Thomson Reuters
A boy receives polio vaccine drops at a clinic in Kiev, Ukraine.
In late 2014, the Gates Foundation made a bold prediction in its Annual Letter: "By 2035," the letter stated, "there will be almost no poor countries left in the world."Bill Gates, the letter's author, noted this meant "poor" in the way the World Bank defines it, which is a daily budget of less than $1.90. Gates even offered a slew of statistics to back up his forecast.
Less than three years later, the Gates Foundation has doubts about whether the target is still accurate, given the Trump administration's proposed budget cuts and general lack of attention to global health goals.
Rob Nabors, the Gates Foundation's director of US policy, advocacy, and communications, says the idea that falling child mortality rates and polio cases could start climbing again "keeps him up at night."
Trump's proposed cuts are significant - the biggest since the 1970s. If approved, the budget would shrink the foreign-aid budget by 31%, from $30 billion in 2017 to $20.7 billion in 2018. The current budget makes up less than 1% of the $3.8-trillion federal budget.
Congress' preliminary budget suggests Democrats won't allow such drastic cuts anytime soon, but there is no telling what will happen in the coming years - and Trump has made his priorities clear. Nabors says the most pressing issue is the way the proposed budget cuts treat foreign aid as one homogeneous body instead of separate funds earmarked for different purposes.
"It sort of implicitly asserts that aid doesn't work, and as a result we shouldn't be funding it," Nabors tells Business Insider.
There is a mountain of evidence that aid does work to reduce poverty, improve longevity, and kickstart local economies. For instance, keeping children and their mothers alive through the child's adolescence - using measures such as education, vaccination, and contraception - significantly raisees the chances families will escape poverty.
"I think what we've seen is that global health and MNCH types of programs have been hugely effective," Nabors says. "It's hard to see how those programs can continue to be funded in the United States and abroad if there are broader threats to the overall foreign assistance budget."
The Gates Foundation likes to highlight that polio has almost completely been eradicated - there were just 37 cases of the disease in 2016. Gates himself has also emphasized the decline in child mortality rates over the last two and a half decades. Since 1990, the number of child deaths has fallen from 12.1 million to 5.8 million annually.
Nabors fears those numbers could be in danger under a Trump presidency.
"It's not as if we'll just be frozen at those single-digit cases," he says. A lack of concerted investment in keeping polio and other infectious disease at bay could mean they begin to spread anew.
Nabors hopes an open line of communication between the Gates Foundation and the president will alert Trump to the economic benefits of improving global health. Namely, more people have jobs, stay at those jobs longer, and contribute to the economy.
In Asia, for example, 30-50% of the economic growth between 1965 and 1990 has been chalked up to reductions in infant and child mortality.
Historically, presidents haven't gotten full Congressional approval on their proposed budgets in time for the new fiscal year - in this case, October 1, 2017. So there are no guarantees the cuts to foreign aid will end up in the final plan. But Nabors and the Foundation aren't keen on playing a game of wait-and-see.
"I don't think people realize that in 2017 and 2018, we could be in a place where we've eradicated polio," Nabors says. "That's a big deal. And it's up to us to explain to audiences in the developed world what that means and how important the leadership of these countries actually is."