Gates Foundation CEO on cuts to global aid

Summary

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Business Daily (BBC World Service)

Episode: Gates Foundation CEO on Cuts to Global Aid
Date: February 3, 2026
Host: Sam Fenwick
Guest: Mark Suzman, CEO, Bill & Melinda Gates Foundation

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Episode Overview

In this urgent and revealing episode, host Sam Fenwick interviews Mark Suzman, CEO of the Gates Foundation, as the world faces a dramatic rollback in foreign aid funding. With major donor governments—especially the US—slashing development and humanitarian budgets, Suzman shares stark data on the consequences for global poverty and health. The conversation critically examines the reversal of decades-long trends in child survival, the increasingly dominant role of private philanthropy, and the challenges and controversies surrounding power, priorities, and accountability in global health.

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Key Discussion Points

1. A Stark Warning: Reversal in Child Mortality Trends

• Progress Undone: Suzman highlights a dramatic increase in the number of children under five dying of preventable diseases—the first uptick in over two decades.
  • "In 2000, over 10 million children under the age of five died every year of preventable diseases. And in 2024 it reached 4.6 million. And yet last year that number went up for the first time this century." – Mark Suzman [01:25]
• Why the Reversal? Cuts in international development aid, especially from the US, UK, France, Germany, the Netherlands, and Japan, are identified as the leading cause of this regression.

2. Scale of Aid Cuts and Their Human Cost

• Dramatic Reductions:
  • US: Cancelled 83% of USAID programs, agency formally shut by July 2024.
  • UK: Aid cut from $18 billion to $12 billion by 2027 (0.5% to 0.3% of GNI).
  • Germany: 8% cut in development spending; humanitarian funding halved.
  • France: $2 billion (almost 40%) cut.
  • Japan: 10% cut to lowest in years.
• Devastating Fallout:
  • Immediate consequences for millions who relied on these resources.
  • "When you put that into numbers, that's billions and billions of pounds that are cut... It's simple maths." – Mark Suzman [05:11]

3. Direct Testimony from the Ground: Zambia’s Perspective

• Western Aid Withdrawal:
  • Chipoka Malenga, Zambia’s Minister of Commerce, provides a candid account of the human toll:
    • "The west cut the aid from us, knowing clearly that lives will be lost. It is very heartbreaking." – Chipoka Malenga (quoted by Suzman) [06:40]
• Economic and Social Impact: Job losses, loss of stability, and acknowledgement of vulnerabilities created by aid dependency.

4. Dependency vs. Building Self-Reliance

• Suzman's Stance:
  • Acknowledges dependency concerns but stresses mutual responsibility and the ongoing challenge of building local capacity.
  • "Dependency is a strong word though, because at its best this has always been a mutual set of efforts... but the true reality is that is going to be a 10 to 20 year period to build that self-reliance, not a one to two year period." – Mark Suzman [09:57]

5. Impacts on Key Health Initiatives

• GAVI & Global Fund: Both with proven impact (over 80 million lives saved), but both now facing funding shortfalls due to donor cutbacks.
• Human Toll: An estimated extra 200,000 child deaths projected for 2025 alone, with Suzman warning this likely understates the scale [05:45], [05:59].

6. Private Philanthropy’s Rising Role—and Its Risks

• Gates Foundation Now #1 WHO Funder:
  • "The fact that we are now the world's largest funder of the World Health Organization should be a major embarrassment to every country on this planet." – Mark Suzman [12:45]
• Concerns Over Power and Accountability:
  • Critics suggest the Gates Foundation’s outsized role could skew the global health agenda towards its own priorities rather than those of recipient countries.
  • Suzman responds: “The only reason that we are as influential as we are... is because other people are not stepping up... The best way to make us less influential is make us a much smaller proportion of WHO funding.” [13:44]

7. The Future: Gates Foundation Strategy and AI in Health

• Future Goals:
  • Halve child and maternal mortality; eradicate polio and malaria; make HIV and tuberculosis manageable.
    • "We have three broad intentions...” – Mark Suzman [15:15]
• AI for Global Health:
  • Gates Foundation’s new $50 million OpenAI partnership to pilot AI in Rwandan health clinics, aiming to reach 1,000 clinics.
  • Emphasis on working in partnership with governments and data protection: “This is a discussion we have actively with countries. And... it’s their priorities which take precedence.” [17:46]

8. Sustainability and the Next Generation of Global Philanthropy

• Encouraging More Philanthropy: Suzman hopes that the Gates Foundation’s work inspires a new generation of donors, highlighting the disproportionate growth in wealth among the ultra-wealthy.
  • “The one group of people that have got disproportionately wealthier in the last five to seven years have been the world's very wealthy. So there is enormous opportunity for much more extensive and more generous philanthropy everywhere.” [18:21]
• Personal Reflection: When asked about the motivations of today’s billionaires:
  • “Every individual approaches it differently. What I can just say is that we hope and believe that our example is one that will encourage many, many more to do the same thing.” [19:41]

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Notable Quotes & Memorable Moments

• On the new reality of global health funding:
  • “The fact that we are now the world's largest funder of the World Health Organization should be a major embarrassment to every country on this planet.”
    – Mark Suzman [12:45]
• On the human consequences of aid cuts:
  • “The west cut the aid from us, knowing clearly that lives will be lost. It is very heartbreaking.”
    – Chipoka Malenga, Zambia’s Minister of Commerce [06:40]
• On fears of philanthropic overreach:
  • “We would strongly encourage that the best way to make us less influential is make us a much smaller proportion of WHO funding. And we would heartily welcome that.”
    – Mark Suzman [13:44]
• On the challenge of building resilient local health systems:
  • “...that is going to be a 10 to 20 year period to build that self-reliance, not a one to two year period.”
    – Mark Suzman [10:53]
• On philanthropic leadership:
  • “The one group of people that have got disproportionately wealthier in the last five to seven years have been the world's very wealthy. So there is enormous opportunity for much more extensive and more generous philanthropy everywhere.”
    – Mark Suzman [18:21]

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Timestamps for Key Segments

• [01:25] – Suzman on child mortality progress and setback
• [03:29] – Overview of global aid cuts (UK, Germany, France, Japan)
• [06:40] – Zambia’s Minister of Commerce on aid cuts’ immediate impact
• [08:06] – Core multilateral investments: GAVI, Global Fund
• [12:45] – Gates Foundation's new status as top WHO funder
• [13:44] – Accountability and influence in global health priorities
• [15:15] – Foundation’s future priorities (disease eradication goals)
• [16:22] – AI projects in Africa with OpenAI
• [17:46] – Local priorities and AI adoption question
• [18:21] – Hopes for next generation philanthropists

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Conclusion

This incisive episode lays bare the real-world impacts of global aid cuts, offering a rare view from both international leadership and those most affected by policy changes. Mark Suzman is candid about both the limitations and the necessity of philanthropy in this volatile funding environment, repeatedly stressing the need for governments to reclaim responsibility for global health, and for the wealthy to step up and contribute meaningfully. The stakes—measured in lives—could not be clearer.

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Transcript

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[Sam Fenwick]

Hello and welcome to Business Daily from the BBC World Service. I'm Sam Fenwick. Today, a stark warning about global poverty and health.

[Mark Suzman]

In 2000, over 10 million children under the age of five died every year of preventable diseases. And in 2024 it reached 4.6 million. And yet last year that number went up for the first time this century.

[Sam Fenwick]

The Gates foundation, the world's largest philanthropic organization, says cuts to aid funding are now having a huge impact on the lives of the world's poorest.

[Mark Suzman]

The fact that we are now the world's largest funder of the World Health Organization should be a major embarrassment to to every country on this planet.

[Sam Fenwick]

We're speaking exclusively to the foundation's CEO, Mark Sussman, at a moment when the fund has become one of the most influential players in global health and has itself faced questions about its power and priorities. Last year, the White House moved to scale back parts of America's overseas aid budget, arguing resources were needed at home and that foreign assistance wasn't delivering enough impact.

[Mark Suzman]

When we have $36 trillion in debt and we're taking care of countries that.

[Sam Fenwick]

Are very rich and sending aid to countries in some cases that are rich.

[Advertiser/Commercial Voice]

In some cases they're not rich.

[Sam Fenwick]

But no, it should very much decrease. The consequences of the cuts were immediate for countries and communities that relied on that funding. At its peak, the United states provided almost 30% of all international aid and paid for around 43% of the world's humanitarian response. But in January 2024, just weeks into office, the Trump administration cancelled 83% of programmes run by USAID. By July, the agency was formally shut. And the US wasn't alone. As inflation rose, defence spending went up and domestic politics took precedence. That means we will cut our spending on development assistance, moving from 0.5% of GNI today to 0.3% in 2027, fully.

[Mark Suzman]

Funding our increased investment in defence.

[Sam Fenwick]

The UK Prime Minister Keir Starmer announcing a cut to aid from around $18 billion to a projected 12 billion. Germany's cut development spending by 8% and halved humanitarian funding. France cut more than $2 billion, nearly 40% from its 2025 budget. And Japan reduced a 10% to one of its lowest levels in years. In its annual letter published today, the Gates foundation warns these decisions are already costing lives. I asked Mark Sussman why progress appears to have gone into reverse.

[Mark Suzman]

One of the great untold stories of the last 25 years has been the miracle in child survival. In 2000, which is when the Gates foundation was set up, over 10 million children under the age of five died every year of preventable diseases. That number has been steadily declining every single year since then. And in 2024, it reached 4.6 million. So more than halved. And yet last year, new projections show that that number went up for the first time this century to 4.8 million.

[Sam Fenwick]

So why the reversal?

[Mark Suzman]

Well, the primary reason is absolutely the cut in international development aid by first and foremost the United States, which did it very abruptly by closing usaid, but by many countries, including the United Kingdom, France, Germany, the Netherlands, all cutting back.

[Sam Fenwick]

We've had aid for 25 years. Why would suddenly the cut of this aid have such a dramatic impact?

[Mark Suzman]

Because of size and scale and scope. So the proportion of aid is being dropped by nearly 25%. When you put that into numbers, that's billions and billions of pounds that are cut. And those billions and billions of pounds, not all of them, were used for what we would call the highest impact interventions. But if you're buying vaccines for kids, if you're buying antiretrovirals for patients with hiv, if you're buying bed nets for families to prevent them from getting malaria, if you reduce the amount of money that's supporting that, most of which has been funded by international aid, you reduce the number of people that you can help. It's simple maths.

[Sam Fenwick]

So your projected figures for the end of 2025 was that there would be an increase in Deaths of over 200,000. That is modelling. That is your sort of estimation. How accurate is it?

[Mark Suzman]

Yeah, so that's modeling by the Institute for Health Metrics and Evaluation, which is a very credible group located at the University of Washington here in the us we suspect it may be an underestimate. It's very conservative estimates looking at all the different numbers and sort of inputs into what goes on in child mortality. And we think actually the number potentially would have been also much higher had there not been sort of drastic steps taken by some of the countries that are most affected to try and meet the shortfalls.

[Sam Fenwick]

Well, I want to play you a short clip from Zambia's Minister of Commerce, Chipoka Malenga. I spoke to him recently and I talked to him about the immediate impact of the recent aid cuts on the ground.

[Mark Suzman]

I'll be very clear with you. The west cut the aid from us, knowing clearly that lives will be lost. It is very heartbreaking. We never as a government or as a continent invested and believed in ourselves. In every circumstance, situations you need a dependable, unpredictable friend. But this is a situation where we are left now. So now we have come to realize that anybody can kick us or hit us from any direction because now almost every economy wants to take care of their citizens. And how do they do it? They cut aid. And what happens to us who are dependent on aid? We have become vulnerable.

[Sam Fenwick]

When you hear that, what goes through your mind?

[Mark Suzman]

That he's absolutely right and Zambia is one of the countries that was most affected last year. And the government and the minister and others have taken heroic steps with the resources they do have available in Zambia. But Zambia has been struggling through a debt crisis over the last four years. A debt crisis that is not completely of its own making either because it was in response to the hike in interest rates in the United States and dollar based interest rates that left them very vulnerable. And so nobody wants to be dependent on foreign aid. And foreign aid should not last forever, even in these highly targeted, highly impactful investments in global health.

[Sam Fenwick]

Your letter states very clearly that the reversal of child mortality wasn't inevitable and that was actually the result of political choices and funding choices.

[Mark Suzman]

Absolutely. That is the bottom line is if you take the two most successful multilateral investments of the 21st century, and I would argue potentially ever in terms of their impact per pound or dollar or euro spent, they are the Gavi vaccine alliance which vaccinates Millions of children around the world and the Global Fund to Fight aids, TB and Malaria. Both of those were set up in the early 2000s. The Gates foundation was part of setting them up. The UK government has been a very prominent partner throughout the lifetime of those and between them they've saved conservatively over 80 million lives over that period. Now, they both had replenishments last year where they went round to government saying we have a proven track record. We can show you how every dollar or pound or euro you spend on us saves lives. And they raised less money this time round than they had the previous time because donor governments said we need to prioritize our domestic spend.

[Sam Fenwick]

I want to hear from Mr. Malenga again now because he says that aid isn't just about delivering services, it's also about creating jobs, skills and stability. Here he is talking about the wider economic fallout of those cuts.

[Mark Suzman]

It has got a very negative impact on the job numbers for the people where decent professionals had contractual obligations with them, long standing contracts on work and jobs. So the sudden cut translated into job losses, among many other things. It affects the economy on a larger scale.

[Sam Fenwick]

Mr. Malenga was talking about vulnerability being created by dependency and the Gates foundation has arguably added to that because you have created these vulnerabilities that they are reliant on you as well as other philanthropic organizations.

[Mark Suzman]

Yeah, well the key question is how you spend the resource. Actually, to the extent there is a silver lining of the drastic cuts of last year, and it's very difficult to see a silver lining when there are kids deaths increasing, there is much greater political attention being paid at the level of heads of state and finance ministers and others across low and middle income countries about the need to properly resource their own health budgets. Dependency is a strong word though, because at its best this has always been a mutual set of efforts. So when you talk about the provision of those vaccine services or antiretroviral services, most of the governments involved, including Zambia, do have a co financing requirement which increases as they themselves get wealthier. But now we have to really focus on what is the capacity that you're building in the structures and systems on the ground that those countries can actually support themselves over the long term. But the true reality of the financial situation that most of these countries face is that is going to be a 10 to 20 year period to build that self reliance, not a one to two year period.

[Sam Fenwick]

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[Sam Fenwick]

Today I'm speaking to the CEO of the world's largest philanthropic organization, the Gates foundation, about the future of global aid spending. Last month, the United States withdrew from the World Health Organization as one of its biggest donors, contributing more than $1.2 billion in the last funding cycle. The decision has left a hole in global health financing. The Gates foundation says the move is a blow to efforts to prevent disease and save lives. But it also means the foundation now holds even greater influence, and that's raised questions about accountability and power in global health. But Mark Sussman says the shift in funding at the World Health Organization exposes a deeper problem that governments are stepping back from responsibilities they once saw as essential.

[Mark Suzman]

The fact that we are now the world's largest funder of the World Health Organization should be a major embarrassment to every country on this planet. The World Health Organization exists as a public good to provide global health needs, to provide the norms, the rules, the protection against the next pandemic, and it should be fully funded. The fact that the US has pulled out, obviously, we think is a big mistake and have said so publicly in.

[Sam Fenwick]

The U.S. do you worry about the influence that the Gates foundation could potentially have on where money is spent? And I ask that because the British Medical Journal has done some research which suggests that your contribution to the World Health Organization, you are now the largest funder of the World Health Organization, is actually skewing their agenda. So you're deciding where the money gets spent and it might not be the same priorities, perhaps as Zambia or a country where they might have different priorities.

[Mark Suzman]

We would call on all member states of world health organizations to say you should all increase your funding. The only reason that we are as influential as we are through those resources is because other people are not stepping up. Governments are not Stepping up to fund what they should as a critical public good. And we would strongly encourage that the best way to make us less influential is make us a much smaller proportion of WHO funding. And we would heartily welcome that.

[Sam Fenwick]

Does it keep you awake at night, the kind of influence that you could potentially have on the World Health Organization?

[Mark Suzman]

Well, definitely at one level, we constantly think about that, not just through the World Health Organization. I feel a huge obligation as a custodian of philanthropic resources. We have an annual budget of $9 billion, and it's aimed to save lives and provide opportunities for the poorest and most vulnerable. We want to make sure that every dollar is spent as well as possible against the highest impact intervention. And the ultimate metric of that is not the money we put out the door. It is in those lives saved and opportunities provided. We actually want to get you. Did the vaccine reach the child? Did the bed net reach the child? Did the family planning product reach the woman who needed it? Did the seed product reach the farmer who needed it? You know, it's very. That's the proof point. And I do worry about that all the time.

[Sam Fenwick]

You said that the foundation plans to double its spending to $200 billion within the next 20 years. What then are your priorities and what will guide how you spend that money over the next two decades?

[Mark Suzman]

We have three broad intentions as the Foundation. One is to really bring child mortality and maternal mortality down as low as possible, certainly as close to high income levels as possible, meaning the child mortality rates that you have in the UK or in Europe. And similarly on the infectious diseases, we think we can actually eradicate two critical diseases, polio, where we're very close to eradicating. It's only endemic in two countries currently, Pakistan and Afghanistan. That has been a devastating disease over most of human history. And even malaria, which actually kills 600,000 people a year, the vast majority of them children. And has a much bigger effect, especially on Africans, just illness and lost productivity. We think we can eradicate those two diseases and bring HIV and tuberculosis. And tuberculosis is the infectious disease that still kills more than any others. 1.6 million people a year, basically under control as manageable health conditions in the way that they currently are. Again, in rich countries like the uk we're going to go out to clinics in Africa.

[Sam Fenwick]

Last year, the Gates foundation announced a $50 million project with OpenAI to bring AI technology into hospitals and medical centers.

[Mark Suzman]

In Rwanda, helping the healthcare workers who are very overloaded.

[Sam Fenwick]

And it plans to roll it out more widely across Africa.

[Mark Suzman]

We want to get to 1,000 clinics over the next three years.

[Sam Fenwick]

The AI will be used, won't it, to gather patient data alongside all of those things, how can you make sure that that data will be properly protected?

[Mark Suzman]

So that's a critical question throughout, and it precedes AI. And in the health area, health data is one of the things that is most important, that you're keeping safe and secure for patients and for practitioners. And so that is a central element of things. We're working with each of the affected governments with of how do you do that? How do you secure data? This more broadly, say, health is particularly sensitive, but this is true whether it's in the agricultural space as well or the education space, because you want to be very sensitive about preserving data about children's education performance.

[Sam Fenwick]

Is AI a priority for the countries where you're working? I mean, I can understand why it's a priority for Bill Gates. We founded Microsoft. He's a tech guy. He is a tech bro from Silicon Valley. But are you sure it's a priority for the countries where you're working?

[Mark Suzman]

This is a discussion we have actively with countries. And I want to emphasize that for all the work we do, we work with and we're guided by the countries where we work with, you know, it's their priorities which take precedence. And, you know, that's why, for example, this partnership with OpenAI in Rwanda is done very transparently with the government of Rwanda and every other country where we work will do the same.

[Sam Fenwick]

When you wrap up the Gates foundation wraps up, do you have faith that there is a new generation of billionaires that will be taking on the baton of what you have done?

[Mark Suzman]

We certainly hope that's the case, that that is exactly one of the examples we want to set. And back to your earlier question about what keeps me up at night, it's I want to make sure that the work that we're doing as the Gates foundation is able to show the impact and results and the amazing additional catalytic role that philanthropy can play driving those outcomes, and that it helps encourage a whole new generation of philanthropists globally to put their resources into human need and human opportunity. We know that's a challenge right now. It's a call that we make. Braille, that the one group of people that have got disproportionately wealthier in the last five to seven years have been the world's very wealthy. So there is enormous opportunity for much more extensive and more generous philanthropy everywhere. And we are continually advocating very strongly for that. And we certainly hope our example is going to do that not just after we're gone, but even before we're gone. We're hoping that in the next, in the years to come, we'll see more and more very wealthy people feeling an obligation and an opportunity to give back to society.

[Sam Fenwick]

What is your instinct on whether that will happen? You know, you must be sat around the table with these people. When you look into their eyes and you see the whites of their eyes, do you think, oh, you just want to go up to space or do you think, yeah, you're, you're the one that's going to help here?

[Mark Suzman]

Well, it varies. Every individual approaches it differently. What I can just say is that we hope and believe that our example is one that will encourage many, many more to do the same thing. And I do believe that it is actually a broader obligation of the very wealthy to see what they can do to give back the resources that they have and see if they can be for the benefit of the poorest and most vulnerable. And so I'm proud to be leading the Gates foundation and proud that we are trying to be a model for what philanthropy could be and how it can have an impact. And I hope we'll see many more following in our footsteps.

[Sam Fenwick]

That was Mark Suzman, CEO of the Gates foundation, speaking to me. Sam Fenwick, for this edition of Business Daily from the BBC World Service. If you're new here, why not subscribe to our podcast? You'll find episodes on a huge range of business and economic stories, from the rise of AI to the power of bond markets, the weight loss drugs boom, to changing workplace culture, as well as fascinating interviews with company founders and some of the world's most prominent CEOs. You can get in touch with the team as well. Our email address is business dailybc.co.uk thanks for listening.

[Mark Suzman]

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