What you probably already know: The Bill & Melinda Gates Foundation just released a sobering report: 2025 is the first year of this century where child deaths will increase across the world. Child mortality has been dramatically reduced the past two decades, but the Goalkeeper Report says an estimated 4.8 million children worldwide will die this year before they turn 5, or 200,000 more than last year. “Over the last 25 years the world quietly achieved something remarkable: We cut child deaths in half,” Bill Gates says, noting that 9 million children died in 2000. “2025 has seen significant setbacks in this work of keeping kids healthy.”
Why it matters: The report identifies declining funding for global health as a central cause, as many high-income countries and donor agencies are scaling back what’s known as Development Assistance for Health, diverting resources toward debt servicing or other priorities. That shortfall means the world risks losing the gains of decades of effort, including better vaccines, expanded immunization and stronger health systems. The losses could mount dramatically without intervention, as 12 million more children could die by 2045 if health funding decreases by 20% (which some major donor countries are considering) and 16 million more by 2045 with 30% cutbacks.
What it means: Despite the setbacks, Gates says he remains “optimistic,” saying childhood deaths could be reduced to 2 million a year with investments in primary health care involving pregnant women and young kids, especially in low- and middle-income countries. Primary health care costs less than $100 per person per year globally and can prevent up to 90% of child deaths. The report also calls for aggressively reinvesting in routine immunization, calling it the “best buy” in global health, noting that every dollar spent on immunization gives countries a return of $54. Malaria, a disease that kills more than 400,000 children under the age of 5 annually, could conceivably be eradicated by 2040 thanks to new research and interventions including bed nets, spraying or treatments targeted at high-risk zones in lieu of blanket national campaigns.
What happens next: The report lays bare a grim reality and a path to avert catastrophe. Its tone is urgent and moral. Gates, who turned 70 this year, urges a “call to action” for both policymakers and engaged citizens, including targeting health financing toward funds with successful track records, making a commitment to primary health care and supporting the development of health innovations. “The death of a child is always a tragedy,” he says. “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. It doesn’t have to be like this. With millions of lives on the line, we have to do more with less, now.”
