Last year was a hard one for global health. My barometer for optimism can be distilled to a simple question: Did fewer kids die this year compared to last year? In 2025, for the first time this century, that number went up. In 2024, 4.6 million children died before their fifth birthday. Last year, we lost an estimated 4.8 million children—an increase driven, in part, by cuts to health aid.

Immunizing children and supporting other health-related efforts—like fighting malaria, HIV, and tuberculosis—is the biggest focus of my philanthropy. I’m moved to act by the fact that the vast majority of childhood deaths happen in poor countries. Meanwhile, lifesaving tools like vaccines and medicines get developed for diseases that affect those who can pay, and not for ones that mostly affect people in poorer countries.

As a grandfather, I can’t imagine how awful it would be to lose a child, yet millions of families suffer that tragedy every year simply because of where they live. Fixing this disparity is the chief reason the Gates Foundation exists. I go to work each day thinking about how I can help close the gap.