Bill Gates./PHOTO ;Courtesy
The Gates Foundation has released its 2025 Goalkeepers Report titled We Can’t Stop at Almost, sounding an alarm over what it calls an unprecedented reversal in global child survival.
For the first time in more than two decades, the number of children dying before age five is projected to rise, driven by deep cuts in global health funding, fragile health systems, and increasing pressure on public budgets in low- and middle-income countries.
New data modeled by the Institute for Health Metrics and Evaluation (IHME) shows that 4.6 million children died before their 5th birthday in 2024.
That number is expected to increase by more than 200,000 this year, to an estimated 4.8 million deaths in 2025.
The report links this sharp setback to a dramatic 26.9% drop in development assistance for health compared to 2024, alongside rising debt burdens and strained public health systems.
The Goalkeepers Report warns that if these cuts persist, up to 16 million more children could die by 2045.
The foundation argues that while resources are tightening, targeted investments in proven and emerging health solutions could still prevent large-scale loss of life.
“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 foundation and author of the report.
“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.”
Funding Cuts Could Cost Millions of Lives by 2045
IHME projections included in the report show that a sustained 20% cut to global health financing could result in 12 million additional child deaths by 2045.
A 30% permanent reduction raises that figure to 16 million. Gates describes this moment as a defining crossroads for global health, one where scientific breakthroughs exist, but political and financial will is slipping.
“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,” he warns.
“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.”
High-Impact Solutions That Still Deliver Results
The report outlines the most effective investments available to governments and global partners. Strengthening primary health care, the foundation notes, remains one of the most cost-efficient options: for under $100 per person per year, robust systems can prevent up to 90% of child deaths.
Vaccination is another essential tool. Every $1 invested in vaccines generates $54 in economic and social benefits, and through Gavi, more than 1.2 billion children have been immunized since 2000.
The Global Fund to Fight AIDS, Tuberculosis, and Malaria is also cited as a key engine of progress, saving 70 million lives and reducing deaths from these diseases by over 60% since 2002.
Last month’s $11.34 billion pledge for the Global Fund’s Eighth Replenishment signals continued commitment, but the report warns that momentum must not stall.
Next-generation health innovations could further accelerate progress.
The report highlights vaccines for respiratory syncytial virus (RSV) and pneumonia, which could save 3.4 million children by 2045.
New malaria tools could save an additional 5.7 million lives, while long-acting HIV prevention tools like lenacapavir could help drive infections toward zero in high-burden regions.
Voices of Local Leaders Sustaining Progress
This year’s report also features perspectives from frontline workers and policymakers across Africa and Asia navigating shrinking budgets.
In Gombe State, Nigeria, Governor Muhammad Inuwa Yahaya emphasizes political will:
“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 shares why she continued serving mothers and children even after her paid position ended.
“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.”
Ugandan entomologist Krystal Mwesiga Birungi stresses the urgency of malaria innovation:
“Ending malaria is not only possible, it is also urgent… We African researchers know this—and we are leading the way.”
And in India, pediatrician Dr. Naveen Thacker underscores vaccine affordability: “If we want to see more healthy children, affordability of vaccines is key.”
A Call for Urgent Action
Gates concludes the report with an appeal to governments, philanthropies, and citizens to safeguard or expand health funding even in a constrained economic climate.
“We can’t stop at almost,” he 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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