Global progress in reducing deaths of children under five is at risk of reversing. Between 2000 and 2020, annual under‑5 deaths fell from nearly 10 million to under 5 million, but new modeling from the Institute for Health Metrics and Evaluation (IHME) suggests 2025 could be the first year this century with an increase in those deaths.
IHME estimates about 4.6 million children died before age five in 2024 and projects roughly 4.8 million in 2025—a rise of about 200,000. Because comprehensive, timely global death counts are often unavailable, researchers used mathematical models that tie past mortality trends to drivers of child health, with health spending highlighted as a central factor.
A major apparent cause is a sharp drop in international health aid. IHME reports global health aid at about $49 billion in 2024, falling to roughly $36 billion in 2025—more than a 26% decline. Reductions from large donors, including the United States, the United Kingdom, France and Germany, have left many low‑income countries facing funding gaps. Some nations that depend heavily on external support reportedly cut their own health spending by up to 20% in response.
IHME’s projections show the largest increases in child deaths concentrated in countries most reliant on foreign assistance—mainly low‑income nations and many in sub‑Saharan Africa. Reduced funding can undermine vaccination campaigns, malaria control, maternal and newborn care, and other essential services that prevent deaths from infectious disease, prematurity and other leading causes of under‑5 mortality.
Independent reviewers describe the IHME approach as consistent with other analyses and relatively conservative. IHME lead researcher Dr. Steve Lim noted that direct global mortality observations will take years to assemble, making modeling necessary now. Brooke Nichols, a global health researcher who studies aid reductions, called the projected rise “horrific” and said the findings align with other recent estimates.
The team explored scenarios: a sustained 20% shortfall in global health funding could result in roughly 12 million additional child deaths by 2045 versus prior expectations; a 30% sustained cut could add about 16 million. Conversely, maintaining 2024 funding levels and scaling new vaccines, better malaria tools and improved maternal and neonatal care could save an estimated 12 million children by 2045.
Researchers stress that outcomes will depend on policy choices—whether governments protect health budgets, use remaining funds efficiently and accelerate proven interventions. Behind every statistic are children and families, and restoring or sustaining funding alongside expanded proven interventions is central to returning to the long‑term downward trend in child mortality.