Mark Suzman, Gates Foundation: Countries should be embarrassed

Summary

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Podcast Summary: The Interview – Mark Suzman, Gates Foundation: “Countries should be embarrassed”

BBC World Service | Host: Sam Fenwick | Guest: Mark Suzman, CEO of the Gates Foundation

Date: April 12, 2026 | Duration: ~24 minutes

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Episode Overview

This episode of The Interview explores the dramatic impact of recent cuts to global aid budgets—particularly in the UK, US, and several European countries—on the world’s poorest. Sam Fenwick sits down with Mark Suzman, CEO of the Gates Foundation, the largest philanthropic organization in the world. Suzman offers a candid, data-driven analysis of the reversal in child mortality improvements, the responsibilities and limits of philanthropy, the consequences of reduced governmental aid, and the Gates Foundation’s ambitious 20-year strategy, including their approach to AI and global health.

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Key Discussion Points & Insights

1. Child Mortality Progress Reversing ([02:47]–[06:31])

• Massive progress since 2000: Child deaths under age 5 fell from over 10 million in 2000 to 4.6 million in 2024, largely due to global health interventions funded by aid.
• Recent setback: For the first time in the 21st century, child mortality increased in 2024 to 4.8 million.
• Reason for reversal: Suzman attributes this rise directly to abrupt aid budget cuts from the US, UK, and Europe, affecting life-saving interventions like vaccines, antiretrovirals, and bed nets.

“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.”
— Mark Suzman ([04:00])

2. The True Impact & Political Choices Behind Aid Cuts ([05:21]–[07:49])

• Conservative estimates: Projections suggest an increase of more than 200,000 child deaths in 2025 due to cuts, which Suzman believes are likely underestimates.
• Direct cause: Aid reductions are not inevitable—these are deliberate political and funding choices.
• Proven interventions: Investments in Gavi (Vaccines) and the Global Fund (AIDS, TB, Malaria), both with proven life-saving impact, received less funding this cycle even with clear, demonstrated outcomes.

“We can show you how every dollar or pound or euro you spend on us saves lives. And they raised less money this time around than the previous time because donor governments said we need to prioritize our domestic spend.”
— Mark Suzman ([06:45])

3. Misconceptions of Aid & Public Support ([07:49]–[08:52])

• Public perception: Aid is often dismissed as wasteful or corrupt, but Suzman stresses most is used for highly effective, trackable interventions.
• Reframing: If the public were shown their tax directly saves a child’s life, “the overwhelming majority say absolute [yes].”

4. Aid vs Defense Spending: Political Trade-Offs ([08:52]–[10:30])

• Budgetary trade-offs: Cuts to aid in the UK, for instance, are being redirected toward NATO/defense spending. Suzman challenges whether this is the wisest area to cut, given the relatively small sums with massive global impact.
• Acknowledgment: Recognizes a country's right to set priorities, but insists these choices have outsized effects on global health.

5. Dependency Critique & Gates Foundation’s Wind-down Plan ([10:30]–[12:18])

• Not meant to last forever: Aid’s long-term vision is to build self-sufficiency so countries deliver their own services.
• Foundation’s exit plan: Gates Foundation will close by 2045 (20 years after Bill Gates’s death, now expedited), aiming to halve maternal and child mortality again and eradicate/contain major infectious diseases.

“Now…the greatest impact will happen right now…we will actually do ourselves out of business by 2045.”
— Mark Suzman ([11:15])

6. Strategic Priorities & Ambitious Goals ([12:18]–[14:07])

• $200 billion commitment: Over the next 20 years, focused on:
  • Halving child and maternal mortality
  • Eradicating polio and malaria
  • Bringing HIV and tuberculosis under control

7. Philanthropy’s Limits & Tension with Government ([15:16]–[16:35])

• Philanthropy can’t replace government: Suzman repeatedly emphasizes that foundations like Gates cannot, and should not, substitute for governmental responsibility or funding.
• Concentration of influence: As governments reduce funding, the role and influence of Gates—and its tension with public versus private priority-setting—increase.

“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 ([16:35])

8. On Shaping the WHO Agenda & Calls for Embarrassment ([16:35]–[18:15])

• WHO funding imbalance: Gates is now the largest single funder, largely because governments have abdicated responsibility. Suzman calls on countries to restore public funding and make the Foundation “a much smaller proportion” of WHO support.

“We would strongly encourage [governments to increase funding]... The best way to make us less influential is make us a much smaller proportion of WHO funding. And we heartily welcome that.”
— Mark Suzman ([17:40])

9. AI Partnerships in Health & Development ([19:42]–[22:12])

• AI for Good: Gates Foundation’s $50 million OpenAI partnership pilots generative AI in African healthcare clinics—triage, portable ultrasounds, improved diagnostics, and eventually education and agriculture.
• Strong emphasis: These tools are deployed in partnership with national governments (e.g., Rwanda), not unilaterally.

“Can you provide significantly better and cheaper services... to help deliver better health outcomes?”
— Mark Suzman ([19:59])

10. AI’s Job Impact: Risk vs. Opportunity ([22:12]–[23:44])

• In the Global South: Suzman is optimistic that AI technology will increase, not decrease, job opportunities in low-resource settings by expanding the reach of existing limited workforces (in healthcare, education, and agriculture), addressing chronic shortages.

“We think AI is actually an extension tool that’s going to enable the existing workforces to do more and actually help create some new opportunities.”
— Mark Suzman ([22:48])

11. The Future of Philanthropy ([23:44]–[25:13])

• Suzman’s call to the world’s wealthy: Acknowledges that the ultra-rich have only become richer and urges them to give back in greater numbers and amounts, hoping Gates Foundation’s model encourages more “altruistic” billionaires.

“It’s a call that we make: 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 ([24:45])

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Notable Quotes & Memorable Moments

• “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 ([16:35])
• “These are very small amounts of money... relative amount of money going to the world's very poorest that does really save lives in a very concrete way.”
  — Mark Suzman ([09:10])
• “We will actually do ourselves out of business by 2045, because we have a clear vision of the world that we think we can help leave behind…”
  — Mark Suzman ([11:15])
• “If you walk up to a British taxpayer... and say, would you be comfortable if we could guarantee you that pound of your taxpayer is going to actually save a child’s life?...the overwhelming majority say absolute[ly].”
  — Mark Suzman ([08:35])
• “We believe AI will actually increase jobs rather than reduce jobs... AI is actually an extension tool that's going to enable the existing workforces to do more...”
  — Mark Suzman ([22:48])

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Key Timestamps for Important Segments

| Timestamp | Topic | |-------------|----------------------------------------------------------------------------------| | 02:47-04:00 | Mark Suzman explains the reversal in child mortality rates | | 04:00-06:31 | The math and modeling behind projected death increases after aid cuts | | 06:31-07:49 | Child mortality reversal as a political and funding choice | | 08:52-10:30 | Aid vs defence spending and UK parliamentary decisions | | 10:43-12:18 | Self-sufficiency and the Gates Foundation’s closure plan by 2045 | | 12:18-14:07 | Strategic focus: goals for the next 20 years, $200 billion commitment | | 16:35-18:15 | The Gates Foundation’s outsized influence on WHO and the “embarrassment” claim | | 19:42-22:12 | AI in healthcare: specifics of the OpenAI partnership in Africa | | 22:48-23:44 | AI’s impact on jobs in the Global South | | 23:44-25:13 | Hopes for a new, more altruistic generation of billionaires |

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Tone & Closing Insights

Sam Fenwick closes by noting Suzman’s measured, thoughtful approach: emphasizing evidence, impact, and accountability, while candidly acknowledging the tension as the Gates Foundation's influence grows in a climate of reduced public spending. Suzman calls out political short-sightedness, reframes foreign aid as a cost-effective, life-saving investment, and openly invites governments—and wealthy individuals—to reclaim their responsibility in funding global health, arguing that dependency is best overcome not through abandonment, but through strategic, time-limited investment and partnership.

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For more deep-dive interviews on global issues, find “The Interview” on BBC podcasts.

Transcript

[Podcast Narrator]

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[Sam Fenwick]

Hello, I'm BBC presenter Sam Fenwick and this is the interview from the BBC World Service. The best conversations coming out of the BBC People shaping our world from all over the world. If you're not a little bit afraid,

[Mark Suzman]

then you're not paying attention.

[Sam Fenwick]

We have never seen a people so united. Do not make that boat crossing. Do not make that journey. Being born in America, feeling American, having people treat me like I'm not.

[Mark Suzman]

We're more popular than populism.

[Sam Fenwick]

In this interview I met Mark Sussman, the CEO of the Gates foundation, the world's largest philanthropic organization and one of the most influential players in global health. Last year, the United States scaled back parts of its overseas aid budget. It wasn't the only country doing so. With many governments, including the uk, Germany, France and Japan, all spending less, you're going to hear why Mark Suzman thinks cuts are having a huge impact on on the lives of the world's poorest.

[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, new projections show that that number went up for the first time this century.

[Sam Fenwick]

In its annual letter, the Gates foundation said the decisions around AIDS spending are already costing lives. Welcome to the interview from the BBC World Service with Mark Suzman.

[Mark Suzman]

One of the great untold stories of the last 25 years has been the miracle in child survival that you know, in 2000, which is when the Gates foundation was set up, over 10 million kids, 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 at moment when we have proven successes in interventions which we know can save kids lives.

[Sam Fenwick]

Why so quickly we've had aid going into countries and helping children, as you've described for 25 years. Why would suddenly the cut of this aid have such a Dr. Dramatic impact?

[Mark Suzman]

Well, because it's set size and scale and scope. So the, the proportion of aid is being dropped by nearly 25%. That, that 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 modeling. That is your sort of estimation, that is your forecast. How accurate is it?

[Mark Suzman]

Yeah, so that's modeling by the Institute for Health Metrics and Evaluation, which is a very credible, located at the University of Washington here in the US and 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 of 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. So with all of these, we're trying not to just cry. This is a sort of terrible number that we want people to pay attention to. We're trying to be very realistic about what's happening on the ground, largely on the continent of Africa, but well beyond Africa, too, in Asia and other parts of the.

[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 know, I would argue, potentially ever in terms of their impact per pound or dollar or euro spent, we 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 OSIRs, and between them, they. They've saved, conservatively, over 80 million lives over that period. Now, they both had replenishments last year where they went around 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 around than they had the previous time because donor governments said we need to prioritize our domestic spend.

[Sam Fenwick]

Well, that's it. And you've said it there, haven't you? There are different priorities now for governments and there are competing stresses for money.

[Mark Suzman]

Absolutely. But that shouldn't be done on the back of the poorest and most vulnerable. These are very small amounts of money. I think one of the concerns that we have is when you use a big phrase like foreign aid, it tends to get lumps. Then we know that the public in the UK elsewhere say, doesn't this all go to corrupt politicians? Why are we doing this here? And we go, no, if we reframe it and show in a safe, we can guarantee you. And if you walk up to a British taxpayer on the streets of Manchester today and we do this right, often I say, would you be comfortable if we could guarantee you that pound of your taxpayer is going to actually save a child's life? And we can show you how that pound works through the system goes to the Garvey Vaccine alliance, purchases the vaccine, gets to that kid, Would you be comfortable doing it. The overwhelming majority say absolute. What they don't understand is that's what's being cut.

[Sam Fenwick]

But what about defence? Because you mentioned the UK a few times and actually in the UK a lot of the aid budget has gone towards defence and a lot of other European nations will be looking towards that. And that does remain a priority for them.

[Mark Suzman]

Absolutely. But you know, governments all have multiple priorities. The UK has been a historic leader in international aid and development and did put into law that they were going to admit 0.7% of GDP to international aid. That's been cut by successive governments in recent years and most recently by the current government last year announcing they would cut it again from 0.5% to 0.3%. And exactly that 0.2% that would be saved would go towards their NATO contributions. Now that's a choice a government can make. Absolutely. I would question certainly whether that is the right choice of where you would make the savings. Clearly, Britain needs to invest in defense and our European countries and sovereign countries should make choices. But it's such a small relative amount of money going to the world's very poorest that does really save lives in a very concrete way. And where the UK has been such a strong, historic global leader that, you know, we think bluntly that was a mistake. Now, having said that, it was clear that with the remaining resources that the UK has, they did make very generous contributions to both the Global Fund and GAVI last year, but both of them were significant cuts still on what their previous contributions had been.

[Sam Fenwick]

How do you respond then to criticism that aid can leave countries exposed when it is pulled out quickly, that they have perhaps become too dependent on aid?

[Mark Suzman]

I think the long term vision of all international aid, including ours at the Gates foundation, is that it should not be in perpetuity. It's there to build, to deliver services in the short term, but ultimately to build the capacity and the ability of those countries to deliver those services to their own citizens with their own resources.

[Sam Fenwick]

But up until recently, the Gates foundation has just given it in perpetuity. It's only recently that you've decided that you're going to cut it off in 20 years time.

[Mark Suzman]

Yeah, no, we, we've just to be clear, we never were a perpetuity foundation. What we were going to do was do ourselves out of business within 20 years of when Bill Gates died. But now what we did and we changed last year we actually decided that the greatest impact will happen right now. And we announced that we will actually do ourselves out of business by 2045, because we have a clear vision of the world that we think we can help leave behind, even with the challenges of 2025, which is a world that actually has halved maternal and child mortality again to below 2.5 million deaths a year, and broadly, either eradicated or brought under control those big major infectious diseases that disproportionately affect the poorest. So that's our goal and vision and it is now a two decade vision that we believe can be done in a way that builds strong self reliance in the countries and communities where we work.

[Sam Fenwick]

What then are your priorities and what will guide how you spend that money over the next two decades?

[Mark Suzman]

Yes, so for context, Neil, we've spent $100 billion over our first 25 years, which is by far the largest payout by any philanthropic foundation in history. And we've now committed through the generosity of our chair, Bill Gates, who has committed the entirety of his remaining fortune over the next 20 years and our endowment, which will together will amount to $200 billion over that 20 years. And the reason we've done that is very much against this broad set of goals. As I talked about, we have three broad intentions as the foundation. One is to, you know, really bring child mortality and maternal mortality down as low as possible, certainly as close to high income levels as possible, meaning, you know, 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, but 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, such as illness and lost productivity. We think we can eradicate those two diseases and bring H I B 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.

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[Sam Fenwick]

When I met Mark Sussman, there was none of the grandiosity that you might expect from someone running one of the most powerful foundations in the world. He's measured, thoughtful and careful with his words. What struck me, though, was the balancing act he was trying to maintain. On the one hand, he was very clear that philanthropy can't replace governments and that it shouldn't. And yet, as aid budgets shrink and expectations grow, there's an increasing sense that organisations like the Gates foundation are being pulled into a much bigger role. And throughout our conversation, you could hear that tension between influence and responsibility and how far that influence should really go. Let's get back to my conversation now with Mark Sussman. 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]

Yeah. So I'd really like to turn that question on its head and say, as a foundation, we have a set of clear goals which we're transparent about, that we focus on, as I say, primarily in health, child mortality and infectious diseases. Other people can focus on that. There are lots of very important issues, from cancer to diabetes, that require actual health investments. We choose not to do that because we're deliberately focusing on the things that affect the very poorest the most. And our funding to the World Health Organization is focused on those priorities we focus at. The largest contribution we make, World Health Organization, is actually for the polio eradication. 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 the US but 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 on other people. Governments are not funding stepping up to fund what they should as a critical public good. And we would strongly encourage that, that the best way to make us less influential is make us a much smaller proportion of WHO funding. And we 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, do you think? At night? Oh, you know, have we made the right decisions? You know, are we spending all this money in the right direction?

[Mark Suzman]

Well, definitely, at one level we constantly are thinking about that, not just through the World Health Organization. You know, I feel a huge obligation as a custodian of philanthropic resources. You know, 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? The seed product reach the farmer who needed it? That's the proof point. And I do worry about that all the time. I worry even more that the world is not prioritizing what it could and should. Fifteen years ago, it was not a controversial thing to say that this should be a shared global set of priorities. And in fact it was. We saw that great combination of high income and low income countries working together to launch these new initiatives like Garvey and the Global Fund. And the results have been spectacular. But that consensus has now broken down.

[Sam Fenwick]

One of the things the Gates foundation is spending money on is AI. And you've partnered with OpenAI in a $50 million project which will go into healthcare clinics in Rwanda. Just briefly tell us how it will work.

[Mark Suzman]

Yes, so it's actually going to be in several African countries. Rwanda is the first. First. And what this is is to try and use generative AI. See, can you provide significantly better and cheaper services that are provided to help deliver better health outcomes? So for example, if you look at something like pregnancy, you know, the very simple thing, you know, what are the triage mechanisms at a primary healthcare clinic that can use AI to decide whether a potential birth might be at risk or not. We've helped develop in recent years a handheld device that basically attaches a device to a cell phone, which can give you an ultrasound picture, which is a crude ultrasound picture. I think that used as an AI algorithm that gives you the same quality as basically a hospital grade ultrasound to tell you if you this is an at risk pregnancy that might need to be referred up to a secondary or clinic or a hospital. You know, those are the kind of things you want to try and sort of expand out. Can these be tools that really help both the healthcare worker and the patient better understand the. You know, if your child is coming in presenting with a fever, can you decide whether they do they have malaria, do they have something else? What are the kind of treatments available? So this is something that's being done first and foremost directly with the governments and led by the government. So I want to emphasize that in this case, the case of Rwanda, you know, Bill announced that with the Minister of health of Rwanda next to him. And it really is an experiment, but we believe there is huge potential there, not just in healthcare, but actually in areas like education and agricultural development as well. In terms of everything from providing more sophisticated weather forecasting to make it available to smallholder farmers in tropical areas where weather forecasting is more difficult, to basic education apps which are actually going to. Whether you have massive teacher shortages in low resource settings, you can provide much more customized, lower cost interventions for students.

[Sam Fenwick]

Last year your boss, Bill Gates said that advances in AI will mean that humans will no longer be needed for many things in the world. And there are big concerns over the impact that AI could have on jobs. We were talking earlier about how aid is not just about dishing out drugs, it's about generating jobs for people. It's about building an economy. If you're going big into AI, surely you're going to eliminate some of those jobs that could have been made.

[Mark Suzman]

Yes. So there is a broader question about that, which is a sort of very important one that's taking place across pretty well every country on the planet right now. In the areas where we're focused on is the Gates foundation, as they are health, education and agricultural development in low and middle income countries. We believe AI will actually increase jobs rather than reduce jobs. What we have is an existing situation where there are shortages of healthcare workers, of teachers, there's a shortage of ability to provide basic services to smallholder farmers who are overwhelmingly the very poorest people. And so we think AI is actually an extension tool that's going to enable the existing workforces to do more and actually potentially help create some new opportunities, say at the interface where we think it can be most needed.

[Sam Fenwick]

Do you have faith that there is a new generation of billionaires that will be as altruistic as Bill Gates, that they 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, 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 helps encourage a whole new generation of philanthropists globally to put their resources into human need and human opportunity. And we know that's a challenge right now. It's a call that we make rarely that you're 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 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]

Thank you for listening to the interview. You'll find more in depth conversations on the interview wherever you get your BBC podcasts, including episodes with Joy Pumapi, Executive Secretary of the African Leaders Malaria alliance and Samantha Power, former US Ambassador to the UN until next time, bye bye. For now,

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