A recent report from renowned economists, public health experts, and political leaders emphasizes that high levels of inequality are rendering the world more susceptible to pandemics. This vulnerability is compounded as pandemics themselves exacerbate inequality, creating a self-perpetuating cycle driven by insufficient action.
Published on November 3, 2023, by the Council on Global Inequality, AIDS, and Pandemics, the report titled “Breaking the Inequality-Pandemic Cycle: Building True Health Security in a Global Era” outlines practical recommendations aimed at addressing ongoing health crises and enhancing preparedness for future pandemics. It highlights that within nations, intersectional inequality is closely linked to pandemics. Research indicates that countries with greater inequality have experienced significantly higher mortality rates from COVID-19, HIV/AIDS, and other infectious diseases while struggling to implement effective pandemic responses. In contrast, more equitable contexts demonstrate greater resilience against pandemics.
The report illustrates the connection between inequality and pandemics by citing several African countries that have made significant strides in combating AIDS while also addressing persistent urban inequality. Data from the International Monetary Fund shows that pandemics have led to a lasting increase in inequality, with peaks occurring approximately five years after outbreaks such as H1N1, SARS, MERS, Ebola, and Zika. Additionally, the report warns that international disparities among countries globalize pandemic vulnerability; when some nations can respond effectively to outbreaks while others lack resources, global vulnerability increases.
The report further notes that many countries have not acted swiftly enough to address ongoing pandemics and outbreaks, such as HIV, tuberculosis, and malaria, which continue to result in millions of deaths, particularly in low- and middle-income nations and among marginalized groups in wealthier countries. It points out that the withdrawal of much international aid and funding threatens to halt, or even reverse, progress made to reduce new HIV infections to their lowest level since 1980 by the end of 2024.
Nevertheless, the report presents clear evidence that this cycle can be disrupted by establishing a new health security framework through practical actions addressing the social and economic determinants of pandemics on both national and global levels. These measures would target both response efforts during a pandemic and preparations for future emergencies, all while focusing on inequality.
The report advocates for the removal of financial barriers to enhance the fiscal capacity of countries to tackle inequalities. To facilitate this action during ongoing pandemics, such as the current HIV crisis, it suggests an urgent moratorium on debt repayments for struggling nations until 2030. This measure should be complemented by new emergency funding mechanisms for pandemics, including the automatic issuance of Special Drawing Rights from the IMF.
To strengthen future pandemic response capabilities, the report calls for a reorientation of international financial institutions to end pro-cyclical austerity policies and address the underlying structural deficiencies that lead to insufficient fiscal margins to reverse inequalities and combat pandemics. It also emphasizes the need to invest in the social determinants of health during health crises by enhancing social protection systems, particularly for the most vulnerable populations, focusing on housing, nutrition, and other health determinants.
Looking ahead, the report encourages strategic actions targeting the social determinants of pandemics, which contribute to significant health disparities and increased vulnerability during outbreaks. It also suggests promoting local and regional production and establishing new governance structures for research and development through economic measures and intellectual property rights that facilitate technology sharing as necessary public goods to halt pandemics.
Finally, it urges the need for greater trust, equity, and efficiency in pandemic response by investing in community-led multisectoral responses and pandemic infrastructure, engaging community organizations, human rights groups, and scientific leaders in collaboration with governments. The Council on Global Inequality, AIDS, and Pandemics plans to use the report”s findings to inform its collaboration with the G20, international financial institutions, and health sector leaders to establish a preventive, preparatory, and responsive pandemic approach capable of breaking the inequality-pandemic cycle. Failure to take action, the report warns, could lead to devastating consequences.
“The evidence is unequivocal. By reducing inequalities—through access to decent housing, fair work, quality education, and social protection—we reduce the risk of pandemics at their roots. Measures to combat inequality are not a luxury; they are essential for pandemic preparedness and response,” asserted Michael Marmot, director of the Institute of Health Equity at University College London.
