Global Child Deaths Set to Rise as Aid Cuts Bite, Gates Warns

The Bill and Melinda Gates Foundation said today that the number of children under five who will die in 2025 is projected to rise for the first time since 2000, marking a worrying reversal after decades of steady decline. Modeling by the Institute for Health Metrics and Evaluation underpins the finding, which estimates roughly 4.8 million child deaths in 2025, up from about 4.6 million in 2024, an increase of roughly 200,000 deaths.

The foundation’s 2025 Goalkeepers report points to a sharp contraction in international health aid as a primary driver. Aid flows fell by a near 27 percent year over year, the report says, depriving fragile health systems of funding for routine services. At the same time mounting sovereign debt burdens in many low and middle income countries have squeezed government budgets, leaving fewer resources for primary care, immunization programs and essential disease treatments.

Falling vaccination coverage is a particular concern, the report notes, because vaccines are among the most cost effective interventions for saving young lives. Declining reach of routine immunization can result in outbreaks of preventable diseases and erode hard won gains in child survival. Weaker primary health care systems reduce access to treatment for pneumonia, diarrheal disease and other leading causes of under five mortality, which can translate quickly into higher death tolls when preventive measures and basic care are curtailed.

The Gates Foundation urged governments and international donors to protect proven interventions and to prioritize funding that saves the most lives. The report warns that if current funding trends persist the long term toll could amount to millions more child deaths by 2045, reversing significant progress toward the United Nations Sustainable Development Goals.

Public health analysts say the projections underscore how funding instability now can have cascading effects over years. Investments in vaccination, maternal care and community health workers not only prevent immediate deaths but also reduce healthcare costs and strengthen resilience to future shocks. Conversely, cuts that disrupt supply chains, staffing and outreach can take years to repair.

The report arrives amid a broader global debate over fiscal pressure and aid effectiveness. Donor countries face competing domestic priorities while recipient governments contend with shrinking fiscal space and rising debt service costs. Those dynamics complicate planning for long term health programs and threaten the continuity of services that depend on stable financing.

Policy responses recommended by health economists and reflected in the report include ring fencing of core child survival programs, targeted financing for high impact interventions, and exploration of debt relief or restructuring tied to social spending protections. The foundation emphasizes that protecting vaccination and primary care is not only humanitarian but also cost effective, with measurable returns in lives saved and long term development.

As international leaders prepare for end of year negotiations on aid and finance, the report frames child survival as both a moral barometer and a practical test of global commitment to equitable health. Without prompt action to stabilize funding and shore up services the projection of rising child deaths in 2025 may be the first sign of a prolonged and avoidable reversal.