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The Rising Child Mortality Crisis: A Call to Action

In a concerning revelation, the latest Goalkeepers Report from the Gates Foundation indicates that, for the first time this century, the number of children dying before their fifth birthday is projected to rise. This alarming trend threatens to undo decades of progress made in global health initiatives aimed at reducing child mortality. In 2024, approximately 4.6 million children are expected to perish before reaching age five; this number is projected to climb to 4.8 million in the subsequent year, according to modeling from the Institute for Health Metrics and Evaluation (IHME).

A Retreat from Progress

This anticipated rise in child mortality can be attributed to a significant decline in global health funding. The report highlights a staggering 26.9% reduction in global health aid compared to 2024, amid increasing debt burdens on countries and the fragility of health systems. Prominent gains in combating diseases like malaria, HIV, and polio are now at risk of being lost.

The Goalkeepers Report, titled "We Can't Stop at Almost," warns that if funding continues to be cut, up to 16 million additional children could die by 2045. It emphasizes the urgent need for targeted investments in proven health solutions and innovations to prevent this backward trend.

Bill Gates, Chair of the Gates Foundation, stresses the importance of maximizing limited resources: "I wish we could do more, but even in tight times, we can make a meaningful impact.” Gates aims to advocate for increased funding for child health and efficiency improvements within current systems, stating, "We must achieve more with less, as millions of lives are at stake."

A Crucial Turning Point

The implications of continuing cuts to global health funding are dire. IHME's projections suggest that maintaining a 20% reduction in funding could lead to the deaths of an additional 12 million children, while a 30% cut could escalate this figure to 16 million. Gates labels this moment as crucial for global health, emphasizing that the right decisions made now can still save millions of lives.

Gates articulates a hopeful message: "We have the potential to access the most advanced science and innovation in human history but lack the funds to ensure they save lives. By prioritizing effective solutions, we're capable of significantly reducing child mortality and ensuring millions of children are alive by 2045."

Strategic Investments to Save Lives

The report outlines significant investment opportunities that can save countless young lives. Gates calls for doubling down on the most effective interventions—such as essential health care services, routine vaccinations, improved vaccines, and innovative data applications—to make every dollar count. For instance:

• - Strong primary health care systems can prevent up to 90% of child deaths at an annual cost of less than $100 per person.
• - Each dollar spent on vaccines generates $54 in economic and social benefits. Since the year 2000, the Gavi Vaccine Alliance has delivered life-saving vaccines to over 1.2 billion children.

Additionally, the Global Fund to Fight AIDS, Tuberculosis, and Malaria has demonstrated what sustainable investments can achieve, having saved 70 million lives and reduced deaths from malaria, tuberculosis, and HIV by over 60% since 2002. Recent commitments of $11.34 billion from world leaders for the Global Fund's eighth replenishment signify a continuing global commitment to combat these diseases while highlighting the risks of a possible setback.

Investing in next-generation innovations could eradicate some of the deadliest threats to children, such as malaria and pneumonia. Current models suggest sustainable funding for these innovations could help save millions by 2045:

• - Next-generation vaccines against Respiratory Syncytial Virus and pneumonia could save 3.4 million children.
• - New malaria treatments could prevent an additional 5.7 million child deaths, while long-lasting HIV prevention methods like Lenacapavir could reduce infections and deaths in high-burden countries to zero.

Local Leadership, Global Impact

The report also includes perspectives from health leaders, workers, and researchers in Africa and Asia who are advancing sustainable solutions. In Nigeria, Governor Muhammad Inuwa Yahaya prioritizes health and education despite budget constraints, stating, "You don't need perfect conditions to make progress. You need clarity and courage to follow through."

Kenyan health worker Josephine Barasa continues her voluntary efforts in her community even after losing her paid position, focusing on the care and education of mothers and children: "You can take away my money, but you can't take away my women... The support systems may be gone, but the need remains, and so do I."

In Uganda, entomologist Krystal Mwesiga Birungi is developing next-generation tools to combat malaria, affirming, "An end to malaria is not only possible but urgently necessary. We, as African researchers, know this—and we lead in this area."

Indian pediatrician Dr. Naveen Thacker underscores the necessity of affordable and accessible vaccines: “If we want more healthy children, making vaccines affordable is key.”

Gates calls on governments, philanthropists, and citizens to respond to the report’s findings by securing or increasing funding, boosting their willingness to donate, and reminding decision-makers that every child deserves the chance to survive and thrive, regardless of where they are born.

"We cannot settle for 'almost'" Gates states, emphasizing the importance of returning to a world where more resources are available for child health so that a decade from now, we can recount a different story about how we helped more children survive birth and childhood.

For more details, the 2025 Goalkeepers Report can be accessed here.

About the Gates Foundation

Believing that every life is of equal value, the Gates Foundation works toward ensuring that all people can lead a healthy and productive life. In developing countries, they partner with local organizations to develop effective solutions that empower individuals to take control of their futures. In the United States, they aim to ensure that everyone—especially those with the least resources—has access to opportunities essential for success in school and life. Led by CEO Mark Suzman and governed by Bill Gates and their board, the foundation is based in Seattle, Washington.