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

For the first time in 25 years, child mortality rates from preventable diseases are expected to increase, after declining 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 first published in the Gates Foundation’s Goalkeepers report. It shows that 200,000 more children under the age of five could die this year from a disease that modern medicine can prevent, either through vaccines or other treatments. These deaths can be attributed to a number of economic and political factors, the most important of which is the significant reduction in global health spending by the world’s largest donors, including the United States, according to the report.

“It’s a tragedy that the world is richer, and yet because we have disproportionately cut money to help the world’s poorest children, more of them are dying,” Bill Gates, chairman of the Gates Foundation, said in an interview with TIME.

Many of the foundation’s programs focus on improving the health of mothers and children around the world to reduce infant mortality, and Gates said earlier in 2025 that he planned to spend the foundation’s remaining funds over the next 20 years. One of its goals is to halve the infant mortality rate by then, from the 4.8 million children under five who currently die each year to around 2.5 million. But “you can’t cut something in half if the price increases,” he says.

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

According to Gates, reduced spending on global health sets off a vicious cycle that can keep countries, particularly those 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-fed enough to contribute to the economic growth of the country,” he says. “Current investments will make this possible. »

But Gates estimates that the increase in infant mortality could continue in the coming years, mainly because of the scale of aid cuts. “There will very probably be no turnaround in the short term on the generosity of aid,” he says, “so the risk is that [childhood mortality] It’s going to get much worse.

Even if some wealthier countries prioritize other areas of funding, including defense spending, it doesn’t take much to make a difference, according to Gates. “For rich countries, this represents less than 1% of the budget,” he specifies. The impact of ensuring that pregnant mothers and children are vaccinated and fed “is so great that you see very good health outcomes when you just focus on these first interventions,” he says. Investing in primary care is one of the top priorities for maximizing scarce resources, because basic health care can prevent more serious and costly medical needs in the long term.

Although the reversal in infant mortality rates is alarming, Gates remains optimistic that in a few years the trend will start moving in the right direction again, with innovations like new RSV vaccines and treatments for malaria and tuberculosis on the horizon. AI-based programs that accelerate the development of new treatments and facilitate access to healthcare for more people will also begin to impact health outcomes, such as mortality. The shortage of doctors in Africa is so severe that “most people will go their entire lives never seeing a doctor, not when they are born, not when they die, and not in between,” says Gates. This is where AI systems could help fill this gap and keep people connected to quality care. The Gates Foundation is involved in pilot programs that use AI to monitor and advise pregnant women as well as people living with HIV to help them manage their illness and guide them on whether and when they should seek care.