“Progress has now stopped.” “We’ve regressed.” “We’ve been set back about 25 years in about 25 weeks.” These dire statements stand out in the introduction of the Gates Foundation’s Goalkeepers Report, titled COVID-19: A Global Perspective. Released this week, the fourth annual report tracks progress on 18 global goals, ranging from ending poverty to fighting inequalities. The report had always delivered good news on all fronts—until this year, due to the COVID-19 pandemic.

In addition to the illness and death caused by the new coronavirus, the pandemic “affects every aspect of society” across the globe. “In the blink of an eye,” write the authors of the report, “a health crisis became an economic crisis, a food crisis, a housing crisis, a political crisis. Everything collided with everything else.”

For example, extreme poverty increased 7% because of COVID-19, and vaccine coverage—considered a barometer for gauging how well health care systems are operating—decreased to 1990s levels.

What’s more, the pandemic has magnified existing inequalities worldwide. In low-and middle-income countries, women are more likely to be newly impoverished because they work in fields such as domestic work that have been hard-hit by the pandemic and receive little support from the government. And because COVID-19 has disrupted health care related to childbirth, women are more likely than men to suffer and die because of the pandemic.

In the United States, the report points out, 23% of white Americans worried they couldn’t pay rent in August; among African Americans and Latinos, that number jumped to 46%. In addition, African Americans and Latinos are more likely to get sick and die of COVID-19.

The pandemic also hinders the United Nations’ global efforts to end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases. In a video included in the report, Bill Gates explains how COVID-19 disrupts the fight against malaria (you can watch the video at the top of this article).

Bill & Melinda Gates Foundation, 2020 Goalkeepers Report

Bill & Melinda Gates Foundation, 2020 Goalkeepers Report

In a section about HIV, the report looks at various scenarios for rates in the future but also notes:

Current evidence shows that people living with HIV are at increased risk of death due to COVID-19. But the indirect effects of the pandemic are also worrying.

Disruptions to health services could mean people don’t get antiretroviral therapy (ART), which would result in more deaths and more infections (because viral loads are higher in untreated patients, they are more likely to transmit to others). So far, this worst-case scenario has not happened, although some countries are struggling to maintain services. One innovation that seems to be helping is multi-month dispensing—a simple approach that helps people fit treatment into their lives and keeps them out of overburdened clinics. Even after COVID is under control, this will be a more effective, efficient way to dispense ART.

The report does offer a glimmer of hope. Although the pandemic has taken the world a step back from progress, we can act now to prevent even worse outcomes. Innovations such as new ways to distribute meds and conduct contact tracing of people with COVID-19, the report notes, will help. As will vaccine research and the financial support of nations such as the United States.

A press release for the Goalkeepers Report highlighted data from Northwestern University showing that if wealthy countries buy up the first 2 billion doses of vaccines instead of distributing them equally, nearly twice as many people will die of COVID-19.

“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,” Melinda Gates said in the press release. “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.”