“It doesn’t have to be this way.” That’s how Bill Gates, chairman of the Gates Foundation, begins his 2025 goalkeeping report, We Can’t Stop at Almost. this Microsoft After decades of progress in reducing child mortality, the co-founders saw a turning point. “The death of a child is always a tragedy,” he continued, “but the death of a child from a disease we know how to prevent is especially devastating.”
The number of children dying before their fifth birthday is expected to increase for the first time this century, the report found. Modeling by the Institute for Health Metrics and Evaluation (IHME) reveals shocking statistics: 4.6 million children will die before the age of five in 2024. By 2025, this number is expected to increase by just over 200,000, with the number of children worldwide expected to reach 4.8 million. The increase means more than 5,000 classrooms are filled with children “disappearing before they learn to write their name or tie their shoes”. The alarming forecast comes against the backdrop of a sharp decline in global health development aid, with aid this year down 26.9% from 2024 levels. In the United States, the Trump administration disbanded its aid agency, the United States Agency for International Development (USAID), Sharp cuts in foreign aid.
Gates described this “major reversal in child deaths” as something that should be “sobering” for anyone committed to science and human progress. The report warns that if funding cuts continue, the consequences will be catastrophic. If global health funding were cut by 20%, the scale of cuts some major donors are considering, 12 million children could die by 2045. If the cuts were deeper, to 30%, the report projected that 16 million children would die.Number of deaths by 2045.
“We may be the generation that has access to the most advanced science and innovation in human history, but cannot raise the funds to ensure that it saves lives,” Gates wrote.
in May, Gates announced He will donate “nearly all” of the remainder of his wealth – about $100 billion – to the foundation to eradicate or drastically reduce some of the world’s deadliest diseases so that future generations don’t have to worry about them and continue to reduce child mortality.
But he emphasized that the foundation cannot achieve these goals without support from governments, especially those in rich countries. For a deadly infectious disease that threatens to return from the brink of extinction, zero is indeed the magic number.
The new report warns that if funding for these efforts continues to decline, there will be catastrophic consequences. “If we go down this path, we are the generation almost Ending preventable child deaths. almost Polio was eradicated. almost Knocked malaria off the map. almost HIV history was made. But we can’t stop at almost. “
Resilience Roadmap
Gates stressed that while the world is in a period of tight budgets, proven solutions and next-generation innovation exist to protect the progress that has been made and save millions of young lives. Gates said the goal now must be to “do more with less, now.”
The report highlights opportunities to address preventable health conditions that are killing children around the world: malaria, HIV/AIDS, and overall threats to newborns. The tools are within reach, the report says, setting out a three-part road map and calling on countries to double down on the most effective interventions. According to the report, these are:
1. Prioritize primary health care: Investing in strong primary health care systems is “the smartest investment available”, the report said. Costing less than $100 per person per year, these systems can prevent up to 90% of child deaths, detect deadly diseases like pneumonia early and ensure safe births.
2. Double up on routine immunizations: Routine immunization remains “the best option in global health,” the report said, adding that every dollar spent on immunization generates a return of $54 in economic and social benefits. Innovations such as reducing the dosing regimen of pneumococcal conjugate vaccine (PCV) could save approximately $2 billion by 2050.
3. Invest in the next generation of innovation: Modeling shows that new malaria tools could save 5.7 million children by 2045, while scaling up new maternal vaccines against threats such as respiratory syncytial virus (RSV) and group B streptococcus (GBS) could save 3.4 million children.
Local leaders facing resource scarcity
Focusing on the theme of “doing more with less,” the report highlights insights from leaders and health workers who are maintaining health progress despite limited resources. In Nigeria, Gombe State Governor Muhammad Inuwa Yahaya has made primary health care a priority despite a historic budget deficit. “You don’t need perfect conditions to make progress,” he points out. “You need clarity of thought and the courage to persevere.”
Provided by Office of the Governor of Gombe State, Nigeria
The report also points to people stepping in to address funding shortfalls at the grassroots level. In Kenya, community health worker Josephine Barasa continued her unpaid job as a “mother mentor” after being laid off. “They can take the money, but they can’t take me away from my woman,” she told the foundation. “The support system may have disappeared, but the need has not. Neither have I.”
Courtesy Gates Foundation/Natalia Jidovanu (Kenya)