Bill Gates criticizes ‘major increase in child mortality’ as nearly 5 million kids will die before turning 5 this year

It doesnt have to be this way. Bill Gates, co-chair of the Gates Foundation, opens the 2025 Goalkeepers Report, titled We Cant Stop at Almost, with a stark reminder of the challenges facing global child health. After decades of progress, the report signals a worrying shift in childhood mortality trends.

Every childs death is a tragedy, Gates states. But it is particularly heartbreaking when a child dies from a disease we know how to prevent.

For the first time this century, projections indicate an increase in the number of children dying before their fifth birthday. Analysis from the Institute for Health Metrics and Evaluation (IHME) estimates that in 2024, 4.6 million children died before turning five, and in 2025, that figure could rise to approximately 4.8 million worldwideover 200,000 more than the previous year. Gates emphasizes the human cost: This is equivalent to more than 5,000 classrooms of children lost before they can even write their names or tie their shoes.

The report attributes part of this reversal to declining global health funding. Worldwide assistance for health dropped nearly 27% below 2024 levels. In the United States, reductions in foreign aid and the dismantling of USAID by the Trump administration have further weakened international health efforts.

Gates describes this trend as a significant reversal in child deaths, a reality that should concern anyone committed to scientific and humanitarian progress. The report warns that continued funding cuts could have devastating consequences: a 20% reduction in global health funding could result in 12 million additional child deaths by 2045, while a 30% cut could lead to 16 million more.

Highlighting the urgency, Gates wrote, We could have access to the most advanced science in history, yet fail to save lives due to insufficient funding. In May, he pledged nearly all his remaining fortune, roughly $100 billion, to the foundation to combat deadly diseases and continue lowering childhood mortalitybut he stressed that government support, especially from wealthy nations, is critical. Zero is the magic number, Gates notes, referring to the need to fully eradicate preventable diseases.

Roadmap to Protecting Children

Despite tight budgets, Gates says solutions exist to safeguard the progress made and save millions of lives. The report outlines three key strategies:

1. Strengthening Primary Health Care: Investing in robust primary care systems is highly cost-effective, preventing up to 90% of child deaths at under $100 per person annually. Early treatment for diseases like pneumonia and safe childbirth can be ensured through these systems.
2. Expanding Routine Immunization: Vaccines remain the most effective investment in global health, offering $54 in social and economic returns for every dollar spent. Innovations like reduced-dose schedules for pneumococcal vaccines could save $2 billion by 2050.
3. Developing Next-Generation Health Innovations: By 2045, new malaria interventions could save 5.7 million children, while maternal vaccines for illnesses like RSV and Group B streptococcus could save another 3.4 million.

Local Leadership in Resource-Limited Settings

The report highlights examples of local leaders and health workers making an impact despite limited resources. In Nigeria, Governor Muhammad Inuwa Yahaya of Gombe State prioritized primary healthcare even amid a budget deficit. You dont need perfect conditions to make progress, he said. You need clarity and courage to stay committed.

In Kenya, community health worker Josephine Barasa continued her voluntary work as a mother mentor after her position was defunded. They could take away the money, but they couldnt take me away from my women, she said. The need remains, and so do I.

The report serves as a call to action: without renewed funding and commitment, decades of progress in reducing preventable child deaths could be undone.

Analysis: The Growing Threat to Child Health and the Urgent Call for Action

The 2025 Goalkeepers Report, launched by Bill Gates, presents a concerning reversal in global child health. After decades of progress in reducing childhood mortality, projections now show an increase in the number of children who will die before their fifth birthday. The Institute for Health Metrics and Evaluation (IHME) estimates that the global number of child deaths could rise by 200,000 in 2025, reaching approximately 4.8 million. This unsettling trend points to a worrying regression in the battle against preventable diseases.

One of the primary factors contributing to this rise is the decline in global health funding. Gates specifically highlights the dramatic drop in financial support, with global health assistance falling nearly 27% below 2024 levels. This trend, exacerbated by policy shifts in major donor nations like the United States, threatens to undo the significant strides made in reducing child mortality over the past decades. Gates warns that further cuts to health funding could have devastating consequences, with up to 16 million additional child deaths projected by 2045 if funding continues to shrink.

However, the report also presents a roadmap for action. Gates emphasizes the need for continued investment in primary healthcare, which has proven to be one of the most cost-effective solutions for preventing child deaths. Strengthening immunization programs and fostering new health innovations are also critical to securing progress. The examples of local leaders in resource-limited settings, such as those in Nigeria and Kenya, offer hope that even in the face of financial constraints, progress is still possible with determination and leadership.

The bottom line is clear: without renewed commitment from governments, particularly wealthy nations, and continued investment in effective health solutions, we risk losing the progress made in child health. The battle against preventable child deaths is far from over, but with the right investments, it is still possible to secure a future where no child dies from diseases we know how to prevent.

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• Bill Gates decries ‘significant reversal in child deaths’ as nearly 5 million kids will die before they turn 5 this year