When we launched Vox’s Future Perfect section in 2018, it began with a simple question: “What topics would we write about if our only instruction was to write about the most important stuff in the world, particularly the most important stuff that isn’t already widely covered?”

In the years since, the “most important stuff” has grown to encompass everything from the existential risks (and benefits) of AI to the challenges of living a truly ethical life. And for each of the past three years, we’ve honored some of the most important and influential people in these spaces in our annual Future Perfect 50 packages.

But as we began thinking of how to organize the 2025 list, we realized it was time to go back to our fundamentals, because the most urgent story in our wheelhouse is the squeeze on foreign aid and on global health and development, which threatens to reverse some of the most important progress humanity has ever made.

Global aid is trending down just as needs rise. In the US, the evisceration of USAID has only added more strain. These shortfalls translate into rationed food aid, skeletal clinic hours, and broken supply chains.

Routine childhood immunization — still the best deal in public health — has plateaued, leaving more than 14 million “zero-dose” children wholly unprotected. Malaria tells the same story in harsher tones: an estimated 263 million cases and 597,000 deaths in 2023, overwhelmingly in Africa and largely among young children, with conflict, climate shocks, and funding gaps blunting new tools. Even polio — a disease the world was on the brink of banishing — is at

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