The number of children dying before their 5th birthday is projected to rise for the first time this century, reversing decades of global progress, according to new data published today in the Gates Foundation’s 2025 Goalkeepers Report.

In 2024, 4.6 million children died before their 5th birthday. According to modeling in the report, conducted by the Institute for Health Metrics and Evaluation (IHME), that number is projected to rise by just over 200,000—to an estimated 4.8 million children this year. At the same time, global development assistance for health fell sharply this year—26.9% below 2024 levels.

Beyond this year’s drastic funding cuts, countries face mounting debt, fragile health systems, and the risk of losing hard-won gains against diseases like malaria, HIV, and polio.

The report, We Can’t Stop at Almost, warns that if global health funding cuts persist, up to 16 million more children could die by 2045. It offers a roadmap for how targeted investments in proven solutions and next generation innovations can save millions of children’s lives, preventing a reversal in progress in today’s constrained budget environment.

“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,” writes Bill Gates, chair of the Gates Foundation and the report’s author. “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, now.”

A Critical Turning Point

Projections by the IHME show that if global health funding cuts of 20% persist, an additional 12 million children could die by 2045. A 30% permanent cut would bring that toll to 16 million.

Gates describes this moment as a turning point for global health, when the right choices can still save millions of lives.

“We could be the generation who had access to the most advanced science and innovation in human history—but couldn’t get the funding together to ensure it saved lives,” Gates writes. “By making the right priorities and commitments, and investing in high-impact solutions, I’m confident we can stop a significant reversal in child deaths and help ensure millions more children are alive in 2045.”

In the report, Gates identifies investments with the greatest potential to save millions of young lives. He calls for doubling down on the most effective interventions—primary health care, routine immunizations, better vaccines, and new uses of data—to stretch every dollar. For

example:

• For less than $100 per person per year, strong primary health care systems can prevent up to 90% of child deaths.
• Every $1 spent on vaccines returns $54 in economic and social benefits. Through Gavi, the Vaccine Alliance, more than 1.2 billion children have received lifesaving vaccines since 2000.

The work of the Global Fund to Fight AIDS, Tuberculosis and Malaria is also evidence of what sustained investment can achieve. As one of the most effective engines in health, the Global Fund has saved 70 million lives and reduced deaths from malaria, TB, and HIV by more than 60% since 2002. Late last month, leaders pledged $11.34 billion to the Global Fund’s Eighth Replenishment, underscoring continued global commitment to fighting these diseases while laying bare the risks of stepping back.

According to Gates, investment in the development of next-generation innovations could end some of the deadliest threats to children, such as malaria and pneumonia, for good. Modeling in the report projects that sustained funding in these innovations could save millions of children by 2045.

• Next-generation vaccines for respiratory syncytial virus and pneumonia could save 3.4 million children.
• New malaria tools could save another 5.7 million children, while long-acting HIV prevention tools like lenacapavir could help drive infections and deaths toward zero in high-burden countries.

Local Leadership, Global Action

The report also features essays with firsthand perspectives from leaders, health workers, and researchers in Africa and Asia who are advancing solutions to sustain progress:

• In Nigeria, Muhammad Inuwa Yahaya, governor of Gombe State, prioritized primary health and education amid a budget deficit. “You don’t need perfect conditions to make progress. You need clarity, and the courage to stick to it.”
• In Kenya, community health worker Josephine Barasa continued volunteering in her community after losing her paid position, providing care and education to mothers and children. “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. And neither have I.”
• In Uganda, entomologist Krystal Mwesiga Birungi is developing next-generation tools to combat malaria. “Ending malaria is not only possible, it is urgent,” she said. “We African researchers know this—and we are leading the way.”
• In India, Dr. Naveen Thacker, a pediatrician, underscored the importance of affordable and accessible vaccines. “If we want to see more healthy children, affordability of vaccines is key.”

Gates implores governments, philanthropies, and citizens to act on the report’s findings by safeguarding or expanding funding, increasing philanthropic giving, and reminding leaders that every child deserves the chance to survive and thrive, no matter where they are born.

“We can’t stop at almost,” Gates writes. “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: how we helped more kids survive childbirth—and childhood.”

Distributed by African Media Agency (AMA) on behalf of the Gates Foundation.

About the Gates Foundation

Guided by the belief that every life has equal value, the Gates Foundation works to help all people lead healthy, productive lives. In developing countries, we work with partners to?create impactful solutions so that people can take charge of their futures and achieve their full potential. In the United States, we aim to ensure that everyone—especially those with the fewest resources—has access to the opportunities needed to succeed in school and life.?Based in Seattle, Washington, the foundation is led by CEO Mark Suzman, under the direction of Bill Gates and our governing board.

About Goalkeepers

Goalkeepers is the foundation’s campaign to accelerate progress towards the Sustainable Development Goals (Global Goals). By sharing stories and data behind the Global Goals through an annual report, the Gates Foundation hopes to inspire a new generation of leaders—Goalkeepers who raise awareness of progress, hold their leaders accountable, and drive action to achieve the Global Goals.

About the Global Goals

On September 25, 2015, at the United Nations headquarters in New York, 193 world leaders committed to the 17 Sustainable Development Goals (Global Goals). These are a series of ambitious objectives and targets to achieve three extraordinary things by 2030: end poverty, fight inequality and injustice, and fix climate change.