Bill Gates, renowned for his long-standing commitment to advancing global health and development, recently shared a sobering update regarding child mortality trends. In his annual letter published on his website, he revealed that for the first time this century, the number of deaths among children under the age of five increased. Specifically, the toll rose from 4.6 million in 2024 to 4.8 million in 2025, marking a distressing reversal after decades of decline.
Gates attributed this setback primarily to diminishing aid budgets worldwide, notably from affluent countries whose financial contributions have historically underpinned significant health improvements. He highlighted that this fluctuation jeopardizes ongoing efforts and urged the international community to restore and enhance funding to reignite progress.
He cautioned that without such restorative measures, adverse trends may persist, complicating the path to resuming declines in child deaths. The next five years, he emphasized, would be particularly challenging as the global health landscape strives to recalibrate and integrate emerging lifesaving tools essential to these efforts.
While recognizing the gravity of recent developments, Gates stopped short of predicting a catastrophic collapse. He expressed confidence that humanity would avoid regressing into a so-called "Dark Age," maintaining belief that the forthcoming decade could herald new, unparalleled advancements on a global scale. This optimism, he underlined, rests on the foundation of ongoing innovation.
Drawing on historical public health victories, Gates underscored the dramatic transformation in HIV treatment outcomes. He reminded readers that an HIV diagnosis once equated to a near-certain death sentence, whereas now, with current therapies, individuals can anticipate lifespans approaching those without the virus. He also pointed to new preventative interventions capable of reducing transmission risk by as much as 99%.
However, Gates warned that such medical breakthroughs bear limited value without sufficient funding, equitable distribution, and scalable implementation. He linked last year’s increase in child mortality to budget cuts that restricted access to critical healthcare tools, framing this regression as both a tragic occurrence and a preventable failure attributable to resource constraints.
Throughout the letter, Gates qualified his optimism, indicating it is measured and contingent upon addressing key global challenges. Among these is the imperative to sustain and increase financial support. He pressed fellow billionaires and the affluent to contribute more substantially and meaningfully, emphasizing that generosity yields tangible and impactful outcomes.
Gates illustrated the severe consequences of austerity in foreign aid by citing projections: a 20% reduction in health funding could result in an additional 12 million child deaths by 2045. This stark statistic highlights the human cost attached to fiscal decisions and the necessity for sustained investment in health initiatives.
He plans to dedicate time engaging with diverse stakeholders, including diaspora groups, faith-based organizations, and healthcare professionals, advocating for children's health funding. Although he refrained from identifying specific governments, the implication was clear that wealthier nations have a responsibility to reverse current funding shortfalls.
Turning to technology, Gates expressed enthusiasm about the potential of artificial intelligence (AI) to catalyze progress. He envisaged applications such as personalized learning environments, scalable healthcare advice, and climate-adaptive tools for small-scale farmers. Nonetheless, he stressed that these advancements must be accessible and affordable globally to realize their promise.
Gates pointed out that despite past progress, many individuals remain dissatisfied with healthcare systems due to cost and complexity. AI technologies, properly and thoughtfully integrated, could alleviate pressure on overwhelmed systems. The Gates Foundation is piloting AI interventions in underserved regions and working to enhance African language accessibility, aiming to ensure inclusive benefits.
In education, he sees AI enabling the delivery of customized instruction, fulfilling a long-held aspiration for tailored learning experiences. Yet, he warned that technological potential alone is insufficient; equitable implementation is vital.
Highlighting new risks, Gates focused less on hypothetical AI uprisings and more on practical concerns such as security threats and economic disruption. He flagged the danger that non-state actors might exploit open-source AI tools to engineer bioterrorism weapons, urging policymakers to prepare for such scenarios proactively.
He also noted that technological advances could lead to labor market upheaval, as seen among developers already facing shifts in demand. The coming five years might see similar impacts on warehouse and support roles, requiring anticipatory planning rather than reactive fear.
In closing, Gates reflected on humanity's capacities for foresight and empathy, citing abundant historical examples of collective care beyond individual or narrow interests. He believes this foundation supports his measured optimism, contending that continued exercise of these virtues can guide the world back to substantive progress after recent setbacks.