gates Foundation’s report is that modest, targeted investments in primary health care produce extraordinary returns.
“For 100 dollars per person per year, we can prevent 90 percent of preventable childhood deaths,” Suzman said.
He cautioned that governments often overspend on large, centralized hospitals and underspend on the clinics that deliver lifesaving care.
“Primary health care is the front line,” he said. “It is also the primary investment in the long-term health of the workforce.”
Vaccinations, malaria diagnostics, antenatal care and early childhood treatment all take place at the primary level. Strengthening these facilities, he noted, is one of the most cost-effective ways to secure future economic productivity across the continent.
AI as a Transformative Tool for African Health Systems
Suzman highlighted artificial intelligence as a powerful tool for helping African countries manage health challenges despite severe funding constraints.
He cited the example of an AI-powered handheld ultrasound device now being piloted in several countries.
“With AI algorithms, it can give you a hospital-grade ultrasound for a pregnant woman in a primary healthcare facility,” he said. “It can assess the risk of the pregnancy with the same accuracy as a hospital-based facility.”
Developers are working on similar low-cost diagnostic tools for tuberculosis and breast cancer.
AI is also enabling new forms of local-language guidance for parents, improving triage decisions for health workers and strengthening electronic medical records and disease surveillance.
“These are very concrete initiatives already underway in many parts of Africa,” Suzman said. “We hope to scale them in the next few years.”
African Leadership as the Driver of Long-Term Progress
Suzman emphasized repeatedly that African institutions and African expertise must guide the continent’s long-term health priorities.
“Long-term success is only sustainable if it is driven by the countries and communities themselves,” he said. “We need to invest in a generation of African leaders in research, healthcare, politics and philanthropy.”
He pointed to African scientists leading tuberculosis vaccine trials and malaria eradication research in countries such as Uganda, Burkina Faso and Senegal. He also noted the rise of AI research hubs in South Africa, Rwanda and Ghana.
“It is going to be AI hubs in African countries, designing solutions tailored for the African context, that will drive long-term success,” he said.
Optimism With Evidence Behind It
Asked why optimism remains central to the foundation’s approach, especially at a moment when the data shows backsliding.
“Our optimism is grounded in reality,” Suzman said. “We have had 25 years of progress. Country after country across Africa has reduced child mortality, HIV deaths, TB deaths and malaria.”
He described a generation of new tools that make once unimaginable breakthroughs achievable within two decades. These include new vaccines, modern diagnostics and a wave of AI innovations.
“We believe the next generation of Africans should not have to know what HIV deaths or malaria deaths were like,” Suzman said. “We want those to be questions for the history books.”
