One of global health’s biggest gains — the halving of under‑5 deaths since 2000 — is at risk of reversing. Between 2000 and 2020 annual deaths of children under five fell from nearly 10 million to under 5 million. Progress slowed during the COVID‑19 pandemic but kept declining until new estimates suggest 2025 will be the first year this century with an increase.
Modeling by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington projects about 4.6 million under‑5 deaths in 2024 rising to roughly 4.8 million in 2025 — an increase of just over 200,000 children. IHME researchers, including Dr. Steve Lim, stress that reliable, direct counts of child deaths are not yet available globally because many countries lack complete death‑registration systems, so they used statistical models linking past changes in factors such as health spending to child mortality.
The model highlights a sharp drop in international health aid as the main driver. IHME estimates global health aid fell from about $49 billion in 2024 to $36 billion in 2025 — a decline of more than 26%. Major donor countries, including the U.S., the U.K., France and Germany, scaled back contributions as priorities shifted. Some countries have increased giving — for example, Indonesia began contributing more than it receives from Gavi this year, and South Africa boosted its support for the Global Fund — but those increases don’t offset the large cuts.
Because many low‑income countries rely heavily on foreign aid for health budgets, the model forecasts the biggest rises in child mortality in those settings, particularly across parts of sub‑Saharan Africa. IHME estimates some countries have cut health spending by about 20% as a result of aid reductions, which would substantially weaken services such as vaccination, malaria control, maternal and neonatal care, and other childhealth programs.
The researchers ran scenarios for the coming decades. If global health funding remains about 20% below 2024 levels, their model suggests roughly 12 million additional children could die by 2045 above earlier expectations. A 30% sustained cut would raise that toll to about 16 million extra deaths. Conversely, if funding were maintained at 2024 levels and new health interventions are adopted, the model estimates about 12 million more children could be saved by 2045.
Experts say the modeling is consistent with other analyses and appears conservative. But the projections will need revision as better mortality data and information on how countries respond to funding changes become available. As Brooke Nichols, an associate professor of global health, emphasizes, these numbers represent real children and families — the human cost behind the statistics.