The Bill & Melinda Gates Foundation's fourth annual Goalkeepers Report shows how the ripple effects of COVID-19 have hampered 20 years of progress toward the United Nations' (UN) Sustainable Development Goals (Global Goals), and calls for a global response to end the pandemic.

The report provides the most up-to-date global dataset for how the pandemic is affecting progress toward the UN's Global Goals. It shows that by nearly every indicator, the world has regressed because of COVID-19: extreme poverty has increased by 7%. Vaccine coverage, a good proxy measure for how health systems are functioning, has dropped to lows last seen in the 1990s, setting the world back 25 years in 25 weeks.

According to the report, economic damage from COVID-19 is also reinforcing inequality. The pandemic has had a disproportionate impact on women, racial and ethnic minority communities, and people already living in extreme poverty. Around the world, women are facing an increased burden from rising demands in total unpaid care work and are experiencing the majority of job losses. In the United States, the percentage of Black and Latinx people who say they cannot pay their rent is twice the percentage of white people.

Despite the bleak projections, Bill and Melinda Gates describe a path to ending the pandemic and resuming progress toward the Global Goals. In the report, which they co-author every year, they call on the world to collaborate on the development of diagnostics, vaccines, and treatment; manufacture tests and doses as quickly as possible, and deliver these tools equitably based on need rather than the ability to pay.

The report also outlines several viable strategies to help achieve an equitable outcome, including continued backing of the Access to COVID-19 Tools (ACT) Accelerator, the most serious collaborative effort to end the pandemic, which has brought together proven organizations like Gavi, the Vaccine Alliance, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

"The response to the COVID-19 pandemic has shown us some of the best of humanity: pathbreaking innovation, heroic acts by frontline workers, and ordinary people doing the best they can for their families, neighbors, and communities," Bill and Melinda Gates write. "This is a shared global crisis that demands a shared global response."

The report makes clear that no single country could meet this challenge alone. Any attempts by one country to protect itself while neglecting others will only prolong the hardships caused by the pandemic. Finally, developing and manufacturing vaccines will not end the pandemic quickly unless they are delivered equitably.

For these reasons, Bill and Melinda Gates believe COVID-19 is a true test for the global community.

"One of the most troubling things about this pandemic is that by disrupting health systems and the global economy, it's starting to erase the progress people have made toward living healthier, more productive lives," said Melinda Gates.

"Our report highlights actions the world can take to turn things around. Researchers are very close to developing safe, effective coronavirus vaccines, but breakthrough science must be met by breakthrough generosity. We need leaders in government and the pharmaceutical industry to ensure that everyone, regardless of where they live, can access these vaccines. And we're hopeful that will happen," she said.

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