A hard‑won global success — halving child deaths under age five since 2000 — now appears at risk of reversing. Between 2000 and 2020 annual under‑5 deaths fell from nearly 10 million to under 5 million. Although progress slowed during the COVID‑19 pandemic, mortality continued to decline until new modelled estimates indicate 2025 could be the first year this century with an uptick.
Researchers at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington project 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 investigators, including Dr. Steve Lim, note that global, reliable death counts are incomplete because many countries lack full death‑registration systems. To compensate, they used statistical models that link historical shifts in drivers such as health spending to changes in child mortality.
The model attributes the rise primarily to a sharp fall in international health aid. IHME estimates global health assistance will drop from about $49 billion in 2024 to $36 billion in 2025 — a decline exceeding 26%. Several major donors, such as the U.S., the U.K., France and Germany, have cut or reprioritized contributions. A few countries have ramped up giving — for example, Indonesia recently moved to contribute more than it receives from Gavi, and South Africa increased support to the Global Fund — but those increases do not offset the large reductions from traditional donors.
Because many low‑income countries depend heavily on external financing for health, the model forecasts the biggest increases in child mortality in those settings, particularly in parts of sub‑Saharan Africa. IHME estimates that some countries could see health budgets fall by roughly 20% because of aid losses, substantially weakening routine vaccination programs, malaria control, maternal and newborn care, and other services that protect young children.
The team ran longer‑term scenarios. If global health funding stays about 20% below 2024 levels, the model suggests roughly 12 million additional under‑5 deaths by 2045 compared with earlier expectations. A sustained 30% cut would raise that excess toll to about 16 million. Conversely, maintaining 2024 funding levels combined with adoption of new interventions could save an estimated 12 million children by 2045.
Experts say the IHME estimates align with other analyses and may be conservative, but they emphasize the projections will need updating as better mortality data and clearer information about how countries respond to funding changes become available. As Brooke Nichols, an associate professor of global health, warns, behind every number are real children and families — a human cost that these statistics represent.