Today, the Gates Foundation released its annual Goalkeepers report that tracks the progress of the Sustainable Development Goals. This year’s report, We Can’t Stop at Almost, highlights the growing number of child deaths given the recent cuts to global health funding, including the America First Global Health Strategy. In 2025, the UK also substantially reduced its global aid.

According to modeling by the Institute for Health Metrics and Evaluation (IHME), the number of children dying before their fifth birthday is projected to rise from about 4.6 million in 2024 to roughly 4.8 million in 2025 — an increase of over 200,000. This marks the first projected increase in global under-five mortality this century.

What explains this sudden setback? The report points squarely to a major decline in global health funding: in 2025, global development assistance for health (DAH) dropped by about 26.9% compared to 2024, according to the report. Alongside these funding cuts, many low- and middle-income countries now face mounting debt, weakened health systems, and increased difficulty sustaining past gains made against preventable diseases. This is particularly troublesome to child health when one of the globe’s major donors, the United States, shifted to a program with an emphasis on weaning countries from the American global aid payroll.

“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,” writes 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.”

The Gates Foundation, however, remains optimistic that these child mortality numbers are reversible through inexpensive innovations, vaccines for malaria and maternal HIV/AIDS, as well as through primary health care. While the modeling numbers are expected to increase given these cuts, Gates believes that more children’s lives can be saved regardless of how much funding is allotted.

Photo by Vikram Aditya on Unsplash