The global coronavirus pandemic has worsened ongoing equity gaps between wealthy and poor countries, pushed millions of people into extreme poverty and cratered many economic projections — but a recent report from the Bill & Melinda Gates Foundation found the state of the world near the end of 2021 could have been much worse.

In the Gates Foundation’s fifth annual Goalkeepers report this year, a report that tracks the United Nations’ global health, poverty and climate goals, the effects of the coronavirus pandemic sit at the heart of each progress check. The report shows that for some countries, years of work remain before they can return to pre-pandemic normalcy.

“I was really worried about things falling off a cliff last year,” said Vishal Gujadhur, the deputy director of development policy and finance at the Gates Foundation. He said he was particularly concerned people would be too afraid of getting sick to go to in-person health clinics to receive vaccines for other diseases.

In last year’s Goalkeepers report, researchers predicted a 14% drop in the global vaccination rate, near levels last seen in the 1990s and almost “erasing 25 years of progress in 25 weeks.” New data shows, however, the decline was about half of what was expected.

Last week, Gujadhur said, “people adapted” and “the community-based networks that made sure that falloff didn’t happen were really strong.”

The report, published Monday evening, uses data from the Institute of Health Metrics and Evaluation — a global health research center housed at the University of Washington — and online scientific publication Our World in Data.


Much of the new report draws attention to the world’s growing equity gaps, including those between wealthier and poor countries, as well as between men and women. While men are 70% more likely to die from COVID-19, the report notes, women have been disproportionately economically impacted. For example, while men’s employment is largely expected to recover to pre-pandemic rates, women’s employment globally is expected to remain 13 million jobs below the 2019 level, the report found, although it didn’t detail reasons why.

“Women face structural barriers in every corner of the world, leaving them more vulnerable to the impacts of the pandemic,” Melinda French Gates wrote in a Monday statement.

In addition, about 31 million people around the world have been “pushed into extreme poverty as a result of COVID-19,” the report says.

In analyzing the economic and health data from this past year, Gujadhur said his main take-away is that while global pandemic recovery numbers are not ideal, they’re not as bad as they could have been.

“There were some really dire predictions last year — it was looking apocalyptic,” he said. ” … And it’s still not great, considering where we thought we would be.”

Still, “it wasn’t as bad as it could be,” Gujadhur continued. “It wasn’t as bad because of the actions that we took and that the international communities took. … There were enough points of light that the kind of worst case scenarios were averted.”


In the United States, and other wealthier countries, Gujadhur pointed to how quickly communities seemed to adapt to virus restrictions and “significant” government action — including large stimulus packages — as two reasons why we “averted some of the worst.”

“But that’s really only been enabled because we’re a wealthy country,” Gujadhur said. “Other countries don’t have those same means available to them. That’s one of the reasons they’re coming back more slowly. … Unfortunately, it’s making our unequal world even more unequal.”

While about 90% of “advanced economies” are expected to bounce back to pre-pandemic per capita income levels by next year, only a third of low- and middle-income economies are expected to do the same, according to the report. South Africa, for example, might not regain pre-pandemic per capita income levels until 2026, Gujadhur said.

The gap means nearly 700 million people around the world will likely remain in extreme poverty by 2030, the report says.

“That’s the part where we’re sort of surveying the wreckage now and saying, ‘Well OK, this is what it looks like,” Gujadhur said. “It’s bad, but we have some good things and let’s build on those good things and let’s try and chart a sort of faster way out of this.”

Vaccine equity gaps also remain significant: More than 80% of all COVID-19 vaccines have been administered in high- and upper-middle-income countries, but in low-income countries, less than 1% of doses have been given, according to the report.


In Africa, just over 3% of people have been fully vaccinated, and health officials often are unsure what will be available from one day to the next, The Associated Press reported over the weekend. While more vaccines have been shuttled in recently, the World Health Organization’s director in Africa said last week the continent will receive 25% fewer doses than anticipated by the end of the year — partially because of the rollout of booster shots in wealthier countries, like the United States.

The worsening divide wasn’t a surprise, Gujadhur said, but he was still “disappointed” to watch the disparity grow, particularly around unequal vaccine distribution.

“You expect, to some extent, that wealthier counties might have a bit more access,” he said. “But I think that we’ve shown we were able to invent a vaccine. … The fact that we can do that says that we should be able to do it and scale (distribution) up faster than we did.”

The report’s findings — which call for more investment in research and development, infrastructure and innovation in “places closer to the people who stand to benefit” — will be disseminated broadly, particularly among global policy makers able to direct resources toward these issues. Gujadhur said he hopes this year’s report will remind government leaders how closely linked global communities can be.

“The interconnected nature of what’s (been) happening over the last year is really stark,” he said. “Hopefully that makes it a little bit clearer in the last year that for a lot of us, things that happen overseas have an impact over here. Innovation overseas can be applied at home.”

Among the report’s other key findings:

  • Poverty: As of 2020, 9% of the world’s population is below the international poverty line. In places where “extreme poverty, epidemic waves, economic challenges, and demographic factors continue to persist,” the report predicts poverty reduction will stall at near current levels by 2030.
  • HIV/AIDS: There now are about 0.25 new cases of HIV per 1,000 people, reflecting a consistent downward trend since the mid-90s.
  • Malaria: This June, the World Health Organization declared China malaria-free, the end to a 70-year journey that at one point counted 30 million cases in the country. In 2020, global data showed 30.8 new cases of malaria per 1,000 people, with a 2030 projection of 31.8 new cases per 1,000 people.
  • Universal Health Coverage: In 2020, data reported a 57.5 score for coverage of essential health services — out of 100 — with a projection of 63.1 by 2030.
  • Vaccines: The pandemic led to “major” disruptions for vaccines for the communicable and noncommunicable diseases that primarily affect developing countries. In 2020, about 75% of the world had completed three doses of the DTP (diphtheria, pertussis and tetanus) vaccine, which WHO says is a key indicator of immunization coverage levels.
  • Gender Equality: Women generally spend 3.1% more time in unpaid care and domestic work than men, with the largest gap between men and women falling in the North African and Central Asian groups of countries. The gap, however exists in every region, the report found.