The study, published on Monday ahead of G20 meetings taking place later this month in Johannesburg, South Africa, shows that unequal access to housing, healthcare, education and employment leaves millions more vulnerable to disease.
The report launched by UNAIDS – the global body’s agency dedicated to ending AIDS and HIV infection – finds that inequality not only exacerbates the spread and impact, but also undermines the global capacity to prevent and respond to outbreaks.
Breaking the inequality-pandemic cycle: building real health security in a global age, calls for a fundamental shift in what we mean by “health security.”
Vicious circle
The new data shows that pandemics increase inequality, fueling a cycle seen not only in the wake of COVID-19, but also for AIDS, Ebola, influenza, mpox and more.
Chaired by Nobel laureate Joseph E. Stiglitz, Namibia’s former first lady Monica Geingos, and leading epidemiologist Professor Sir Michael Marmot, the Global Council on Inequality, AIDS and Pandemics – which carried out the research – has a stark conclusion: pandemics and inequality are locked in a vicious circle, each feeding the other in a way that threatens global stability and progress.
“Inequality is not inevitable. It is a political choice and a dangerous choice that threatens everyone’s health“, Ms. Geingos said. “Leaders can break the inequality pandemic cycle by applying the proven policy solutions in the Council’s recommendations.”
Global inequalities exacerbate risks
Studies reviewed by the Council reveal that unequal access to housing, education, employment and health protection created conditions where COVID-19, AIDS, Ebola and Mpox spread faster and hit hardest.
For example, people living in informal settlements in African cities were found to have higher HIV prevalence than those in formal housing. In England, overcrowded housing was associated with higher COVID-19 mortality.
In Brazil, people without primary education were several times more likely to die from COVID-19 than those who completed primary school.
The Mathare slum in Nairobi houses 500,000 people within 5 square kilometers.
Between countries, global inequalities exacerbate shared risks. Low-income countries have repeatedly faced obstacles in accessing vaccines, medicines and emergency funding, leaving outbreaks unchecked and prolonging global disruption.
“The evidence is unequivocal,” Professor Marmot said. “If we reduce inequality through decent housing, fair work, quality education and social protection, we will reduce pandemic risk at its roots.”
Towards real health security
UNAIDS Executive Director Winnie Byanyima said the findings come at a crucial time as the G20 meets under South Africa’s presidency.
“This report shows why leaders urgently need to tackle the inequalities that drive pandemics, and it shows them how they can do this,” said Ms. Byanyima.
Pensioner Xhane Grodani, who lives with her husband in Tirana, Albania, receives her third COVID-19 vaccination at a clinic in the capital.
“Reducing inequalities within and between countries will enable a better, fairer and safer life for all,” she added.
The report aligns with South Africa’s G20 theme of “Solidarity, Equality, Sustainability” and highlights that achieving true health security will depend on economic justice and social equity as much as on vaccines or laboratories.
The Global Council outlines four key actions to break the “inequality pandemic cycle”:
- Removing financial barriers to ensure that all countries have the fiscal space to tackle inequality.
- Investing in the social determinants of health, such as housing, nutrition, education and employment, to reduce vulnerability to disease.
- Guarantee equal access to pandemic-related technologies by treating research and innovation as global public goods and promoting regional production.
- Strengthening community-led, multi-sectoral responses by embedding pandemic preparedness in local systems and ensuring broad participation across government, civil society and science.
