Inequality predicts pandemic outcomes better than technical readiness, study finds

Economic inequality is the clearest way to predict how countries will fare during a pandemic, a high-profile panel said Wednesday, calling for a rethink of how governments prepare for the next global health crisis.

The research, which was published in a prestigious journal and will be presented at a major AIDS conference in Brazil, pushed back against traditional measures of pandemic preparedness.

“For decades the world judged how ready a country is for a pandemic by counting its laboratories, stockpiles and response plans,” study co-author and economics Nobel laureate Joseph Stiglitz said.

“This research shows that this is not enough,” he added in a statement. “High economic inequality can leave even wealthy, well-equipped nations dangerously exposed.”

The United States and United Kingdom topped pandemic preparedness indexes, yet during the COVID-19 pandemic both recorded significantly more cases and deaths than the global average.

Brazil and South Africa, considered the most prepared countries in their regions, also fared particularly badly.

However, countries considered less prepared but with lower levels of inequality, such as Vietnam, Mauritius, Ethiopia, Uruguay and Norway, were significantly better off, the research said.

The new paper, published in the New England Journal of Medicine, found no association between a country’s technical capacity—for example, laboratories to test for viruses or trained emergency health care workers—and how well it handled the COVID and AIDS pandemics.

However, it found a clear and consistent link between a nation’s level of economic inequality and how it performed during both crises.

Not inevitable

“The deeper the inequality in the country is, the deeper that pandemic is going to be,” lead study author Matthew Kavanagh of Georgetown University in the U.S. told AFP.

“We’re not talking about reaching utopia—we’re talking about what would it look like for the whole world to reach the level of inequality of South Korea.”

Stiglitz said that “the encouraging news is that inequality is not inevitable—it is the result of policy choices, and we know how to change them.”

The panel urged nations to consider “inequality-informed pandemic preparedness.”

This included social protections such as paid sick leave, unemployment support and cash transfers in times of crisis.

During pandemics, this money can mean people are able to stay home “without having to worry: am I going to be able to feed my family?” Kavanagh explained.

The researchers called for low-income countries to receive debt relief when a pandemic is declared.

Life-saving new technology should also be made available to the entire world during such emergencies, they added.

Recipe for continued pandemics

After COVID spread across the world, wealthy nations snapped up the earliest vaccine doses, provoking outrage among developing countries left behind.

Exactly how vaccines, drugs and tests developed to fight future pathogens will be shared remains the biggest sticking point in negotiations to finalize the world’s first global pandemic treaty.

Protesters at the annual AIDS conference being held in Rio de Janeiro this week called for more Latin American countries—where HIV rates are rising—to get access to generic versions of a breakthrough HIV drug called lenacapavir.

The paper called for patents on such drugs to be replaced with prizes that reward “innovators while allowing medicines and vaccines to be produced anywhere.”

Kavanagh said that letting pharmaceutical companies choose who can access these drugs was “a recipe for continued pandemics.”

The research was conducted by the Global Council on Inequality, AIDS and Pandemics, which was convened after COVID, and will be presented at the conference in Rio on Thursday.

Raina MacIntyre, a professor of global biosecurity at the University of New South Wales who was not involved in the research, told AFP it “makes many valid points” that need to be addressed.

However, she cautioned, “there are assumptions in this paper which are not supported by quantitative methods such as modeling or risk analysis.”

MacIntyre pointed to her own research, which determined that universal health care, national leadership and culture were also significant factors in how countries perform during pandemics.

Who’s behind this story?

Andrew Zinin

Master’s in physics with research experience. Long-time science news enthusiast. Plays key role in Science X’s editorial success.

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