During a recent roundtable discussion with The Africa Report, Gates emphasized that although politics in military-led governments differ, their health sectors in stable areas have remained intact and relatively efficient.
“Some of those countries run, within the areas of stability, pretty decent health systems,” Gates said. “Burkina Faso also runs a good health system. That has not changed.” he noted.
In stark contrast, Gates expressed deep concern about the state of healthcare in northern Nigeria, particularly Sokoto State, which he said lags behind Niger in vaccination coverage.
“I wish that Sokoto, which is a state up here, could have nearly the vaccination rate that Niger has. It’s much worse, much lower. More children die because the primary healthcare system is not as well run as it is in Niger,” he stated.
He added that northern Nigeria has the lowest vaccination rates in Africa, even lower than Somalia, despite having more children than several other conflict-affected countries combined.
“The Sahel is tough, but more children live in northern Nigeria than in all those other countries combined, and that’s where we have the lowest vaccination rates in Africa. Even lower than Somalia.”
Gates also mentioned that while other nations such as the Central African Republic, South Sudan, and the Democratic Republic of Congo continue to struggle with healthcare delivery, northern Nigeria stands out due to the sheer number of children affected.
Health leadership and stability in military-led Sahel nations
Also speaking at the roundtable, Dr. Paulin Basinga, the Gates Foundation’s global director for policy, advocacy, and communication, explained that the military regimes in Mali, Burkina Faso, and Niger did not interfere with existing health leadership.
In Burkina Faso, for example, the army retained the same minister of health, helping to maintain continuity in care delivery.
“It’s actually more stable than many other places,” Basinga noted.
He added that the Foundation’s approach of working closely with local partners has helped build trust in these regions. He also pointed to Mali’s celebrated former health minister, Sambo Sow, who was retained during the transition, as a contributor to the resilience of the country’s health system.
Gates acknowledged some positive efforts by Nigeria’s Health Minister, Ali Pate, particularly the move to increase the federal health budget. In April, the Nigerian government allocated an additional $200 million in its 2025 budget to avert a potential crisis after the administration of US President Donald Trump announced sweeping cuts to foreign aid.
However, Gates said this additional funding is not enough.
“There’s no way the government can cover all of that shortfall. I mean, they’ll fund some things. They’ve got an extra $200m, but that’s nowhere near enough to replace the money that’s disappearing.”
He warned that the situation could worsen once the US cuts to funding for UNICEF, Gavi the Vaccine Alliance, and other multilateral institutions are fully implemented.
Gates also expressed concern that other wealthy Western countries, including the United Kingdom and Germany, have reduced their foreign aid budgets by about 40% to boost security spending a move he says will have deadly consequences.
“But, you know, I’m very upset about it, and we’ll see more HIV deaths, more malaria deaths, more maternal deaths. There’s just no denying that the money was being well spent and there’s no alternative source that comes close to what was previously available,” Gates said.
Despite being Africa’s most populous nation and a regional economic leader, Nigeria’s healthcare shortcomings, especially in the North, persist. Gates’s message was clear: political instability has not crippled public health in neighboring countries lack of commitment has.
