Billionaire philanthropist Bill Gates has criticized the United States government’s decision to reduce funding for the U.S. Agency for International Development (USAID).
Speaking after the release of the Bill & Melinda Gates Foundation’s 2025 Goalkeepers Report titled “We Can’t Stop at Almost,” Gates said the move could lead to a sharp rise in child deaths around the world. He described the cuts as “a gigantic mistake” and warned that they could reverse decades of progress in global health.
According to the report, child mortality is projected to increase for the first time this century. In 2024, an estimated 4.6 million children died before reaching the age of five. That number is expected to rise to 4.8 million in 2025, an increase of more than 200,000 deaths in a single year.
The Foundation links the rise directly to a drop in global health funding. It reports that development assistance for health fell by 26.9% in 2025 compared with the previous year. Gates said the funding reduction is partly driven by decisions from wealthy nations, including the United States, to scale back international aid spending.
“If global health funding cuts persist, no fewer than 16 million children could die by 2045,” the report stated. It added that a permanent cut of 20% could result in 12 million additional deaths, while a 30% reduction would push that figure to 16 million.
The criticism comes after President Donald Trump, following his return to office, signed an executive order pausing large portions of U.S. foreign aid under his “America First” policy. The order affects funds distributed through the State Department and USAID. The administration said the move is intended to ensure that foreign assistance aligns with U.S. national interests and is spent efficiently.
USAID is the main American agency responsible for providing humanitarian and development support overseas. It funds health programs that include childhood vaccinations, HIV treatment, malaria prevention, maternal health services and responses to disease outbreaks.
Gates said the impact of the cuts would be felt most in low-income countries where public health systems depend heavily on international support. “Millions of lives are on the line,” he said, adding that the world has the scientific tools to prevent many of these deaths, but is failing to provide the funding to deliver them.
The Gates Foundation acknowledged it will continue to support global health programs but said private organisations cannot replace government funding. “Even with strong private philanthropy, the scale of government support cannot be matched,” the report said.
The Foundation also highlighted evidence that investment in health brings long-term benefits. It stated that strong primary healthcare systems can prevent up to 90% of child deaths for less than $100 per person per year, and that every $1 spent on vaccines delivers about $54 in economic and social returns. Through Gavi, the Vaccine Alliance, more than 1.2 billion children have received vaccinations since 2000.
In Nigeria, health officials and medical groups have raised concerns that the U.S. decision could severely affect healthcare delivery. USAID funds a significant share of Nigeria’s programs for immunisation, HIV treatment, malaria control and maternal healthcare.
Gates called the current situation a critical moment for global health. He said the choices made by governments in the coming years would determine whether child survival continues to improve or begins to decline.
“We have the knowledge to save lives,” Gates said. “What is missing is the will to fund it.”
