Monica Geingos: Executive Chairperson of the One Economy Foundation, and former First Lady of Namibia.
For Monica Geingos, this line explains the core argument of the new inequality–pandemic report she co-authored. COVID-19, like AIDS before it, protected those with resources and exposed those without. The global system that produced that outcome has not changed.
Geingos, a lawyer, former First Lady of Namibia and long-time adviser on AIDS policy and feminist economics, is one of three co-chairs of the Global Council on Inequality, AIDS and Pandemics. The report released this week argues that inequality is not a background condition to pandemics, but the force that decides how long they last, who dies, and who emerges more powerful. Because inequality exacerbates pandemics, it is a threat to the whole world. The other co-chairs — economist Joseph Stiglitz, epidemiologist Sir Michael Marmot, and the convenor, UNAIDS Executive Director Winnie Byanyima — bring academic influence, multilateral reach and economic authority. Geingos brings something different: the political memory of what happens when life-saving technology is rationed by income and geography.
She describes inequality as both a public-health risk and a political one. “Inequality drives, deepens and prolongs pandemics. But it also delegitimises authority,” she says. “Anyone who is concerned about collapsing power structures should be concerned about inequality, because it is changing how people respond to power.”
The point is directed as much at governments in the global North as at elites in the global South. South Africa and Namibia are the world’s two most unequal countries; that imbalance shapes how their societies understand risk. But Geingos argues that countries with narrower wealth gaps are not insulated. The same forces that allowed high-income states to monopolise vaccines will, in the next emergency, produce more political backlash than stability.
Whether the world has learned anything since AIDS and COVID-19 is, in her view, still an open question. “One has to ask whether it’s really a mistake, or whether it’s a political choice,” she says. “The Gini coefficient has risen since 2020. The rich have become richer, the poor have become poorer — and as Sir Michael Marmot put it yesterday, the rich had a great pandemic.”
This is why she rejects the idea that pandemic-era intellectual-property waivers should be optional or dependent on negotiation. Namibia, she reminds us, was not a passive victim of scarcity: it had the financial means to buy vaccines, but still could not access them. “There were countries that didn’t have the money. And then there were countries like Namibia that had the money but couldn’t access vaccines because of hoarding,” she says. “What is the point of innovation if it doesn’t save the lives of the majority?”
The report calls for an automatic IP waiver the moment the World Health Organisation declares a pandemic. Geingos frames it as a necessary correction: “Medical technology is vital to defeat pandemics. It should be a public good, not a private asset.” She supports replacing monopoly patents with “prizes for innovation” so that scientists are still rewarded, but the resulting vaccines, diagnostics and therapeutics can be manufactured in Africa, Asia and Latin America.
She is equally direct about the political stakes of the G20 process now under South Africa’s presidency. She rejects the idea that Africa is simply “included” in global diplomacy. “Africa is not seen as a source of solutions. We are seen as the source of problems,” she says. The consequences are structural. As long as Africa is treated as a testing site rather than a policy author, the next pandemic will repeat the same hierarchy of protection.
That is why she sees a shift in the current moment. “The solutions are here. We are home to pioneering approaches to public health — community monitoring, medical technology, public policy that works for us. With the withdrawal of traditional aid, we now have a moment to redefine the architecture, because there was too much external influence over what the ‘right’ responses should be.”
Her analysis is not only about infrastructure and patents. It is also about the debt trap that now constrains public-health capacity. “We agreed that pandemics worsen inequalities. So fiscally, many African states are now in an even tighter position because of debt interest after COVID-19,” she says. “It is not just about producing medicines. It is about releasing ourselves from these debt strangleholds and creating fiscal space.”
Where, then, does real power sit? Not in a single institution. “I’ve seen that leaders have formal power, but can be made powerless by civil servants and technocrats,” she says. “The gatekeepers exist in government, in philanthropy, in multilateral institutions.” The more decisive form of power, she argues, is often informal: “It sits in the drafting rooms, in the negotiating committees, with wealthy friends — but also with loud, persistent voices that don’t go away.” She sees Generation Z as reshaping that landscape by refusing to treat authority as automatic.
Asked what meaningful progress should look like in five years, she lists concrete policy changes: stalled debt repayments, new pandemic financing facilities, investment in social determinants of health, regional manufacturing, and research governance that treats technology as a public good. But she ends with the moral test behind the data. “It must look like a world where we no longer decide who should die and who should live based on where they live, what they earn or who they are. Being Black, being poor, being a woman — that should not be the criteria for survival.”
She is insistent that the report’s proposals are not idealistic. “These problems are not intractable. They can be resolved, but not without global assistance and not without leadership that examines how it wields power.” What she rejects is the fatalism that treats inequality as inevitable. “There are solutions that work. It can be done, and it must be done.”
Her argument sits comfortably inside the formal language of multilateralism but pushes harder than it. For Geingos, the pandemic was not only a story of viral spread but of structural permission — permission to hoard, to profit, to decide who should wait and who should live. Ending that permission is, for her, the real project of pandemic preparedness.
And if the next outbreak begins in Africa? “We learned the hard way that we cannot rely on medicines being produced in the global North,” she says. Whether Africa has more leverage next time will depend on whether the rules change now — not in the middle of the next emergency. “The instinct of wealthy countries was to protect themselves first. That will not change unless the architecture changes.”
The shift she is arguing for is not symbolic, but about who gets counted, who gets care, and who has the power to refuse scarcity. “We must stop treating survival as a privilege assigned by income or geography,” she says. “If we do not change the rules, the next pandemic will not just expose inequality. It will entrench it.”