One of global health’s biggest gains is at risk. Between 2000 and 2020, annual deaths of children under age five fell from nearly 10 million to under 5 million. That steady progress slowed during the COVID-19 pandemic but did not reverse—until now. Modeling by the Institute for Health Metrics and Evaluation (IHME) suggests 2025 will be the first year this century in which under‑5 deaths increase rather than decline.
IHME estimates that 4.6 million children died before age five in 2024 and projects that number will rise by about 200,000 to 4.8 million in 2025. The team did not base this on direct, complete global death counts—such data are often unavailable or delayed—so they used a mathematical model that links past trends in child mortality to factors known to affect child health, especially health spending.
A central driver in their analysis is a large drop in foreign health aid. In 2024, about $49 billion was provided in international health aid; IHME estimates that fell to roughly $36 billion in 2025, a decline of more than 26%. Cuts from major donors, including the United States, the United Kingdom, France and Germany, mean many low‑income countries face substantial funding shortfalls. Some countries that rely heavily on external financing reportedly reduced health spending by as much as 20% because of these cuts.
IHME’s projections indicate the largest increases in child deaths will occur in countries most dependent on foreign aid—primarily low‑income countries and many in sub‑Saharan Africa. Reduced funding can weaken vaccination programs, malaria control, maternal and neonatal care, and other essential services that prevent deaths from infectious diseases, prematurity, and other leading causes of child mortality.
Experts who reviewed the work say the methodology is consistent with other analyses and appears conservative. Dr. Steve Lim of IHME, a lead researcher on the estimates, notes that direct observations of global child mortality will take years to compile, so modeling is currently necessary. Brooke Nichols, an associate professor of global health who has studied the effects of foreign aid reductions, called the projected rise “horrific” and said the IHME approach aligns with other recent estimates.
The IHME team modeled future scenarios. If global health funding remains 20% below 2024 levels, their estimates suggest an additional 12 million child deaths by 2045 above what was previously expected. A 30% sustained cut could add about 16 million extra deaths by 2045. Conversely, if international health funding is maintained at 2024 levels and innovations (new vaccines, improved malaria interventions, better maternal and neonatal care) are implemented, an estimated 12 million more children could be saved by 2045.
Researchers caution that exact outcomes will depend on how countries respond—whether they reallocate domestic resources to protect health services, how efficiently remaining funds are used, and how quickly innovations are scaled. They also emphasize the human meaning behind the numbers: each percentage point increase in mortality represents children and families.
In short, the modeling links recent steep cuts in international health aid to an increased risk of child deaths, especially in the poorest countries. Restoring or sustaining funding and accelerating proven health interventions would be needed to reverse the projected rise and keep global child mortality on its long‑term downward path.