For the first time this century, the number of children worldwide who die before their fifth birthday is projected to rise, according to a new study published by the Gates Foundation.
A key factor behind the jump is significant cuts in international development assistance from several countries, researchers said. If funding cuts of 20 percent persist, they said, 12 million more children under 5 could die by 2045.
“Over the last 25 years we’ve made incredible progress in global health, specifically for children,” said Margaret Miller, a senior program officer at the Gates Foundation. “It’s really tragic that it’s now at risk.”
Scientific advances and social progress in recent decades have caused under-5 deaths to drop from around 88 for every 1,000 live births in 1990 to around 36 through the 2020s.
The number is expected to increase this year to 37, according to the Gates Foundation Goalkeepers reportpublished last week — the first time this century that child mortality has increased. Last year, an estimated 4.6 million children died before turning 5; this year, that figure is expected to rise by over 200,000 deaths.
The data was modeled by the Institute for Health Metrics and Evaluation at the University of Washington using several key drivers, including Global Burden of Disease risk factors and interventions including vaccines. Researchers also analyzed the relationships between historical health spending and each indicator to measure the impact of funding cuts to foreign aid.
Development assistance for health dropped from $49 billion last year to about $36 billion this year, recent assessments show, a decline of more than 25 percent. Those cuts disproportionately impact health outcomes in low-income countries that cannot as easily respond to funding cuts, said Stephen Lim, IHME senior director of science and engineering, in a briefing.
President Donald Trump presided over the dismantling of the U.S. Agency for International Development. The impact of the cuts have been felt across the world.
The foundation launched the Goalkeepers reports to report on the progress in recent decades toward U.N. Sustainable Development Goals, but this year’s projections in some cases shows a step back. In a separate studypublished by the Lancet, researchers from the U.S. and other countries found that the USAID cuts could lead to 14 million additional deaths over the next five years.
The U.N. aimed to get under-5 mortality down to 25 deaths per 1,000 live births by 2030. The new modeling projected it will instead be hovering around 36 that year.
“The way I see it, there are two ways the next chapter can play out,” Bill Gates, chair of the Gates Foundation, said in a statement. “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.”
Health funding restrictions and decreases played a key part in impacting health indicators this year, Gates Foundation CEO Mark Suzman said in a briefing. “The headline message is that we need to reverse course. … We cannot stop at almost ending preventable child mortality.”
Researchers see a critical turning point.
Many of the roughly 13,000 under-5 deaths each day are preventable, UNICEF says. Leading causes are infectious diseases including pneumonia, diarrhea and malaria and preterm birth, congenital defects and neonatal disorders. The majority occur in sub-Saharan African and southern Asia.
“In a time of tight budgets,” Gates said, the world must make smart spending meet innovation at scale. That includes prioritizing innovations that “stretch each and every dollar,” including vaccines that require fewer doses or using data to help deploy interventions in precise areas.
Immunizations “remain the best buy in global health,” the report says: A dollar spent on immunization gives countries a return of $54.
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