The Bill and Melinda Gates Foundation likes to promote a sense of optimism about the progress that the world has made in fighting poverty and improving global health over the last two decades—for instance, the fact that as more children in low-income countries have gotten access to childhood vaccines, millions of lives have been saved. But in the foundation’s newest Goalkeepers Report, an annual report that tracks how the world is advancing on the United Nations’ Sustainable Development Goals, the news is now grim: After years of progress, the pandemic is setting the world back on most of the goals.

The number of people getting vaccinated, for example, has dropped to levels not seen since the 1990s. “In other words, we’ve been set back about 25 years in about 25 weeks,” Bill and Melinda Gates write in the report. Disruptions in healthcare mean that people with diseases such as HIV or TB are less likely to get treatment. The economic catastrophe caused by the virus means that people are struggling to afford food or keep a roof over their heads. Developing countries are finding innovative ways to help—India sent digital cash transfers to 200 million women soon after the pandemic began—but are still limited by budgets. As part of the report, the Institute for Health Metrics and Evaluation, a Gates-backed program at the University of Washington, calculated that so far this year, nearly 37 million people globally have fallen below the extreme poverty line of $1.90 a day.

The situation can’t improve until the pandemic is under control, something that’s still far from happening.

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