More than 200,000 additional children under 5 are expected to die this year, according to modeling in the Gates Foundation’s annual Goalkeepers report. Cuts by President Donald Trump’s administration are “part of that picture” contributing to the expected rise in deaths, Gates said in an interview.

The Gates Foundation, which plans to wind down operations by 2045, has accelerated spending since May as it pushes to drive progress. The latest report argues for scaling up proven tools — from dual-insecticide bed nets for malaria to new vaccines for respiratory syncytial virus and long-acting HIV prevention drugs like Gilead Sciences Inc.’s lenacapavir — to prevent millions of avoidable deaths.

Global aid funding has dropped almost 27% this year, putting pressure on programs that had relied heavily on sustained support. The US cuts have drawn the most attention, but the UK, France and Germany have also slashed spending.

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The Gates Foundation plans to double its spending over the next 20 years. Still, Gates himself has been clear that a single funder cannot make up for the US pullback. And while traditional aid recipients are increasingly looking to become self-sufficient, such a shift will likely take many years.

“For the African countries that are fairly poor, they are in no position to become self-sufficient,” Gates said. “That’s a 20-year goal, not a four-year goal.”