Last year was difficult for Bill Gates. As a philanthropist who has given billions of dollars to improve healthcare, education and climate change action, Gates had to watch as the Trump administration cut many foreign aid contracts.

The Microsoft co-founder has criticised these cuts, many of which were made under Elon Musk's Department of Government Efficiency (DOGE). He warned that these actions could directly cause the deaths of children. Tesla CEO Musk asked Gates to provide evidence for this claim.

In his annual letter this year, Gates was honest about his feelings. He wrote: "I believe the world will keep improving—but it is harder to see that today than it has been in a long time."

Gates explained what upset him most: "The thing I am most upset about is the fact that the world went backwards last year on a key metric of progress: the number of deaths of children under five years old. Over the last 25 years, those deaths went down faster than at any other point in history. But in 2025, they went up for the first time this century, from 4.6 million in 2024 to 4.8 million in 2025—an increase driven by less support from rich countries to poor countries."

Last month, the Gates Foundation's Goalkeepers Report showed that 12.5 million additional child deaths could happen by 2045 if health development assistance is reduced by 20% from 2024 levels. This prediction is based on data from the Institute for Health Metrics and Evaluation.

Gates wrote: "Friends and colleagues often ask me how I stay optimistic in an era with so many challenges and so much polarization. My answer is this: I am still an optimist because I see what innovation accelerated by artificial intelligence will bring."

However, Gates added that his optimism has limits. "The next five years will be difficult as we try to get back on track and work to scale up new lifesaving tools," he continued. "As hard as last year was, I don't believe we will slide back into the Dark Ages. I believe that, within the next decade, we will not only get the world back on track but enter a new era of unprecedented progress."

Filling the Funding Gap

In 2025, Gates announced his $200 billion plan: He was donating "virtually all his wealth"—about $100 billion—to his foundation. It was the largest philanthropic commitment in modern history. The money must be spent in the next 20 years.

Gates has been planning this for many years. In 2010, Gates, his wife at the time Melinda French Gates, and Berkshire Hathaway co-founder Warren Buffett launched the Giving Pledge. This is a public commitment to philanthropy, which has been signed by people like philanthropist Mackenzie Scott and Airbnb CEO Brian Chesky.

Gates is now calling on other wealthy people to help fill the gap in government funding. He wrote: "This idea of treating others as you wish to be treated does not just apply to rich countries giving aid. It must also include philanthropy from the wealthy to help those in need—both domestically and globally—which should grow rapidly in a world with a record number of billionaires and even centibillionaires."

A report from Oxfam released in January 2025 showed that in 2024, the number of billionaires rose to 2,769, up from 2,565 a year before. The report also said it expects at least five people to reach trillionaire status within ten years.

Gates added: "I know cuts won't be reversed overnight, even though aid represented less than 1% of GDP even in the most generous countries. But it is critical that we restore some of the funding."