The discussions signal growing momentum toward tackling the global obesity epidemic through equitable innovation and international cooperation.

Weight-loss drugs such as Novo Nordisk’s Wegovy and Eli Lilly’s Mounjaro have revolutionized obesity management in developed nations, but their high costs—often hundreds of dollars per month—have kept them out of reach for millions in developing economies.

Recognizing this imbalance, both Gates and PAHO have expressed interest in identifying solutions that make these breakthrough treatments more widely available.

A New Frontier for Global Health Equity

In a recent interview, Bill Gates emphasized the importance of bridging the affordability gap in medical innovation. While obesity is not yet a primary focus area for the Bill & Melinda Gates Foundation, he acknowledged that its long-term health consequences make it an increasingly urgent issue, particularly in low-income regions where healthcare systems already face mounting challenges.

“The Gates Foundation has always taken proven medical innovations and figured out how to make them super, super cheap so they can reach everyone in the world,” Gates said. “If there’s a pathway to bring down costs and expand access to these drugs, that’s something we’d seriously look at.”

The Foundation is already collaborating with Indian pharmaceutical manufacturer Hetero to develop affordable versions of a new HIV prevention drug, priced as low as $40 per year for lower-income countries. This model of partnership—combining innovation, generic development, and global distribution—could serve as a blueprint for future efforts in obesity care.

PAHO’s Collective Procurement Approach

Dr. Jarbas Barbosa, Director of PAHO, confirmed that the organization is examining the potential of using its Strategic Fund, a pooled procurement mechanism that allows its 35 member states to purchase essential medicines in bulk at lower prices.

This mechanism has already been successful in improving access to vaccines and critical drugs across Latin America and the Caribbean. Applying the same strategy to weight-loss medicines could help significantly reduce costs and enable middle-income nations to address rising rates of obesity and related diseases such as diabetes and cardiovascular illness.

A Growing Health Challenge in Developing Regions

According to global estimates, around 70% of the world’s one billion people living with obesity are in low- and middle-income countries. These regions face dual burdens—malnutrition and obesity—both of which strain healthcare systems and lead to higher risks of chronic diseases.

Experts believe that equitable access to next-generation weight management therapies could help reduce long-term healthcare costs, improve quality of life, and ease the social and economic impacts of obesity. The World Health Organization (WHO) recently estimated that the economic toll of obesity and overweight could reach $3 trillion by 2030 if left unaddressed.

From next year, semaglutide, the active ingredient in Wegovy, will lose patent protection in several countries including China and India, opening the door for generic manufacturers to produce low-cost alternatives. This development aligns with the Gates Foundation’s strategy of supporting generic competition to ensure life-saving drugs become affordable for all income levels.

The Foundation is also conducting early-stage research on how these treatments could improve health outcomes for women with gestational diabetes, a condition increasingly linked to obesity and limited healthcare access in developing nations.

A Global Step Toward Inclusive Healthcare

While Gates remains focused on tackling diseases like malaria and HIV—the primary causes of death in low-income countries—his recognition of obesity as an emerging global health threat highlights a shift in public health priorities. By combining philanthropic expertise, international cooperation, and market-based affordability strategies, initiatives like this could redefine how the world approaches chronic disease prevention.

PAHO’s experience in bulk procurement and the Gates Foundation’s innovation-driven funding model present a powerful partnership opportunity to democratize access to advanced health solutions.

As Gates put it, “When science delivers powerful new tools, it’s our responsibility to make sure those tools don’t stay locked away for the few—they should work for everyone, everywhere.”

Speaking at a Reuters Newsmaker event in New York, Gates said the world was at a crossroads, with millions of children at risk of dying if funding drops too steeply.

The Gates Foundation’s pledge matches its donation in 2022. That was the last time the Global Fund, a Geneva-based independent nonprofit, raised money on its three-year budget cycle. The announcement follows deep aid cuts from governments around the world, led by the United States.

“A kid born in northern Nigeria has a 15% chance of dying before the age of 5. You can either be part of improving that or act like that doesn’t matter,” Gates said in an interview before the foundation’s annual Goalkeepers event in New York on Monday.

The event celebrates and seeks to accelerate progress on United Nations global development goals set for 2030, including improving health and ending poverty.

“I am not capable of making up what the government cuts, and I don’t want to create an illusion of that,” he said about his pledge.

The Gates Foundation, the philanthropy started by the Microsoft co-founder and his then-wife in 2000, is one of the world’s biggest funders of global health initiatives, with a particular focus on ending preventable deaths of mothers and babies, tackling infectious diseases and lifting millions out of poverty.

Earlier this year, Gates pledged to give away almost his entire $200 billion fortune by 2045, more quickly than planned because of the urgent need worldwide.

Millions More Could Be Saved

According to the U.S.-based Institute for Health Metrics and Evaluation, global development assistance fell by 21% between 2024 and 2025 and is now at a 15-year low.

That could still change, said Gates, with organizations like the Global Fund trying to raise money before the end of the year. But if the trajectory remains the same, progress that cut child mortality in half since 2000, saving 5 million lives a year, could be in jeopardy, he said in a statement.

Gates said that there was still an opportunity to save millions of lives and end some of the deadliest childhood diseases by the time he will have donated the rest of his fortune in 2045.

That would require maintaining funding for institutions like the Global Fund as well as Gavi, the Vaccine Alliance, prioritizing primary healthcare and rolling out innovations – such as the long-acting HIV prevention drug lenacapavir – quickly.

“What’s happening to the health of the world’s children is worse than most people realize, but our long-term prospects are better than most people can imagine,” Gates said in a statement.

At the Goalkeepers event, the foundation gave Spanish Prime Minister Pedro Sánchez its annual Global Goalkeeper Award. While other countries reduced global health support, Spain increased its donations to the Global Fund this year by 12% and Gavi by 30%.

The Goalkeepers event usually involves publication of a progress report on the U.N. sustainable development goals, originally adopted in 2015. But that has been delayed until an event in Abu Dhabi in December, when global health funding will be clearer, the foundation said.