Gates Foundation Boosts Budget as Global Health Funding Falters

The philanthropic empire built by Microsoft co-founder Bill Gates and his wife, Melinda, is to spend more this year than ever before. The 2024 budget the foundation’s board agreed on is up 4% on last year and $2 billion more than in 2021. It also makes the foundation the biggest giver in the world and the single largest in American history.

The Gates Foundation has an endowment of about $50 billion and distributes about half its spending to global health, poverty, and education programs. Its goal is to “give every person on Earth a fair chance to live a healthy, productive life,” the couple wrote in a letter to their supporters this week.

This latest investment will help the foundation meet the challenges that lie ahead. Amid a global retrenchment from public spending as governments grapple with the economic fallout of the COVID-19 pandemic, the foundation will step up efforts in polio eradication and scaling child azithromycin deliveries in the highest mortality settings, improve digital courseware for post-secondary education, accelerate the world’s TB drug portfolio, and push back against “compounding global crises.”

As the foundation focuses on these goals, it is expected to reduce its giving to local issues, such as reducing hunger in the United States or improving urban infrastructure, which it considers less urgent than its other priorities. The foundation will also expand its efforts in two significant new areas: climate change and gender equity.

Although governments worldwide ramped up their spending in response to the pandemic, deteriorating economic conditions and competing national priorities will likely limit those increases next year, the Gates Foundation said. Without those gains, low- and lower-middle-income countries will need help to meet their health targets and lift their citizens out of poverty.

Amid the gloom, the Gates Foundation is looking to strengthen its position as the most prominent private donor to the WHO and increase the number of countries it can represent on the WHO board of directors. It also plans to boost funding for the Global Fund, which it has criticized as underfunding key priorities.

In the past, some observers have questioned whether it is ethical for private entities to wield such power. This is particularly true when a private foundation can leverage its money to influence the outcomes of other governments’ decisions, which is central to the WHO financing system. But the Gates Foundation’s board of trustees has already begun to decentralize its decision-making, appointing new members pushing for greater transparency and accountability. The foundation has also made its work more inclusive by partnering with groups with different ideas and expertise.

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