| Billionaire Bill Gates announced Thursday that he was sunsetting his foundation and doubling its spending to $200 billion over the next 20 years. The announcement came after some wealthy nations stepped back from funding global health efforts. In January, the US pulled out of the World Health Organization, causing sweeping layoffs at the agency. President Donald Trump also dismantled the US Agency for International Development, slashing billions from aid to poor countries, including efforts to combat malaria in Africa and decades of HIV research. The UK has reduced its aid budget and is looking to cut funding for Gavi, a vaccine alliance that immunizes children against diseases like malaria. But as the world pulls away, can the Gates Foundation fill the bill for global health? “I don’t think his goal is to duplicate USAID or Pepfar,” the US AIDS program, said Lawrence Gostin, professor of global health law at Georgetown University and director of a WHO center on national and global health law. Gostin expects most funding to continue going toward Gates’ interests, like childhood vaccinations and infectious diseases. The statement from the Gates Foundation said the spending will be focused on ending preventable childhood deaths, eliminating deadly infectious diseases and lifting people out of poverty. Health systems and noncommunicable diseases like heart disease and diabetes that used to get US funding are usually not Bill Gates’ priority, Gostin said. And there’s no expectation that his money will be used to start tackling those issues now. “It’s not sufficient to meet all of the needs,” said Onyema Ogbuagu, an associate professor and HIV specialist at the Yale Institute for Global Health. Ogbuagu, who does HIV work in Liberia, said local health systems are already seeing layoffs and shortages of medicine and laboratory equipment. The aid pullback is a wake-up call for countries to change their budgets, Ogbuagu added. On Thursday, South Africa announced that it would fully fund its HIV-AIDS treatment program this year after the US withdrawal. In an interview with Bloomberg TV, Gates criticized the Elon Musk-led Department of Government Efficiency that has slashed US support for global health initiatives. “There’s no doubt that the USAID payment cutoffs that Elon drove have resulted in a dramatic increase in childhood death,” Gates said. “Children that would have been protected from getting HIV from their mothers during birth — that money’s been cut off.” Since Gates started the foundation 25 years ago with Melinda French Gates, it has spent $100 billion has and saved 82 million lives by increasing access to vaccines and combating HIV, malaria and tuberculosis. Gostin said he hopes the Gates Foundation decision will spark action from other billionaires to fund global health initiatives. “Is it perfect? No,” said Gostin. “But is it an enormous benefit to the world? A resounding yes.” — Jessica Nix | 
