By Stacy M. Brown
Black Press USA Senior National Correspondent
The signs were visible to anyone willing to look. Clinics running out of medicine, health workers sent home in silence, and governments bracing for a wave they could no longer afford to stop. Now the evidence is written in hard numbers. For the first time this century, the number of children dying before their 5th birthday is rising. The Gates Foundation’s 2025 Goalkeepers Report states that 4.6 million children died before age 5 in 2024 and projects that the total will reach 4.8 million this year, reversing decades of progress in child survival.
The report’s modeling, completed by the Institute for Health Metrics and Evaluation, warns that the coming decades could bring even heavier losses. If recent global health funding cuts continue, as many as 16 million more young children could die by 2045. The findings show that development assistance for health fell 26.9 percent below the previous year, leaving already strained health systems exposed in regions where clinics were fragile long before budgets began tightening.
“We have to do more with less, now,” Bill Gates wrote in the Goalkeepers Report. “I wish we were in a position to do more with more because it’s what the world’s children deserve.”
The projections grow heavier when paired with the collapse of programs once funded through the U.S. Agency for International Development. A Lancet analysis cited by NBC News shows that the Trump administration’s 83 percent cancellation of USAID programs could lead to more than 14 million deaths over five years, including 4.5 million children under age 5. “The numbers are striking,” Davide Rasella told NBC News. He said multiple research teams reached similar conclusions: “Millions and millions of deaths that will be caused by the defunding of USAID.”
Before the cuts, USAID-funded programs prevented nearly 92 million deaths from 2001 through 2021 across 133 countries. NBC News reported that once the programs shut down, food kitchens, HIV clinics, malaria treatment sites, and maternal health centers went dark. “If you wanted to reduce USAID funding, it could have been done in a more gradual manner,” Amira Albert Roess told NBC News. She said the sudden closures left people unable to refill lifesaving medications, adding, “That’s creating a situation where the individual can start to deteriorate fairly rapidly.”
The workforce behind these programs also collapsed. Newsweek reported that about 50,000 jobs were disrupted worldwide. “These were the most educated people … and then ‘poof’ overnight they don’t have an income and a livelihood,” Lara Andes told Newsweek. U.S.-based nonprofits endured deep layoffs, some cutting 40 to 60 percent of their staff. “It has been nothing short of devastating,” Christy Grimsley told Newsweek after losing her job and health insurance during the cuts.
On the ground, the unraveling is visible in communities already carrying heavy burdens. In Nigeria’s Gombe State, Governor Muhammad Inuwa Yahaya described taking office in 2019 amid a historic deficit and failing clinics. He discovered 500 ghost workers on the state payroll and spent ₦2.8 billion (US$1.8 million) saved from payroll reform on training and rehiring. “You don’t need perfect conditions to make progress,” Yahaya told the Goalkeepers Report. “You need clarity, and the courage to stick to it.”
In Kenya, community health worker Josephine Barasa received an abrupt email ending her employment after years spent mentoring young mothers and survivors of violence. “They could take away the money, but they couldn’t take me away from my women,” Barasa said. She returned to her work unpaid, gathering donations from churches, mosques, and community centers to continue screenings, health lessons, and support for children who lost access to services when the funding ended.
The stakes remain high in Uganda, where malaria still threatens millions. Entomologist Krystal Mwesiga Birungi recalled her younger brother falling ill with fever when her family could not afford mosquito nets. “Nets are for rich people,” Birungi remarked, describing what her mother often said. Now she develops next-generation tools aimed at reducing mosquito populations and preventing infections that continue to claim lives. “Ending malaria is not only possible, it is urgent,” Birungi stated.
The Goalkeepers Report details solutions that could save millions of children. Next-generation vaccines for pneumonia and RSV, new malaria-prevention technologies, maternal immunization programs, and strong primary care systems that cost less than $100 per person per year and can prevent up to 90 percent of child deaths. Every $1 invested in vaccines returns $54 in economic and social benefit. Gavi has already helped deliver vaccines to more than 1.2 billion children since 2000.
Still, even the most promising innovations cannot overcome systems deprived of resources. “It takes infrastructure to get an organization and keep it going,” Andes said. “And all that infrastructure has collapsed.”
At the end of the road — beneath the numbers, the projections, and the policy reversals — are the people still trying to hold the line. Their work carries a reminder that even when global systems falter, individuals continue to move forward on determination alone.
“The support systems may have disappeared, but the need has not,” Barasa explained. “And neither have I.”
