Global health funding cuts could reverse decades of progress in child survival and lead to the deaths of millions of children, the Gates Foundation has warned.
In its 2025 Goalkeepers Report, titled “We Can’t Stop at Almost,” the foundation highlighted that for the first time this century, the number of children dying before their fifth birthday is projected to rise.
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The report indicated that in 2024, 4.6 million children died before turning five, with the number projected to rise to 4.8 million this year.
The rise comes amid a decline in global development assistance for health, which, according to the report, fell 26.9 per cent this year, “increasing pressure on already strained and debt-burdened African health systems.”
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The report warned that if global health funding cuts of 20 per cent persist, an additional 12 million children could die by 2045, and the toll could rise to 16 million if the cuts reach 30 per cent.
Global health funding cuts began in early 2025, particularly from the United States, due to shifts in foreign aid policy. The Goalkeepers report highlighted that the reductions in funding have already begun to affect low- and middle-income countries, particularly in Africa.
Consistent advocacy
In his comments cited in the report, Bill Gates, the chair of the Gates Foundation, noted that, despite tight budgets, the world can still make a significant difference.
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“I’ll continue to advocate, however and wherever I can, for increased funding for the health of the world’s children—and for efficiencies that improve our current system. But with millions of lives on the line, we have to do more with less, now,” Mr Gates said.
“By making the right priorities and commitments, and investing in high-impact solutions, I’m confident we can stop a significant reversal in child deaths and help ensure millions more children are alive in 2045.”
The report highlighted specific investments that offer the greatest potential to save lives.
Strengthening primary health care, ensuring routine immunisations, developing better vaccines, and using data more effectively are identified as high-impact interventions.
It noted that for less than $100 per person per year, robust primary health care systems can prevent up to 90 per cent of child deaths.
“Every $1 spent on vaccines returns $54 in economic and social benefits. Through Gavi, the Vaccine Alliance, more than 1.2 billion children have received lifesaving vaccines since 2000,” it added.
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Evidence from the Global Fund
The report also highlighted the Global Fund to Fight AIDS, Tuberculosis, and Malaria as a model of sustained investment, noting that since 2002, the fund has saved 70 million lives and reduced deaths from these diseases by more than 60 per cent.
“Late last month, leaders pledged $11.34 billion to the Global Fund’s Eighth Replenishment, underscoring continued global commitment to fighting these diseases while laying bare the risks of stepping back,” it noted.
According to the Gates Foundation, investment in the development of next-generation innovations could end some of the deadliest threats to children, such as malaria and pneumonia.
The report also featured essays from local leaders, health workers, and researchers in Africa and Asia. In Nigeria, Gombe State Governor Muhammad Yahaya emphasised the power of focus and persistence:
“You don’t need perfect conditions to make progress. You need clarity, and the courage to stick to it,” Mr Yahaya was quoted as saying.
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