The 2026 Gates Foundation Annual Letter: Reaching 2045

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.

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 the 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.