Just ahead of the annual meeting of the U.N. General Assembly that opens on Tuesday, leaders of the Gates and Rockefeller Foundations — grant makers that have committed billions of dollars to fight the coronavirus — are warning that without larger government and philanthropic investments in the manufacture and delivery of vaccines to people in poor nations, the pandemic could set back global progress on education, public health, and gender equality for years.

The calls from philanthropy leaders for more action from wealthy countries comes as President Biden plans to call for a "COVID Summit" to coincide with the meeting, according to news reports.

In an annual analysis of progress made toward development goals set by the United Nations on poverty, access to clean water, gender equality, and other indicators of well-being, the Gates Foundation found that the spread of the pandemic had significantly reversed progress made in recent years.

A big reason is that the disease disproportionately hit poor countries that did not have access to COVID vaccines. More than 80 percent of COVID vaccines have been administered to people in wealthy countries, according to the report. The entire continent of Africa, the report noted, has a population about 300 times that of California. But the number of people vaccinated was roughly the same through the first half of the year.

The health crisis cast a shadow over many measures of well-being. During the pandemic, childhood immunizations over all dropped 7%. Health officials last year predicted it was going to be even worse, but the decline still represents 10 million children who have fallen behind immunization schedules. While men's employment is expected to return to pre-pandemic levels this year, 13 million fewer women will have jobs than in 2019, according to the report.

"The lack of equitable access to COVID-19 vaccines is a public-health tragedy," said Bill Gates, in statement accompanying the report. "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."

While the Gates Foundation has been one of the biggest philanthropic supporters in the fight against COVID, pouring $1.8 billion into a range of global health efforts to curb the spread of the disease, it has also attracted significant criticism. For much of the first year of the pandemic, it so staunchly defended the intellectual property rights of the pharmaceutical companies that developed the vaccines that experts say it slowed the delivery of vaccines to people in need.

In May, the foundation seemed to reverse course and said it would back a "narrow waiver" of intellectual property rights to help get vaccines to poor countries. Writing on the foundation's website, Mark Suzman, the CEO, wrote that "no barriers should stand in the way of equitable access to vaccines, including intellectual property."

Rockefeller's president, Rajiv Shah, has called for a "COVID Charter," in which rich countries would peg international development and climate assistance to 1% of their gross domestic product and require middle- and low-income nations to devote more money to public health and climate-change mitigation. His plan would tap funds from emergency accounts held by the International Monetary Fund and enlist philanthropy to increase its support for international development.

Writing in the journal Foreign Affairs, Shah identified the impact of climate change and COVID-19 on vulnerable populations as a "near-term" threat to global stability. Failure to address the inequitable impact of those crises could have a lasting effect, according to Shah.

"Without significant development interventions, increased poverty and suffering will be a decades-long problem," wrote Shah, who was director of the U.S. Agency for International Development in the Obama administration.

The Rockefeller Foundation in October 2020 committed $1 billion over three years to respond to COVID and prevent future outbreaks.

The Gates Foundation is the largest private philanthropy, with nearly $50 billion in assets.

The nearly $2 billion the foundation has committed to fighting the pandemic has gone toward developing tests and vaccines, financing the procurement of medical supplies by poor countries, and softening the pandemic's economic blow.

The report Gates released Monday did not include new commitments to COVID but called on other foundations and governments to make long-term, global investments in health care research and the logistics required to get a vaccine from a factory to a clinic and into a patient's arm.

The damage caused by the pandemic has been somewhat mitigated by the speed with which researchers developed successful vaccines, said Suzman. The rapid development of protection against the virus, he said, was possible because of large investments over several years by the Gates fund and others.

"This is also now an opportunity for both responding to the current crisis, but making sure that we are building a ... set of national and regional infrastructures that make sure we never face this kind of crisis again," Suzman told reporters on a conference call last week.

The Gates Foundation's protection of pharmaceutical companies' intellectual property rights during much of the first year of the pandemic attracted criticism from some public-health leaders.

When the vaccines became available, rich countries rushed to gather supplies for their own populations. One reason low-income countries weren't able to procure their own supplies is that patents on the vaccines hampered the development of low-cost generic batches of the immunizations. In his announcement backing an intellectual property waiver, Suzman said the details of such a waiver should be negotiated at the World Trade Organization.

More than 100 countries favor such a waiver. The Biden administration announced its support in May, but agreement has been stalled because of opposition mainly from European nations. After a nearly two-month hiatus, talks on the issue resume Tuesday at the World Trade Organization.

The Gates Foundation's Suzman stressed the bottlenecks in delivering vaccines at the country and local level.

"So much focus is on the vaccine procurement, which is critically important, that often we don't focus as much on the need for the vaccine-delivery infrastructure," he said.

Kyle Knight, a senior health researcher at the advocacy group Human Rights Watch, said the focus on the local manufacturing and distribution capabilities is largely misplaced. He called the international response to COVID an inadequate "charity-based" response that put commercial interests before human rights obligations.

"When you have that much power, you also have a moral responsibility to pay attention to the power dynamics that are causing harm," he said.

He called the Gates Foundation's focus on expanding local vaccine-manufacturing plants and distribution to medical centers disingenuous. Health ministries around the world have no reason to make those investments, he said, as long as large companies hold patents on the vaccines.

"The idea that the problem is lack of infrastructure in poor countries is ridiculous," he said. "The problem actually exists upstream. It exists at this debate on a global health crisis that is happening at a multilateral trade agency."

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This article was provided to The Associated Press by the Chronicle of Philanthropy. Alex Daniels is a senior reporter at the Chronicle. Email: [email protected]. The AP and the Chronicle receive support from the Lilly Endowment for coverage of philanthropy and nonprofits. The AP and the Chronicle are solely responsible for all content. For all of AP's philanthropy coverage, visit https://apnews.com/hub/philanthropy.