For the first time in decades, the world is witnessing a heartbreaking reversal in the fight against child mortality. According to the Gates Foundation’s annual Goalkeepers report, released on December 5, 2025, the number of children dying before their fifth birthday is projected to rise to 4.8 million this year—an increase of 200,000 from 2024. This marks the first uptick in global child deaths this century, ending a remarkable period of progress that had halved childhood mortality since 1990.
Bill Gates, co-founder of Microsoft and a leading philanthropist, did not mince words about the causes behind this grim milestone. In interviews with Agence France-Presse and the Wall Street Journal, Gates placed primary blame on wealthy Western countries slashing international aid, singling out the United States for making the deepest cuts. “It is tragic that child deaths will increase worldwide for the first time this century,” Gates told AFP, emphasizing the profound consequences of these decisions.
The United States, once a cornerstone of global health aid, has drastically changed course in 2025. President Donald Trump’s return to the White House brought sweeping government workforce cuts, including the abrupt dismantling of the U.S. Agency for International Development (USAID)—a move Gates described as “a gigantic mistake.” According to the Daily Kos, the Trump administration shuttered USAID in July, despite the agency’s decades-long role in reducing child mortality around the globe. Gates underscored the impact of this decision, telling the Wall Street Journal, “I believe that was a gigantic mistake, and that’s partly why we’ve had the turmoil and increase in deaths this year.”
The consequences of these aid cuts have been swift and severe. The Gates Foundation’s report found that international aid for developing countries plummeted by 27% in 2025, threatening hard-won progress against diseases like malaria, HIV, and polio. Gates linked the surge in child deaths directly to this funding shortfall, warning that if global aid cuts of around 30% become permanent, an additional 16 million children could die by 2045. “That’s 16 million mothers who are experiencing something that no one wants to or should have to deal with,” Gates said, painting a stark picture of the human toll.
The fallout from these decisions is not confined to abstract statistics. On the ground, the effects are devastating and immediate. In Ethiopia, for example, the loss of funding has led to shortages of hospital staff, forcing children to be discharged prematurely. In Nigeria, malnutrition deaths among children are rising as food aid dries up. The Daily Kos reported that in Afghanistan and Pakistan, food bound for 1.5 million children was destroyed, depriving some of the world’s most vulnerable of their lifeline.
Impact Counter, a group tracking the human costs of these cuts, estimates that over 600,000 people have died as a result, with children making up two-thirds of that staggering total. The numbers are hard to process: 14.7 million fewer children have received treatment for pneumonia or diarrhea, and about 168,000 children are dying each year from malnutrition alone. Malaria cases among children are projected to climb by more than 6 million due to the loss of preventive aid.
It’s not just child health that’s at risk. The Trump administration’s termination of maternal and child health funds has eliminated postnatal care for over 11 million children, according to the Daily Kos. A modeling study published in The Lancet in April 2025 predicted that, if these trends continue, maternal mortality will rise by 29% by 2040, under-five child deaths will increase by 23%, and stillbirths will jump by 13%—a devastating reversal of decades of progress.
Gates has been vocal about the preventable nature of this crisis. Back in July, he warned on X (formerly Twitter), “The devastating effects of these cuts are entirely preventable—and it’s not too late to reverse them.” Despite his efforts, including direct conversations with President Trump, Gates remains uncertain whether aid levels will be restored. “I’m talking to President Trump about encouraging him to restore aid so that it is at most a modest cut—I don’t know if I’ll be successful with that,” Gates admitted to AFP.
Other Western nations have also slashed their contributions, though not as deeply as the U.S. Gates pointed to Britain, France, and Germany as having “disproportionately” reduced their aid, compounding the crisis. The cumulative effect has been to undermine global efforts to combat deadly diseases and support basic health infrastructure in the world’s poorest countries.
Historically, the United States has played a pivotal role in driving down child mortality rates. In 1990, 11.6 million children under five died worldwide. Thanks to a concerted global effort—much of it supported by American aid—that figure had fallen to 4.6 million by 2024. Now, with the projected rise to 4.8 million deaths in 2025, the world is at risk of losing hard-won gains.
Gates warned that the damage will not be quickly undone. “I think we’re going to have five very tough years where at best we’ll be able to plateau the deaths,” he told the Wall Street Journal. The loss of funding, he explained, will take years to make up, even if aid is eventually restored.
The situation is further complicated by the role of Elon Musk’s so-called U.S. Department of Government Efficiency (DoGE), which Gates accused of being “responsible for a lot of deaths” after it abruptly cut off grants from USAID earlier this year. The chaos that followed, Gates said, underscored the dangers of making drastic policy changes without considering their humanitarian impact.
As the world grapples with this crisis, the numbers tell a sobering story—but behind each statistic is a child, a family, and a community affected by decisions made in distant capitals. The reversal in child mortality trends is not just a setback for global health; it’s a stark reminder of the interconnectedness of nations and the real-world consequences of policy choices.
With millions of lives hanging in the balance, the call to action is clear. Whether or not political leaders heed it remains an open—and urgent—question.
