Millions of children face preventable deaths as health aid collapse reverses global gains

For the first time this century, the number of children dying before the age of five is expected to rise, reversing decades of global progress, according to the Gates Foundation’s 2025 Goalkeepers Report.

The World Health Organisation notes that most under-five deaths are caused by preventable and treatable conditions. These include complications during birth, preterm birth, infections such as pneumonia, diarrhoea and malaria, malnutrition, and vaccine-preventable diseases like measles.

Many children die because they lack access to essential healthcare, clean water, proper nutrition, and timely medical treatment.

The report shows that in 2024, 4.6 million children died before their fifth birthday. Modelling by the Institute for Health Metrics and Evaluation (IHME), cited in the report, projects that this figure will rise by just over 200,000, reaching an estimated 4.8 million deaths this year.

Health assistance falls

At the same time, global development assistance for health has fallen sharply—26.9 per cent below 2024 levels.

Alongside these funding cuts, many countries are grappling with mounting debt, fragile health systems, and the risk of losing hard-won gains against diseases such as malaria, HIV and polio.

The report, titled We Can’t Stop at Almost, warns that continued cuts to global health financing could result in up to 16 million additional child deaths by 2045.

It outlines how targeted investment in proven interventions and next-generation innovations could still save millions of lives, even in today’s constrained funding environment.

12 million child deaths

IHME projections suggest that a sustained 20 per cent reduction in global health financing could lead to 12 million additional child deaths by 2045, while a 30 per cent permanent cut could push this figure to 16 million.

Gates describes the moment as a critical turning point for global health, emphasising that with the right priorities and investment in high-impact solutions, a reversal in child mortality is still avoidable.

The report identifies interventions with the greatest potential to save lives, including strengthened primary healthcare, routine immunisations, improved vaccines, and innovative data use to boost efficiency.

Robust primary healthcare systems—costing less than $100 per person per year—could avert up to 90 per cent of child deaths. Vaccination remains one of the most cost-effective tools available, generating $54 in economic and social benefits for every $1 spent.

Lifesaving vaccines

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Since 2000, more than 1.2 billion children have received lifesaving vaccines through Gavi, the Vaccine Alliance.

Sustained investment in initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria has already saved 70 million lives and cut deaths from these diseases by more than 60 per cent since 2002.

Recent pledges amounting to $11.34 billion for the Global Fund’s Eighth Replenishment signal continued global commitment, but also underline the risks associated with reducing support.

The report also highlights the potential of next-generation innovations to tackle deadly health threats. New vaccines for respiratory syncytial virus and pneumonia could save 3.4 million children, novel malaria tools could save 5.7 million, and long-acting HIV prevention methods could help drive infections and deaths towards zero in high-burden countries..

Chance to survive and thrive

Gates urges governments, philanthropies and citizens to act—by maintaining or increasing funding, supporting innovation, and ensuring that every child has the chance to survive and thrive. He stresses that the world cannot “stop at almost” and that decisive action now could ensure millions more children survive childbirth and early childhood in the decades ahead.

“I wish we were in a position to do more with more because it’s what the world’s children deserve. But even in a time of tight budgets, we can make a big difference,” writes Bill Gates, chair of the Gates Foundation and the report’s author.

“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.”

Maternal and newborn mortality in Kenya remains a serious public health concern. Ministry of Health data show that each day, 92 newborns and 96 stillborn babies lose their lives.

The leading causes include infections, sepsis, excessive bleeding, and other preventable pregnancy-related complications.

Avoidable deaths

Although many of these conditions can be treated if detected early, delays in seeking care, limited access to skilled health services, and inadequate resources continue to lead to avoidable deaths.

Over the course of a year, these daily losses translate into more than 5,000 maternal deaths and more than 35,000 newborn deaths.

Most under-five deaths worldwide could be prevented through basic interventions such as skilled birth care, breastfeeding, vaccinations, adequate nutrition, safe drinking water, and prompt treatment of infections.

Poverty, weak health systems and broader socioeconomic factors remain major contributors, particularly in low- and middle-income countries.

Globally, under-five mortality is still a significant public health challenge. In 2023, approximately 4.8 million children under the age of five died worldwide—about 13,100 every day, according to the WHO.