By Helen Branswell

he Covid-19 pandemic has, of course, been devastating over the past year. But by other measures of public health, the year wasn’t quite as calamitous as Bill Gates and Melinda French Gates feared when they wrote their annual report in 2020.

That doesn’t mean the first year of the Covid pandemic hasn’t been hard.

The foundation’s 2021 Goalkeepers report, published late Monday, shows an additional 10 million children around the globe didn’t get key childhood vaccines this past year, because of public health service disruptions. Another 31 million people were pushed into extreme poverty by the pandemic. And employment among women is expected to remain 13 million jobs lower around the world this year than it was in 2019.

Covid-19 has deepened what was already a profound chasm between the rich and the poor, Bill Gates told STAT.

“Every dimension of inequity — rich versus poor in the U.S., inner city schools versus suburban schools, Blacks versus Caucasians, rich countries versus middle-income versus low-income [countries] — this has exacerbated every dimension of inequity that I can think of,” Gates said.

Gates spoke to STAT as part of a wide-ranging interview timed to the release of the Goalkeepers report. Excerpts from the interview have been lightly edited for clarity and length.

What are the things that you found most concerning in the Goalkeepers Report this year?

The most concerning thing is the economic situation in low-income countries. Their economic losses are very high and they’re not able to stimulate their economies in the same way that most of the rich countries and some of the middle-income countries have done. And the indebtedness levels are building up. So the borrowing is going to be restricted. That was true even before the pandemic, but it’s gotten worse now.

And so the extreme poverty number in some ways is the most depressing number. And global trade, tourism into the low-income countries — all of those things, there’ll still be some lower level of activity for several years to come. Particularly if you end up with a situation where Covid is still circulating in these low-income countries and so people are making it hard to travel in or travel out, just to restrict the spread of the disease.

Up until the Delta variant came along, the low-income countries … were not having nearly as bad an epidemic as almost all the middle-income and rich countries, for a variety of reasons. Young age, outdoor work and … a lot of the populations are out there in the rural areas. Now, although it’s still not dire in most African locations, if you look at the Institute for Health Metrics and Evaluation figures, they are forecast to have a fair number of deaths. So they’re going to get hit hardest at the tail.

Some of the things did not go exactly as we expected. The [non-Covid] vaccination rates so far only dropped by 7%, and we had predicted that that might go down by 14%. Malaria deaths, which we predicted might go up quite a bit, have actually stayed flat, partly because we have been able to get the [treated] bed nets out. The Global Fund [to Fight AIDS, Tuberculosis and Malaria] has done a very good job on that. But the economic numbers are sort of the ultimate measure that poor countries have had a very bad epidemic just because of the economic factors.

Your foundation likes to focus on the positive, trying to encourage people to effect change by highlighting the positive as opposed to always the negative. But just last week the annual report of the Global Fund came out and it had a much more dire take on some of the metrics in your report. Do you ever wonder whether focusing on the positive downplays the urgency of the situation?

There’s a tradeoff. If you don’t explain the progress the world has made in reducing poverty and reducing childhood deaths, then you’re really not creating an accurate picture.

There really is good news there. And I think if you only give the bad news — which both on health stuff and climate, sometimes that’s how messages are delivered — people might think, well, it’s hopeless, I should just go ignore all this stuff.

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