The 2025 Goalkeepers Report from the Bill & Melinda Gates Foundation highlights a troubling reversal in decades of progress against child mortality. In 2024, an estimated 4.6 million children died before their fifth birthday globally. This number is projected to rise to 4.8 million in 2025—marking the first increase in child deaths this century. Over 5,000 classrooms of children are disappearing before learning basic skills such as writing their names or tying shoes. The report warns of even more devastating effects if global health funding continues to decline.
Development assistance for health plummeted by nearly 27% in 2025. This drastic reduction places further pressure on already strained and debt-burdened health systems across Africa, where child mortality rates remain alarmingly high. If funding cuts of 20% persist, an estimated additional 12 million children could die by 2045; a deeper 30% cut could push that toll to 16 million. These potential losses underscore the critical need for sustainable investment in health systems that protect children’s lives.
The report emphasizes that investing in strong primary health care is the most cost-effective way to prevent child deaths. For less than $100 per person annually, health systems can avert up to 90% of child fatalities through services such as safe childbirth support, immunization, treatment of pneumonia, and disease outbreak prevention. Primary health care acts as the foundation of all other health efforts by enabling early detection and timely care to vulnerable populations.
Real-world examples from Africa affirm this message. In Nigeria’s Gombe State, Governor Muhammad Inuwa Yahaya prioritized rebuilding the health system despite budget deficits by focusing on frontline primary care and eliminating ‘ghost workers’ who inflated payroll costs. In Kenya, community health workers like Josephine Barasa continue to serve women and children with limited resources, embodying the resilience and hope needed to sustain gains.
The report is also cautiously optimistic, projecting that emerging health innovations could save millions of children by 2045. New vaccines such as those targeting pneumonia and respiratory syncytial virus (RSV) could prevent 3.4 million deaths. Advanced malaria tools—including dual-insecticide bed nets and genetic approaches like gene drives—could save another 5.7 million children, particularly in sub-Saharan Africa where malaria remains the leading infectious killer of children under five.
Long-acting HIV prevention methods like lenacapavir, administered via one or two annual injections, promise to dramatically reduce infections and deaths in high-burden countries. These innovations reduce the burden of daily medication adherence, decrease mother-to-child transmission, and improve long-term health outcomes.
Routine immunization remains the best investment for child health. According to the report, every dollar spent on vaccines returns approximately $54 by averting treatment costs and productivity losses. The success stories of vaccine programs in India and Senegal highlight how affordable, locally produced vaccines can dramatically reduce deadly childhood diseases such as pneumonia, diarrhea, polio, and tetanus, transforming childhood survival rates within a generation.
The 2025 Goalkeepers Report concludes with a call for stronger political commitment and increased funding. Protecting programs like Gavi and the Global Fund, expanding vaccine coverage, supporting frontline health workers, and scaling new technologies will be essential to sustain and accelerate progress. The report implores communities, governments, and global partners to collaborate urgently to ensure millions more children get the chance to grow, learn, and thrive.
