Mark Suzman, executive director of the Gates Foundation: "We are facing a crisis in global development financing."

Mark Suzman (Johannesburg, 56) is a man who accumulates numbers in his head and crunches them with surgical precision. He is also the executive director of the Gates Foundation, the world's largest philanthropic organization, which this week traveled to Seville to participate in the 4th UN Conference on Financing for Development , along with more than fifty heads of state and government. He has been seen sitting in the VIP row at the conferences, and the waters seemed to part as he walked through the corridors of the Palacio de Congresos in the Andalusian capital. With an annual budget more than double, for example, all Spanish aid, Bill Gates' foundation has gained even more relevance in the face of historic cuts in development aid funds from countries like the United States and European donors.

Suzman believes, however, that organizations like his should act as catalysts at most, and that it is the states that should bear the burden of cooperation and development policies. This former journalist, who grew up in apartheid South Africa, maintains that the last 25 years have seen the greatest progress, with significant reductions in deaths from preventable diseases such as AIDS, malaria, and tuberculosis. That progress, he believes, is now in jeopardy. "We are facing a crisis in global development financing ," says the head of the Gates Foundation, the foundation that provides financial support to Planeta Futuro , the development section of this newspaper.

Question: What makes you think this development financing conference is different, that the agreements reached won't be a dead letter as they have been on previous occasions?

Answer: The world is in a very different place. We are facing a crisis in global development financing. It is very different from the last 25 years, which were arguably the most successful period for progress in human history. We have seen avoidable child mortality cut by more than half. We have witnessed a reduction by more than half of preventable deaths from the major infectious diseases that were killing large numbers of people at the beginning of the century: AIDS, tuberculosis, and malaria. We saw extreme poverty halved around the world, in Africa, Asia, and Latin America. Although many factors contributed, there was a significant increase in international aid, in key sectors such as health.

The last 25 years were possibly the most successful period for progress in the history of humanity.

Q. That era is clearly over, with aid cuts from major donor countries, including the US.

A. We don't have the data yet, but it's very likely that this will be the first year of the 21st century in which we see an increase in preventable child mortality, in which we will probably see an increase in malaria and HIV cases and deaths again. Given the abruptness of many of the cuts that have occurred in the first part of this year, especially by the US, but not exclusively, we can already see the impact, especially in Africa. The development community needs to come together and be brutally honest about the global situation. There are some honorable exceptions like Spain, which is trying to increase [its contribution], but overall, we are seeing a reduction of tens of billions. Still, I think that in the next 10, 15, or 20 years, there will be more room for progress.

Q. Thanks to technology?

A. I prefer to use the word "innovation" because it's not just technology, but, for example, the way primary care workers or education are organized. The question is how to ensure that progress isn't linear, but accelerates. If we develop, for example, the first new vaccine against tuberculosis in more than a century—in which the Gates Foundation is investing hundreds of millions of dollars—it could turn the tables on the infectious disease that continues to kill more people than any other. Amazing transformations are also taking place in artificial intelligence, but none of this will work without strong financial backing.

Q. If we look at the debt crisis, which means 3.4 billion people live in countries where they spend more on debt repayment than on healthcare and education, the scope for action even for large foundations like yours becomes almost irrelevant.

A. That's right. In the last three or four years, the origins of the debt crisis were indirectly caused by COVID . There was huge fiscal spending to combat the effects of the pandemic. For a couple of years, that led to the return of inflation, and the US raised interest rates. Most of the debt is in dollars, and that meant that low- and middle-income countries that had borrowed suddenly saw their debt payments skyrocket. This led to the current situation, where at least 60 countries in the Global South are paying more in debt service than on health and education. The other side of the debate taking place in Europe and the US is that these countries should invest more in themselves, maximizing what they can invest in their own people. No country wants to be dependent on debt or aid. They all want to be fiscally independent and able to meet the needs of their own citizens, and that can and should be our common goal. The Gates Foundation, in fact, is not going to exist in perpetuity.

P. Bill Gates has announced that the foundation will close in 20 years and will spend its entire fortune before then. How?

A. We've committed to completing our work by the end of 2045, and that allows us to maximize the support we can provide now. In a time of great volatility, we can be reliable and predictable partners. This year, we're disbursing nearly $9 billion [€7.645 billion], making us by far the largest philanthropic organization in this sector—more than double the aid from the Spanish government—and we can maintain that level for 20 years. We've committed to donating $200 billion, which means Bill Gates will donate almost all of his remaining fortune. We believe infant mortality can be reduced again by at least half, perhaps more, bringing it closer to that of high-income countries. We believe the same will be possible for major infectious diseases. But no matter how large philanthropic organizations we are, our money isn't enough.

No matter how big philanthropic organizations we are, our money is not enough.

Q. States are proving to be the opposite, unpredictable in their cooperation budgets. What makes you think the world will be different in a few years?

A. Under these circumstances, it's very difficult to see significant increases. We hope that some countries, like Spain, will make increases, but we would like the focus to be on understanding which investments are the most effective. The funds spent, for example, on hosting refugees in Europe, which is counted as a very significant portion of aid, clearly don't contribute to the development of the refugees' countries of origin. Let's not pretend to call it development financing. Even pure humanitarian aid for natural disasters or wars doesn't contribute to long-term economic growth or self-sufficiency. For us, it's about investing in human capital, and that's essentially health. And of course, in nutrition. People underestimate that if you don't receive adequate nutrition in the first 1,000 days of life, your body and brain will never fully develop to their potential. The world has sufficient resources to continue financing this on a large scale.

Q. The most vulnerable countries are those that have contributed the least to the climate crisis , yet are also the most affected. How much does it affect health?

A. The greatest impact is on nutrition. When natural disasters such as floods or droughts occur, access to food is severely affected. Furthermore, floods often trigger sudden outbreaks of diseases such as malaria or dengue fever. We know that very high temperatures increase the risk of childbirth. So there are clear links between health and climate, although the greatest impact lies in building resilience to weather shocks. We have, for example, made major investments in India in a type of rice that can remain flooded for up to two weeks and still germinate. Or corn that can germinate in drought-affected soil. These are areas of research where, with US cuts, we have become the largest funders, a bit like the WHO. And this is a clear indication that the world is not putting its resources where they should be, because the responsibility lies primarily with sovereign governments. Philanthropic organizations should be, at most, catalysts; we cannot be the ones filling the gaps in states.

Q. Foundations like yours are nothing more than private capital, which is not accountable as governments should be.

A. The UN or the WHO could be funded quite successfully without too many additional resources. But we've seen with COVID and now with the climate crisis that the world isn't very good at addressing global challenges.

Spain has taken the lead by hosting a financing for development conference at a time when it is not considered a global priority.

Q. Spain has been left almost alone in increasing its aid at a time when others are cutting back. Does that make sense?

A. Spain has taken the lead by hosting a financing for development conference like this one at a time when it is not considered a global priority, and by taking concrete steps, such as the generous 30% increase in the replenishment of Gavi [the global vaccine alliance] funding. We believe this is what all countries should do, because it is in both Spain's national and global interest. And it demonstrates the power of supporting multilateral approaches to addressing global problems. We applaud the Spanish government's leadership and will encourage other countries to follow its example.