In a troubling reversal of decades of progress, a new Gates Foundation report warns that global mortality rates for children under five are expected to rise for the first time in the 21st century. The study highlights a sharp reduction in international development aid as the primary factor putting millions of young lives at risk.
First Increase in Under-5 Deaths in Over Two Decades:
After years of consistent improvements driven by healthcare investments, vaccines, and widespread social development, under-5 mortality had fallen dramatically from 88 deaths per 1,000 live births in 1990 to roughly 36 per 1,000 in recent years.
But this positive trajectory is now under threat.
According to the Gates Foundation’s Goalkeepers Report, the figure is expected to rise to 37 per 1,000 live births in 2024. Last year, an estimated 4.6 million children died before turning five. This year, that number is projected to increase by over 200,000 additional deaths.
Aid Cuts Could Lead to 12 Million Additional Child Deaths by 2045:
Researchers say the alarming trend is closely linked to a significant decline in global health funding. Development assistance for health has fallen from $49 billion to $36 billion a drop of more than 25% in just one year.
If these cuts continue, the Institute for Health Metrics and Evaluation (IHME) estimates that 12 million more children under five could die by 2045.
Senior Program Officer at the Gates Foundation, called the situation “tragic,” stressing that 25 years of global health gains now stand at risk.
Low-Income Countries Hit the Hardest:
The funding gap disproportionately impacts low-income countries across sub-Saharan Africa and South Asia, where health systems heavily depend on external aid. Diseases such as pneumonia, diarrhea, malaria, and complications from premature births remain leading causes of child mortality despite being largely preventable.
Senior Director at IHME, emphasized that when aid declines, “low-income countries have the least ability to absorb the shock.”
Past Funding Cuts Still Creating Ripple Effects:
Analysts also point to earlier disruptions, including the dismantling of parts of the U.S. Agency for International Development (USAID) under the Trump administration. A separate study published in The Lancet predicts USAID reductions alone could lead to 14 million additional deaths over the next five years.
UN Goals Now Out of Reach:
The United Nations had set a goal to reduce under-5 mortality to 25 per 1,000 live births by 2030. The new projections suggest the world will remain stalled around 36 per 1,000, moving further off track from global health targets.
Gates Foundation Calls for Urgent Action:
Bill Gates warned that the world could become a generation that “had access to the most advanced science in human history but couldn’t secure funding to save lives.”
The report emphasizes that smart spending and scalable innovation, such as single-dose vaccines, precision data tools, and lower-cost interventions are crucial to reversing current trends.
“Immunization remains the best buy in global health,” the report states, noting that every $1 invested in vaccines generates $54 in economic returns for countries.
A Critical Crossroads for Global Health:
With nearly 13,000 children under five dying every day, researchers say the world is at a pivotal moment. They stress that many deaths are preventable and financial commitment must match scientific advancement to safeguard the next generation.