Bill Gates and the Gates Foundation are raising the alarm over the deadly impacts of international funding cuts in global health. Slashed budgets are projected to reverse decades of progress, causing the number of children dying before their fifth birthday to rise for the first time this century. An estimated 4.8 million children are expected to die this year, an increase of 200,000 deaths compared to last year.

“That is something that we hope never to report on, but it is a sad fact. And there are many causes, but clearly one of the key causes has been significant cuts in international development assistance from a number of high-income countries,” said Mark Suzman, CEO of the Gates Foundation, in a briefing with media this week.

Suzman specifically called out the U.S., the United Kingdom, France and Germany for “making significant cuts” to their support. Internationally, funding plunged 26.9% below last year’s levels, according to the philanthropy.

The Gates Foundation today released its annual Goalkeepers Report, which tracks progress on measures including poverty, hunger, access to clean water and energy, environmental benchmarks and other metrics.

The Seattle-based foundation worked with the University of Washington’s Institute for Health Metrics and Evaluation to model the effects of reduced assistance. The researchers found that if the cuts to aid persist or worsen, an additional 12 million to 16 million children could die over the next 20 years.

While offering dire projections, the document aims to be a call to action for governments and philanthropists large and small.

“This report is a roadmap to progress,” Gates writes, “where smart spending meets innovation at scale.”

The billionaire Microsoft co-founder calls out some specific areas that could yield the most benefit, including primary healthcare, routine immunizations, the development of improved vaccines and new uses of data.

Modeling in the report predicts that by 2045, better vaccines for respiratory syncytial virus (RSV) and pneumonia could save 3.4 million children, while new malaria tools could save an additional 5.7 million kids. Shots of lenacapavir could successfully prevent and treat HIV.

The foundation calls attention to the life-saving benefits of vaccinations as the U.S. Secretary of Health Robert F. Kennedy Jr. continues to undercut public support of vaccines.

With the backdrop of reduced federal funding for global humanitarian causes and backpedaling on vaccinations, Gates earlier this year announced plans to give away $200 billion — including nearly all of his wealth — over the next two decades through the Gates Foundation.

The Seattle-based organization, which celebrates its 25th anniversary this year, will sunset its operations on Dec. 31, 2045. The philanthropy is the world’s largest and has already disbursed $100 billion since its founding.

“If we do more with less now — and get back to a world where there’s more resources to devote to children’s health — then in 20 years, we’ll be able to tell a different kind of story,” Gates writes in the report. “The story of how we helped more kids survive childbirth, and childhood.”

Less than two weeks ahead of the United Nations climate conference, Bill Gates posted a memo on his personal blog encouraging folks to just calm down about climate change.

“Although climate change will have serious consequences — particularly for people in the poorest countries — it will not lead to humanity’s demise. People will be able to live and thrive in most places on Earth for the foreseeable future,” Gates wrote.

The missive seems to run counter to earlier climate actions taken by the Microsoft co-founder and billionaire, but also echoes Gates’ long-held priorities and perspectives. In some regards, it’s the framing, timing and broader political context that heighten the memo’s impact.

What the world needs to do, he said, is to shift the goals away from reducing carbon emissions and keeping warming below agreed-upon temperature targets.

“This is a chance to refocus on the metric that should count even more than emissions and temperature change: improving lives,” he wrote. “Our chief goal should be to prevent suffering, particularly for those in the toughest conditions who live in the world’s poorest countries.“

More than four years ago, Gates published “How to Avoid a Climate Disaster,” a book highlighting the urgency and necessity of cutting carbon emissions and promoting the need to reduce “green premiums” in order to make climate friendly technologies as cheap as unsustainable alternatives.

“It’ll be tougher than anything humanity’s ever done, and only by staying constant in working on this over the next 30 years do we have a chance to do it,” Gates told GeekWire in 2021. “Having some people who think it’s easy will be an impediment. Having people who think that it’s not important will be an impediment.”

Gates’ clean energy efforts go back even earlier. In 2006 he helped launch the next-gen nuclear company TerraPower, which is currently building its first reactor in Wyoming. In 2015 he founded Breakthrough Energy Ventures, a $1 billion fund to support carbon-cutting startups, which evolved into Breakthrough Energy, an umbrella organization tackling clean tech policies, funding for researchers and data generation.

Earlier this year, however, Gates began taking steps that suggested a cooling commitment to the challenge.

Roughly two months after President Trump took office in January, and as clean energy policies and funding began getting axed, Breakthrough Energy laid off staff. In May Gates announced he would direct nearly all of his wealth to his eponymous global health foundation, deploying $200 billion through the organization over two decades.

At the same time, many of the key points in the memo published today reflect statements that Gates has made in the past.

In both his new post and at a 2022 global climate summit organized in Seattle by Breakthrough Energy, Gates urged people to focus on reducing green premiums more than on cutting emissions as a key benchmark.

“If you keep the primary measures, which is the emissions reductions in the near term, you’re going to be very depressed,” Gates said. At his summit talk, he shared optimism that new innovations were arriving quickly and would address climate challenges.

A curious paradox in Gates’ stance is the reality that people living in lower-income nations and in regions important to the Gates Foundation are often hardest hit by the rising temperatures and natural disasters that are stoked by increased carbon emissions.

Gates acknowledged that truth in his post this week, and said that solutions such as engineering drought tolerant crops and making air conditioning more widespread can address some of those harms. At the Seattle summit three years ago, one of the Breakthrough Energy executives likewise said the organization was going to increase its investment into technologies for adapting to climate change.

On Nov. 10, global climate leaders will meet in Brazil for COP30 to discuss climate progress and issues. Gates has often attended the event, but the New York Times reported that won’t be the case this year.

UN efforts meanwhile continue to emphasize the importance of reducing emissions. A statement today from the organization notes that while carbon emissions are curving downward, it’s not happening fast enough.

The world needs to raise its climate ambitions, the statement continues, “to avoid the worst climate impacts by limiting warming to 1.5°C this century, as science demands.”