GFO Issue 468, Article Number: 2
ABSTRACT
This article analyzes Goalkeepers New York 2025, the flagship event of the Bill & Melinda Gates Foundation, which has placed child survival back at the center of the global agenda. In a context of reduced international aid to health, the message is clear: do more with less by focusing resources on the most cost-effective interventions—immunization, newborn health, large-scale innovations, and strengthening primary care. By awarding Spain for its financial commitment, the foundation also sent a strong political signal in favor of multilateralism and sustainable financing. The 2025 edition thus serves as a plea for proactive realism, calling for immediate budgetary decisions to prevent the progress made since 2000 from being permanently stalled.
The Bill & Melinda Gates Foundation's Goalkeepers event brought child survival back to the forefront. In two highly staged hours, the message was simple and direct: "We cannot stop at almost." In other words, the world has halved the under-five mortality rate since 2000, but the curve is slowing dangerously; the budgetary and political choices of the coming months will determine, for a generation, the trajectory of lives saved. Beyond the event's veneer, what should we take away from this 2025 edition? What place does it occupy within the ecosystem of major health initiatives? And where are the blind spots?
Where does Goalkeepers come from and what is its purpose?
Launched in 2017 by the Bill & Melinda Gates Foundation, the Goalkeepers platform set itself a simple mission, difficult to maintain: to keep the Sustainable Development Goals (SDGs) "on edge" by publishing indicators, celebrating "champions," and creating an annual political moment at the United Nations General Assembly. The 2025 edition saw a strategic tightening: making the end of preventable child deaths the central theme of the narrative, panels, and announcements. This "specialization" is not a mere communication whim; it responds to a stark statistical reality : 4.8 million children died before the age of five in 2023, including 2.3 million newborns, and the rate of decline has slowed since 2015 - a major warning for SDG 3.2. Data from the United Nations Inter-Agency Group (UN IGME) sets the scene: we are halfway through with no trajectory compatible with 2030, unless there is a rapid shift in investment policies, vaccination coverage, neonatal health and nutrition.
A “media moment” aimed at influencing budgetary decisions. The choice of September 22nd in New York - at the opening of the General Assembly - is not insignificant: Goalkeepers seeks to juxtapose health advocacy with the budgetary calendar of donors, replenishment conferences (Global Fund , Gavi), and national finance laws. In 2025, the event's official website clearly states its ambition: “to protect achievements, celebrate leaders, and unlock the next wave of breakthroughs for the world’s children,” with the motto “ we "can't stop at almost ." The framework is twofold: defense of effective multilateral mechanisms (Global Fund, Gavi) and acceleration of deployable innovations (maternal vaccines, new generations of anti-malarial tools, long-acting products against HIV, targeted uses of AI for the supply chain and quality of care).
Goalkeeper Champions are Dr. Abhay and Dr. Rani Bang (India), David Beckham (United Kingdom), and Krystal Mwesiga. Birungi (Uganda), Toni Garrn (Germany), John Green (United States), Osas Ighodaro (Nigeria), Dr. Donald Kaberuka (Rwanda), Jerop Limo (Kenya), Reem Al- Hashimy (United Arab Emirates), and Dr. Naveen Thacker (India). The foundation also named Pedro Sánchez , President of the Spanish Government, as the recipient of the Global Goalkeeper Award. Award 2025.
By awarding this prize to the Spanish Prime Minister, the New York edition sent a clear signal: to reward policymakers who increase their ODA and support the replenishment of major mechanisms. Official documents mention increased contributions to Gavi and the Global Fund, as well as Spain's role in the Financing for Development conference (June 2025). Beyond the symbolism, this decision establishes a narrative of coalition that links financial diplomacy, multilateralism, and measurable health outcomes for children.
2025 Edition: Between Budgetary Advocacy and a Techno-Political Roadmap
1) A plea for "offensive realism" in a period of economic hardship
The 2025 edition comes at a time when IHME projections indicate a decline in development aid for health (DAH) between 2024 and 2025 – a context of health austerity where every dollar must prove its worth. Faced with this contraction, New York's message was not to promise the moon but to "direct every dollar" towards the most cost-effective interventions to save children's lives, with a focus on immunization, neonatal care, and the fight against major endemic diseases (HIV, tuberculosis, malaria).
In a context of shrinking global aid for health, Bill Gates called for "doing more with less" and announced a commitment of $912 million to the Global Fund for the 2026-2028 replenishment cycle, with a clear appeal to governments to "come to the table" before the end of the cycle . More broadly, the message is twofold: on the one hand, the centrality of multilateral performance mechanisms (Global Fund, Gavi) for child survival is affirmed; on the other, it is acknowledged that the political window for decision-making is now measured in weeks rather than years, under penalty of losing hard-won gains.
2) A three-step roadmap… and “evidence of scalability”
The first step: reinvest in what works. Immunization remains the cornerstone of child survival; however, the gains made between 2000 and 2015 were hampered by "zero-dose" children, measles, and, in Africa, malaria. By 2025, Gavi confirmed a change of scale: 23 African countries had integrated a malaria vaccine into their routine immunization schedules by September 18, while the cost per dose is structurally decreasing (prices announced for RTS,S , and R21). This momentum, which began in Cameroon (launched in 2024) and has continued in Ghana, Kenya, Burkina Faso, and elsewhere , aims to protect millions of children by 2024-2025 (aggregated plans of approximately 6.6 million), with a clear operational challenge: cold chain, stockpiles, and adherence to vaccination schedules.
The second priority is strengthening primary healthcare and neonatal care. Neonatal deaths - prematurity, asphyxia, infections - require comprehensive care packages (quality delivery, medical oxygen, judicious antibiotic therapy, kangaroo care, breastfeeding, infection prevention) and robust systems (trained staff, reliable oxygen and electricity, referrals). The 2025 roadmap emphasizes optimizing supply chains (where AI can reduce disruptions and obsolescence) and improving the quality of care in the last mile, precisely where "avoidable" lives are lost. UNIGME estimates confirm that this is where the majority of stagnant mortality occurs.
Third step: financing and deploying innovations ready for scale. Beyond malaria vaccines, the 2025 plan includes maternal vaccines (RSV, Group B streptococcus in the future), long-acting agents (contraception, HIV prevention), AI-enhanced imaging and diagnostic tools, and group purchasing models adapted to the volumes and risks of low- and middle-income countries. The key word is not "innovation" but "industrialized innovation": products whose cost, manufacturing capacity, and logistics are compatible with mass deployment in districts. The Beginnings Fund (launched in April 2025) illustrates this bet in MNCH: patient capital, partnership approach and explicit impact metrics (mothers and newborns saved) .
3) Symbols that matter: prices, coalitions, financial diplomacy
Let us emphasize once again that by honoring Pedro Sánchez, Goalkeepers has linked advocacy, budgeting, and diplomacy. The message to other capitals is clear: pro-multilateral alignment is measured by increased contributions (Global Fund, Gavi) and the facilitation of coalitions (Conference on Financing for Development), not by virtuous declarations. The foundation's official channels explicitly detail this sequence of actions and expected results.
Blind spots and political shifts
1) “Health austerity” and the hierarchy of priorities
The projected cuts to healthcare funding create a constraint: every dollar must prove its health-economic return. The risk? An over-reliance on vertical integration that marginalizes nutrition, maternal mental health, or the fight against antimicrobials. The balance proposed by Goalkeepers - vertical (diseases) and cross-cutting (PHC, supply chains) - is sound, but depends on difficult national budgetary trade-offs.
2) Philanthropy and accountability
The weight of philanthropic announcements (for example, funds dedicated to maternal and neonatal health) is increasing, but the criteria for additionality and country alignment must be robust. The 2025 event emphasized working "with" governments, not "instead of" them. Concrete transparency mechanisms will be needed to avoid duplication and measure the impact on the major causes of death (prematurity, infections, pneumonia, diarrhea).
3) Regional production and health sovereignty
The 2024-2025 period saw the rise of the African Vaccine Manufacturing Accelerator (AVMA) and an intensification of the debate on regional capacity. Goalkeepers refers to them as stakeholders in the "next breakthroughs," but industrial integration into funded programs (Gavi , Global Fund) needs to be clarified to avoid a gap between the narrative and the markets.
Conclusion: "Don't stop at almost"
In New York, Goalkeepers 2025 didn't just celebrate heroes; it focused on the most fundamental question: when a child dies from a preventable cause, it's a failure of investment and organization, not of science. International data shows a slowdown in progress since 2015; the announcements in New York (roadmap, Global Fund funding, focus on Gavi) offer a realistic and proactive approach: securing the mechanisms that deliver care, strengthening primary healthcare, and accelerating the deployment of scalable innovations.
The credibility of this promise will be tested in the coming months, during the national budget and spending decisions. If these decisions are met, millions more children will be able to live beyond their fifth birthday; if not, the decade will end on a near miss – and history will judge harshly this "adjustment" that could have been avoided.
The Bill & Melinda Gates Foundation's Goalkeepers event brought child survival back to the forefront. In two highly staged hours, the message was simple and direct: "We cannot stop at almost." In other words, the world has halved the under-five mortality rate since 2000, but the curve is slowing dangerously; the budgetary and political choices of the coming months will determine, for a generation, the trajectory of lives saved. Beyond the event's veneer, what should we take away from this 2025 edition? What place does it occupy within the ecosystem of major health initiatives? And where are the blind spots?
Where does Goalkeepers come from and what is its purpose?
Launched in 2017 by the Bill & Melinda Gates Foundation, the Goalkeepers platform set itself a simple mission, difficult to maintain: to keep the Sustainable Development Goals (SDGs) "on edge" by publishing indicators, celebrating "champions," and creating an annual political moment at the United Nations General Assembly. The 2025 edition saw a strategic tightening: making the end of preventable child deaths the central theme of the narrative, panels, and announcements. This "specialization" is not a mere communication whim; it responds to a stark statistical reality : 4.8 million children died before the age of five in 2023, including 2.3 million newborns, and the rate of decline has slowed since 2015 - a major warning for SDG 3.2. Data from the United Nations Inter-Agency Group (UN IGME) sets the scene: we are halfway through with no trajectory compatible with 2030, unless there is a rapid shift in investment policies, vaccination coverage, neonatal health and nutrition.
A “media moment” aimed at influencing budgetary decisions. The choice of September 22nd in New York - at the opening of the General Assembly - is not insignificant: Goalkeepers seeks to juxtapose health advocacy with the budgetary calendar of donors, replenishment conferences (Global Fund , Gavi), and national finance laws. In 2025, the event's official website clearly states its ambition: “to protect achievements, celebrate leaders, and unlock the next wave of breakthroughs for the world’s children,” with the motto “ we "can't stop at almost ." The framework is twofold: defense of effective multilateral mechanisms (Global Fund, Gavi) and acceleration of deployable innovations (maternal vaccines, new generations of anti-malarial tools, long-acting products against HIV, targeted uses of AI for the supply chain and quality of care).
Goalkeeper Champions are Dr. Abhay and Dr. Rani Bang (India), David Beckham (United Kingdom), and Krystal Mwesiga. Birungi (Uganda), Toni Garrn (Germany), John Green (United States), Osas Ighodaro (Nigeria), Dr. Donald Kaberuka (Rwanda), Jerop Limo (Kenya), Reem Al- Hashimy (United Arab Emirates), and Dr. Naveen Thacker (India). The foundation also named Pedro Sánchez , President of the Spanish Government, as the recipient of the Global Goalkeeper Award. Award 2025.
By awarding this prize to the Spanish Prime Minister, the New York edition sent a clear signal: to reward policymakers who increase their ODA and support the replenishment of major mechanisms. Official documents mention increased contributions to Gavi and the Global Fund, as well as Spain's role in the Financing for Development conference (June 2025). Beyond the symbolism, this decision establishes a narrative of coalition that links financial diplomacy, multilateralism, and measurable health outcomes for children.
2025 Edition: Between Budgetary Advocacy and a Techno-Political Roadmap
1) A plea for "offensive realism" in a period of economic hardship
The 2025 edition comes at a time when IHME projections indicate a decline in development aid for health (DAH) between 2024 and 2025 – a context of health austerity where every dollar must prove its worth. Faced with this contraction, New York's message was not to promise the moon but to "direct every dollar" towards the most cost-effective interventions to save children's lives, with a focus on immunization, neonatal care, and the fight against major endemic diseases (HIV, tuberculosis, malaria).
In a context of shrinking global aid for health, Bill Gates called for "doing more with less" and announced a commitment of $912 million to the Global Fund for the 2026-2028 replenishment cycle, with a clear appeal to governments to "come to the table" before the end of the cycle . More broadly, the message is twofold: on the one hand, the centrality of multilateral performance mechanisms (Global Fund, Gavi) for child survival is affirmed; on the other, it is acknowledged that the political window for decision-making is now measured in weeks rather than years, under penalty of losing hard-won gains.
2) A three-step roadmap… and “evidence of scalability”
The first step: reinvest in what works. Immunization remains the cornerstone of child survival; however, the gains made between 2000 and 2015 were hampered by "zero-dose" children, measles, and, in Africa, malaria. By 2025, Gavi confirmed a change of scale: 23 African countries had integrated a malaria vaccine into their routine immunization schedules by September 18, while the cost per dose is structurally decreasing (prices announced for RTS,S , and R21). This momentum, which began in Cameroon (launched in 2024) and has continued in Ghana, Kenya, Burkina Faso, and elsewhere , aims to protect millions of children by 2024-2025 (aggregated plans of approximately 6.6 million), with a clear operational challenge: cold chain, stockpiles, and adherence to vaccination schedules.
The second priority is strengthening primary healthcare and neonatal care. Neonatal deaths - prematurity, asphyxia, infections - require comprehensive care packages (quality delivery, medical oxygen, judicious antibiotic therapy, kangaroo care, breastfeeding, infection prevention) and robust systems (trained staff, reliable oxygen and electricity, referrals). The 2025 roadmap emphasizes optimizing supply chains (where AI can reduce disruptions and obsolescence) and improving the quality of care in the last mile, precisely where "avoidable" lives are lost. UNIGME estimates confirm that this is where the majority of stagnant mortality occurs.
Third step: financing and deploying innovations ready for scale. Beyond malaria vaccines, the 2025 plan includes maternal vaccines (RSV, Group B streptococcus in the future), long-acting agents (contraception, HIV prevention), AI-enhanced imaging and diagnostic tools, and group purchasing models adapted to the volumes and risks of low- and middle-income countries. The key word is not "innovation" but "industrialized innovation": products whose cost, manufacturing capacity, and logistics are compatible with mass deployment in districts. The Beginnings Fund (launched in April 2025) illustrates this bet in MNCH: patient capital, partnership approach and explicit impact metrics (mothers and newborns saved) .
3) Symbols that matter: prices, coalitions, financial diplomacy
Let us emphasize once again that by honoring Pedro Sánchez, Goalkeepers has linked advocacy, budgeting, and diplomacy. The message to other capitals is clear: pro-multilateral alignment is measured by increased contributions (Global Fund, Gavi) and the facilitation of coalitions (Conference on Financing for Development), not by virtuous declarations. The foundation's official channels explicitly detail this sequence of actions and expected results.
Blind spots and political shifts
1) “Health austerity” and the hierarchy of priorities
The projected cuts to healthcare funding create a constraint: every dollar must prove its health-economic return. The risk? An over-reliance on vertical integration that marginalizes nutrition, maternal mental health, or the fight against antimicrobials. The balance proposed by Goalkeepers - vertical (diseases) and cross-cutting (PHC, supply chains) - is sound, but depends on difficult national budgetary trade-offs.
2) Philanthropy and accountability
The weight of philanthropic announcements (for example, funds dedicated to maternal and neonatal health) is increasing, but the criteria for additionality and country alignment must be robust. The 2025 event emphasized working "with" governments, not "instead of" them. Concrete transparency mechanisms will be needed to avoid duplication and measure the impact on the major causes of death (prematurity, infections, pneumonia, diarrhea).
3) Regional production and health sovereignty
The 2024-2025 period saw the rise of the African Vaccine Manufacturing Accelerator (AVMA) and an intensification of the debate on regional capacity. Goalkeepers refers to them as stakeholders in the "next breakthroughs," but industrial integration into funded programs (Gavi , Global Fund) needs to be clarified to avoid a gap between the narrative and the markets.
Conclusion: "Don't stop at almost"
In New York, Goalkeepers 2025 didn't just celebrate heroes; it focused on the most fundamental question: when a child dies from a preventable cause, it's a failure of investment and organization, not of science. International data shows a slowdown in progress since 2015; the announcements in New York (roadmap, Global Fund funding, focus on Gavi) offer a realistic and proactive approach: securing the mechanisms that deliver care, strengthening primary healthcare, and accelerating the deployment of scalable innovations.
The credibility of this promise will be tested in the coming months, during the national budget and spending decisions. If these decisions are met, millions more children will be able to live beyond their fifth birthday; if not, the decade will end on a near miss – and history will judge harshly this "adjustment" that could have been avoided.
