Child mortality rates from preventable diseases are projected to rise for the first time in 25 years, after declining for 25 years.
The new estimate is based on models created by the Institute for Health Metrics and Evaluation at the University of Washington and was first published in Goalkeepers report from the Gates Foundation. It shows that another 200,000 children under five could die this year from a disease that modern medicine can prevent through vaccines or other treatments. According to the report, these deaths may be related to a number of economic and political factors, the most important of which are significant cuts in global health spending by the world's largest donors, including the United States.
“It’s a tragedy that the world has gotten richer, but because we’ve disproportionately cut the money that helps the world’s poorest children, more of them are dying,” says Bill Gates, chairman of the Gates Foundation, in an interview with TIME magazine.
Many of the foundation's programs are aimed at improving the health of mothers and children around the world with the goal of reducing child mortality, and Gates previously stated in 2025 that he plans to spend the remaining funds of the fund over the next 20 years. One of his goals is to halve the child mortality rate by then, from the current 4.8 million children under five who die each year to about 2.5 million. But “you can't cut something in half if it's growing,” he says.
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Last year, the largest global health donors cut their spending by nearly 27%, and the report estimates that if such cuts continue or even increase to 30%, an additional 16 million children (or more) will die from preventable causes by 2045.
Cutting global health spending starts a vicious cycle, Gates says, that could keep countries, especially in Africa, poor and unable to build and maintain their own health systems. “Being generous now means that children in these countries survive and are well-nourished enough to contribute to the countries' economic growth,” he says. “Investment now will make this possible.”
But Gates believes the rise in infant mortality could continue over the next few years, mainly due to the scale of aid cuts. “There will likely be no change in the generosity of aid in the short term,” he says, “so the risk is that [childhood mortality] It's going to get a lot worse.”
While some richer countries are prioritizing other areas of funding, including defense spending, it won't take much to change the situation, Gates said. “For rich countries it’s less than 1% of the budget,” he says. The impact of providing vaccinations and nutrition to pregnant mothers and children “is so great that you'll see very good health outcomes if you focus on just those first few interventions,” he says. Investment in primary health care is a key priority in optimizing scarce resources, as basic health care can prevent more serious and costly health needs in the long term.
While the change in infant mortality rates is alarming, Gates remains optimistic that the trend will begin moving in the right direction again in a few years, with innovations such as new RSV vaccines and treatments for malaria and tuberculosis on the horizon. AI-powered programs that speed up the development of new treatments and make health care easier for more people will also begin to have an impact on health indicators such as mortality. The shortage of doctors in Africa is so severe that “most people go their entire lives without ever seeing a doctor—not at birth, not at death, and in between,” Gates says. This is where artificial intelligence systems could help fill this gap and ensure people have access to quality healthcare. The Gates Foundation is involved in pilot programs that use artificial intelligence to monitor and counsel expectant mothers and people with HIV to help them manage their disease and guide them on whether and when they should seek medical help.
But how quickly these innovations reach people will depend on continued funding for global health, Gates says, both from philanthropies such as the foundation and from governments. “This is money very well spent, so we need to return the generosity,” Gates says. “And I will do everything I can to work with the president and Congress to get that done.”
