The road to 2045

It’s been two years since my last letter, and the world has changed dramatically since then.

Faced with compounding crises and competing priorities, leaders everywhere are making hard decisions about how to do more with less. Wealthy countries have withdrawn tens of billions of dollars in health and development funding. Meanwhile, low-income countries face increasingly severe debt burdens, leaving them with far fewer resources to invest in their people.

These are real constraints—but not permanent ones. And while these conditions will have significant repercussions for global health and development for the next few years, priorities can shift. Debt can be restructured. Generosity can return.

Hard-won progress has slowed

We’ve seen what’s possible when the world chooses to act together. The start of the 21st century kicked off two decades of unprecedented progress. Child deaths fell by half, as did deaths from diseases like HIV, tuberculosis (TB), and malaria.

But momentum in the last few years has slowed. The COVID-19 pandemic showed just how fragile gains can be. And under the weight of new, overlapping crises, the arc of progress is bending backward.

Last year, deaths from HIV, TB, and malaria rose. And in 2025—for the first time this century—it’s almost certain that more children died than the year before.

That’s a sentence I hoped I’d never have to write. After all, it's not as if the world forgot how to save children’s lives. It just wasn’t prioritized. Funding and attention went elsewhere, even though we know more about how to save lives now than at any other time in human history.

And so, millions of children died the most tragic kind of death—a preventable one.

As long as the world continues to neglect children’s health, millions more will die, simply because of where they happened to be born.

That’s the greatest injustice of poverty. It doesn’t just limit what’s possible for children when they grow up; it determines whether they’ll get the chance to grow up at all.

In his now-iconic 2005 speech at Trafalgar Square, Nelson Mandela said: “Overcoming poverty is not a gesture of charity. It is an act of justice. It is the protection of a fundamental human right, the right to dignity and a decent life. While poverty persists, there is no true freedom.”

Over the years, I’ve held fast to that conviction: poverty is not a sad inevitability but a solvable problem—one we have a moral obligation to take on.

That's why I'm so proud to lead the Gates Foundation, an institution built on a simple but powerful premise: everyone deserves the chance to live a healthy life and reach their full potential.

In the next two decades, we believe that the problems the foundation was founded to tackle can finally be solved—for good. That’s what motivated Bill to make this historic announcement last year: the Gates Foundation will accelerate our work over a 20-year timeline, spend an additional $200 billion to help save and improve lives, and close our doors by December 31, 2045.

That day is still a generation away—and if history is any indication, an incredible amount of progress can be made in that time. That’s why over our final two decades, we’ll focus on achieving three goals:

These are goals that I hope people of all backgrounds, faiths, and political convictions can agree on. After all, they’re rooted in values that parents around the world, one way or another, teach their children.

Focused on impact today

Since announcing our plan to accelerate our impact over the next 20 years, we’ve gotten a lot of questions. One in particular comes up a lot, and I hope to use this letter to answer it:

With $200B to spend—double what we spent in our first 25 years—what’s the Gates Foundation going to prioritize in its last 20 years?

To make the greatest impact, we know we have to be more focused, particularly on our core priorities: maternal and child health, nutrition, infectious disease, agriculture, and U.S. education.

On those issues, we’ll keep swinging for the fences until 2045, to borrow a baseball metaphor Warren Buffett was fond of using at the foundation. We believe opportunities for transformative progress are real—and within reach.

We believe philanthropy has the greatest impact when it acts as a catalyst—taking risks others can’t or won’t to unlock progress others can carry forward. Our role isn’t just to fund good ideas; it’s to help turn them into solutions that change how systems work.

We prove what’s possible, show it works, and partner with governments, businesses, and communities to ensure it reaches as many people as possible, as soon as possible. That’s what we mean by catalytic innovation—early, bold investments that can lead to lasting change.

Of course, discovering new solutions is only part of the story of progress. Delivering those innovations presents its own challenges. A breakthrough innovation can’t change lives unless it reaches the people who need it—and that often comes down to two things: cost and access.

A new crop might be resistant to pests and drought, but if it’s too expensive or too hard to access, farmers won’t get a chance to plant it. A groundbreaking treatment might cure a deadly disease, but it won’t save lives if health workers don’t have the supplies or training to deliver it. That’s why we invest in making innovations affordable, available, and scalable.

One game-changing tool we didn’t have at our disposal over our first 25 years was generative AI.

We believe it can revolutionize virtually every field in which we work. And while there are very important conversations taking place about guardrails and best practices, we’re extremely excited about AI’s ability to help limited resources go farther and unlock new ways to solve persistent problems.

For example, in sub-Saharan Africa, there is a shortage of nearly six million health care workers. As a result, health professionals are forced to care for too many patients with too little support.

AI tools can help change that. In January, the foundation announced Horizon 1000—a new partnership with OpenAI to bring AI tools to 1,000 primary health care clinics and surrounding communities across sub-Saharan Africa. These tools can support health workers with everything from patient intake and triage to follow-up care, helping them deliver more efficient, high-quality services to more people who need them.

We’re going to do all we can to ensure AI is designed with equity in mind, so that its benefits reach people who are too often left behind.

Why collaboration is key to the success of this vision

Of course, all our work requires partnership.

Every day, I get to work alongside extraordinary partners: the kind who hope their jobs will be irrelevant for the next generation because the problems they exist to confront will be solved. Some grew up while diseases like HIV ravaged their communities. Others watched their siblings convulse with fever—struck not once, but many times, by malaria. Others saw mothers go into childbirth filled with hopes for the future, only to come out without a baby—or not to come out of it at all.

But they didn’t just see these problems. They devoted their lives to doing something about them.

Partners of Human Potential

Watch our partners in action.

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None of the progress of the last 25 years would have been possible without our partners. Until our very last day, we’ll be right beside them, supporting their efforts to save and improve lives.

But for our partners to be able to solve problems on a greater scale, they’ll need stronger systems and sustained support. That’s why in our final 20 years, we’ll focus on deepening existing coalitions and forging new ones.

What the world needs now is a new era of cooperation centered on saving and improving lives. That means working with governments in low- and middle-income countries as they strengthen their capacity to sustain progress and stretch limited resources efficiently. And it means bringing in other donors and philanthropists to carry this work forward long after we’re gone.

To do that, we’ll need to answer some big, urgent questions: how can we save the most lives, most efficiently? Where can we help drive progress, funding innovations that will change the way the world tackles its most complex problems? And how can we help the next generation of innovators, especially in the countries most affected by infectious disease and poverty, lead the way?

The foundation's three goals, explained

To illustrate how we’re thinking about our final 20 years, I’ll focus on our three goals: what we plan to do, how we plan to do it, and where we see others playing a role in saving and improving millions of lives.

1. No mother, baby, or child dies of a preventable cause.

Over the next 20 years, we aim to help bring maternal and child mortality rates in global South in line with those in the global North, so that geography no longer dictates a child’s chance of survival. Reaching that milestone will require halving child mortality again by 2045.

To help make that possible, our foundation will continue our work in the areas where we’ve made the biggest impact: vaccines, maternal and child health, and nutrition.

In our 2025 Goalkeepers Report, Bill laid out some of the most effective interventions to save children’s lives: smart investments in the basics—like strong primary health systems—and in groundbreaking innovations like immunizations that protect babies before they’re even born.

We believe that vaccines remain the best buy in global health, and we’ll continue to invest in helping discover, scale, and deliver lifesaving immunizations for some of the leading causes of death.

We’ll also keep investing in nutrition, an area where we’re funding exciting research that could help millions of children around the world. Malnutrition is the underlying cause of half of child deaths. Improved nutrition won’t just help save lives—it will give more kids the building blocks for healthy brain development.

And we will continue to focus on women’s health. Last year, we made a $2.5 billion commitment to accelerate research and development (R&D) focused on five critical, chronically underfunded areas.

Pregnancy and childbirth remain far too dangerous for many women, even in wealthy countries. Take pre-eclampsia, a common condition ​​​worldwide​. It’s also one of the most neglected conditions in maternal health: doctors don’t know what causes it, and there’s virtually no way to treat it besides delivering the baby early. For women in low-resource settings, it’s often deadly.

So, we’re supporting innovations like a screening tool that helps healthcare workers spot risk early, a quick and affordable blood test that lets clinics diagnose and manage cases without having to send the blood to a separate lab, and promising drug candidates that could finally move us beyond managing symptoms to treating the disease itself.

Some of those tools exist now, while others might be a decade or more away. But this suite of approaches can help protect mothers now—and save even more lives in the future.

2. The next generation grows up in a world without deadly infectious diseases.

With a concerted push now and sustained effort over the next two decades, by 2045 the world’s infectious disease landscape could completely transform.

By 2045, we believe the world can eradicate polio and malaria and bring ​TB​ and HIV under control as manageable conditions.

I’m not saying no one will ever suffer from infectious disease again. But the next generation will grow up in a world that never has to face these diseases in the profoundly unequal way it does today.

This isn’t wishful thinking—it’s a realistic outcome if innovations in the pipeline today reach the people who need them.

The world has already made so much progress in the fight against infectious diseases. HIV, once the deadliest pandemic on earth,​​ is becoming easier and more affordable to prevent—and we could see a cure in our lifetimes. Twenty million people are walking today who would otherwise have been paralyzed by polio. But polio anywhere is a threat everywhere, so we won’t stop until the virus is gone for good.

We know eradicating malaria is an incredibly ambitious goal. But we believe it’s possible by 2045. We’re already supporting a new generation of tools that can offer protection before a bite from a malaria-carrying mosquito, during exposure, and after infection. And by harnessing science to stop mosquitoes from transmitting malaria to humans, we could finally end the disease.

And then there’s ​TB​, which kills more people than HIV, AIDS, and malaria combined. Next month, I’ll take our board to South Africa, where we’ll visit a site of the trial of a vaccine candidate called M72—which, if successful, could be the first new TB vaccine in over 100 years.

Last year, I visit​ed​ a clinic where they’re running the trial in ​the​ ​​Mbekweni ​​community. The clinic’s community liaison officer told me that most people who live there have lost at least one family member to ​TB​. 

I hope I’ll be able to give an update on the success of M72 in a future letter, for the families of Mbekweni and the millions more who live under the specter of this disease.

3. Hundreds of millions of people break free from poverty, putting more countries on the path to prosperity.

Over 70 percent of our funding focuses on the first two goals; a share that is likely to grow over our final two decades. We believe these goals can be met by 2045 and will do all we can to make sure that happens.

But to help more people reach their full potential, we will also continue to focus on two powerful drivers of economic opportunity: education in the United States and agriculture in low- and middle-income countries.

We know that achieving opportunity for all is a challenge beyond our means. But we can help drive the innovations that will make progress go further, faster—and leave a legacy that others can build on long after we’re gone.

We firmly believe education remains the most powerful driver of economic opportunity, especially in the United States. But while every student has potential, not everyone has the chance to achieve it.

Our education strategies are focused on helping all students succeed, especially those who are furthest from opportunity, like students from low-income backgrounds and underrepresented communities.

We invest in math because students who pass Algebra 1 by 9th grade are far more likely to graduate, pursue college, and earn family-sustaining wages. We’re also supporting partnerships that connect K–12, college, and career pathways, ensuring that students get the support they deserve to build the futures they want.

While we’re proud of the impact we’ve made in U.S. education, progress has fallen short of what we hoped for in the last 25 years. On such a complex, system-level challenge, we believe AI can play a transformative role. In fact, it already has—and we have a responsibility to ensure it transforms education for good.

Used thoughtfully, AI tools can help teachers save time on administrative tasks like grading and lesson planning, allowing them to focus more on engaging directly with students. And when designed responsibly, AI can offer students more personalized, adaptive learning experiences—acting as “personalized tutors.” Realizing these benefits will require a strong focus on accuracy, safety, and security—and a commitment to making sure these tools help every student thrive, not just those with the most access or resources.

For hundreds of millions of people, particularly in South Asia and sub-Saharan Africa, the path to prosperity runs through agriculture. Most people in these regions support their families by raising crops and livestock on small farms—and growth in agriculture is two to three times more effective at reducing poverty than growth in any other sector, with the greatest benefits accruing in the poorest households.

Not only does this help farmers feed their families—it increases the self-sufficiency of entire communities and countries. That’s why at COP30, the United Nations Climate Change Conference, our foundation committed $1.4 billion over the next four years to help millions of smallholder farmers adapt.

Graduating programs, transitioning responsibility

I can confidently say that as long as there’s a Gates Foundation, it will invest in U.S. education and agriculture. But that’s not true for every strategy we currently invest in.

Some of our programs will reach their goals before 2045. Others will graduate even sooner— because we’ve achieved what we set out to do, or because there’s a natural opportunity to transition the work to other partners.

Our Inclusive Financial Systems program, for example, will conclude in 2030, having helped hundreds of millions of people gain access to banking and digital finance. Our U.S. Economic Mobility and Opportunity program graduated in 2025, with a final investment in co-creating a a new $1 billion partnership to expand economic opportunity by harnessing innovation and AI.

As we make decisions about how and when to end or evolve our work in other areas, we’ll use a similar playbook, giving our teams and partners time to transition responsibly.

My hope for 2045

I started this letter reflecting on the sobering fact that 2025 was the first year this century where child deaths rose. But here’s what we don’t know yet: was 2025 an anomaly, or the beginning of an extended reversal of progress?

Here’s my hope: that future generations will one day learn the story of how the world ended preventable child deaths. How we eradicated malaria. How we cured HIV. I hope they’ll have to zoom in on the graph tracking under-5 deaths to see, around 2025, a small spike—an almost-forgotten time when progress hung in the balance, before the world got back on track.

The world faces many challenges—and new ones are bound to appear. But there will also be new innovations, new voices, and new coalitions. That’s what makes me confident that our best days are still ahead: because all around the world, people are committed to making a difference for others.

And by 2045, I believe the world will be better off than when we began because the inequities that once plagued humanity will no longer dictate its future—and the solutions we helped catalyze will endure long after our doors are closed and our last dollar is spent.