The Gates Foundation says urgent action is needed to prevent a “reversal” in child survival, warning that millions of children could die in the coming decades without increased investment in health and vaccines.
The warning came in the foundation’s 2025 Goalkeepers Report, “We Can’t Stop at Almost”, which highlights the risk of reversing decades of progress in child survival.
In 2024, 4.6 million children under five died worldwide, and in 2025, deaths are projected to rise to 4.8 million. If global health funding cuts of 20% persist, an additional 12 million children could die by 2045, a 30% permanent cut could put 16 million lives at risk. The report notes that global development assistance for health fell 26.9% in 2025, leaving fragile health systems at risk.
Chairperson of the foundation, Bill Gates, emphasized the urgent need to prioritize high-impact interventions:
“We could be the generation with the most advanced science and innovation in human history, but we risk failing to save lives because of insufficient funding. By prioritizing high-impact solutions, we can prevent a significant reversal in child deaths”.
Key interventions include primary healthcare, vaccines, and next-generation tools such as vaccines for RSV, pneumonia, and malaria.
“We can’t stop at almost. Every child deserves the chance to survive and thrive, no matter where they are born”, Gates said.
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