Economic inequality is a stronger predictor of how countries respond to pandemics than traditional measures of preparedness such as laboratory capacity and emergency response systems, according to new study published in the New England Journal of Medicine.
The study, led by international expert group the Global Council on Inequality, AIDS and Pandemics, argues that strong health systems alone are not enough to protect countries during global health emergencies.
The study findings presented at the 26th International AIDS Conference in Rio de Janeiro, Brazil.
For decades, global pandemic preparedness has focused on strengthening technical capacities such as laboratories, disease surveillance, vaccines, medicines and emergency response systems. However, experience from COVID-19 and HIV/AIDS suggests these measures alone do not determine how well countries respond to health crises.
The study identifies economic inequality as the strongest factor influencing how effectively countries manage infectious disease outbreaks.
The findings are particularly significant as the world faces increasingly frequent pandemics alongside widening economic disparities.
More than 90 per cent of the global population now lives in countries with high levels of economic inequality. While income gaps between some nations have narrowed, global disparities remain severe. Researchers also highlight that economic inequality intersects with discrimination based on race, gender, ethnicity, and sexual orientation, further increasing vulnerability to infectious diseases.
The study points out that traditional preparedness rankings often fail to predict actual pandemic performance. For example, the United States ranked among the world’s best-prepared countries before COVID-19 but experienced COVID-19 death rates more than twice the global average and continues to report high HIV incidence. In contrast, countries such as Vietnam, Mauritius, Uruguay, and Ethiopia achieved comparatively better pandemic outcomes despite receiving lower preparedness scores.
The study identifies four ways in which inequality worsens pandemics. First, unequal living and working conditions increase people’s exposure to infectious diseases. Crowded housing, insecure employment and limited access to healthcare make it difficult for vulnerable populations to follow public health measures such as isolation or social distancing.
Second, inequality weakens governance and public trust, reducing compliance with public health measures and vaccination campaigns.
Third, unequal financial resources limit countries’ ability to respond quickly to outbreaks. During COVID-19, high-income nations spent trillions of dollars protecting their populations, while many low-income countries struggled with debt and limited health budgets.
Finally, unequal access to vaccines, treatments, and medical technologies prolongs outbreaks and increases the risk of new variants emerging.
The report recommends addressing these inequalities through expanded social protection programmes, including paid sick leave, unemployment benefits, and cash transfers during health crises. It also calls for long-term investments in housing, education, and secure employment, stronger collaboration across government sectors, greater community participation, emergency debt relief, and fairer global access to life-saving medical technologies. Together, these measures can build more resilient societies and improve preparedness for future pandemics.