Gates Foundation urges global leaders to target scarce resources where they save the most lives
Projections by the IHME show that if global health funding cuts of 20 percent persist, an additional 12mln children could die by 2045. A 30 percent permanent cut would bring that toll to 16mln
KAMPALA, December 4, 2025 — 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 4.8mln children this year. At the same time, global development assistance for health fell sharply this year—26.9 percent 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 16mln 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 percent persist, an additional 12mln children could die by 2045. A 30 percent permanent cut would bring that toll to 16mln.
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 US$ 100 per person per year, strong primary health care systems can prevent up to 90 percent of child deaths; Every US$ 1 spent on vaccines returns US$ 54 in economic and social benefits. Through Gavi, the Vaccine Alliance, more than 1.2bln 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 70mln lives and reduced deaths from malaria, TB, and HIV by more than 60 percent since 2002. Late last month, leaders pledged US$ 11.34bln 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.
The report says next-generation vaccines for respiratory syncytial virus and pneumonia could save 3.4 million children while new malaria tools could save another 5.7mln 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, prioritised 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.”
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