Child Mortality Projected to Rise Amid Funding Cuts

The number of children dying before age five is expected to increase for the first time this century, reversing decades of global progress, according to the Gates Foundation. Experts warn that declining health funding and under-vaccination could worsen preventable child deaths worldwide.

Global child survival, which has improved dramatically over the past three decades, is now facing a potential setback. In 2024, approximately 4.6 million children under five died worldwide, and projections from the Gates Foundation’s Goalkeepers 2025 report indicate that figure could rise to 4.8 million in 2025. This marks the first projected increase in under-five mortality in the 21st century, reflecting the combined effects of reduced international health funding, fragile health systems, and persistent infectious diseases.

The report, produced in partnership with the Institute for Health Metrics and Evaluation (IHME), highlights the consequences of a 26.9% reduction in global health development aid in 2025 compared to the previous year. Bill Gates, Chair, Foundation, called the situation “a critical moment for global health,” urging governments and philanthropic organizations to prioritize high-impact interventions despite constrained budgets. “Even in times of tight budgets, we can make a difference,” Gates wrote, emphasizing the importance of strategic investments in primary health care, immunizations, and next-generation health innovations.

Globally, child mortality rates have declined from 94 deaths per 1,000 live births in 1990 to 37 per 1,000 in 2023, yet progress has slowed. The annual rate of reduction in under-five mortality dropped from 3.7% during the Millennium Development Goals era (2000–2015) to 2.2% in the early Sustainable Development Goals period (2015–2023). Infectious diseases—including pneumonia, diarrhoea, malaria—as well as complications from preterm birth and birth-related issues, remain leading causes of death among children under five.

The report stresses that continued reductions in funding could have severe long-term consequences. Persistent 20% cuts could result in 12 million additional child deaths by 2045, while 30% cuts could push that number to 16 million. Targeted investments, however, could avert these losses. For example, primary health care systems costing less than US$100 per person annually could prevent up to 90% of child deaths, and vaccines provide an estimated US$54 in economic and social benefits per dollar spent. Since 2000, Gavi, the Vaccine Alliance, has helped immunize over 1.2 billion children, while the Global Fund to Fight AIDS, Tuberculosis, and Malaria has saved 70 million lives through sustained investment.

In addition to funding gaps, under-vaccination is contributing to rising child mortality risks. Measles, which had been eliminated in the Americas, is resurging after vaccination coverage fell below the 95% threshold needed to prevent outbreaks. In Mexico, more than 5,000 cases have been reported in 2025, primarily affecting children under five, with Chihuahua serving as the epicenter. Nationwide, two-dose coverage remains at 81.1%, leaving hundreds of thousands of children unprotected. Authorities have deployed over 8.8 million vaccine doses and expanded eligibility to young children, adolescents, adults, and frontline workers to contain the outbreak. Experts stress that maintaining coverage above 95% is essential to control measles and prevent similar reversals in child survival.

The Goalkeepers report also highlights local leadership driving solutions amid constrained resources. In Nigeria, Governor Muhammad Inuwa Yahaya prioritized primary health care despite budget deficits, while in Kenya, community health worker Josephine Barasa continued voluntary care in her community after losing her paid position. In Uganda, entomologist Krystal Mwesiga Birungi is advancing tools to combat malaria, and in India, Dr. Naveen Thacker underscores the importance of affordable vaccines. These examples demonstrate that strategic leadership, combined with investments in proven interventions and innovations, can preserve and extend decades of progress in child health.

Bill Gates concluded that reversing the trend in child mortality will require immediate action to optimize available resources and protect ongoing programs. “We cannot stop at almost,” he wrote. “If we act now, investing wisely and sustaining funding, millions of children can survive and thrive in the decades ahead.”