Case study

Child mortality

Global number of deaths of children under age 5 (in millions)
Current projectionIf we progressIf we regress
Gavi, the Vaccine Alliance, is formed

The story behind the data

Melinda Gates

Co-chair, Bill & Melinda Gates Foundation

If I had to pick just one data point to focus on, it would be the number of children who die every year before reaching the age of 5.

There’s so much packed into that number. Child mortality is a proxy for overall well-being; it’s also a leading indicator of progress (or the lack of it). And when you talk to mothers who have experienced the death of a child, you understand what that number means in human terms. What is more fundamental than keeping children alive so they can thrive and build the future?

Based on global child mortality data, the world is on the right track. In the years I’ve been working in global health, the number of child deaths has gone down every year. By a lot. Six million fewer children died in 2016 than in 1990. That’s more than the total number of children in France.

What is more fundamental than keeping children alive so they can build the future?

Unfortunately, not many people know about this success. On average, as my friend and mentor the late Hans Rosling pointed out, chimpanzees do better than people on a multiple-choice test about how many children the world has saved. I don’t quite understand why people aren’t more aware of, and more proud of, this accomplishment.

Still, the global child mortality curve doesn’t tell the whole story. It hides an important insight about what it will take to save the next 5 million. If we were to break this single, global line into separate lines for each country, we would see massive differences among them. Children are 75 times more likely to die if they happen to be born in Angola instead of Finland. Warren Buffett calls this the ovarian lottery. The work of this generation is to make the ovarian lottery fairer (and save millions more lives) by addressing child mortality in countries like Angola, Nigeria, Democratic Republic of Congo, and Pakistan, where children are most at risk.

Bill and I began investing in health and development because we believed it was possible to eliminate gross inequities. We’ve seen many poor countries prove the point. Take Malawi. In 1990, one in four children there died. Now, it’s one in 16. This is great news, because Malawi is closing the gap between itself and Finland. It’s also a call to action, because now there’s a big gap between Malawi and Angola.

To answer the call, the world must spread best practices from exemplars like Malawi. Fortunately, we are learning a lot about how to save children’s lives.

Close to half of the almost 5 million children who will die next year will die in the first 28 days of their lives. Most could be saved by a few simple interventions: for example, resuscitation if they can’t breathe, antiseptics that cost pennies to prevent infection, and breastfeeding to strengthen their immune systems. Cambodia and Ethiopia have shown what happens when a country prioritizes its newborns. The challenge is reaching the most vulnerable people in the world with basic information and services that save babies’ lives.

The global child mortality curve doesn’t tell the whole story. It hides an important insight about what it will take to save the next 5 million.

About 1.5 million of the children who will die next year will die from diseases that we can prevent with vaccines. Many countries, including Bangladesh, Honduras, and Tanzania, immunize more than 90 percent of their children, but there are still nearly 20 million children in the world who aren’t immunized at all. This explains why measles, preventable with a vaccine that costs less than 20 cents, still kills almost 150,000 children every year.

It’s a huge challenge to reach children in countries in conflict or in remote regions hours away from any infrastructure whatsoever. But it’s doable, and it’s more doable now than ever before. Consider how difficult it is to deliver a vaccine that needs to be kept at a specific cold temperature to a child who lives in a desert. New coolers using insulation developed for spacecraft can keep vaccines cold for a month and help us reach millions of children we’re currently missing.

Picture of an Arktek cooler keeping vaccines cold in Ethiopia The Arktek cooler can keep vaccines cold for a month, allowing health workers to reach children in the most remote regions (Addis Ababa, Ethiopia). (Photo courtesy Intellectual Ventures)

In 2000, our foundation joined many partners in launching what was then called the Global Alliance for Vaccines and Immunization (now Gavi, the Vaccine Alliance). Since then, Gavi has helped more than 70 countries vaccinate 600 million children. It has helped dozens of countries add new vaccines against leading childhood killers such as diarrhea and pneumonia to their immunization programs. It has saved more than 7 million lives.

We know what it takes to give millions of children the opportunity to thrive. The question is, do we have the commitment?

The stories behind the data

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