The 2025 Goalkeepers Report: We Can’t Stop At Almost

What follows is an excerpt from our 2025 Goalkeepers Report. You can read the full report here. 

By Bill Gates, Chair, Gates Foundation  

A Generation of Progress, A Choice to Make 

The death of a child is always a tragedy. 

But there’s something especially devastating about a child dying of a disease we know how to prevent.  

For decades, the world made steady progress saving children’s lives. But now, as challenges mount, that progress is reversing.  

In 2024, 4.6 million children died before their fifth birthday. In 2025, that number is projected to rise for the first time this century, by just over 200,000, to an estimated 4.8 million children.  

That means more than 5,000 classrooms of children, gone before they ever learn to write their name or tie their shoes.  

It doesn’t have to be like this.  

The way I see it, there are two ways the next chapter can play out.  

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.  

Over the past several months, our foundation has worked with the Institute for Health Metrics and Evaluation (IHME) at the University of Washington to quantify the stakes. 

What we found is sobering. 

If funding for health decreases by 20 percent—the scale of cuts some major donor countries are currently considering—12 million more children could die by 2045. If the cuts are steeper—30 percent—it’s even worse: 16 million more children could die by 2045.  

If we take this path, we’re the generation that almost ended preventable child deaths. Almost eradicated polio. Almost wiped malaria off the map. Almost made HIV history. 

But we can’t stop at almost.  

We know kids are dying. We know why. And we know how to stop it.  

For the good of humanity, we need to choose the other path: one where we harness all we’ve learned and make sure innovations reach the children who need them—saving millions of young lives.  

I’ll continue to advocate however and wherever I can for increased funding for the health of the world’s children—and for efficiencies that improve our current system. But with millions of lives on the line, we have to do more with less, now. 

That’s not a new idea for health ministers around the world. They’ve long had to make limited budgets go further. But today, with so many countries spending more on debt than on health or education, every dollar has to work even harder.    

Luckily, there are strategies and innovations that can help do exactly that.  

This report is a roadmap to progress: where smart spending meets innovation at scale.  

I wish we were in a position to do more with more because it’s what the world’s children deserve. But even in a time of tight budgets, we can make a big difference. Over the last 25 years, we’ve learned so much about how to save lives, even with scarce resources.  

This isn’t just about money. It’s about priorities, commitment, and choices. 

First, we’ll need to double down on the most effective interventions: strong primary health systems and lifesaving vaccines. 

Then, we need to prioritize innovations that stretch each and every dollar. I’m talking about solutions like vaccines that require fewer doses to give the same—or better—protection as old ones—or smart new uses of data that help ensure the most effective interventions against diseases like malaria are deployed in the exact places that need them the most.  

Finally, we’ll need to continue to support the development of next-generation innovations that are so effective, they could end some of the deadliest threats to children for good. 

That won’t just save children’s lives. It will fundamentally change the world they inherit.  

That may sound ambitious—and it is. But it’s also within reach. 

My hope is that by the end of this report, you won’t just be optimistic we can get there—you’ll be energized about making it happen.  

I am. 

Click here to read the entire 2025 Goalkeepers Report.