Gates describes this “significant reversal in child deaths,” as something that should be “sobering” for anyone committed to scientific and human progress. The report warns that if funding cuts persist, the consequences will be catastrophic. If global health funding decreases by 20%—the scale of cuts some major donor countries are considering—an additional 12 million children could die by 2045. Should the cuts be steeper, reaching 30%, the report grimly forecasts 16 million more child deaths by 2045.
“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 writes.
But he emphasized that the foundation could not achieve these goals without the support of governments, particularly those of wealthy countries. And with deadly infectious diseases, which can come roaring back from the brink of extinction, zero is really the magic number.
The new report warns of the catastrophic results if the reduction in funding for these efforts continues. “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.”
Gates emphasizes that though the world is in a time of tight budgets, proven solutions and next-generation innovations exist that can protect the progress made and save millions of young lives. The immediate goal, according to Gates, must be to “do more with less, now.”
The report highlighted opportunities to tackle the preventable health conditions killing children worldwide: malaria, HIV/AIDS, and overall threats to newborns. The tools are within our grasp, the report says, laying out a three-part roadmap and calling for countries to double down on the most effective interventions. These are, according to the report:
1. Prioritizing Primary Health Care: Investing in robust primary health care systems is the “smartest investment now,” the report says. For less than $100 per person per year, these systems can prevent up to 90% of child deaths, catching deadly diseases like pneumonia early and ensuring safe deliveries.
2. Doubling Down on Routine Immunization: Routine immunizations remain the “best buy in global health,” the report says, adding that every dollar spent on immunization yields a return of $54 in economic and social benefits. Innovations such as reduced dosing schedules for pneumococcal conjugate vaccines (PCV) could save around $2 billion by 2050.
3. Investing in Next-Generation Innovations: Modeling suggests that by 2045, new malaria tools could save 5.7 million children, and scaling up new maternal vaccines for threats like Respiratory Syncytial Virus (RSV) and Group B streptococcus (GBS) could save 3.4 million children.
On the theme of doing more with less, the report highlights insights from leaders and health workers who are sustaining health progress despite limited resources. In Nigeria, Governor Muhammad Inuwa Yahaya of Gombe State prioritized primary health despite a historic budget deficit. “You don’t need perfect conditions to make progress,” he noted. “You need clarity, and the courage to stick to it.”
The report also featured people stepping in to address funding deficits on a grassroots level. In Kenya, community health worker Josephine Barasa continued her unpaid work as a “mother mentor” after her employment was cut. “They could take away the money, but they couldn’t take me away from my women,” she told the foundation. “The support systems may have disappeared, but the need has not. And neither have I.”
