rewrite this title For the First Time This Century, Child Mortality Is Likely to Rise

For the first time in 25 years, child mortality rates for preventable diseases are projected to increase, after having declined for 25 years.

The new estimate comes from models created by the Institute for Health Metrics and Evaluation at the University of Washington and was released for the first time in the Goalkeepers report from the Gates Foundation. It shows that an additional 200,000 children under age five may die this year of a disease that modern medicine can prevent, either with vaccines or other treatments. The deaths can be traced to a number of economic and political factors, the most important of which are significant cuts to spending in global health from the world’s largest donors, including the U.S., according to the report.

“It’s a tragedy that the world is richer, and yet because we have made disproportionate cuts to the money that helps the world’s poorest children, more of them are dying,” says Bill Gates, chair of the Gates Foundation, in an interview with TIME.

Many of the foundation’s programs focus on improving the health of mothers and children around the world in order to reduce childhood mortality, and Gates said earlier in 2025 that he plans to spend the foundation’s remaining funds over the next 20 years. One of his goals is to halve the childhood mortality rate by that time, from the current 4.8 million children under five who die each year to around 2.5 million. But “you can’t cut something in half if it’s going up,” he says.

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In the past year, the largest donors to global health have reduced their spending by nearly 27%, and the report estimates that if such reductions continue or even expand to 30%, an additional 16 million more children (or more) will die of preventable causes by 2045.

The reduced spending on global health sets in motion a vicious cycle, says Gates, that can keep countries, especially those in Africa, in poverty and unable to build and sustain their own health systems. “Being generous now means kids in those countries are surviving and well-nourished enough to contribute to the countries’ economic growth,” he says. “Investments now will make that possible.” 

But Gates believes the increase in childhood mortality may continue over the next few years, mainly because of the depth of the aid cuts. “There will very likely be no near-term reversal on aid generosity,” he says, “so the risk is that [childhood mortality] will get a lot worse.”

While some wealthier nations are prioritizing other funding areas —including defense spending—it doesn’t take much to make a difference, according to Gates. “For rich countries, it is less than 1% of the budget,” he says. The impact of ensuring that pregnant mothers and kids are vaccinated and fed “ is so great that you see very good health outcomes when you focus on those first few interventions alone,” he says. Investing in primary care is one of the key priorities in optimizing scarce resources, since basic health care can prevent more serious and costly medical needs in the long run.

While the reversal in childhood mortality rates is alarming, Gates remains optimistic that in a few years, the trend will start moving in the right direction again, thanks to innovations such as new vaccines for RSV and treatments for malaria and tuberculosis that are on the horizon. AI-based programs that accelerate the development of new treatments and make it easier for more people to access health care will also start having an impact on health outcomes like mortality. The shortage of doctors in Africa is so severe that “most people will spend their entire lifetime never seeing a doctor—not when they are born, not when they die, and not in between,” says Gates. That’s where AI systems could help fill the gap and keep people connected to quality care. The Gates Foundation is involved in pilot programs that use AI to monitor and advise expectant moms as well as people with HIV to help them manage their conditions and guide them about if and when they need to seek care.