The number of children dying under the age of five is expected to rise for the first time this century due to deep cuts in global health funding by high-income countries, according to a new report from the Gates Foundation.
Child mortality worldwide is projected to reach an estimated 4.8 million in 2025, an increase of 200,000 preventable deaths compared to last year, the Gates Foundation said in its new Goalkeepers report, which tracks global progress towards the UN’s Sustainable Development Goals. This represents a reversal of decades of global health progress, given that child mortality rates have declined every other year since 2000.
“It’s 100% preventable. There’s no reason why children should have to die,” said Mark Suzman, CEO of the Gates Foundation. He called on governments and private donors to redouble the most cost-effective and life-saving interventions, such as strengthening primary health care systems and routine immunization.
The expected increase in deaths follows a significant cut in global health aid this year, which is 26.9% below 2024 funding levels.
“There are many causes, but clearly one of the main causes is the significant reduction in international development assistance by many high-income countries,” Suzman said at a briefing. “The US, UK, France, Germany and several other countries have made significant cuts.”
The report noted that foreign aid cuts were made by at least 24 high-income donor countries this year. The Trump administration’s deep cuts were particularly impactful because the United States has historically been the world’s largest donor to global health.
CNN has reached out to the US State Department for comment.
Meanwhile, low- and middle-income countries receiving development aid face increasingly weak health systems and mounting debt as they seek to address the leading causes of child mortality, such as pneumonia, diarrheal diseases, malaria and other infectious diseases, the Gates Foundation said.
According to the Gates Foundation, 12 million more children will die by 2045 if global health funding cuts continue by 20%. The Gates Foundation worked with the University of Washington’s Institute for Health Metrics and Evaluation to quantify the impact of the funding cuts.
If the reduction rate jumps to 30%, data projections show that the situation will worsen further, with 16 million more child deaths by 2045.
“I think this is a call to action and a moment of deep reflection for the world because we know how to save the lives of these children,” Suzman said, adding, “We need to pivot.”
The study found that “investing in primary health care is the best way to save more lives with limited resources.” The report found that for less than $100 per person per year, up to 90% of child deaths could be prevented by stronger primary health care systems.
And the report says routine immunization remains the “best buy” in public health. For every dollar spent on vaccines, countries receive $54 in economic and social benefits, the report said.
“Vaccines not only save lives; they prevent outbreaks that would overwhelm hospitals, disrupt education, and draw resources from other priorities,” Dr. Naveen Thakkar, director of India’s Deep Children’s Hospital, said in the report. “Every dollar spent on vaccinations yields even more benefits in avoided treatment costs and sustained productivity.”
Tucker, who is also executive director of the International Pediatric Association, added: “If we want to see more healthy children, vaccine affordability is key.”
For example, improvements to the twice-yearly shot called lenacapavir could make significant progress toward eliminating deaths from HIV/AIDS, the report said. Researchers are working on a version of the vaccine that requires only one injection a year, and a cheaper generic version of the vaccine is expected to be available within the next few years.
Innovations related to respiratory syncytial virus (RSV) also have the potential to prevent millions of children from becoming infected with pneumonia, the leading cause of death among children from infection. And scientists say a new generation of malaria vaccines could help eradicate the mosquito-borne disease.
The Gates Foundation is calling on policymakers to increase investment in immunization and support the development and deployment of innovations like improved vaccines. The foundation also urges governments to preserve funding for “proven successes like GAVI and the Global Fund,” international efforts to tackle some of the world’s biggest public health problems.
Gavi, the international vaccine alliance, says it has vaccinated 1.2 million children and averted more than 20 million deaths since 2000.
The United States, once one of the alliance’s biggest donors, stopped funding GAVI this year. The Trump administration has also proposed shutting down the U.S. Centers for Disease Control and Prevention’s global health division in its 2026 budget, which would end a massive program to vaccinate children against polio, measles and other diseases.
U.S. Health and Human Services Secretary Robert F. Kennedy Jr. announced the funding cut in a June video statement in which he called on Gabi to “regain the public’s trust and justify the $8 billion in funding the United States has provided since 2001,” Reuters reported at the time.
France, Norway and the UK also cut funding to Gavi this year, according to an analysis by the Global Development Center think tank.
But the Trump administration has made significant contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria, accounting for about a third of the total amount. But France, Japan, Sweden and the European Commission have yet to announce commitments at the latest meeting to replenish the fund at the end of November, so there is still a risk that the Global Fund’s overall funding will fall significantly short of its funding target, according to The Lancet.
Bill Gates, chairman of the Gates Foundation and billionaire co-founder of Microsoft, said we are at a turning point in global health, where prioritizing the right interventions can make or break efforts to eradicate some diseases, and prioritizing penny-pinching innovation can further reduce preventable deaths.
“It’s almost unstoppable,” Gates said in the report. “If we can do more with less now, and if we go back to a world where we can devote more resources to children’s health, then in 20 years we’ll be able to tell a different kind of story: that we’ve helped more children get through childbirth and childhood.
“We may be the first generation in human history to have access to the most cutting-edge science and innovation, but we haven’t been able to raise the money to reliably save lives,” Gates added. Earlier this year, he announced plans to give away “virtually all” of his wealth, estimated at about $200 billion, through a foundation over the next 20 years.
