Seattle, Dec. 4, 2025 — Child mortality is projected to increase this year for the first time in more than two decades, reversing longstanding global progress, according to the Bill & Melinda Gates Foundation’s 2025 Goalkeepers Report released Thursday. The foundation is urging world leaders to target shrinking health budgets toward the most effective, lifesaving interventions.
New modeling by the Institute for Health Metrics and Evaluation (IHME), featured in the report, shows that the number of children who die before age five—4.6 million in 2024—could rise by over 200,000 this year, reaching an estimated 4.8 million. The alarming projection comes as global development assistance for health has dropped sharply, falling 26.9% from last year’s levels.
The cuts threaten decades of gains against preventable diseases such as malaria, HIV, and polio, and exacerbate existing challenges including high debt burdens and fragile health systems. The report, We Can’t Stop at Almost, warns that if funding reductions persist, up to 16 million more children could die by 2045.
“We are at a critical turning point,” wrote Bill Gates, who authored the report. “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… With millions of lives on the line, we have to do more with less, now.”
A Reversal Within Reach—If Funding Holds
IHME projections show that sustained 20% cuts to global health budgets could result in an additional 12 million child deaths by 2045. A 30% permanent reduction would increase that toll to 16 million.
Gates warned that the world risks squandering advances in science and technology if funding fails to keep pace. But he emphasized that targeted investments in high-impact solutions—primary health care, routine immunization programs, and advances in data use—can still save millions of lives even as budgets tighten.
According to the report:
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Strengthening primary health care for less than $100 per person per year could prevent up to 90% of child deaths.
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Vaccines remain one of the highest-value interventions, returning an estimated $54 in social and economic benefits for every $1 invested. Through Gavi, the Vaccine Alliance, more than 1.2 billion children have been immunized since 2000.
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The Global Fund to Fight AIDS, Tuberculosis and Malaria, which has saved 70 million lives since 2002, secured $11.34 billion in pledges in its latest replenishment—evidence that sustained international cooperation is still possible despite economic headwinds.
The report also highlights the potential of next-generation innovations. New RSV and pneumonia vaccines could save 3.4 million children by 2045, while emerging malaria tools could save an estimated 5.7 million. Long-acting HIV prevention therapies, such as lenacapavir, could further accelerate progress in high-burden countries.
Voices From the Front Lines
This year’s Goalkeepers Report amplifies perspectives from leaders and health workers across Africa and Asia who are navigating shrinking budgets with determination and creativity:
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Muhammad Inuwa Yahaya, governor of Gombe State, Nigeria, underscored the importance of prioritizing health and education even amid fiscal constraints: “You don’t need perfect conditions to make progress. You need clarity, and the courage to stick to it.”
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Josephine Barasa, a community health worker in Kenya, continued volunteering after losing her paid role: “They could take away the money, but they couldn’t take me away from my women… The support systems may have disappeared, but the need has not.”
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Krystal Mwesiga Birungi, an entomologist from Uganda, emphasized the urgency of innovation to eliminate malaria: “Ending malaria is not only possible, it is urgent.”
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Dr. Naveen Thacker, a pediatrician in India, stressed the importance of vaccine affordability: “If we want to see more healthy children, affordability of vaccines is key.”
A Call to Action
Gates urged governments, donors, and citizens to protect or expand funding for global health programs and to increase philanthropic commitments. The choices made now, he wrote, will determine whether global progress continues—or whether millions of children lose their chance to survive and thrive.
“If we do more with less now—and get back to a world where there are more resources to devote to children’s health—then in 20 years we’ll be able to tell a different kind of story,” Gates said. “We can’t stop at almost.”
The Goalkeepers Report is part of the Gates Foundation’s broader campaign to accelerate progress toward the United Nations Sustainable Development Goals.
