Inequality Will Make the Next Pandemic Worse

Feb 28 , 2026
By Joseph E. Stiglitz , Monica Geingos and Michael Marmot

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During COVID-19, rich countries spent eight percent of their GDPs on responses, while low-income countries spent two percent. In the aftermath, developing countries are carrying 31 trillion dollars in debt, the highest level in more than 20 years. In parts of sub-Saharan Africa, between 40pc and more than 50pc of tax revenue goes to debt service, with some governments spending more on repayments than on education and health combined. In this commentary provided by Project Syndicate (PS), Joseph E. Stiglitz, a Nobel laureate in economics, a former chief economist of the World Bank, Monica Geingos, a former first lady of Namibia, and executive chairperson of the One Economy Foundation, and Michael Marmot, a professor of epidemiology at University College London, argued that many lower-income countries lack the resources to respond adequately to current pandemics like AIDS, let alone prepare for the next one, and will need debt relief to do so.

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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 only 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 hospitalisation, partly because they could not retreat to Zoom meetings. And when they did fall ill, they had no choice but to dig into their meagre 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 healthcare 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 should thus be central to how we prepare for and respond to future pandemics, not simply because caring for the vulnerable is the right thing to do, but also because it is 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 practised 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 to construct 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 should be an automatic intellectual-property waiver for all critical therapies and products, triggered the moment the World Health Organisation (WHO) 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 are not shared, what good will global vaccine-production facilities be in the next pandemic?

Finally, providing healthcare and protection for everyone during pandemics requires money. During the COVID-19 pandemic, rich countries spent eight percent of their (much larger) GDPs to address the crisis, while low-income countries spent two percent. And now, owing to the previous pandemic, developing countries are saddled with 31 trillion dollars 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 40pc and more than 50pc 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.

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 will also take political will to implement the policies needed to ensure greater health equity. That starts with prioritising ordinary people's lives over drug companies' monopoly profits.

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PUBLISHED ON Feb 28,2026 [ VOL 26 , NO 1348]

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