The Bill & Melinda Gates Foundation has warned that the world may witness a sharp and deeply worrying rise in child mortality this year, driven largely by a dramatic reduction in international funding for global health. According to a report released on Thursday, deaths among children under the age of five could increase by more than 200,000 in 2025 compared with 2024—a reversal that would mark the first rise in preventable child mortality in the twenty-first century.
The report notes that global progress in reducing child deaths, achieved steadily over the past two decades, is now at risk of unravelling. Since the year 2000, child mortality had fallen by nearly half thanks to widespread vaccination campaigns, expanded maternal health services, improved nutrition programmes, and broader access to basic healthcare. Last year, an estimated 4.6 million children under five died worldwide. This figure could climb to 4.8 million by the end of the current year if the funding crisis continues.
Bill Gates, co-chair of the Gates Foundation, expressed deep concern at the reversal of long-standing progress. “For decades the world has been inching forward—slowly but surely—in saving children’s lives. But the challenges have increased, and the progress is now going in the wrong direction,” he warned. Gates stressed that the consequences will be severe unless donor countries and global institutions take immediate action.
The Gates Foundation’s annual report typically assesses progress towards the United Nations Sustainable Development Goals (SDGs), particularly those relating to poverty reduction and improvements in global health. However, this year’s publication was delayed due to uncertainty surrounding donor commitments and the scale of funding reductions facing many health programmes.
The funding shortfall began early in the year when the United States—the largest contributor to global health finance—implemented cuts to its international aid budget. Soon afterwards, major donors such as the United Kingdom and Germany followed suit, further reducing their contributions to multilateral health initiatives. According to the Gates Foundation, development assistance for global health has fallen by around 27 per cent this year compared with 2024—a decline unprecedented in recent decades.
While cuts in international aid remain the primary driver of the projected rise in child deaths, the report highlights several compounding factors. Many low-income and middle-income countries are facing severe debt distress, limiting their ability to invest in healthcare. As a consequence, national health systems have weakened significantly. Basic services such as childhood vaccinations, maternal care, and infectious disease programmes are being disrupted, leaving millions of children vulnerable.
If the current level of funding cuts becomes permanent, the Foundation warns that an additional 12 to 16 million children could die between now and 2045—deaths that would otherwise be preventable through routine immunisation, adequate nutrition, and timely medical treatment.
The report urges the international community to recognise the gravity of the crisis. It calls for urgent restoration of development assistance, better debt relief mechanisms for struggling countries, and stronger commitments from global institutions. Without decisive action, it warns, the world risks losing decades of hard-won progress in child survival—a setback that would disproportionately affect the world’s poorest communities.