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By Jasmine Laws
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The number of children dying before their fifth birthday is projected to rise for the first time this century, according to a new report by the Gates Foundation, a private philanthropic organization cofounded by Bill Gates.
The report, released on December 3 and titled We Can't Stop At Almost, noted that the forecast comes as global development assistance for health fell significantly this year, to 26.9 percent, and below 2024 levels.
"I’m not surprised, given what’s happening in the world, but it’s completely unacceptable and sickening," Brooke Nichols, a professor of global health at Boston University, told Newsweek.
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"The idea that the number of children dying before their fifth birthday could rise for the first time this century should shock all of us. What if it were your child?" she added. "We should not accept this as an inevitable consequence of global crises—all of which, in one way or another, are man-made (like the climate crisis), and some intentional and man-made (like the cutting of foreign assistance)."
Why It Matters
Since around 1990, the death rates among children have been declining, driven by the delivery of vaccines, medicine, and improved nutrition, as well as wider access to healthcare for mothers and young children.
However, the report projected this decades-long trend is about to change. In 2024, 4.6 million children died before their fifth birthday, and this year that number is projected to rise by just over 200,000, to an estimated 4.8 million children—reversing the steady progress made.
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The Impact Of Foreign Aid
The report stated projections by the Institute for Health Metrics and Evaluation (IHME) suggest that if global health funding cuts of 20 percent persist, an additional 12 million children could die by 2045, and that a 30 percent permanent cut would bring that number to 16 million.
At the start of this year, the U.S. Agency for International Development (USAID) was shut down by the Trump administration and Gates warned at the time the move was "killing the world's poorest children," according to Reuters.
USAID was the world's largest provider of humanitarian aid, providing billions of dollars of aid for more than 100 countries. In 2023, the agency distributed $72 billion worth of aid.
And, the cuts to global aid are not just stemming from the U.S., as Britain and Germany have also reportedly cut their international assistance, Reuters reported.
Newsweek has contacted the White House via email for comment outside of regular working hours. A White House spokeswoman said the U.S. provides more foreign aid than any other country, up to and including this year, in a statement to The Wall Street Journal.
"The Trump administration is ensuring all programs funded by American taxpayers align with American interests. Partner countries want to be self-reliant in addressing the needs of their people," said White House deputy press secretary Anna Kelly.
Nichols said that foreign assistance from USAID and other donors has been "hugely impactful for decades—these programs are a major reason child mortality has fallen so dramatically over the past 20 years, which has been demonstrated in a recent publication in The Lancet."
"Also, instead of other countries stepping up when the U.S. cut funding, we’ve seen the vast majority retreat as well. This collective withdrawal is appalling, and its consequences are measured in the lives of real children," she said.
William (Bill) Weiss, a professor of international health at Johns Hopkins University, told Newsweek he wasn't surprised about the projection in the report, as previous studies showed the impact USAID programs had in reducing child mortality.
"While the State Department has continued some programs, they have or are reducing the number of programs as well as reducing the number of countries that will receive assistance going forward," he said.
He added that the total humanitarian funding alone has dropped over 40 percent in 2025 from prior levels, according to United Nations Office for the Coordination of Humanitarian Affairs (OCHA) data, and that U.S. humanitarian funding has dropped over 75 percent from prior years.
Investment In Primary Care, Immunization
The Gates Foundation report called for greater investment in certain interventions Gates believes will have the most notable impact, such as primary care and routine immunizations.
The report said that investing less than $100 per person per year in primary health care systems could prevent up to 90 percent of child deaths, while every $1 spent on vaccines returns $54 in economic and social benefits.
The foundation also said that investing in the development of "next-generation" vaccines could save children from deadly threats such as malaria and pneumonia.
A vaccine for respiratory syncytial virus and pneumonia could save 3.4 million children, the report said, while new malaria innovation could save another 5.7 million children.
Mosquito-borne illness kills more than 400,000 children under 5 every year, the report said, but Gates wrote that new science could end malaria cases by 2040.
Climate And Conflict Impacts
Aside from cuts to global aid, Nichols said that other factors are also likely contributing to this projection. "Climate-change-fueled droughts and floods are deepening food insecurity, and children are especially vulnerable to severe acute malnutrition," she said.
She added that ongoing conflict in places such as Gaza and Sudan "is causing direct mortality while also pushing entire regions toward famine."
Nichols said that all of this is happening alongside "deep cuts to foreign assistance, especially from the U.S., historically the world’s largest contributor to global food aid."
"The broader dismantling of healthcare systems by cuts to USAID is likely to contributing to an overall rise in the completely avoidable death of children," she said.
What People Are Saying
Bill Gates, chair of the Gates Foundation and the report’s author, wrote: "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. 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: "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. 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."
Brooke Nichols, a professor of global health at Boston University, told Newsweek: "In the short term, we urgently need governments (especially in the U.S., EU, and other high-income countries) to step up and fill the gaps rather than retreat. We urgently need citizens, you and me, to push our governments to step up. To speak out. To call our representatives. Restoring and expanding foreign assistance, stabilizing food systems, and supporting health systems in crisis-affected regions are all critical, for every single individual affected, but also for regional and global stability. Given the tools, resources and knowledge the world has in 2025, this rise in child mortality is certainly not inevitable; it is a choice. And it is a choice we should refuse to accept."
William (Bill) Weiss, a professor of international health at Johns Hopkins University, told Newsweek: "The American public and the citizens of other donor countries need to understand a different but more truthful narrative of development and humanitarian assistance. Programs that are based on evidence do actually save lives and have saved many lives in the past. In addition, the lessons learned from these programs lead to continuous improvement in how the programs are implemented. For example, serious efforts have been underway to build capacity of low- and middle-income countries to better implement health programs and increase the level of local financing; but this takes time to do well and avoid corruption."
He added: "Another thing that has been done in the past but could be done better to support the programs that the American public supports, is to think about matching funds. The State Department could rely more on matching funds of efforts that the American people already support—but with strict criteria on programs that are evidence-based for saving lives. Detractors have identified programs that many Americans do not widely support; and these can be weeded out through a variety of approaches like matching funds."
Dr Michael VanRooyen, a professor and director of the Harvard Humanitarian Initiative at Harvard University, told Newsweek: "This rise in child deaths is a predictable result of converging pressures: the collapse in foreign assistance, conflict and displacement in fragile states, food insecurity, and setbacks in routine immunizations. When donor support declines, the health systems that protect children simply can’t absorb the shock, and children die. Foreign assistance from the U.S., Europe, and other global health funders has been a major driver of child survival in the last two decades. The elimination of USAID set a global trend of divestment in lifesaving care, and the consequences are immediate and measurable."
He added: "Global leaders must step up and take responsibility for the health of the world. First, we need to urgently stabilize and restore funding for proven, high-impact interventions like primary health care, routine immunization, and malaria and pneumonia prevention. The relative investment by the U.S. and Europe has minimal impact on national budgets but is a huge contributor to actual lives saved. These excess deaths are on our hands, and international community donors must treat this as a preventable crisis. Saving lives globally in not a partisan issue, it is a global collective responsibility."
Dr Chris Beyrer, a professor and director of the Duke Global Health Institute at Duke University, told Newsweek: "The report findings are tragic, but not a surprise. Since the massive cuts to global health funding, nutrition programs, and maternal child health from the U.S. began on January 20, 2025, we knew children would be the most impacted—and that many young lives would be lost. These programs have saved many millions of lives, and so the cuts to the programs have been devastating."
He added: "There is an urgent need to restore funding for vital programs, and the recent replenishment of the Global Fund to fight AIDS, TB, and malaria is an important start. It's also critical to continue childhood immunization programs and other basic public health programs that we know save lives."
What Happens Next
The report calls on policymakers to expand investment in primary health care and routine immunization for the world's children, while supporting the development of new scientific technology and innovation to reduce preventable child deaths.
Update 12/04/25, 08:35 a.m. ET: This article has been updated with comment from William (Bill) Weiss, Dr Michael VanRooyen and Dr Chris Beyrer.
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