Gates Foundation pushes vaccine investment as COVID-19 derails SDGs

The Bill & Melinda Gates Foundation is pushing for more long-term investments in health infrastructure worldwide — including vaccine research, development, and manufacturing capacity — in a new report, which highlights how the COVID-19 pandemic has derailed progress on the Sustainable Development Goals.

In the fifth annual Goalkeepers report, released Monday ahead of the United Nations’ General Assembly, the foundation said investments in building and expanding health systems can serve as “the foundation for emergency disease response” in low-income countries, where millions continue to be disproportionately affected by the economic impacts of COVID-19 and a lack of access to vaccines.

For example, the African continent, which is home to 17% of the world’s population, has less than 1% of the world’s vaccine manufacturing capability, the report said. And it administered roughly the same number of COVID-19 vaccine doses as the U.S. state of California through the first half of 2021, despite having a population that is 30 times larger, according to data collected by the Institute for Health Metrics and Evaluation, a Gates partner. More than 80% of all COVID-19 vaccine doses have been administered in high- and upper-middle-income countries.

“The lack of equitable access to COVID-19 vaccines is a public health tragedy,” Bill Gates, co-chair and trustee at the foundation, said in a statement. “We face the very real risk that in the future, wealthy countries and communities will begin treating COVID-19 as yet another disease of poverty. We can’t put the pandemic behind us until everyone, regardless of where they live, has access to vaccines.”

The Gates Foundation has provided millions of dollars to help deliver COVID-19 vaccines to lower-income countries through COVAX, which aims to provide equitable access to doses. However, the program is now expected to fall nearly 30% behind its goal of providing 2 billion shots this year.

Vishal Gujadhur, deputy director of development policy and finance at the Gates Foundation, told Devex that it was “disappointing” but not surprising that COVAX wouldn’t be able to meet its targets for the year, given the recent surge of the delta variant of COVID-19. Still, he said, the foundation is optimistic that at least 2.3 billion doses will be delivered by the first quarter of next year.

There has been “intense dialogue between COVAX and its member governments to get updated timelines” and to do “as much as they can on the back end so that once things are flowing again, it becomes a little easier to do,” he said.

The Gates Foundation said it is focused on investing in supply chain improvements that would help meet the demands for COVID-19 and other vaccines.

Foundation CEO Mark Suzman said on a press call last week that “there’s work underway with Gavi, [the Vaccine Alliance]; with WHO [the World Health Organization]; with other partners at the country level to make sure that some of that infrastructure is built and ready to distribute the vaccines and ideally to do so in a way that lays the platform and leaves infrastructure behind for addressing broader health challenges going forward.”

He also said that “more significant suppliers” are expected to soon enter into contracts with vaccine manufacturers and that it is “critically important” for high-income countries such as the U.S. to donate some of their COVID-19 vaccine supplies to lower-income nations.

Reversals on extreme poverty and routine vaccinations

The Goalkeepers report also provides data on 18 SDG indicators that the foundation is tracking. It found that COVID-19 also continues to upend progress on eradicating poverty, eliminating gender inequality, and vaccinating children against communicable diseases, furthering a backslide first identified in last year’s Goalkeepers report.

The pandemic reversed progress on eradicating extreme poverty by about four years, the Gates Foundation said. It also disrupted progress on boys’ and girls’ education and resulted in a 7 percentage point dip in the rate of vaccine coverage globally, according to the report.

However, previous projections of up to 25 years’ worth of setbacks on vaccinations have not borne out largely because of “bold action by governments and international agencies,” Suzman said. This included public campaigns encouraging people to stay up to date on routine vaccinations.

A dip in vaccine rates also is something that can be quickly changed, he added.

“The thing with something like vaccination is that it is something that you can catch up on,” Suzman said, adding that “we’re hoping we can actually make up a lot of that difference even still.”

The report also highlights the need for further investment in women and girls. It notes that while men were more likely to die from COVID-19, women have faced more severe economic and social consequences during the pandemic.

The Gates Foundation pledged $2.1 billion for addressing gender equality over five years during the U.N. Generation Equality Forum in June.

One area where the report found that COVID-19 continues to speed progress is financial inclusion. The pandemic has accelerated digital adoption and use of financial services, with nearly 60 low- and middle-income countries having used digital payments to deliver emergency relief, according to the report.

Governance updates expected soon

The release of this latest Goalkeepers data follows a rocky year for the Gates Foundation, which has faced inner turmoil amid the divorce of Bill Gates and Melinda French Gates, as well as the departure of billionaire philanthropist Warren Buffett, who served alongside the two as a trustee.

The foundation is expected to announce new trustees early next year. When asked to share additional details during last week’s press call, Suzman did not provide any further updates on leadership changes. Instead, he highlighted that the foundation had committed more than $1.7 billion to the COVID-19 response in the past 18 months, in addition to its existing spending. Bill Gates and Melinda French Gates also recently added $15 billion to the endowment.