Bill Gates is sounding an alarm the world cannot afford to ignore.
In the latest Goalkeepers report, “We Can’t Stop at Almost,” he warns that global progress in reducing child mortality is reversing for the first time this century.
He begins with a sobering reminder: “It doesn’t have to be like this.” Yet the data shows a deeply troubling shift. After decades of steady improvement, the number of children dying before their fifth birthday is now rising again.
Research from the Institute for Health Metrics and Evaluation shows that 4.6 million children died before age five in 2024. That number is expected to rise by more than 200,000 this year, reaching an estimated 4.8 million.
Gates describes this as the equivalent of over 5,000 classrooms of children “gone before they ever learn to write their name or tie their shoes.” This surge comes at a time when global health funding is collapsing. Development assistance for health has fallen nearly 27% compared to last year, and major international aid programs have been dismantled or sharply reduced, worsening the crisis.
Gates calls this a “significant reversal in child deaths” and says it should be a wake-up call for anyone committed to scientific and humanitarian progress. The report warns that prolonged funding cuts could lead to devastating consequences.
If global health support drops by 20%, an additional 12 million children could die by 2045. If the cuts deepen to 30%, the number of additional child deaths could reach 16 million. Gates warns that the world risks becoming the generation that had the most advanced science in history but still failed to save the lives it could have protected.
Earlier this year, Gates pledged almost all his remaining wealth, about $100 billion, to help end some of the world’s deadliest diseases and continue reducing global child mortality. But he stresses that philanthropy alone is not enough.
Governments, especially those in wealthier nations, must step up. Many infectious diseases can return quickly if consistent funding and preventive measures are not maintained.
The message in the report is clear: if the world turns away now, it will be remembered as the generation that almost ended preventable child deaths, almost eradicated polio, almost wiped out malaria, almost made HIV history, but stopped too soon.
Despite the financial strain many countries face, Gates insists that powerful solutions already exist, along with promising new innovations. The challenge now is to “do more with less.”
Strengthening primary health care remains one of the most effective strategies, capable of preventing up to 90% of child deaths with early diagnosis and basic medical access. Routine immunization continues to be described as the best investment in global health, with every dollar generating massive economic and social returns.
Emerging tools from advanced malaria prevention technologies to new maternal vaccines for RSV and Group B strep could save millions of young lives in the coming years.
