Bill Gates doesn't mince words in his latest annual letter: sweeping foreign aid cuts under the Trump administration have undone decades of progress, and the consequences are being measured in lives lost.
The Microsoft Corp (MSFT) co-founder and philanthropist called out Trump-era foreign aid reductions on Friday, saying they've contributed to something that hasn't happened this century: child mortality rates going in the wrong direction.
"The thing I am most upset about is the fact that the world went backwards last year," Gates wrote. After falling steadily for a quarter century, deaths among children under five climbed from 4.6 million in 2024 to 4.8 million in 2025, according to his analysis.
This isn't the first time Gates has raised concerns. He previously warned that aggressive cost-cutting measures, many linked to Elon Musk's Department of Government Efficiency, could lead to preventable deaths. Musk publicly challenged Gates to provide evidence. Gates says the data now speaks for itself.
The Math Gets Worse From Here
The Gates Foundation's latest Goalkeepers Report paints a grim picture if current trends continue. Using modeling from the Institute for Health Metrics and Evaluation, the foundation estimates that an additional 12 million children could die by 2045 if global health funding drops 20% from 2024 levels.
Gates points out that even at their peak, foreign aid budgets represented less than 1% of GDP in most donor nations. "It is critical that we restore some of the funding," he wrote. Translation: we're not talking about massive budget items here, but the impact of cutting them is massive.
AI Offers Hope, But No Quick Fixes
Despite documenting what amounts to a public health crisis, Gates hasn't given up. He remains cautiously optimistic about innovation driven by artificial intelligence. "I believe the world will keep improving — but it is harder to see that today than it has been in a long time," he wrote.
Still, he's realistic about the near-term outlook. The next five years will be particularly tough as governments and nonprofits try to scale lifesaving interventions while operating with tighter budgets. Innovation is great, but it doesn't solve funding gaps overnight.
Putting His Money Where His Mouth Is
Gates isn't just criticizing from the sidelines. In 2025, he pledged to donate virtually all of his wealth, roughly $100 billion, to the Gates Foundation as part of a $200 billion plan to be spent over the next two decades.
He's also calling on other billionaires to step up their philanthropy as government aid contracts. With a current net worth of $118 billion, Gates ranks 16th on the Bloomberg Billionaire Index. He resigned from Microsoft's board in March 2020 to focus more on philanthropic work.
The message is clear: if governments are pulling back, private philanthropy needs to fill the gap. Whether that's realistic or sustainable is another question entirely, but Gates is betting his fortune that it's necessary.
