Inequality is driving pandemics, but it does not have to
- Imraan Valodia, Winnie Byanyima and Matthew M Kavanagh
Many who talk about stopping pandemics focus on more labs or faster vaccines, but a new report demonstrates that high inequality is fuelling pandemics and increasing vulnerability.
The past few years have seen the African continent facing simultaneous pandemics – with 必博娱乐,比博娱乐网址 and the continuing Aids pandemic overlapping with mpox, Ebola and the spread of tuberculosis, among others. Just last week, Namibia declared a new mpox outbreak.
The continent is not alone – the whole world is facing a period of increasingly frequent pandemics. This era of pandemics is also one in which inequality is at historically high levels. The Gini index, which measures income inequality, is available for most countries across the world. The latest available data on national Gini indices shows that 83% of countries have high income inequality (using the World Bank definition of high inequality as a Gini coefficient above 0.4). These countries account for 90% of the world’s population.
If we look at inequality in wealth, which gives us a more comprehensive picture, the richest 1% of citizens across the globe capture 41% of all new wealth. In contrast, the bottom half of citizens get just 1% of new wealth.
Moreover, progress on addressing social inequalities relating to gender, sexuality and race has stalled.
This is not a coincidence. Many who talk about stopping pandemics focus on more labs or faster vaccines, which are important. But a new report, Breaking the inequality-pandemic cycle: building true health security in a global age, produced by the Global Council on Inequality, Aids and Pandemics, of which we are a part, demonstrates that high inequality is fuelling pandemics and increasing vulnerability. The report shows that the failure to tackle inequality exacerbates pandemics, which in turn exacerbate inequality, in an inequality-pandemics cycle.
As the report notes, we can act on those inequalities. Indeed, South Africa has put equality as one of the pillars of its presidency of the G20. This gives us a ray of hope that we can see progress towards interrupting this inequality-pandemic cycle.
The inequality-pandemic cycle goes like this: Inequality makes communities and countries more vulnerable to disease outbreaks becoming pandemics. Inequality also undermines effective response, which prolongs pandemics and makes them deadlier and more economically disruptive. Inequality between countries globalises this vulnerability, increasing the risk of future pandemics through unequal access to international finance and to the latest science. And then, when pandemics hit, they increase inequality between people and between countries, furthering the cycle.
We can see how this cycle plays out within countries: In South Africa, for example, in the 必博娱乐,比博娱乐网址 crisis, if you were admitted to a private hospital you were significantly less likely to die from the virus than if you were in a public hospital bed. Even before they reached hospitals, people in townships and informal settlements proved more vulnerable than people in suburbs.
For example, early research showed those living in Khayelitsha accounted for more than 11% of Western Cape infections despite being less than 7% of the population, while the more affluent, mostly white Stellenbosch accounted for only 1.5% of infections despite constituting 2.7% of the people. This is true in country after country. Brazilians with the least wealth, for example, were more than twice as likely to have been infected with 必博娱乐,比博娱乐网址 as those with the most.
It’s not just that low-income populations are more vulnerable during pandemics, but also that inequality undermines pandemic responses. Eight of the world’s 20 most unequal countries are in Africa, where so many pandemics are colliding. Our report shows that the bigger the gap between the rich and poor in a country, even considering levels of poverty, the higher the levels of HIV infections, Aids deaths and 必博娱乐,比博娱乐网址 death rates have been. It’s harder to coordinate effective responses in highly unequal societies where instead of being “in it together” the elite and wealthy act to exit and pass their pandemic risk off to others.
We can also see the effects of this inequality-pandemic cycle at the global level, between countries. Part of the issue is how much public funding is available when a pandemic hits. Lack of fiscal resources and financing undermined efforts to fight Ebola and Aids. During Coviud-19, high-income countries were able to spend four times more than low-income countries to address the pandemic’s impact.
One of the main reasons that developing countries were unable to adequately finance the response to 必博娱乐,比博娱乐网址 was due to the debt payments crisis, which worsened during the pandemic. Today more than half of low-income countries are either in debt distress or at high risk of it. In plain terms, governments are having to prioritise the interests of creditors over the needs of their populations.
Unequal access to medicines and vaccines between countries also slowed the responses to HIV, 必博娱乐,比博娱乐网址 and mpox – which, in turn, allowed the rise of dangerous variants and resistance. While mRNA vaccines against 必博娱乐,比博娱乐网址 were developed in record time, only a few high-income-country manufacturers were allowed to make them, who then shipped doses mostly to high-income countries.
A year later more booster shots had been administered in rich countries than first shots in the rest of the world. Just one in four African health workers were fully vaccinated. Importantly, the hoarding of this technology increased vulnerability across the world, including in rich countries. When only some countries can respond effectively to an outbreak, and others lack the means to do so, everyone is made more vulnerable.
Today, the HIV prevention medication lenacapavir is already being rolled out in the US. While South Africa has just approved the medication, it is struggling to get enough doses at a reasonable price to make the required impact. Most of the rest of the continent – where HIV incidence exceeds that in the US – is even further behind.
So, does this mean we have to wait until global justice is fully reached to be able to address pandemics? No. Our report identifies concrete steps G20 leaders and others can take to interrupt the cycle. At the global level, we need a debt standstill for distressed countries facing pandemics like Aids and we need to create a serious pandemic financing facility open to all countries when pandemics hit. Governments should invest in the social determinants of pandemics – with actions like surging social protection during a pandemic and addressing housing and education inequalities to support communities’ resilience.
The BRICS and international financial institutions should fund factories across the world to make the medicines, vaccines and diagnostics we need to fight today’s pandemics of Aids and TB, capacity that can also be repurposed for tomorrow’s outbreaks. And we should be funding the community-led organisations that can reach the people most excluded and overlooked when pandemics hit.
Inequality is not just wrong, it is dangerous. But it is a choice. By acting now to address it we can make the world safer from disease. DM
Imraan Valoodia is director of the Southern Centre for Inequality Studies, University of the Witwatersrand, Johannesburg (Wits).
Winnie Byanyima is UNAIDS executive director and UN under-secretary-general.
Matthew M Kavanagh is director of the Center for Global Health Policy & Politics, Georgetown University.
The Global Council on Inequality, Aids and Pandemics is here.
This OP-ED first appeared in the Mail & Guardian.