Seattle, Washington – December 4, 2025 – Bill Gates has issued one of the most urgent warnings of his decades-long campaign against global poverty and disease: for the first time in this century, the number of children dying before their fifth birthday is no longer falling — it is rising.
In the Bill & Melinda Gates Foundation’s latest Goalkeepers Report, titled “We Can’t Stop at Almost,” Gates reveals that after years of historic progress, an estimated 4.6 million children died before age five in 2024. That number is projected to climb by more than 200,000 in 2025 to 4.8 million — a reversal driven almost entirely by the collapse of international health funding.
“It doesn’t have to be like this,” Gates writes. He describes the coming increase as the equivalent of more than 5,000 classrooms full of children lost forever — children who will never learn to write their names or tie their shoes.
The primary culprit is a historic drop in development assistance for health. Global health aid has fallen nearly 27% in the past year alone. Major programs have been dismantled or slashed, leaving clinics without vaccines, mothers without prenatal care, and newborns without basic medicines. In some of the world’s poorest countries, domestic health budgets have also shrunk as governments struggle with debt and competing crises.
If current funding trends continue, the consequences will be catastrophic. A sustained 20% cut in global health support could mean an additional 12 million child deaths by 2045. A deeper 30% reduction would push that toll to 16 million. Gates warns that the world risks becoming “the generation that had the most advanced science in history but still failed to save the lives it could have protected.”
The report is blunt: we are on the verge of being remembered as the generation that almost ended preventable child deaths, almost eradicated polio, almost wiped out malaria, almost made HIV history — but stopped just short.
Gates has put his own fortune on the line to prevent that outcome. Earlier this year he pledged to give away virtually all of his remaining wealth — approximately $100 billion — to the Gates Foundation, accelerating its spending to fight the world’s deadliest diseases and drive child mortality back down. Yet he is unequivocal that philanthropy alone cannot reverse the tide. Governments, especially in wealthy nations, must recommit to sustained, predictable funding.
The good news, according to the report, is that the tools to prevent nearly all of these deaths already exist. Strengthening primary health care — simple clinics with trained workers, basic drugs, and early diagnosis — can stop up to 90% of child deaths. Routine immunization remains the single best investment in global health, delivering enormous economic and social returns for every dollar spent.
New breakthroughs are also within reach. Advanced malaria prevention technologies, maternal vaccines for respiratory syncytial virus (RSV) and Group B streptococcus, and low-cost diagnostics could save millions more lives in the coming decade if they are funded and rolled out quickly.
Despite tightening budgets worldwide, Gates insists the challenge is not a lack of solutions but a lack of political will. The world must learn to “do more with less” — prioritizing the highest-impact interventions, cutting waste, and protecting the gains made over the past quarter-century.
As clinics close, vaccine shipments halt, and preventable diseases begin to creep back, the message of the Goalkeepers Report is unmistakable: the progress humanity has fought so hard to achieve is fragile. Turn away now, and the children who could have been saved will become the lasting proof that we almost succeeded — but chose not to finish the job.
