INEQUALITY WILL MAKE THE NEXT PANDEMIC WORSE / PROJECT SYNDICATE

Inequality Will Make the Next Pandemic Worse

Crowded living conditions, frontline occupations, and poverty all fuel the spread of pandemics, as do poor nutrition and baseline health characteristics. Unless these issues – which came to define the COVID-19 pandemic – are addressed head-on, the most vulnerable will surely suffer the most in the next crisis.

Joseph E. Stiglitz, Monica Geingos, and Michael Marmot

NEW YORK – The science of fighting disease has never been stronger. 

We have the means to detect outbreaks immediately, sequence pathogens in the space of days, and develop new vaccines in just months. 

Yet pandemics are coming faster and spreading more widely, threatening more lives and livelihoods than ever before.

Recall the trauma of COVID-19, which inflicted economic hardship on billions of people and caused an estimated 18.2 million excess deaths between January 1, 2020, and December 31, 2021. 

Public-health officials had previously warned of the likelihood of a pandemic, and US President Barack Obama had responded by setting up a pandemic-preparedness office within the US National Security Council. 

But his successor, Donald Trump, dismantled it, leaving the United States more exposed.

Once again, public-health officials are warning that another pandemic is a matter of “when, not if.” 

Yet despite the devastating effects of the last one, the world seems to have turned a blind eye to the issue.

The Global Council on Inequality, AIDS, and Pandemics, which we co-chair, recently issued a report on this risk, in conjunction with the G20 meeting of health ministers in Johannesburg. 

Using evidence from COVID-19, AIDS, Ebola, and mpox, the report identifies a vicious cycle: inequality and its associated deprivations increase the chances of pandemics and deepen their effects; and pandemics increase inequality, often with devastating effects for the lowest-income people.

In the case of COVID-19, low-wage frontline workers typically suffered disproportionately – exhibiting a greater incidence of illness and hospitalization – partly because they couldn’t retreat to Zoom meetings. 

And when they did fall ill, they had no choice but to dig into their meager savings.

Thus, addressing pandemics entails more than a medical response. 

We also must look at socioeconomic factors. 

Crowded living conditions, frontline occupations, and poverty all contribute to the spread of pandemics, as do poor nutrition and baseline health characteristics. 

That is why countries with universal health-care systems did better during the COVID-19 crisis than those without. In the absence of such systems, economic inequality leads to health inequality.

Addressing inequality thus must be central to how we prepare for, and respond to, future pandemics, not just because caring for the vulnerable is the right thing to do, but also because it’s the best approach overall. 

COVID-19 showed that when regions anywhere in the world did not have access to vaccines, therapeutics, and protective gear, the disease festered and mutated, creating new risks for everyone. 

The “me-first” vaccine apartheid practiced by advanced economies was not only morally abominable; it was also self-defeating.

This lesson may explain why some developed countries are showing slightly more generosity nowadays. 

For example, a recent G20 initiative will help enable technology transfers needed for construction of pharmaceutical-manufacturing facilities in every region of the world – a key step in preparing for the next crisis. 

But this program is not enough. 

There must be an automatic intellectual-property waiver for all critical therapies and products, triggered the moment the World Health Organization declares a pandemic. 

This would allow any firm that has the technical capacity to produce desperately needed pandemic-related products to do so, as long as it pays the IP owner a fair royalty.

These changes matter, because during the COVID-19 pandemic, some poor countries that had funds to buy Western vaccines still could not secure ample supplies, and some that had technology to manufacture critical products could not do so. 

In fact, thanks to a Promotion of Access to Information Act lawsuit, we now know that Johnson & Johnson vaccines produced in Africa at the height of the pandemic were shipped to Europe and the US while Africans went without.

Although it is well established that governments may use compulsory licenses to make generic medicines when needed – as the US threatened to do in 2001 during the anthrax scare – drug companies have undermined the intent of this principle through incessant litigation. 

Even with all the gains made in breakthrough science and improved pandemic-response capacities, this hampers progress overall. 

If the know-how and the right to produce medicines aren’t shared, what good will global vaccine-production facilities be in the next pandemic?

Finally, providing health care and protections for everyone during pandemics requires money. 

During the COVID-19 pandemic, rich countries spent 8% of their (much larger) GDPs to address the crisis, while low-income countries spent just 2%. 

And now, owing to the previous pandemic, developing countries are saddled with $31 trillion in debt – the highest level in more than 20 years. 

As a result, many lower-income countries lack the resources to respond to current pandemics like AIDS, let alone prepare for the next one.

This injustice helps us see how pandemics can create greater inequality (between countries, in this case). 

Countries in Sub-Saharan Africa are spending between 40% and more than 50% of the taxes they raise on debt repayments to their creditors, and many spend more on debt service than on education and health combined. 

If there is to be any hope for an adequate pandemic response from these countries, they must receive debt relief.

Moreover, a large automatic disbursement of funds from the World Bank or other international financial institutions (perhaps in the form of the International Monetary Fund’s special drawing rights) should be part of the response to the next crisis. 

Like an IP waiver, it should be triggered as soon as a pandemic is declared.

We can break the inequality-pandemic cycle. 

Doing so will require resources, but doing nothing ultimately would be far more expensive. 

It also will take political will to implement the policies needed to ensure greater health equity. 

That starts with prioritizing ordinary people’s lives over drug companies’ monopoly profits.

Joseph E. Stiglitz, a Nobel laureate in economics and University Professor at Columbia University, is a former chief economist of the World Bank (1997-2000), former chair of the US President’s Council of Economic Advisers, former co-chair of the High-Level Commission on Carbon Prices, and lead author of the 1995 IPCC Climate Assessment. He is Co-Chair of the Independent Commission for the Reform of International Corporate Taxation and the author, most recently, of The Road to Freedom: Economics and the Good Society (W. W. Norton & Company, Allen Lane, 2024).

Monica Geingos, a former first lady of Namibia, is Executive Chairperson of the One Economy Foundation and Founder of Leadership Lab Yetu.

Michael Marmot is Professor of Epidemiology at University College London, Director of the UCL Institute of Health Equity, and Past President of the World Medical Association.