The number of children who die before age 5 is expected to rise for the first time this century, amid sweeping cuts to global health funding by high-income countries, according to a new report from the Gates Foundation.

Child mortality around the world is projected to reach an estimated 4.8 million deaths in 2025, an increase of 200,000 preventable deaths compared with last year, the Gates Foundation said in its new “Goalkeepers” report, which tracks global progress toward the United Nations Sustainable Development Goals. That represents a reversal of decades of global health progress, given that child mortality had decreased every other year since 2000.

“It is 100% avoidable. There is no reason why those children should be dying,” said Mark Suzman, CEO of the Gates Foundation. He urged governments and private donors to double down on the most cost-effective, lifesaving interventions, such as bolstering primary health care systems and routine immunizations.

The projected rise in deaths follows drastic cuts this year in global aid for health care, to 26.9% below 2024 funding levels.

“There are many causes, but clearly one of the key causes has been significant cuts in international development assistance from a number of high-income countries,” Suzman said in a briefing. “The United States, the United Kingdom, France, Germany and several others have all been making significant cuts.”

US cuts have outsize impact

Cuts to overseas assistance were made by at least 24 high-income donor countries this year, the report noted. Steep cuts by the Trump administration have had a particularly large impact, as the US has historically been the world’s largest donor to global health.

CNN has reached out to the US State Department for comment.

Meanwhile, low- and middle-income countries that receive development assistance are grappling with increasingly fragile health care systems and mounting debt as they try to tackle the leading causes of child mortality, like pneumonia, diarrheal diseases, malaria and other infectious illnesses, the Gates Foundation said.

The cuts steepen to 30%, the data projections show a worsening picture, with 16 million more child deaths by 2045.

“It’s a call to action and a moment of deep reflection, I think, for the world, because we know how to save these children’s lives,” Suzman said, adding: “We need to reverse course.”

Vaccinations are ‘best buy’

The study found that “investing in primary health care is our best bet at saving the most lives with limited resources.” It noted that for less than $100 per person per year, up to 90% of child deaths can be prevented by stronger primary health care systems.

And routine immunizations remain the “best buy” in public health, according to the report. Every dollar spent on vaccines gave countries a return of $54 in economic and social benefits, it said.

“Vaccines don’t just save lives — they prevent outbreaks that strain hospitals, disrupt education, and pull resources from other priorities,” Dr. Naveen Thacker, director of Deep Children Hospital in India, said in the report. “Every dollar spent on immunization returns many more in averted treatment costs and preserved productivity.”

“If we want to see more healthy children, affordability of vaccines is key,” added Thacker, who is also executive director of the International Pediatric Association.

For example, improvements to a biannual injection called lenacapavir could make significant progress toward eliminating deaths from HIV/AIDS, the report said. Researchers are working to create a version that requires only one injection a year, and a less expensive generic version of the vaccine is expected to be available in the next few years.

Innovations related to respiratory syncytial virus (RSV) could also prevent millions of children from getting pneumonia, which is the leading infectious killer of children. And scientists say a new generation of malaria vaccines could help eradicate the mosquito-borne disease.

Gavi, the international vaccine alliance, has vaccinated 1.2 million children since 2000, saying it averted more than 20 million deaths.

The US, once one of the biggest funders of the alliance, stopped funding GAVI this year. The Trump administration has also proposed in the 2026 budget to shut down the US Centers for Disease Control and Prevention’s global health unit, which would end its large program to vaccinate children against polio, measles and other diseases.

US Health and Human Services Secretary Robert F. Kennedy Jr. announced the funding pause in a video statement in June, in which he called on Gavi to “re-earn the public trust and to justify the $8 billion that America has provided in funding since 2001,” Reuters reported at the time.

Turning point for global health

However, the Trump administration did make a significant contribution to the Global Fund, which fights AIDS, tuberculosis and malaria, covering about one-third of the total fund. There is a still a risk, though, that the Global Fund’s overall financing will fall well short of its funding targets, as France, Japan, Sweden and the European Commission did not yet announce pledges at the most recent conference for replenishing the fund in late November, according to the Lancet.

Bill Gates, chair of the Gates Foundation and the billionaire co-founder of Microsoft, described the current moment as a turning point for global health, when prioritizing the right interventions can make or break efforts to eradicate some diseases, and prioritizing innovations that stretch every dollar can help further reduce preventable deaths.

“We can’t stop at almost,” Gates wrote in the report. “If we do more with less now — and get back to a world where there are more resources to devote to children’s health — then in 20 years we’ll be able to tell a different kind of story: how we helped more kids survive childbirth — and childhood.

“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,” Gates added. Earlier this year, he announced plans to give away “virtually all” of his wealth — which he estimated at around $200 billion — within the next two decades through the foundation. (CNN)

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