The Gates Foundation has warned that 16 million more children could die by 2045 if global health funding cuts persist, calling for increased investment in primary healthcare, routine immunisations, and vaccines.

The foundation on Thursday, in its 2025 Goalkeepers Report titled ‘We Can’t Stop at Almost’, cautioned that without urgent intervention, the trend would reverse decades of global progress.

According to modelling in the report, conducted by the Institute for Health Metrics and Evaluation, 4.6 million under-five children died in 2024, disclosing the number is projected to rise to an estimated 4.8 million children in 2025.

The report revealed that at the same time, global development assistance for health fell sharply this year—26.9 per cent 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,” it stated.

The report provided a roadmap for how targeted investments in proven solutions and next-generation innovations can save millions of children’s lives, preventing a reversal in progress in today’s constrained budget environment.

“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,” wrote 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,” Mr Gates said.

Projections by the IHME showed that if global health funding cuts of 20 per cent persist, an additional 12 million children could die by 2045, while a 30 per cent permanent cut would bring that toll to 16 million. Mr Gates describes this moment as a turning point for global health, when the right choices can still save millions of lives.

“We could be the generation who had access to the most advanced science and innovation in human history—but couldn’t get the funding together to ensure it saved lives,” Mr Gates stated. “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.”

Mr Gates identified investments with the greatest potential to save millions of young lives, calling for doubling down on the most effective interventions—primary health care, routine immunisations, better vaccines, and new uses of data—to stretch every dollar.

“For less than $100 per person per year, strong 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,” he said.

He also pointed to the work of the Global Fund to Fight AIDS, Tuberculosis and Malaria as evidence of what sustained investment could achieve.

“As one of the most effective engines in health, the Global Fund has saved 70 million lives and reduced deaths from malaria, TB, and HIV by more than 60 per cent since 2002. 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,” he said.

According to Mr Gates, investment in the development of next-generation innovations could end some of the deadliest threats to children, such as malaria and pneumonia.

Modelling in the report projects that sustained funding in the innovations could save millions of children by 2045.

“Next-generation vaccines for respiratory syncytial virus and pneumonia could save 3.4 million children. New malaria tools could save another 5.7 million children, while long-acting HIV prevention tools like lenacapavir could help drive infections and deaths toward zero in high-burden countries,” it said.

Mr Gates urged governments, philanthropists, and citizens to act on the report’s findings by expanding funding, increasing philanthropic giving, and reminding leaders that every child deserves the chance to survive and thrive, no matter where they are born.

“We can’t stop at almost. If we do more with less now and get back to a world where there are more resources to devote to children’s health, then in 20 years we’ll be able to tell a different kind of story: how we helped more kids survive childbirth and childhood,” Mr Gates added. 

(NAN)