Exclusive interview with MARK SUZMAN, CEO THE GATES FOUNDATION

The developing world is still reeling from the sudden and wholesale dismantling of the world’s largest aid organisation the United States Agency for International Development. The swinging cuts loped off billions of dollars of support for some of the world’s most needy. At the same time, the world’s biggest philanthropic organisation, the Gates Foundation celebrated its 25^th anniversary by saying it would double its spend to $200bn over a 20 year period. New African Editor Anver Versi discusses the fallout and implications with the CEO of the Trump Foundation, Mark Suzman.

It was a bizarre week in April – one the one hand, Bill Gates, celebrating the 25^th anniversary of the world’ biggest philanthropic organisation, said “I will give away virtually all my wealth through the Gates Foundation over the next 20 years to the cause of saving and improving lives around the world”; on the other hand, Elon Musk, the Trump administrations ‘wrecker without portfolio’ was taking his notorious chainsaw to what has been hitherto the world’s biggest national humanitarian organisation, the entire USAID programme.

Musk, in a frenzy of dismembering a host of US public organisation, has effectively loped off $60bn in worldwide US humanitarian development support, plunging hundreds of countries and NGOs in despair.

He described USAID, which has not only saved millions of lives across the globe but also stablised scores of vulnerable nations, as ‘a criminal organisation’. Its only crime, it would seem, has been a steadfast desire to do good in an increasingly lopsided world.

Gates, who has studiously avoided involvement in political currents and toned down his statements as a rule, was finally drawn into issuing a sharp rejoinder to Musk.

“The picture of the world’s richest man killing the world’s poorest children is not a pretty one,” he told the Financial Times. Indeed, the cuts are already taking their toll on some of the world’s most vulnerable. In Uganda, which is host to Africa’s largest refugee population of 1.8m (with 60,00 new arrivals in the last three months), the World Food Programme (WFP) says that  food rations for more than a million people have been completely cut off “due to severe funding shortages.” Earlier it had appealed for $50m, urgently needed to help refugees and asylum seekers fleeing conflicts in the Democratic Republic of the Congo, South Sudan and Sudan.

The full severity of the sudden cuts in the US funding soon started to become apparent: In the Congo, aid group Action Against Hunger was forced to stop treating tens of thousands of malnourished children; in Ethiopia, food assistance stopped for more than one million people, according to the Tigray Disaster Risk Management Commission.

In Senegal, the biggest malaria project was closed; in South Sudan, the International Rescue Committee closed a project providing access to quality health care and nutrition services to more than 115,000 people; in war-torn Sudan, 90 communal kitchens closed in Khartoum, leaving more than half a million people without consistent access to food, according to the International Rescue Committee.

In Kenya, more than 600,000 people living in areas plagued by drought and persistent acute malnutrition will lose access to lifesaving food and nutrition support, according to Mercy Corps.

Discontinuing funding to the Emergency Plan for AIDS Relief (PEPFAR) since January 24, may have already led to more than 4,800 child deaths.

The list goes on and this is just the immediate impact of the cut in US aid. The negative domino effects on vast numbers of people around the world, added to the general disruption of global trade and in Africa, the anticipated loss of AGOA privileges are too horrific to contemplate.

But Musk, a White South African who grew up in very privileged circumstances and is now considered the world’s richest man, was not finished.

The US withdrew from the World Health Organisation where it has been the biggest contributor, accounting for 12-15% of the body’s budget. It gave $1.2bn to the WHO for the 2022-23 biennium.

The Gates Foundation, which also contributes generously to the world’s most important health entity, said it would raise its contribution but of course, no philanthropic organisation can hope to fill the cavernous shortfall the withdrawal of the US has left.

What has appalled the world the most is the complete lack of rhyme or reason behind Musk’s aid bloodletting. The ignorance of the impact and the complete indifference to the fate of millions has been chilling – and goes against the grain of traditional US moral, philosophical and political outlook which holds the sanctity of all human life as sacrosanct…

The execution of the orders too is causing great consternation. For example, Musk cancelled grants to a hospital in Gaza Province, Mozambique that prevents women transmitting HIV to their babies, because he thought that the US was supplying condoms to Hamas in Gaza in the Middle East!

“I’d love for him to go in and meet the children that have now been infected with HIV because he cut that money,” Gates said.

GAVI, Global Fund get the chop

Musk’s wildly swishing blade also cut funding to two of the most effective organisations against global pandemics and diseases – the Global Fund and Global Alliance for Vaccines and Immunization (GAVI). GAVI, co-created by Gates, was a response to the anomaly of advanced pharmaceutical companies able to produce powerful vaccines against some of the worst diseases affecting largely the poorer countries but these countries being unable to purchase the vaccines.

The Gates Foundation and a group of founding partners including the World Health Organization, UNICEF, the World Bank, sovereign governments, private sector foundations, corporate partners, NGOs and vaccine manufacturers to not only lower the prices of vaccines but to enable developing countries to make their own.

Without the work of GAVI, the impact of pandemics such as Covid, and childhood disease such as polio, would have been very much more severe. The US’s annual contributions to GAVI had increased from $48m in 2001 to $300m in 2024 as part of a $2.6bn contract. Another yawning gap in the funding of an essential service.

The Global Fund to Fight AIDS, Tuberculosis and Malaria (known simply as the Global Fund) is another international financing partnership initiative by the Bill and Melinda Gates Foundation. Established in 2002,

It works with countries to help prevent, diagnose and treat HIV, TB and malaria. It also helps countries prepare for future pandemics and disease threats.

Until Musk took his chainsaw to USAid. America had been the Global Fund’s largest donor. It has contributed $26.31bn billion to date. Fresh replenishment for both organisations is due this year. The work of the two organisations is believed to have saved the lives of over 80m people.

It is believed Gates officials at the highest level are working to persuade Trump to rollback some cuts to prevent a global disaster – just when it seemed that the battle against dire health challenges in the developing world had begun to turn the corner.

The silver lining

The silver lining in the massed clouds of doom generated by Elon Musk’s rampage was the announcement that the Gates Foundation would accelerate its spending to $200bn over the next 20 years with 2045 as the point to ‘sunset’ its operations.

“There are too many urgent problems to solve for me to hold onto resources that could be used to help people.” Gates explained. “That is why I have decided to give my money back to society much faster than I had originally planned,” writes Gates. “I will give away virtually all my wealth through the Gates Foundation over the next 20 years to the cause of saving and improving lives around the world.”

In another post, Gates said the rationale for accelerated spending was to have maximum impact, with the potential for finding once-and-for all solutions such as eradicating polio and curing HIV. “It gives us clarity,” he said. “We’ll have a lot more money because we’re spending down over the 20 years, as opposed to making an effort to be a perpetual foundation.”

The Foundation, he said, will continue to spend the bulk of its budget, which will rise to about $10bn a year, on global health, with vaccines, maternal and child health continuing to be a focus. But Gates added that private philanthropy could not make up the shortfall from the cuts to USAID.

Accelerating the spending

A few days before Bill Gates made his announcement about accelerating the spending over a 20 year time frame, I had the pleasure of an exclusive interview with Mark Suzman, the CEO of the Gates Foundation.  I asked him what the thinking had been behind the change of time frames from an ‘infinite’ vista to a defined period.

He said that after reflecting on the progress that has been made over the last 25 years, particularly in reducing preventable child mortality and the impact of infectious diseases particularly in the Global South, including Africa, yhe thinking was that by focussing on these goals over the next two decades, it would be possible to successfully address those issues.

“Our intention is to bring preventable child mortality as close to zero as possible,” he said. “We think it’s been halved over the last 25 years, including on the continent of Africa. We believe it can at least be halved again, and hopefully more than that.

“We believe that for the infectious diseases, we can actually eradicate polio and potentially even malaria in that timetable, and really bring TB and HIV, which are the other big infectious diseases, under control, fully, with new treatments, new interventions and new prevention programs.”

I asked him how the organisation would ensure that the remaining funds are spent effectively over the next 20 years, rather than just quickly to meet the closure date you’ve given yourselves.

He said that alongside successes, the organisation had also made mistakes over its 25 years. “We think we now have a clear idea of where our highest impact interventions are.” He added that the Foundation’s primary strength is “focusing on and developing innovation – new tools, new devices, new interventions, new policies that can actually accelerate the rate of progress.

“That’s something that philanthropy can do better than governments, because we’re able to take risks and [absorb] failures at the things that governments struggle to do – then governments have to be responsible for the scale up and implementation.”

He told me that there are new interventions in the pipeline around maternal-child healthcare and nutrition as well as  new research into the microbiome and other related issues in the prevention and treatments for HIV.

“There’s the potential of the first new TB vaccine in over a century, which we’re currently sponsoring the trials of across the continent of Africa- and we’re investing $700m into that vaccine,” he said.

“If it works, could be transformative for tuberculosis, which is still the disease that kills more adults than any other worldwide.

In each case, he says there are specific investments that can be made in this time period – for example in the TB vaccine or even outside the field of health such as new AI tools in agricultural development or financial inclusion that can reach the people who need them.

Will the new timeline and spending parameter change the way the organisation works, I wanted to know.

He said the Foundation is not planning to expand into new areas but doubling down on global health and areas such as agricultural development, “which is critical for Africa and will remain committed to over that time period”.

He put the accelerated funding into perspective: “At $200bn over 20 years, that’s an average of $10bn a year; it allows us to be is very consistent and stable at the very high volume of grants we already give – which is far more than any other foundation in the world.

I raised the thorny question of the impact of the dismantling of USAID and slashing of humanitarian support by the current US administration.

“The United States has historically, by far, been the largest, the single largest global donor,” he replied. “It gave nearly $70bn in total aid last year. It’s also the largest donor in global health. Its global health support is significantly more than double what the Gates Foundation does.

“And so, yes, that is causing very significant challenges, and other countries like the United Kingdom, which recently announced a 40% cut in its aid, France, which announced a 37% cut in its aid, the Netherlands, which announced a 50% cut in its aid, those are very significant setbacks.

“We don’t believe that’s the final word,” he said optimistically. “We are advocating very strongly in Washington, DC, in London, in Paris, all across capitals, that these countries in the Global North need to retain some form of funding – and that even if their total ODA (Overseas Development Assistance) is dropping, out of what remains, they need to focus those investments on what are going to be the highest, most impactful investments, which we know save lives.

He said that he was confident that the “the U.S. will still end up providing some funding for the GAVI Vaccine Alliance, and especially the Global Fund to fight AIDS, TB and malaria, where they are the largest fund.

He added that he believed there would still be resources coming from the Global North “but it’s also very much a wake-up call for all of us who work in the sector. We cannot rely on resources from elsewhere”.

Africa to step forward

He raised another crucial issue: “We hope and believe this is two decades where African countries will be stepping in and really taking accountability and leadership. We’ve already seen some strong steps in that regard.”

He mentioned that countries such as Nigeria, Ethiopia and South Africa are already exploring what they can do in the health sector in the wake of the cuts and “we’re providing support to them”. This has taken the form of a commitment of $30m for over a dozen African countries helping them map out the impacts of these cuts.

Given the unforeseeable cuts and their sudden and wholesale implementation, was he confident the Foundation would achieve all its aims over the next two decades?

“We feel confident that the world has the tools and that we will be able to develop the innovations and the platforms and the pathways to meet them; but there is a huge dependency on that success, which will only happen if we get global support, and that support has to come from the public sector and the private sector.

“Our work needs to be driven first and foremost by the countries themselves- and is very much our focus and commitment in Africa.

“We now have five offices in Africa. When we set up, we didn’t have any offices outside the United States. We now operate in Senegal, Kenya, Ethiopia, Niger and South Africa, and we work all over the continent.”

Reviewing the last 25 years, which achievement was he most proud of?

“Back in 2000 when the Millennium Development Goals were launched and the Gates Foundation was created, a goal was set for reducing child and maternal mortality and global poverty,” he said but if someone had said that the rates could be halved in 25 years, most would have said it was impossible.

“And yet, we have met many of those milestones. When I say ‘we’, it’s the Gates Foundation, which I stress again is just one of the many, many partners across the public and private sector that came together, that focused on these goals, that made sure they were actually delivered to people”.

“The impact at the Gates Foundation is measured not in terms of our dollars out the door, but in terms of lives saved and opportunities provided for the poorest and most vulnerable.”

So it goes –while the billionaire Elon Musk and his masked raiders are busy dismantling vital support for the poor, the ill and the vulnerable, another billionaire, Bill Gates is doing the exact opposite – bringing help and support and new hope to the struggling masses of the world.