For the first time this century, child deaths under the age of five are projected to rise. Between 2000 and 2020, the number of children dying before their fifth birthday decreased from approximately 10 million to under 5 million annually, a period of notable global health progress partly due to widespread childhood vaccinations. This decline slowed during the COVID-19 pandemic but did not reverse until now.
Estimates from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle project that 2025 will be the first year this century to show an increase in child deaths. In 2024, an estimated 4.6 million children died before reaching age five. This figure is projected to increase by over 200,000, reaching an estimated 4.8 million children, in 2025.
Brooke Nichols, an associate professor of global health at Boston University, who was not involved in this research, stated that the IHME methodology appears sound and consistent with other estimates, including one published in The Lancet. The U.S. State Department did not respond to inquiries regarding these findings.
The IHME researchers utilized a mathematical model to forecast future child mortality, as reliable direct data on child deaths is not yet available and typically takes several years to compile from health agencies globally. The model correlated factors such as a country's health spending with child health outcomes, specifically focusing on the impact of reductions in foreign aid. While leading causes of death in young children, such as infectious diseases and pre-term birth complications, have remained consistent, the report did not concentrate on specific diseases or conditions.
Dr. Steve Lim, an IHME researcher, noted that many countries lack robust death tracking systems. The model's predictions are based on historical relationships between health spending, largely influenced by foreign aid, and child mortality.
A significant reduction in foreign aid has occurred this year. In 2024, approximately $49 billion was allocated for foreign health aid, decreasing to $36 billion in 2025, a reduction exceeding 26%. This reduction includes contributions from high-income countries such as the United States, the United Kingdom, France, and Germany, which have scaled back international aid due to shifting priorities. While some countries, including Indonesia and South Africa, have increased their contributions, these do not offset the overall cuts.
IHME's model indicates that the largest increases in childhood deaths are expected in countries most reliant on foreign aid for their health budgets. Low-income countries and those in Sub-Saharan Africa are anticipated to be most affected, with some countries potentially experiencing up to a 20% reduction in health spending as a result of these cuts, which could have significant consequences for health services.
The estimates, released as part of the Gates Foundation's annual Goalkeepers Report, also modeled future scenarios. If global health funding cuts of 20% below 2024 levels persist, an additional 12 million child deaths could occur by 2045 beyond current projections. A 30% cut could lead to 16 million additional child deaths. Conversely, if global funding for health in the poorest countries were recommitted to 2024 levels, researchers project that health innovations could save an additional 12 million children by 2045. Predicting specific country-level reallocations of funds remains challenging, and these estimates will require updates as circumstances evolve.