For a generation, the world celebrated a quiet miracle: the number of children dying before their fifth birthday was dropping, year after year. From nearly 10 million annual deaths in 2000, the figure fell to just under 5 million by 2020, a triumph of global health collaboration, vaccination campaigns, and community-based care. But this progress has now hit a jarring setback. According to projections released December 5, 2025, by the Gates Foundation and the University of Washington’s Institute for Health Metrics and Evaluation (IHME), child mortality is expected to rise this year for the first time in a quarter-century—a reversal that has stunned health experts and advocates worldwide.
The numbers are stark: an estimated 4.8 million children under five will die in 2025, up by more than 200,000 from the previous year. The increase, as outlined in the Gates Foundation’s 2025 Goalkeepers Report, represents a break in decades of steady improvement. The last time the world saw a year-over-year rise in child mortality was at the turn of the millennium. This year’s uptick is not a statistical blip, but a signal of deep trouble in the systems that have protected the world’s youngest and most vulnerable.
What’s driving this historic setback? The answer, experts say, lies in a dramatic drop in global health funding from the world’s wealthiest nations. According to IHME, global health aid fell by more than 26% in 2025, dropping from $49 billion in 2024 to $36 billion. The United States, United Kingdom, France, and Germany all slashed their contributions, while some countries like Indonesia and South Africa increased their support. However, these increases were nowhere near enough to offset the losses. As Dr. Steve Lim of IHME told NPR, "We expect low-income countries and countries in Sub-Saharan Africa to be the most affected," with some spending 20% less on health as a result of the cuts. "Such large cuts will have substantial consequences on health services," he warned.
Bill Gates, chair of the Bill & Melinda Gates Foundation, was blunt in his assessment. "It’s a tragedy that the world is richer, and yet because we have made disproportionate cuts to the money that helps the world’s poorest children, more of them are dying," he told TIME. Gates emphasized that the death of a child from a preventable disease represents a failure of systems and priorities. "You can’t cut something in half if it’s going up," he said, referencing his goal to halve child mortality over the next two decades.
The causes aren’t mysterious. Reductions in global health aid have weakened support for vaccination campaigns, destabilized long-standing international public health partnerships, and left frontline medical systems in poor countries struggling to cope. Malaria, for example, remains a leading killer of children under five. In July 2024, Ivory Coast launched its first malaria vaccination campaign for infants, an effort emblematic of both progress and the fragility of health gains. As funding wanes, such campaigns become harder to sustain, and the risk of disease resurgence grows.
Gates and other experts point out that investments in primary health care and routine immunization are among the most effective ways to save young lives. The 2025 Goalkeepers Report notes that robust primary care—costing less than $100 per person per year—can prevent up to 90% of child deaths. Since 2000, widespread childhood vaccination has cut child mortality nearly in half, delivering an estimated $54 return for every dollar spent. But as vaccine coverage slips, the world faces a real risk of outbreaks of diseases like measles, which can have devastating consequences if left unchecked.
The models released by IHME and featured in the Gates Foundation’s report underscore the long-term stakes. If global development assistance for health remains 20% below 2024 levels, as some countries are now considering, up to 16 million additional children could die by 2045. Even a 20% reduction would mean 12 million extra deaths. Conversely, if the world recommits to 2024 funding levels and supports the roll-out of new health innovations, 12 million lives could be saved over the same period.
Innovations in vaccines and treatments offer hope, but only if they reach those in need. New pneumococcal conjugate vaccine schedules—requiring fewer doses—can cut costs and logistical burdens while maintaining strong protection. Next-generation malaria vaccines, digital tools for targeting mosquito control in places like Zambia, and maternal vaccines for respiratory syncytial virus (RSV) could all dramatically reduce child deaths. Gates highlighted the potential of AI-based programs to help fill gaps in care, especially in regions where doctor shortages are severe. "Most people will spend their entire lifetime never seeing a doctor—not when they are born, not when they die, and not in between," he noted.
The recent U.S. policy shift under Secretary of Health and Human Services Robert F. Kennedy Jr.—a prominent critic of vaccines—has also drawn scrutiny. Policies linked to Kennedy’s "health freedom" ideology have contributed to weakened support for vaccinations and the destabilization of global health partnerships, according to the Gates Foundation and other observers. The Trump administration’s earlier cuts and reorganization of the U.S. Agency for International Development further compounded the problem. Gates was unequivocal: "I believe that was a gigantic mistake, and that’s partly why we’ve had the turmoil and increase in deaths this year."
Health experts stress that the projected increase in child mortality is not inevitable. The 2025 Goalkeepers Report makes clear that these are choices—about funding, delivery, and global commitment. Examples from countries like Nigeria and Kenya, where strategic local leadership and community health workers have improved maternal and child survival, show what’s possible even with constrained budgets. "For rich countries, it is less than 1% of the budget," Gates pointed out. "The impact of ensuring that pregnant mothers and kids are vaccinated and fed is so great that you see very good health outcomes when you focus on those first few interventions alone."
Brooke Nichols, a global health professor at Boston University, put the numbers in perspective: "Sometimes we talk about numbers. Oh, this is an increase in mortality, a percent increase. What is a percent? It’s a human. It’s a child. It could be your child. It could be my child."
As the world confronts this grim milestone, the message from experts and advocates is clear: the tools to save millions of young lives exist, but only if the political will and financial resources are restored. The reversal of child mortality gains is a stark warning—and a call to action that cannot wait.
