Gates Foundation Sounds an Alarm About the World’s Children. The U.S. Plays a Role.

Low- and middle-income countries—many saddled with high levels of debt—need funding to prevent and treat diseases. (Gates Archive/Adeokun Adesegun)

Key Points

• Preventable deaths of children under five are projected to rise by over 200,000 to 4.8 million this year, a first in 25 years.
• This increase is attributed to a nearly 30% cut in global health aid from wealthy nations, according to the Gates Foundation.
• Continued funding cuts of 30% could lead to 16 million additional childhood deaths by 2045, compared to maintaining resources.

Preventable deaths of children under five are expected to rise globally this year for the first time in 25 years—the result of a nearly 30% cut to global health aid from a year earlier by the U.S., the U.K., France, Germany, and several other wealthy countries, the Gates Foundation reported on Thursday.

The number of children expected to die before age 5 is projected to rise by a little more than 200,000 to an estimated 4.8 million, after declining year-after-year from 9.2 million since 2000, according to data modeling included in the foundation’s annual “Goalkeepers Report” from the Institute for Health Metrics and Evaluation, or IHME.

Although medicine and technology continue to advance health solutions and outcomes, without fiscal resources, low- and middle-income countries—many saddled with high levels of debt—need additional funding to prevent and treat diseases such as pneumonia, malaria, HIV, and tuberculosis.

“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,” Microsoft co-founder and foundation chair Bill Gates wrote in the report. Gates co-founded the organization with his ex-wife Melinda French Gates; the couple divorced in 2021 and French Gates left the foundation in May 2024.

Bill Gates Photo: Bryan Bedder/Getty Images for Bloomberg Philanthropies

The report also shows that “if those cuts continue, which is currently the plan in many of those countries, we will likely see many more preventable deaths in the next 20 years,” Mark Suzman, CEO of the Gates Foundation, said in a media conference call ahead of the report’s release.

IHME’s projections show that funding cuts of 20% will mean 12 million additional childhood deaths by 2045; a 30% permanent cut will mean the loss of 16 million children. If global health resources had instead been maintained, and progress continued, “it’s a difference of nearly 30 million deaths,” Suzman said.

The foundation’s annual report, which tracks progress against 18 indicators among the U.N. Sustainable Development Goals specific to global health, is titled “We Can’t Stop at Almost”—underlying the point that the Gates Foundation and other global health advocates are close to eradicating or reducing the impact of several diseases that harm children.

Suzman added that low- and middle-income countries “have to take primary responsibility for the health of their own populations,” which many are trying to do. But they are “facing the greatest fiscal crisis of the last 25 years.” According to the foundation, more than 60 countries are paying more in debt service than on health and education.

The Goalkeepers report details how lives can be saved for relatively low amounts of funding for preventive measures including routine exams and immunizations. New vaccines for RSV and pneumonia, for example, could save 3.4 million children, while new tools for fighting malaria could save another 5.7 million.

Gates wrote that global health providers, and local governments, can still make a difference, but “with millions of lives on the line, we have to do more with less, now.”

In May, Gates announced that he would wind down his fortune, and the foundation’s endowment, over the next 20 years, committing $200 billion to global health. The foundation had $86 billion in endowed assets (unaudited) as of July 31, according to a fact sheet.

Although not alone, cuts to global health by the U.S. that were administered through U.S. Agency for International Development and other agencies, were particularly harsh “because there was very little information and understanding of what had been cut, what was being resumed. We spent a lot of time with partners trying to track that,” Suzman said in the media briefing.

Last week, the U.S. committed to funding a third of the Global Fund to fight AIDS, TB, and malaria with $4.5 billion over the next three years, although its funding is contingent on other countries supplying the remaining funds, Suzman said.

“Currently there’s a risk that might fall short, depending on where France and Japan end up,” he said. “Combined with the U.K. and German commitments, we’re not sure where that final number will end up.”

The Gates Foundation pledged $912 million over three years to the fund in September, bringing the organization’s total gifts to the fund to $4.9 billion.

Write to Abby Schultz at abby.schultz@barrons.com