Bill Gates Unveils Roadmap to Halve Child Deaths Again by 2045, Urges World Leaders to Act

Nairobi, Kenya — September 28, 2025 (EAT).

At the 2025 Goalkeepers event in New York, philanthropist and health advocate Bill Gates outlined an ambitious plan to further reduce child mortality by half by 2045, warning that recent global cuts to health funding threaten decades of progress. 

The Latest

• Gates revealed a “roadmap for saving millions of children” hinged on both sustaining proven interventions and accelerating breakthrough innovations.

• He announced a $912 million pledge over three years to the Global Fund to Fight AIDS, Tuberculosis and Malaria (2026–2028 cycle) to reinforce global health systems. 

• Gates cautioned that development assistance for health (DAH) has declined by 21 percent between 2024 and 2025 — dropping to a 15-year low. 

• He framed this moment as a crossroads: global leaders must decide whether to renew commitment or risk reversing gains in child survival. 

The Roadmap: Key Pillars

According to modeling by the Gates Foundation and the Institute for Health Metrics and Evaluation (IHME), the world can halve child deaths again by 2045 through a combination of:

1. Reinvesting in proven global health institutions and pledge mechanisms

   • Strengthening financing for the Global Fund, Gavi (vaccine alliance), and other core platforms. 

   • Ensuring countries can gradually transition to sustainable, self-reliant health financing. 

2. Bolstering primary health care systems

   • Prioritizing early detection, prevention, and treatment in local clinics to catch diseases before they escalate. 

   • Expanding access to basic diagnostics, essential medicines, and trained community health workers. 

3. Scaling pipeline innovations

   • New malaria tools and vector control technologies. 

   • Long-acting HIV prevention drugs (vs daily pills). 

   • Maternal vaccines against diseases such as RSV (respiratory syncytial virus) and Group B streptococcus. 

   • Use of artificial intelligence and digital platforms to deliver medicines more cost-effectively and equitably. 

Risks, Challenges & Warnings

• Funding decline: The steep drop in global health aid could derail progress unless donor commitments rebound. 

• Implementation gaps: Many low- and middle-income nations struggle with infrastructure, human resources, supply chains, and governance—limiting adoption of innovations.

• Uneven progress: Gains to date have been more pronounced in some regions than others; inequality in health access may widen if interventions are uneven.

• Dependency risk: Overreliance on external funding or philanthropy without domestic investment may not be sustainable long term.

What to Watch

• Whether countries commit to filling DAH gaps and co-financing health systems.

• How the Global Fund replenishment proceeds (especially 2026–2028 cycle) and donor uptake.

• Progress on key innovations (e.g. long-acting HIV drugs, maternal vaccines) and their deployment in high-burden settings.

• How priorities in national health budgets shift toward early child survival, vaccines, and primary care.

• Monitoring whether child mortality begins to plateau—or even reverse—amid global funding stress.