The Bill & Melinda Gates Foundation has warned that up to 16 million additional children could die by 2045 if global health funding cuts continue, calling for urgent investment in primary healthcare, routine immunization, and vaccines.
The Foundation issued the alert on Thursday in its 2025 Goalkeepers Report, titled “We Can’t Stop at Almost,” cautioning that without immediate action, decades of global health progress could be reversed.
According to modelling by the Institute for Health Metrics and Evaluation (IHME), cited in the report, 4.6 million children under the age of five died in 2024, with the figure expected to rise to an estimated 4.8 million in 2025.
The report also revealed a sharp decline in global development assistance for health, which fell by 26.9 per cent compared to 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,” the report warned.
It outlined a roadmap showing how targeted investments in proven interventions and next-generation innovations could save millions of lives, even in a tight fiscal 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 Foundation and author of the report.
“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,” he added.
IHME projections show that if global health funding cuts of 20 per cent persist, an additional 12 million children could die by 2045. A permanent 30 per cent cut could increase that toll to 16 million.
Gates described this period as a critical turning point for global health, noting that the right investments and commitments could prevent a major reversal in child survival.
“We could be the generation that had access to the most advanced science and innovation in human history—but couldn’t get the funding together to ensure it saved lives,” he wrote.
He expressed confidence that prioritizing high-impact solutions could ensure millions more children are alive in 2045.
Gates highlighted investments with the greatest potential to reduce child deaths, urging greater emphasis on primary healthcare, routine immunization, improved vaccines, and smarter use of data.
“For less than $100 per person per year, strong primary healthcare 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 cited the achievements of the Global Fund to Fight AIDS, Tuberculosis and Malaria as proof of what sustained health financing can accomplish.
“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 highlighting the risks of stepping back.”
The report noted that investments in next-generation innovations could dramatically reduce child deaths by tackling leading killers such as malaria and pneumonia.
It projected that sustained funding for these 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.”
Gates urged governments, philanthropists, and citizens to act on the report’s findings by expanding health financing, increasing philanthropic contributions, and holding leaders accountable to ensure every child has the chance to survive and thrive.
“We can’t stop at almost,” he wrote.
“If we do more with less now—and get back to a world where there are more resources for 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.”
