Fiscal constraints: One to One mobile clinc attending to patients of Lucingweni village from the O.R. Tambo
district, Eastern Cape on February 28, 2024. Pandemics are less about future viruses and more about present
budgets. Photo: Oupa Nkosi
The Global Council on Inequality, Aids and Pandemics has issued a warning that turns the usual pandemic logic on its head.
The next global health emergency, it argues, will not be triggered by a virus but by the economic conditions that allow disease to spread unchecked.
Debt, austerity and collapsing public budgets are becoming the true accelerants of future pandemics, leaving countries too fiscally suffocated to respond, even if science delivers the tools to intervene.
The findings were released in Johannesburg this week at the Gordon Institute of Business Science (GIBS), where members of the council presented a two-year, evidence-heavy investigation into how inequality fuels pandemics and how pandemics, in turn, deepen inequality.
The launch brought together ministers, economists and activists from across the global South, signalling a shift in terrain.
Pandemic preparedness is no longer being discussed solely in hospitals and laboratories. It has entered treasuries, debt offices and credit-rating meetings.
What gives the warning added weight is timing. South Africa will chair the G20 leaders’ summit in 2025 — the same G20 that controls 85% of global GDP and more than 90% of lending power.
The council’s plea is blunt: if pandemic preparedness is not treated as a fiscal issue in the G20 agenda, the next outbreak will repeat the same cycle — science succeeds, but politics and finance fail.
Nobel Prize-winning economist, former chief economist of the World Bank and one of the architects of the post-2008 global financial reform agenda, Joseph Stiglitz, co-chairs the council. He said the starting point is no longer biological risk but political and economic choice.
“If governments enter the next pandemic already trapped in debt and austerity, you have lost before the virus arrives,” he told the audience.
“The most dangerous co-morbidity is inequality. It shapes who gets infected, who gets treated, who recovers and whose economy survives.”
The council argues that pandemics do not become global catastrophes because viruses mutate faster than scientists can act. They escalate because health systems collapse under the weight of fiscal constraints, because vaccine manufacturing is concentrated in a few countries, and because austerity policies hollow out states’ ability to respond.
Once a pandemic strikes, the poorest lose income first and recover last. That widening inequality, in turn, creates the conditions for the next outbreak. The report calls it a “self-feeding cycle of vulnerability”.
Winnie Byanyima, executive director of UNAids, said the evidence is now overwhelming.
“We are living with cutting-edge science, early-warning systems and record innovation, yet pandemics are becoming more frequent and more destructive. The reason is not a lack of technology. It is the structural inequality that decides who gets the technology and who does not.”
The council’s argument comes at a time of tightening budgets.
Since Covid-19, global health spending has fallen in real terms for the first time in two decades. More than 50 countries are in, or near, debt distress. Over 100 low- and middle-income countries now spend more on interest repayments than on health.
The warning is not theoretical: the world is walking into the next pandemic with weaker buffers than it had in 2020.
The timing is deliberate. As South Africa prepares to host the G20 leaders’ summit, the council is warning that the next pandemic will not be stopped by science but by balance sheets.
A world already trapped in debt, austerity and shrinking health budgets will not have the fiscal oxygen to respond, no matter how fast a vaccine is discovered.
The council wants inequality treated the same way the world now treats climate risk: measured, tracked, and backed by enforceable policy.
For Monica Geingos, former first lady of Namibia and council member, the lesson is simple.
“Breakthrough medicines exist, but they are not reaching the people who need them in time. That is not a scientific failure. It is a failure of power, access and political choice. Inequality is not just unfair. It is deadly.”
She pointed to Namibia’s experience during Covid-19, when the country had the money to buy vaccines but still struggled to access supplies.
“We were told low-income countries could not afford vaccines. But that was not the full story. Some of us could pay. We just could not get a place in the queue.”
The council’s report recommends automatic intellectual property waivers during pandemics, advance financing for regional vaccine production, and new incentives for innovation that reward discovery without locking it behind a monopoly.
“Prizes instead of patents,” Geingos said. “Innovation should save lives, not inflate shareholder value while communities wait.”
The report is unambiguous on finance. The global South cannot prepare for pandemics while servicing debt at the levels now seen across Africa, Latin America and parts of Asia.
Stiglitz called debt restructuring “a public-health intervention disguised as macroeconomics”.
He added, “When 60% of your tax revenue goes to creditors, you are not sovereign. You are drained. And a drained state cannot protect its people from a pandemic.”
The council proposes a new pandemic financing facility, backed by IMF Special Drawing Rights, that would release funds automatically when the World Health Organisation declares an international emergency. No waiting for donor pledges. No austerity negotiations in exchange for loans.
“We already know pandemics will happen,” Stiglitz said. “What is irrational is pretending every one of them is a surprise.”
Byanyima echoed this, arguing that the world should have learned after HIV, Ebola and Covid-19 that health security cannot be built on charity.
“Pandemics expose the truth about how societies value human life. You find out very quickly who is disposable. That is why we are saying inequality is not a development issue. It is a threat multiplier.”
The report also calls for a permanent global body to monitor inequality, modelled on the Intergovernmental Panel on Climate Change.
“What climate did right was make the crisis measurable,” Stiglitz said. “Once you quantify the problem, you force markets, governments and regulators to respond. We need the same for inequality.”
South Africa’s health system, Health Minister Aaron Motsoaledi argued, makes the council’s case in real time.
“A few years ago, we had 14 departments of health, each for a different racial group. Fourteen ministers of health. That is what apartheid looked like in the health system,” he said.
“We abolished that in the Constitution, but we wake up today and we still have two healthcare systems. One for the rich, one for the poor. The moment you divide people, you can forget about fighting a pandemic.”
Equality, he said, is not ideology but operational logic.
“In HIV, we learned that if you test and treat everyone equally, mortality drops. Inequality is what kills.”
The warning lands at a moment when fiscal tightening is accelerating. Global health budgets are being cut in real terms, donor spending is flat, and at least 52 countries are in, or near, debt distress.
The council concludes that the next pandemic will hit a world with less financial oxygen than it had in 2020 and that this, not the biology of a new virus, is the real threat.
What makes the council’s warning different from previous alarm bells is its tone. It is less about future viruses and more about present budgets. Pandemics, it argues, have become financial events long before they become medical ones.
“The next outbreak is already underway,” the report reads. “It is taking place in debt offices, in credit-rating downgrades, in austerity programmes and in the quiet shrinking of public-health payrolls.”
The G20 will decide whether that continues. As host, South Africa has the rare ability to put inequality on the same diplomatic footing as climate change — not as a moral issue but as a systemic risk to markets, stability and life expectancy. If the G20 treats pandemics solely as a medical problem, the world will repeat the pattern: science races ahead, finance lags, and the poorest pay first and longest.
The kicker is stark. The world now has the scientific capacity to control most pandemics. What it no longer has is the fiscal capacity. If economic conditions remain unchanged, the next virus will do precisely what Covid-19 did: follow the fault lines of inequality, kill where states are weakest, and turn recession into depression.
As Stiglitz put it, “Viruses exploit biology. Pandemics exploit inequality. And we are running out of time to decide which one we want to fight.”