2025 is the first year of this century where child deaths will increase.
But we can stop this reversal before it becomes a trend, even in a time of tight budgets.
With proven solutions and next-generation innovations that do more with less, we can save millions of children's lives, protect the progress we've fought so hard for, and wipe out diseases that have plagued humanity for generations.
By Bill Gates
Chair, Gates Foundation
A Generation of Progress, A Choice to Make
The death of a child is always a tragedy.
But there's something especially devastating about a child dying of a disease we know how to prevent.
For decades, the world made steady progress saving children's lives. But now, as challenges mount, that progress is reversing.
In 2024, 4.6 million children died before their fifth birthday. In 2025, that number is projected to rise for the first time this century, by just over 200,000, to an estimated 4.8 million children.
That means more than 5,000 classrooms of children, gone before they ever learn to write their name or tie their shoes.
It doesn't have to be like this.
The way I see it, there are two ways the next chapter can play out.
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.
Over the past several months, our foundation has worked with the Institute for Health Metrics and Evaluation (IHME) at the University of Washington to quantify the stakes.
What we found is sobering.
HUMANITY AT A CROSSROADS
MILLIONS OF CHILDREN’S LIVES AT STAKE
If funding for health decreases by 20 percent—the scale of cuts some major donor countries are currently considering—
12 million more children could die by 2045.
If the cuts are steeper—30 percent—it's even worse:
16 million more children could die by 2045.
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.
We know kids are dying. We know why. And we know how to stop it.
For the good of humanity,
we need to choose the other path:
one where we harness all we've learned and make sure innovations reach the children who need them—saving millions of young lives.
Health funding refers to development assistance for health (DAH)—aid from high-income countries and donors to improve health in low- and middle-income countries. The chart shows projected impacts of 20% and 30% reductions in DAH. See methodology for details.
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I'll continue to advocate however and wherever I can for increased funding for the health of the world's children—and for efficiencies that improve our current system. But with millions of lives on the line, we have to do more with less, now.
That's not a new idea for health ministers around the world. They've long had to make limited budgets go further. But today, with so many countries spending more on debt than on health or education, every dollar has to work even harder.
Luckily, there are strategies and innovations that can help do exactly that.
This report is a roadmap to progress: where smart spending meets innovation at scale.
I wish we were in a position to do more with more because it's what the world's children deserve. But even in a time of tight budgets, we can make a big difference. Over the last 25 years, we've learned so much about how to save lives, even with scarce resources.
This isn't just about money. It's about priorities, commitment, and choices.
First, we'll need to double down on the most effective interventions: strong primary health systems and lifesaving vaccines.
Then, we need to prioritize innovations that stretch each and every dollar. I'm talking about solutions like vaccines that require fewer doses to give the same—or better—protection as old ones—or smart new uses of data that help ensure the most effective interventions against diseases like malaria are deployed in the exact places that need them the most.
Finally, we'll need to continue to support the development of next-generation innovations that are so effective, they could end some of the deadliest threats to children for good.
That won't just save children's lives. It will fundamentally change the world they inherit.
That may sound ambitious—and it is. But it's also within reach.
My hope is that by the end of this report, you won't just be optimistic we can get there—you'll be energized about making it happen.
I am.
A Roadmap to Progress
The smartest investment now is primary health care.
Primary health care is the quiet workhorse of every health system; the part that doesn't make headlines but makes everything else possible. It helps mothers deliver their babies safely. It catches pneumonia before it turns fatal. It vaccinates children before outbreaks happen. It spots new threats before they become full-blown emergencies.
And it's remarkably cost-effective. For less than $100 per person per year, a robust primary health care system can prevent up to 90 percent of child deaths.
In short, investing in primary health care is our best bet at saving the most lives with limited resources.
In Nigeria, when faced with a tough budget deficit, Governor Muhammad Inuwa Yahaya of Gombe State didn't wait for perfection: he prioritized the basics.
Progress through Partnership
ByThe Honorable Muhammad Inuwa Yahaya
Governor of Gombe State, Nigeria
Supplied by Governor's office
In 2019, when I became governor of Gombe State in Northern Nigeria, a historic budget deficit existed. We had broken systems, failing clinics, crumbling schools—and very little money to fix them. Our health system received only 3.5 percent of the state's total budget. Infrastructure was dilapidated, trained staff were few and often absent, and services were unaffordable for poor people. It would have been easy to wait to fix things and not spend money. But people weren't waiting, and so, neither could we.
Often, people think budget cuts save money. But what really saves money—and lives—is spending with vision, discipline, and purpose.
We made a choice to focus our resources and rebuild. We prioritized the basics: primary health, education, and trust. Today, Gombe has one renovated or newly built primary health center in every ward—114 in total—to deliver 24/7 services. More than 300,000 people are enrolled in our state's health insurance scheme. And we've constructed three general hospitals and rebuilt our specialist hospital. None of this was done with donor funding but with the budget we already had.
It wasn’t easy. One of the hardest things I had to do was introduce biometric attendance for health workers. On paper, our facilities were staffed. But when I walked into clinics, I found nurses alone, treating twice the number of patients with half the team. We found 500 ghost workers. By addressing these issues—we saved ₦2.8 billion (US$ 1.8 million). And we reinvested all of it into training, hiring, and expanding care.
We're using that same lens now as health financing is changing to improve efficiency through technology—tracking not just attendance but service delivery too. When you know where the gaps are, you know where to act. And we improved coordination of external funding by appointing a special adviser who reports directly to me to ensure we're maximizing resources.
What I’ve learned is this: You don’t need perfect conditions to make progress. You need clarity, and the courage to stick to it.
In Gombe, we didn't wait for perfection. We didn't wait to be rescued. But we didn't try to go it alone either. We started with what we had. We built what we needed. And then, we invited partners to walk with us—not because we had the loudest needs, but because we had a clear vision.
Leadership isn’t about chasing recognition. It’s about ensuring people no longer wake up fearing the same suffering they knew yesterday.
As a leader, you will face resistance and doubt. But if you stay grounded in your people—if you start with data, stay consistent, and lead with purpose—support will come. And change will follow.
We are not alone in this work. The path forward is one we walk together: communities, governments, and global partners, side by side. That's how real change is built, and how it lasts.
Despite real setbacks, health workers like Josephine Barasa in Kenya haven't given up. They're doing everything they can, even with fewer resources and less support, to save lives every day.
That was my job title. I'm a health worker and a gender-based violence champion.
Women—girls, really—would come to me for help. Most had barely been allowed to be children before motherhood was thrust on them. Some of them had not chosen it. Many had experienced violence.
I know what it means to carry the weight of a wound you didn't ask for. As a young woman, I experienced violence, too. So, when I looked at these girls, I saw more than pain. I saw myself.
I walked with them through pregnancy and early motherhood. I was there through the fear, the confusion, the questions no one else would answer. And I taught them how to keep their babies healthy: when to vaccinate, what to eat, how to breastfeed, how to stay clean, when to visit the health clinic.
Then, one afternoon in January, everything stopped.
I received the email just after 2 p.m. It was brief.
"We are sorry. We no longer need your services."
I froze. And then I went silent. For four days, I didn't speak. I didn't leave my bed. I couldn't. For someone whose life had been built on being able to speak, to guide, to help, I felt that I had lost my voice.
Five days after the email, they brought me and my team in for a debrief. Talking together, all around the wreckage, I found the words slowly coming back. And I realized: They could take away the money, but they couldn't take me away from my women.
So, in February, I went back—unofficially, unpaid, and on my own. I still show up every day. I still screen women for gender-based violence. I still offer health education and basic care to their children. I still listen. The support systems may have disappeared but the need has not. And neither have I.
We've been trying to fill the gaps however we can. We've gone to churches, mosques, community centers, explaining what we're doing, asking for small donations, a place to meet, anything that can help us keep going, to keep caring for children, and to keep supporting their mothers. Sometimes we get a little support. Sometimes we're just told to come back later. But we keep trying.
The Kenyan government has stepped in where it can. The government has begun communicating more clearly and responding to some of the immediate gaps in maternal health services. It's a start.
And through it all, I still carry hope. I've seen what happens when a woman is supported—how she transforms not only her own life but also her child's, and her community's life, too. If we women don't do what we are supposed to do, our communities may never grow, may never change.
But I believe they can. I believe they will. And every day that I show up, I'm choosing that future—for myself, for my children, and for the girls still learning how to become mothers.
Routine immunizations remain the best buy in global health.
Since 2000, the world has cut child deaths in half. The biggest reason? Vaccines, delivered to the children who need them most.
And every dollar spent on immunization gave countries a return of $54.
In a way, that actually undersells the impact per dollar. Because every health investment does more than saves lives—it transforms them. A healthy kid can go to school and learn. Healthy parents can work and provide for their families. And healthy societies are economically stronger and can invest more in their people.
For people in wealthy countries, it's hard to remember what life was like before vaccines were commonplace.
But Dr. Awa Marie Coll Seck, former two-time Minister of Health of Senegal, remembers.
She's talked about how in her culture, people once said that until a child reached the age of five and survived measles, you didn't truly "have" a child.
Senegal used to have hospital wards filled with children suffering from measles—many left with brain damage, and too many never went home.
But with support from Gavi, The Vaccine Alliance, Senegal strengthened their routine immunization system. As they reached more and more children with vaccines, cases plummeted—from a high of 24,000 in 2000 to just hundreds of cases in the past few years. Today, many of those once-crowded hospital wards have closed.
That progress is remarkable. But it's also fragile—because every time routine immunization slips, deadly diseases can return. And the cost of catching up is far higher than the cost of staying on track.
Innovations that Stretch Every Dollar
To fight malaria, countries are targeting the most effective resources to the areas of highest need.
Today, in communities across sub-Saharan Africa every rainy season brings the same fear: the world's deadliest animal, the Anopheles mosquito, and the disease it carries, malaria.
It's so common that most people have been infected at some point in their lives, and so lethal that almost everyone has heard of someone who didn't survive malaria—a baby, a parent, a friend.
One big problem is that malaria doesn't behave the same way in every community across a country. A one-size-fits-all approach isn't the most effective strategy to save lives.
That's where subnational tailoring comes in. It's a process countries use to decide which malaria interventions to deploy, where, when, and at what intensity.
The upshot? Fewer campaigns to target malaria, only in the most important places.
With the money saved by being more targeted about where to run these campaigns, countries can afford to layer on multiple interventions—giving children (and their families) even more protection.
By tailoring their response to make the biggest impact, countries can maximize the number of lives saved per dollar.
In Zambia, adding a digital smart map to guide spray teams to the highest-risk areas reduced the cost per case of malaria prevented by more than 20 percent.
Fewer malaria cases mean more capacity to treat other diseases, too—because it's much easier to supply and staff a health center when it isn't completely swamped with malaria cases four months out of the year, every single year.
With vaccines that deliver the same protection in fewer doses, countries have more money to reinvest in health systems.
Pneumococcal conjugate vaccines (PCV) help protect children from pneumonia, the leading infectious killer of children under the age of 5.
In March of this year, the World Health Organization (WHO) updated its guidance on PCV. In countries with an established PCV program, they included a reduced dosing schedule. Instead of children having to get the traditional three doses (two initial doses plus a booster), they could get one primary PCV dose and one booster—and still have strong protection.
Dropping one shot may not seem like much. But it's game changing. Not only will it reduce costs and simplify logistics, but it also lessens the strain on health systems, all while keeping kids safe.
If eligible countries switch to two doses, it could save around $2 billion by 2050. With the money saved from the reduced dosing schedule, countries can reinvest in expanding vaccine coverage—or introduce vaccines to fight other diseases that disproportionately kill children.
The Power of Immunization
ByDr. Naveen Thacker, India
Consultant Pediatrician, Deep Children's Hospital, Gandhidham, Gujarat, Executive Director, International Pediatric Association
Some breakthroughs take generations to leave their mark. Vaccines didn't. In my four decades as a pediatrician, I watched their impact unfold in real time, reshaping childhood within a single lifetime.
When I was growing up in Satna, India, it wasn't unusual to hear someone say, "We were seven, now we are five." Families had many children, not just by choice, but because it was quietly understood that not all of them would survive. Most people of my generation carry the same story: a sibling lost early to fever, pneumonia, or something unnamed that came suddenly and took them away.
Today, parents can choose to have one or two children because they trust they will live.
When I began my residency, the hospital ward was filled with children suffering from neonatal tetanus, diphtheria, pneumonia, and rotavirus. Later, I recall a time when I saw 55 cases of polio in a single month. I was considered an expert in meningitis simply because I had treated so many children who had it. The suffering I saw daily was profound. Many children did not survive, and those who did often had lifelong health challenges.
Today, those diseases have largely disappeared from my practice.
Why? Because of vaccines.
In India, the introduction of the pentavalent vaccine—which protects children against diphtheria, tetanus, pertussis (whooping cough), hepatitis B, and Haemophilus influenzae type b—and rotavirus vaccines helped cut deaths from pneumonia and diarrhea—once two of the biggest killers of children—by more than half. In 2024, 94 percent of eligible children received the pentavalent vaccine, one of the highest coverage rates in the region.
Mission Indradhanush, India's flagship immunization initiative launched in 2014, aims to ensure that every child under 2 and every pregnant woman is fully immunized against all vaccine-preventable diseases—with a focus on reaching low-coverage areas. The campaign has reached over 50 million children and 12 million pregnant women so far. It has helped close childhood immunization gaps by building on the lessons of polio eradication—microplanning, outreach, and community engagement. And now full immunization coverage in the world's largest country is well over 90 percent.
The Government of India's consistent investments in strengthening its supply chain and frontline healthcare workforce—while leveraging digital tools—have been critical to this success. Drawing on lessons from the COVID-19 vaccination effort, India digitized its national immunization system, recording over 79 million registered recipients and 292 million vaccine doses, making it one of the world's largest electronic immunization registries. The impacts are visible, not just in statistics but in the faces of the children who now thrive.
At a time when health budgets everywhere are under pressure, routine immunization stands out as one of the smartest investments we can make. Vaccines don't just save lives—they prevent outbreaks that strain hospitals, disrupt education, and pull resources from other priorities. Every dollar spent on immunization returns many more in averted treatment costs and preserved productivity. In other words, vaccines are not a cost center—they're a cost saver.
If we want to see more healthy children, affordability of vaccines is key. It's been a key driver in India's success and contributed to much of the progress we've seen in children's health around the world. India produces 60 percent of the world's vaccines, making immunization affordable and globally accessible, saving lives not only in India but also in Africa and Southeast Asia. Two major examples: the pneumococcal conjugate vaccine developed by the Serum Institute of India (SII) was introduced at just US$2 per dose; an India-developed rotavirus vaccine brought the price down to around US$1 per dose, enabling broad introduction across Africa and Asia.
When I started practicing medicine, I saw countless children fighting for a chance at life from diseases that today don't stand a chance against vaccines.
So much can change in one lifetime.
That's the power of immunization.
Wiping Diseases Off The Map
By the 2040s, new science could end malaria—eradicating a mosquito-borne illness that kills more than 400,000 children under the age of 5 every year.
A series of innovations are coming together, creating a triple-layered shield to keep malaria from killing:
Before the bite. Research into a new generation of vaccines has the potential to close critical gaps—protecting older children and those already exposed to the disease, especially in high-burden areas such as sub-Saharan Africa, where 94 percent of malaria cases occur.
During exposure. Approximately two decades ago, the widespread rollout of insecticide-treated bed nets in sub-Saharan Africa triggered the fastest drop in malaria deaths in history.
But as our defenses improved, mosquitoes have adapted.
In just 18 months, a single mosquito population can cycle through 20 generations, giving them plenty of chances to build resistance to the insecticide on those bed nets.
That's why scientists developed dual-insecticide bed nets, pairing two different insecticides to beat resistance. In early use across 17 countries in Africa, these bed nets have already helped prevent over 13 million cases.
Even though global funding cuts have slowed the rollout, the math is simple: For a little over $1 per person, we can save tens of thousands of lives per year.
But that's not all. A leading insect-repellent manufacturer has developed a small, poster-like spatial repellent—a square that sticks to the wall and keeps mosquitoes away around the clock. It looks like something you might see on a child's bedroom wall—perhaps next to a superhero poster. Only this poster is a superhero: It saves lives.
After infection. Treatment is becoming radically simpler. A single-dose cure will be able to clear certain types of malaria, replacing multi-day regimens with just one pill.
With these next-generation innovations, plus strong trust and partnership with local governments and experts, we can stop malaria from being common and expected, or even fatal.
BY 2045,
5.7 MILLION CHILDREN COULD BE SAVED
WITH NEXT GENERATION MALARIA TOOLS
And we're on our way to stop malaria from existing at all—within our lifetimes.
It's a bold idea, and African scientists are leading the way.
A Future without Malaria
ByKrystal Mwesiga Birungi
Research and Outreach Associate, Target Malaria Uganda
Some of my earliest memories are of my younger brother convulsing with fever while my mother tried desperately to cool his body. He had malaria. We knew treatment existed, but we could not afford it. All we could do was pray.
He didn't just suffer once—he suffered again and again. Watching him, I felt terror and helplessness. When I caught malaria myself, the pain was so unbearable that sometimes… I wished it would all just end. That is the reality of malaria: You cannot avoid it when it strikes, and once it does, survival is never guaranteed.
Back then, even mosquito nets were out of reach for my family. My mother once told me, "Nets are for rich people." She faced impossible choices: stay home to tend to a sick child and risk the family going hungry or go to work and risk losing her child. Many Ugandan parents still make those choices today.
Everything changed when the Global Fund to Fight AIDS, Tuberculosis and Malaria arrived in my country—I was 14 years old. Suddenly, mosquito nets and medicines were distributed free of charge. Community health workers could diagnose and treat malaria in our neighborhoods. For the first time, being poor didn't mean malaria was a death sentence. In countries where the Global Fund invests, like my own, malaria deaths have dropped by 29% in less than two decades. Without these programs, malaria deaths would have doubled during that same time.
Those interventions gave me a future—and a purpose. Today, I am an entomologist working with Target Malaria at the Uganda Virus Research Institute, developing new genetic technologies to reduce the number of mosquitoes that spread this disease. When I first learned about genetics as a teenager, I saw how powerful it could be. Many told me my dream to use genetics to combat malaria was impossible. My mother said otherwise. She was right.
Science has continued to advance since I was a child. Today, the world has more tools than ever to fight malaria. Newer, stronger bed nets, indoor spraying, medicines, and vaccines have saved millions of lives. But each faces limits. Mosquitoes develop resistance to insecticides. Parasites evolve resistance to drugs. Vaccines are lifesaving but not yet strong enough to stop transmission alone. And none are sufficient to stop malaria from existing. That is why we need new innovations that could break transmission altogether.
We are studying how gene drive technology—a tool that helps a specific genetic trait spread through a population much faster than normal—could help fight malaria. Only certain mosquito species carry and transmit the malaria parasite. African scientists, including at Target Malaria where I work, are exploring whether modifying the malaria-transmitting mosquitoes' genes could make them less able to reproduce or prevent them from passing the parasite to humans. Normally, such genetic changes are inherited only about half the time, but with gene drive, the traits can be passed on to nearly all offspring—reducing or even eliminating malaria transmission in the local area.
Of course, research isn't just about science; it's about trust. So together with our partners, we are working hand-in-hand with communities—listening, explaining, and ensuring our work is shaped by them.
What drives me is simple: Children are still dying today from the disease that haunted my childhood. I survived because someone invested in me. Now it is my turn to make that possible for others.
A year ago, my son turned 5. For many parents, that milestone is about school readiness. For me, it was about survival. In Uganda, one in 25 children dies before their 5th birthday—most from malaria. When my son blew out his birthday cake candles, all I could think was: He is alive. He made it.
Every child deserves that chance. Ending malaria is not only possible, it is urgent. We African researchers know this—and we are leading the way. We have the innovations. We have the knowledge. And we are advancing our understanding of science to take us over the finish line.
By the late 2040s, new innovations could virtually eliminate deaths from HIV/AIDS, once the world's deadliest pandemic.
Imagine it's the year 2044. A teenage girl in Botswana knows what HIV/AIDS is, but neither she, nor anyone her age, knows someone who has died from it.
When her grandparents were children, things were very different. No affordable or effective treatments for HIV/AIDS existed. A diagnosis was almost always a death sentence and onward transmission almost certain.
By the time her parents were young adults, HIV had become more manageable. Daily antiretroviral therapy, a daily combination of HIV medications (one pill a day), made it possible to live a long, healthy life with the disease. And PrEP (pre-exposure prophylaxis) pills helped prevent infection for people at risk. These tools had once been too expensive or hard to find, but thanks to efforts such as PEPFAR (the U.S. President's Emergency Plan for AIDS Relief) and the Global Fund, they became more widely available in low- and middle-income countries.
Still, it wasn't always easy to get these treatments. Clinics were often far away. Stigma kept people from seeking care. Some people, including children, couldn't avoid infection. Mothers passed the virus to their babies. And many of those babies didn't survive.
But that's a world our teenager can barely imagine. She opens her phone, taps her health app. It's a smart AI concierge that helps her navigate everything from mental health to contraception.
Today, it walks her through HIV prevention.
She learns about her risks, and a wide array of options for reliable, affordable, long-acting HIV prevention—a monthly pill, an annual injection, and even an effective vaccine.
She selects one.
Within hours, it's available.
It's a single shot—an injection called Lenacapavir. One dose a year. That's it.
That future may sound far away. It isn't.
Lenacapavir already exists—and when a generic is available in the next few years, it will be even more affordable. It's not one shot per year yet, although that may come by 2028. For now, it's two injections per year, which is still 363 fewer doses than the daily pill people rely on today, and even that pill is evolving: A monthly version of oral PrEP is now in late-stage trials.
In an era of scarce resources, this kind of innovation has never mattered more. Getting the twice-a-year version to just 4 percent of high-incidence areas could prevent up to 20 percent of new infections.
That's life-changing for everyone, but especially for children. Fewer women infected means fewer babies born with the virus.
New maternal vaccines that protect babies before they are even born are our chance to ensure that a baby's first few months aren't their last.
All these innovations will help save millions of children.
But there's one category of tragedy we still haven't solved. Nearly half of all child deaths happen in the first month of life.
Innovations like the pneumococcal vaccine (PCV) have helped turn the tide against bacterial pneumonia. But some viruses and bacteria strike so fast—within days or weeks of birth—that we can't immunize babies quickly enough.
Respiratory Syncytial Virus (RSV) is one of those threats. In high- and low-income countries alike, it's the leading cause of pneumonia in infants, and a major reason newborns land in the hospital struggling to breathe.
Not only that, babies who are hospitalized with RSV in the first six months of life are three times more likely to suffer from recurrent lower respiratory tract infections later in childhood.
BY 2045,
3.4 MILLION CHILDREN COULD BE SAVED
BY SCALING NEW IMMUNIZATION PRODUCTS FOR RSV AND PNEUMONIA
Then there's Group B streptococcus, or GBS, a stealthier but equally deadly disease. Many pregnant women carry it without symptoms. But when it's passed to a newborn, it can lead to blood infections, brain damage, or death within hours of birth. And right now, there's no vaccine to prevent it.
In the late 2000s, scientists increased exploration of a different strategy: If we can't protect babies fast enough, what if we immunize their mothers instead?
The idea is simple but powerful. When a pregnant woman is immunized, she passes antibodies to her baby through the placenta, providing protection before her baby is even born. It's like fitting a newborn with a suit of armor.
Maternal vaccines are already used to protect against tetanus and pertussis. But new vaccines for RSV and GBS could redefine what maternal immunization can do.
Safety comes first with all vaccines—and especially with vaccines for expectant mothers—which is why this approach has taken years of careful progress.
If you gave birth in the United States, United Kingdom, or Canada recently, you and your baby may have already benefitted from the RSV vaccine.
Mothers and babies everywhere deserve the best protection possible. Rollout of the RSV vaccine began in high-income countries two years ago. Now it will be available in Gavi-supported countries to protect babies in low-income countries where most of the deaths occur.
As for GBS, a vaccine is in development that could change the game. If successful, it would be the first ever vaccine to prevent GBS infections in newborns.
Delivery of these vaccines is being developed to specifically address the needs of low- and middle-income countries. Currently, the Gates Foundation is supporting the development of multidose vials—containers that hold enough vaccine for 2 to 20 people. These vials help cut costs and make distribution more efficient, especially in places where resources are scarce and demand is high.
These kinds of innovations have multiple benefits: saving lives, saving money, and freeing up resources for countries to spend on other critical priorities.
And for the babies whose lives are protected, they can change everything—not just in those first few precious months of life, but for everything that comes after.
A Call to Action
I turned 70 this year, an age when many people retire. I'm not slowing down anytime soon because I know that over the next 20 years we can make an even bigger difference for the world's children.
We all have a role to play.
If you're a policymaker:
Target health financing to best buys and fund proven successes like Gavi and the Global Fund
Protect and expand investment in primary health care and routine immunization
Support the development and uptake of health innovations to accelerate impact
If you're an engaged citizen:
Use your voice to remind leaders what we have in common: a belief that children should survive and thrive, no matter where they happened to be born.
The last generation proved that with innovation and commitment, we could save millions of children's lives.
We can do it again—this time faster, smarter, and more affordably.
Because parents deserve the chance to find out what their children will do when they grow up—not wonder if they'll grow up at all.
We can give them that chance.
If we do more with less now—and get back to a world where there's more resources to devote to children's health—then in 20 years, we'll be able to tell a different kind of story: The story of how we helped more kids survive childbirth, and childhood.
More first words, first steps, first days of school.
More candles on birthday cakes.
More lives that reach their full potential—not by luck but by design.
Because every life we protect is a future we create. And that's worth fighting for.
Explore The Data
In 2015, 193 world leaders agreed to 17 ambitious Sustainable Development Goals (SDGs) to end poverty, fight inequality, and improve health by 2030. Goalkeepers works to accelerate progress toward the SDGs, focusing on Goals 1-6.
Each year, the Goalkeepers Report tracks 18 key indicators—from poverty to education—offering the latest estimates on where innovation and investment are driving progress, and where we're falling short. These data remind us that progress is possible but not inevitable.
With just five years left, the world is off track. And this year, reductions to health funding have put achieving the SDGs even further out of reach.
The 13 health indicators we track with our partner, the Institute for Health Metrics and Evaluation (IHME), incorporate the projected impact of potential health funding reductions, assuming a 20% reduction to Development Assistance for Health in 2026 compared to 2024 funding levels.
It's clear: Urgent action is needed to meet the SDG targets and create a more equitable, safer future for all by 2030.
