Staff Reporter
ECONOMIC inequality, rather than traditional measures of pandemic preparedness such as laboratory capacity and emergency response systems, is the strongest predictor of how countries respond to health crises, according to new research published in the New England Journal of Medicine.
The study, co-authored by global experts including Nobel laureate Joseph Stiglitz, epidemiologist Professor Sir Michael Marmot, and Chairperson of the One Economy Foundation and former First Lady of Namibia Monica Geingos, argues that technical capacity alone is insufficient to protect societies from pandemics.
The research by the Global Council on Inequality, AIDS and Pandemics found that countries with high levels of inequality were less successful in responding to COVID-19 and HIV/AIDS, even when they had strong healthcare infrastructure and high rankings on conventional pandemic preparedness assessments.
The authors are calling for an “inequality-informed pandemic preparedness and response” approach, which recognises that social and economic conditions influence whether countries can effectively use their available health resources during a crisis.
The study challenges the traditional view that pandemic readiness is primarily determined by factors such as laboratories, medical supplies and emergency response plans. It found that some countries ranked among the most prepared before COVID-19, including the United States and the United Kingdom, experienced some of the highest infection and death rates.
Researchers found that inequality affects how societies respond to pandemics by influencing factors such as whether people can afford to stay home when sick, whether communities trust public institutions and whether vulnerable groups can access healthcare services.
Using the Gini coefficient, a standard measure of income inequality, the researchers found that every one-point increase in inequality was associated with approximately 12.5 additional COVID-19 deaths per 100 000 people. Similar patterns were identified in relation to HIV infections and AIDS-related deaths.
The report highlights several measures governments can implement to reduce pandemic risks, including expanding social protection programmes, strengthening cooperation across government sectors, reforming global financial systems and improving access to life-saving medical technologies.
Recommended measures include paid sick leave, cash transfers and unemployment support during outbreaks, as well as longer-term investments in housing, education and secure employment to strengthen societal resilience.
The researchers also called for greater involvement of finance, labour and education ministries in pandemic planning, alongside stronger participation from community-based organisations.
At the global level, the report recommends emergency debt relief mechanisms, automatic release of international pandemic funding and expanded access to pandemic financing to ensure all countries have the resources needed to respond effectively.
The authors further called for open licensing of publicly funded medical research, global incentives for innovation and expanded regional manufacturing of vaccines and treatments.
Geingos, who is among the co-authors of the analysis, said addressing inequality is essential to improving global health security.
“The evidence is clear: out-of-control inequality is bad for everyone’s health. Effective pandemic preparedness includes taking practical action to tackle the inequalities which drive them,” she said.
Stiglitz said governments must move beyond measuring preparedness through technical capabilities alone.
“For decades the world judged how ready a country is for a pandemic by counting its laboratories, stockpiles and response plans. This research shows that this is not enough,” he said.
Professor Sir Michael Marmot added that health outcomes are closely linked to social conditions.
“The inequalities that damage health in ordinary times are the same ones that leave whole societies exposed when a pandemic strikes. Creating fairer conditions of daily life is not a nice-to-have — it is the foundation of health security,” he said.
The research is being published ahead of a special panel discussion at AIDS 2026 in Rio de Janeiro, where global health leaders will discuss the role of inequality in pandemic preparedness.
The Global Council on Inequality, AIDS and Pandemics, an international expert group convened by UNAIDS, said more than 90% of the world’s population now lives in countries with high income inequality, increasing vulnerability to future health emergencies.
The authors warned that inequality and pandemics reinforce each other, with health crises widening existing economic and social gaps, which in turn increase the risks posed by future outbreaks.
A GROWING DIVIDE: Mortality data (Panel A) are from the World Health Organization and the U.S. Centers for Disease Control and Prevention. Data on global wealth shares (Panel B) are from the World Inequality Database. SARS denotes severe acute respiratory syndrome, and MERS Middle East respiratory syndrome. Graph: The New England Journal of Medicine
