“It doesn’t have to be like this.” That’s how Bill Gates, chair of the Gates Foundation, opens the 2025 Goalkeepers report, “We Can’t Stop at Almost.” The Microsoft co-founder sees a turning point after decades of progress in reducing childhood mortality. “The death of a child is always a tragedy,” he continues, “But there’s something especially devastating about a child dying of a disease we know how to prevent.”
TL;DR
- Child mortality is projected to rise for the first time this century, with 4.8 million deaths expected in 2025.
- Significant reductions in international health funding, including U.S. foreign aid cuts, are contributing to this concerning trend.
- The Gates Foundation warns catastrophic consequences if funding cuts persist, potentially leading to millions more child deaths.
- The report outlines strategies like prioritizing primary healthcare, doubling down on immunizations, and investing in innovations to save lives.
For the first time in this century, the analysis indicates, the count of youngsters perishing before their fifth year is anticipated to climb. Projections from The Institute for Health Metrics and Evaluation (IHME) expose concerning figures: In 2024, 4.6 million young ones passed away before reaching the age of five. By 2025, this figure is expected to grow by slightly more than 200,000, totaling an estimated 4.8 million children worldwide. This rise signifies over 5,000 schoolrooms of children, “gone before they ever learn to write their name or tie their shoes.” This troubling outlook emerges alongside significant reductions in international support for health initiatives, which dropped 26.9% lower than 2024 figures this year. Within the U.S., the Trump administration has dissolved its foreign aid body USAID and drastically cut foreign aid.
Gates describes this “significant reversal in child deaths,” as something that should be “sobering” for anyone committed to scientific and human progress. The report warns that if funding cuts persist, the consequences will be catastrophic. If global health funding decreases by 20%—the scale of cuts some major donor countries are considering—an additional 12 million children could die by 2045. Should the cuts be steeper, reaching 30%, the report grimly forecasts 16 million more child deaths by 2045.
“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.
In May, Gates announced that he would commit “virtually all” his remaining wealth—about $100 billion—to the foundation in an all-out effort to eradicate or drastically reduce some of the world’s most lethal diseases so future generations won’t have to worry about them, and to continue reducing mortality rates for children.
However, he stressed that the organization wouldn't be able to reach these objectives without backing from administrations, especially from affluent nations. And concerning lethal contagious illnesses, which have the potential to surge back from near eradication, zero truly represents the ideal target.
The new report warns of the catastrophic results if the reduction in funding for these efforts continues. “If we take this path, we’re the generation that almost ended preventable child deaths. Almost eradicated polio. Almost wiped malaria off the map. Almost made HIV history. But we can’t stop at almost.”
A roadmap to resilience
Gates highlights that despite the current global financial constraints, effective strategies and advanced advancements are available to safeguard advancements and rescue countless young lives. The pressing objective, as stated by Gates, should be to “do more with less, now.”
The document pointed out chances to address the avoidable illnesses causing child fatalities globally, including malaria, HIV/AIDS, and general dangers to infants. The report states that the necessary resources are readily available, presenting a three-step plan and urging nations to intensify their commitment to the most impactful strategies. As outlined in the report, these are:
1. Prioritizing Primary Health Care: Investing in robust primary health care systems is the “smartest investment now,” the report says. For less than $100 per person per year, these systems can prevent up to 90% of child deaths, catching deadly diseases like pneumonia early and ensuring safe deliveries.
2. Doubling Down on Routine Immunization: Routine immunizations remain the “best buy in global health,” the report says, adding that every dollar spent on immunization yields a return of $54 in economic and social benefits. Innovations such as reduced dosing schedules for pneumococcal conjugate vaccines (PCV) could save around $2 billion by 2050.
3. Investing in Next-Generation Innovations: Projections indicate that by 2045, novel malaria interventions might prevent the deaths of 5.7 million youngsters, and expanding the availability of new maternal immunizations against dangers such as Respiratory Syncytial Virus (RSV) and Group B streptococcus (GBS) could spare 3.4 million children.
Local leadership during times of shortage
Focusing on achieving more with fewer resources, the document presents perspectives from administrators and medical professionals who are maintaining advancements in healthcare despite insufficient funding. In Nigeria, Governor Muhammad Inuwa Yahaya of Gombe State placed a premium on frontline healthcare services even with a record budget shortfall. “You don’t need perfect conditions to make progress,” he remarked. “You need clarity, and the courage to stick to it.”
The report additionally highlighted individuals stepping up to tackle financial shortfalls at a local scale. In Kenya, Josephine Barasa, a community health worker, carried on her volunteer efforts as a “mother mentor” following the termination of her paid position. “They could take away the money, but they couldn’t take me away from my women,” she stated to the foundation. “The support systems may have disappeared, but the need has not. And neither have I.”
