The Hope Report 2026: A Chance For Every Child

Executive Summary:

For the first time in living memory, the global decline in child mortality has stalled. After decades of steady progress, the number of children dying before their fifth birthday is no longer falling. This marks a critical turning point in global child health and signals that hard-won gains are now under threat.

Since 1990, under-5 mortality has fallen by more than 60%, one of the most significant achievements in global development. Vaccines alone are estimated to have saved over 150 million lives, alongside simple, cost-effective interventions such as bed nets and oral rehydration therapy. These successes were not accidental; they were the result of sustained investment, political commitment, and international cooperation, demonstrating that large-scale progress is possible when the global system works together.

Despite this progress, nearly 4.9 million children still die each year before their fifth birthday, with almost all of these deaths being preventable. Progress has also been deeply unequal: while child mortality has fallen dramatically in regions such as East Asia and the Pacific, reductions in sub-Saharan Africa have been far more limited, leaving children there far more likely to die before age five than in high-income regions. These gaps are not primarily medical failures, but failures of delivery — reflecting underfunded and overstretched health systems.

That progress is now at risk of reversing. Recent reductions in development assistance are already having severe consequences, with modelling suggesting that aid cuts could result in millions of additional avoidable deaths by 2030, including 5.4 million children. Early evidence indicates that hundreds of thousands of children may already have died as a result of abrupt funding withdrawals. These cuts not only cost lives in the present, but also undermine long-term economic and social development.

The report frames a path forward through three interconnected stages: survive, thrive, and drive. Children must first survive, then be supported to thrive through health, education, and opportunity. But sustained progress ultimately depends on “drive” — countries having the resources, agency, and institutions to lead their own health strategies. Where countries are in control, outcomes improve and progress becomes self-reinforcing; without this, survival and thriving remain dependent on unstable external support.

Key findings:

Almost 4.9 million children already die every year before their fifth birthday, almost all of these deaths are from preventable or treatable causes.
New analysis from the ONE Campaign warns that aid cuts could result in one child dying every 35 seconds by 2030, equivalent to an additional 5.4 million child deaths.
A child born in sub-Saharan Africa is around fourteen times more likely to die before age five than a child born in Northern America or Western Europe.

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Recommendations

The UK government should put global child survival at the centre of its international development policy. Three choices will determine whether progress continues or reverses.

Choose Investment. Set a path to restore ODA to 0.7% of GNI. Reinstate full funding to Gavi and the Global Fund. Restore support to the Global Polio Eradication Initiative. Prioritise the proven interventions — vaccines, maternal and neonatal care, nutrition — that save the most lives per pound spent.
Choose Equity. Direct programming towards the highest-burden countries and hardest-to-reach communities — zero-dose children, mothers without skilled care, children in conflict-affected settings. Equity, not just aggregate progress, must be the measure of success.
Choose Reform. Use G20 influence to champion debt restructuring, affordable financing through multilateral development banks, and action on illicit financial flows that cost Africa an estimated $88.6 billion annually.¹ Reform is the precondition for drive — and drive is what makes progress sustainable.

Key Data

Number of deaths per 100 lives births (2024)

Region	Number of deaths per 100 live births
Sub-Saharan Africa	7.12
South Asia	3.35
Middle East & North Africa	2.05
Latin America & Caribbean	1.54
East Asia & Pacific	1.32
Europe & Central Asia	0.78
North America	0.64
World	3.74

Countries with highest incidence of child mortality

Ranking	Country	Incidence of Child Mortality
1	Nigeria	11.6%
2	Niger	11.1%
3	Somalia	10.1%
4	South Sudan	9.7%
4	Chad	9.7%
6	Guinea	9.2%
7	Sierra Leone	9.1%
8	Central African Republic	9.0%
8	Congo, Dem. Rep.	9.0%
10	Liberia	8.6%
11	Mali	7.3%
12	Equatorial Guinea	6.8%
13	Guinea-Bissau	6.7%
14	Cameroon	6.5%
14	Côte d’Ivoire	6.5%
14	Zimbabwe	6.5%
17	Madagascar	6.2%
17	Sudan	6.2%
19	Lesotho	6.0%
20	Mozambique	5.9%
21	Pakistan	5.6%
21	Togo	5.6%
23	Afghanistan	5.3%
23	Haiti	5.3%
25	Kiribati	5.3%
26	Angola	4.9%
26	Djibouti	4.9%
26	Malawi	4.9%
26	Uganda	4.9%
30	Timor-Leste 4.8%	4.8%
30	Zambia	4.8%

The table below shows the link between specific decisions and their projected human cost.

Decision / Trend	Impact
Global aid cuts	22 million additional deaths by 2030² including 5.4m children
US funding reductions (2025)	14 million additional deaths by 2030³
UK Global Fund reduction (£150m)	255,000 fewer lives saved⁴
UK cuts to vaccination funding	170,000 fewer lives saved per £100m cut⁵

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References

Authors

Eden Kulig, ONE Campaign
Sabrina de Souza, Project Everyone