Inequality within and between countries is fuelling pandemics and prolonging global crises, warns UNAIDS.
New report links inequality to higher COVID-19 deaths and HIV infection rates.
Low-income countries and migrants face the greatest barriers to vaccines, medicines, and health security.
Findings released ahead of G20 summit urge fairer access to treatments and technology.
UNAIDS calls for pre-emptive action to break the “inequality–pandemic cycle”.
High levels of inequality—within societies and across nations—are making the world more vulnerable to pandemics, worsening their economic impacts and prolonging their duration, according to a new report by the Joint United Nations Programme on HIV/AIDS (UNAIDS).
The findings are based on two years of research by the UNAIDS-convened Global Council on Inequality, AIDS and Pandemics. The report, Breaking the Inequality–Pandemic Cycle: Building True Health Security in a Global Age, released on November 3, 2025 ahead of the G20 meetings in Johannesburg, South Africa later this month, analyses the deep links between inequality and public health crises.
Using regression models to examine HIV impact data from 217 countries and COVID-19 data from 151, the Council found that nations with higher levels of inequality struggled to mount effective pandemic responses. In contrast, more equal societies proved more resilient. Countries marked by inequality experienced higher COVID-19 mortality, higher HIV infection rates, and greater AIDS-related deaths than their more equal peers.
The report highlighted how unequal access to housing, education, employment, and healthcare has created fertile ground for diseases such as COVID-19, AIDS, Ebola, and Mpox to spread faster and hit harder.
For instance, people living in informal settlements in African cities were found to have higher HIV prevalence than those in formal housing. In Namibia, data from population-based surveys showed higher HIV rates among poorer and less educated women. In England, overcrowded housing was linked to increased COVID-19 mortality, while in Brazil, those without basic education were several times more likely to die from COVID-19 than people who had completed primary school.
The report also underscored how global inequalities exacerbate shared risks. Low-income countries continue to face barriers to accessing vaccines, medicines, and emergency financing, leaving outbreaks uncontrolled and global disruption prolonged.
Migrant communities face particular vulnerabilities. A meta-analysis covering 53 million participants in high-income countries found that international migrants faced an 84% higher risk of COVID-19 infection than non-migrants, with disparities especially stark in North America and northern Europe.
Unemployment is another long-standing health risk factor. In South Africa, data from the 2016 Demographic and Health Survey revealed that unemployed men and women had higher odds of HIV infection than those in work.
The report called for urgent action to tackle inequality before pandemics strike, arguing that prevention and equity are essential to true global health security. It urges fairer access to medicines and health technologies between rich and poor nations, more funding for local and regional manufacturing, and an automatic waiver of intellectual property rights once a pandemic is declared.