📉 Diarrhea-related deaths among children reduced by 72 percent in 25 years

• Deaths from diarrhea among children under five have dropped from 3.1 million annually in 1997 to 340,000 today.
• Rotavirus vaccines that cost $200 per dose in the 2000s now cost about one dollar.
• Since 1990, 2.6 billion people have gained access to safe drinking water.

Vaccines made the difference

When the Gates Foundation started its work in 1997, 3.1 million children died annually from diarrhea, writes Bill Gates. Most were under five years old. Rotavirus was the leading cause of severe diarrhea and death among children.

The first rotavirus vaccines cost around $200 per dose in the early 2000s. This made them inaccessible to most families worldwide. The Gates Foundation worked with vaccine manufacturers in India like Bharat Biotech and Serum Institute to develop cheaper alternatives.

Today, rotavirus protection costs about one dollar per dose. The organization Gavi helped low-income countries purchase vaccines for millions of children and supported countries as they added it to their routine immunization programs.

Improved sanitation and clean water

At the same time, major progress was made in clean water and sanitation. Since 1990, 2.6 billion people worldwide have gained access to safe drinking water. The number of people with basic sanitation has increased dramatically.

These improvements break a cycle where children get sick, recover, and then get reinfected a few weeks later. Public health campaigns promoted treatments like oral rehydration salts and zinc supplements that can save a sick child's life for pennies.

USAID played a major role by helping local governments train community health workers and strengthen their vaccine delivery systems.

Remaining challenges

Despite the progress, around 340,000 children under five still die from diarrhea each year. Many children still don't get vaccinated. Some live in places where health systems are weak or vaccines are hard to transport and store. Others are in conflict zones that make it dangerous for health workers to reach them.

Shigella, one of the nastiest bacterial causes of diarrhea, is becoming increasingly resistant to antibiotics. There is no vaccine against shigella yet. Climate change makes cholera and typhoid outbreaks more common as floods contaminate water supplies and droughts force people to drink from unclean sources.

For malnourished children, everything is harder. They are more vulnerable to diarrheal diseases from the start, and their damaged digestive systems don't respond as well to oral vaccines or treatments.

New tools being developed

The Gates Foundation supports scientists working on a vaccine against shigella, which has become the leading bacterial cause of childhood diarrhea. They also fund efforts to combine different vaccines into a single shot, which would lower costs.

New delivery methods could make a big difference. One example is vaccine patches for measles that don't require needles, refrigeration, or trained staff to administer.

Scientists are studying how chronic infections damage children's guts and make it harder for them to absorb nutrients or respond to vaccines. Now they're researching how to repair that damage.

Environmental monitoring tools are being developed to detect early signs of outbreaks by regularly testing sewage for typhoid. It works like an early warning system for epidemics.

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