Pandemic threat isn’t just the virus — it’s inequality

Science can stop outbreaks, but equality is needed to prevent pandemics, writes Matthew M. Kavanagh, director of the Georgetown University Center for Global Health Policy and Politics.

[GEORGETOWN, US, SciDev.Net] The science of fighting disease has never been stronger. We can sequence a virus in days, build a vaccine in months, and detect outbreaks almost as soon as they begin.

And yet, pandemics are coming faster, spreading wider, and costing more lives and livelihoods than ever before.

The question is no longer whether the world can out-innovate microbes. It is why—despite all our technology—we keep losing.

One key reason is that rising inequality is making the world more vulnerable to disease—and every pandemic, in turn, deepens inequality.

This inequality–pandemic cycle is the silent engine of our modern age: the richer the world grows, the more divided it becomes. The more divided it becomes, the more it falls prey to disease.

Pandemics thrive where inequity does. When those at the margins cannot protect themselves, outbreaks become pandemics, and these pandemics last longer. We have seen HIV continue to devastate LGBTQ communities, particularly where stigma and criminalisation persist.

Similarly, we saw COVID-19 tear through crowded housing, informal jobs, and migrant dormitories. But despite this, the stock markets soared.

It is not just that the poor do poorly in pandemics—inequality itself shapes outcomes. The bigger the gap between rich and poor in a country, the higher the rate of death from COVID-19 and the greater the new HIV infections and AIDS deaths.

This is not coincidence; it is causation. Inequality magnifies vulnerability and weakens the ability to respond.

Political failure

Much of the world’s response to health challenges assumes that pandemics are technical failures, not political ones. The mantra of “more surveillance, faster vaccines” is true, but insufficient. The problem is not the speed of the science, it is who that science reaches, and when.

Governments poured billions into research for COVID-19 and HIV, only to hand the resulting technologies to companies granted global monopolies. Those monopolies, protected by international trade law, limit supply, inflate prices, and prolong crises. The best science in the world can only save those who can afford it.

Likewise, the architecture of global finance constrains the countries most at risk. Debt servicing is draining the same public budgets meant to fund nurses and labs. When a pandemic hits, fiscal space collapses, responses slow, and contagion spreads across borders.

Breaking the cycle

None of this is inevitable. Tackling inequality must become a central pillar of pandemic preparedness and response. There are practical ways to do this—through deliberate choices in finance, technology, and social policy.

First, countries must have access to capital when a crisis strikes. Debt repayments could be paused for nations facing both debt distress and pandemics such as AIDS, freeing up resources for urgent health spending.

Meanwhile, the world still lacks a true pandemic financing facility. When a pandemic is declared, emergency reserves—such as those held by the International Monetary Fund—should be made automatically available.

Second, the global rules of technology must change. Instead of assuming rich countries will share vaccines or that companies based in rich countries will prioritise the lives of those elsewhere, we should share the means of producing them.

Governments can compel technology transfer and make it a condition of publicly funded research and development.

Brazil has proposed a global coalition on regional manufacturing—building factories perhaps in Brazil for Latin America, in Kenya or Senegal or South Africa for Africa, in Thailand for Asia. This could radically shorten future pandemics by making vaccines and treatments accessible faster.

A new model of innovation could replace patents with prizes, rewarding the creation of new vaccines with large lump-sum payments rather than decades-long monopolies.

Third, at a national level, addressing the so-called “social determinants” of pandemics must be treated as core preparedness.

That means improving the conditions of life—income, housing, nutrition, and beyond. In a pandemic, for example, cash transfers and food assistance enable people to isolate without going hungry.

South Africa’s child grants reduced hunger during COVID-19; in Brazil, the government social welfare programme Bolsa Família cut AIDS deaths by 40 per cent. Across Africa, improved financial security for women has measurably reduced their risk of HIV.

Fourth, community organisations must sit alongside ministries of health and finance and scientists in response planning and execution.

For too long, global health has tried to work within a system that guarantees failure: a financial order that penalises social spending and an innovation model that rewards scarcity.

Governments have the tools to change this. They can legislate technology-sharing, restructure debt, fund community infrastructure, and build social protection into the architecture of health security. What they lack is not power but political imagination.

These ideas are drawn from ongoing research and discussions convened by the Global Council on Inequality, AIDS and Pandemics, which recently published recommendations on how to break this pandemic–inequality cycle.

Scientific progress can prevent outbreaks. But only equity can stop pandemics.

This piece was produced by SciDev.Net’s Global desk.