Child deaths rise in historic reversal, Gates Foundation reveals

After decades of progress in preventing child deaths, 2025 marks the first year of this century where the number of children dying under the age of 5 will increase, according to the Gates Foundation’s annual Goalkeepers Report. In 2024, 4.6 million children died before their fifth birthday. The report indicates that figure is projected to rise by just over 200,000 — to an estimated 4.8 million children this year. The deaths are taking place concurrently with steep cuts to global health funding. Overall development assistance fell sharply this year, totaling 26.9% below 2024 levels, the foundation said. If the aid cuts become a trend over the next 20 years, the numbers will be even more grim. A 20% decrease in global health funding would translate into 12 million more child deaths by 2045, while a 30% drop would result in 16 million more deaths in that time frame. “We need to resume the kind of progress that the world has seen,” said Mark Suzman, CEO of the Gates Foundation, in a call with reporters ahead of the report’s Dec. 4 release. “That whatever the challenge is — and we know there are huge fiscal challenges in high- and low-income countries — that the price of those budget cuts should not come at the expense of the world's very poorest and most vulnerable. And no one is poor and more vulnerable than a child who could live and instead dies.” “And so the message of our report … is we cannot stop at almost,” he added. “We cannot stop at almost ending preventable child mortality. We cannot stop at almost ending HIV, almost ending polio, almost ending malaria. We need to redouble our efforts.” For founder Bill Gates, that means stretching every dollar. “I wish we were in a position to do more with more because it’s what the world’s children deserve. But even in a time of tight budgets, we can make a big difference,” Gates writes in the report he authored. “I’ll continue to advocate however and wherever I can for increased funding for the health of the world’s children — and for efficiencies that improve our current system. But with millions of lives on the line, we have to do more with less.” And cost-effective interventions are what the Gates Foundation specializes in. For instance, it calls primary care “the workhorse of every health system,” estimating that for less than $100 per person per year, a robust primary health care system can prevent up to 90% of child deaths. And as Suzman pointed out, every dollar spent on immunization gave countries a return of $54. Suzman said these are figures that people should be bringing to their governments to push for why investing in preventable diseases such as malaria is worth the cost. At the moment though, that argument seems to be on the losing end of the debate as foreign aid cuts sweep the globe. While Suzman noted that some smaller donors are stepping up, such as Spain, as are aid recipient governments, “the truth is, while those are very welcome moves, they can't compensate for the size of the cuts from the very large traditional contributors.” “It’s important to stress … that the U.S. is not alone in cutting aid this year,” Suzman added, pointing to European donors such as the United Kingdom and Germany. “And so combined with the U.S. cuts … the estimates are that total global health funding will be cut by nearly 30% over the last year,” he said. “And no field can cope with cuts of that magnitude.” He did praise the U.S. for its “generous” contribution of $4.6 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria last month, while also describing the lack of any U.S.contributions to Gavi, the Vaccine Alliance as “very challenging.” Suzman also said the “way in which the U.S. did its early cuts was particularly damaging because there was little information and understanding of what had been cut, what was being resumed. We spent a lot of time with partners trying to track that.” He also pointed out that the cuts made to organizations such as Gavi represent a “tiny, tiny” fraction of national budgets that have “no real impact on domestic savings, but it does mean the difference in hundreds of thousands of lives saved.” But Suzman expressed optimism that governments will ultimately see the value of preventing child deaths and that the reversal can be turned around in the coming decades. “We remain very optimistic about what can be done by 2045. We believe that we can persuade … governments, philanthropists, and other partners to step up and resource these important priorities, to save mothers’ and kids’ lives.”