- Child mortality could increase due to funding cuts and global challenges.
- COVID-19 did not halt child mortality progress; however, projections foresee more deaths.
- Foreign aid cuts have led to decreased health funding, exacerbating child mortality rates.
What has been hailed as a “crowning achievement in global health,” as NPR put it, may soon unravel. In the first 24 years of this century, the number of children younger than age 5 who died was cut in half, due in large part to improvements in global health, including availability worldwide of childhood vaccines.
Even COVID-19 didn’t stop the progress in reducing the number of children who die before their 5th birthday. But it’s expected that the final 2025 reckoning will show that child deaths went up instead of down, according to an analysis from the Gates Foundation.
The foundation’s 2025 Goalkeepers Report said that in 2024, 4.6 million children died before turning 5. The projection for 2025 by the Institute for Health Metrics and Evaluation at the University of Washington in Seattle includes an increase of 200,000 deaths, to 4.8 million children.
The analysis included key drivers of child mortality, but not direct counts, which are inconsistent from country to country. Some don’t track deaths well. So the university’s team built a mathematical model based on known factors like health spending that have been important in reducing child deaths.
As NPR explained, “Their model used past data and analysis on the relationship between these factors to make the predictions. Their approach zeroed in on one factor: The impact of cuts to foreign aid. They looked at this by considering historical data on what the relationship has been between health spending, driven in large part by foreign aid and child mortality.”
“Over the last 25 years we’ve made incredible progress in global health, specifically for children,” Margaret Miller, a senior program officer at the Gates Foundation, told The Washington Post. “It’s really tragic that it’s now at risk.”
Reductions in foreign aid
The report explains the news this way: “At the same time, global development assistance for health fell sharply this year — 26.9% below 2024 levels. Beyond this year’s drastic funding cuts, countries face mounting debt, fragile health systems and the risk of losing hard-won gains against diseases like malaria, HIV and polio."
NPR noted the U.S. is not alone in cutting back on foreign aid. The United Kingdom, France and Germany are among two dozen high-income countries providing less aid, though cuts from the U.S. have reportedly had outsize impact. CNN reported that “the U.S. has historically been the world’s largest donor to global health.”
Meanwhile, some other countries have stepped up their contributions, including Indonesia and South Africa, but “it does not make up for the cuts.”
Changing course, saving lives
The Gates Foundation report, titled “We Can’t Stop at Almost,” says the reversal can be stopped “before it becomes a trend, even in a time of tight budgets.”
Failure to do so “means more than 5,000 classrooms of children, gone before they ever learn to write their name or tie their shoes,” wrote Bill Gates, foundation chairman, in the introduction. He called the reversal “sobering.”
The report noted that major donor countries are considering future funding cuts for vaccines and other health-related aid by as much as 20%. Such a cut would mean the death of 12 million more children by 2045.
Gates calls for “doubling down” on strong primary health systems and lifesaving vaccines, which he calls “the most effective interventions.” He said innovation to stretch money is crucial, as is development of next-generation innovations.
The report estimates that “next generation malaria tools” alone could save 5.7 million children by 2045. Other innovations could actually eliminate death from HIV/AIDS, per the report. And 3.4 million children could be saved by “scaling new immunization products for RSV and pneumonia.”
Brooke Nichols, an associate professor of global health at Boston University, wasn’t involved in this research, but has done her own work on the impact of reduced health aid. She urged people to remember what the numbers actually represent: “It’s a human. It’s a child,” she told NPR. “It could be your child. It could be my child.”