Global Council Report Reveals Inequality–Pandemic Cycle

Proven actions can break the cycle, say experts

South Africa is not treating its G20 presidency as ceremonial. It is using the platform to make an argument that reaches far beyond aid, health or moral appeal: inequality is not a social crisis to be managed, but a structural global risk that determines who survives the next pandemic and who does not. Failure to tackle the deep inequalities within and between countries, it points out, puts the whole world in greater danger. The strategic calculation is that once inequality is recognised as systemic, it moves out of the language of compassion and into the language of collective security, regulation and liability.

That argument sharpened in Johannesburg this week with the launch of a new report by the Global Council on Inequality, AIDS and Pandemics, convened by UNAIDS and co-led by Winnie Byanyima, Nobel laureate Joseph Stiglitz, former Namibian First Lady Monica Geingos and epidemiologist Sir Michael Marmot. The report does not appeal for generosity. It warns that inequality has now become a pandemic accelerant — the ignition point that decides who is infected first, who dies first, and who recovers last.

“The more unequal a society is, the deadlier and longer a pandemic becomes,” Byanyima told the launch. “Inequality makes us more vulnerable to disease outbreaks and it traps us in a vicious cycle. Pandemics do not level us. They expose us.”

Marmot dismantled the lingering myth that pandemics are egalitarian events. “At the start of COVID-19, the world pretended that prince and pauper were equally at risk. The data showed the opposite. The poorer you were, the more likely you were to be exposed, hospitalised and die.” The pattern, he said, held not only for COVID-19, but for HIV, tuberculosis, Ebola and influenza. “Pandemics are magnifying devices for social injustice.”

Stiglitz, who has spent decades warning that austerity deepens both economic and biological vulnerability, translated that evidence into politics. “The pandemic world is built on a design flaw,” he said. “If you don’t have resources, you can’t prevent diseases from spreading. But you also can’t prevent the increase in inequality that pandemics always bring.”

More than half of all tax revenue in many African states is consumed by debt repayments, he noted. “That leaves no fiscal space to build hospitals, expand laboratories or buy vaccines. And when governments respond with austerity, they are not stabilising their economies. They are preparing them to fail again.”

He reminded the audience how uneven the global rescue was. “Thirty percent of GDP in stimulus spending in advanced economies. Four percent in developing countries. And four percent of a very small number is not a rescue package — it is a sentence.” Inequality, he argued, is not a market accident but “a policy choice, enforced by rules written to protect the wealth of the few at the expense of the resilience of the many.”

Geingos brought the argument back to lived experience. Pandemic inequality, she said, is not only about who accesses vaccines or ventilators, but who absorbs unpaid care work, who loses their income first, and whose deaths are never counted. “Pandemics inherit the old patriarchies,” she said. “You will always find women buffering systems that were already breaking long before the virus arrived.”

She linked COVID’s gendered fallout to Namibia’s experience of AIDS. “We learnt from the slow rollout of ARVs in the 1990s and 2000s that monopolies over life-saving technology cost millions of African lives. We watched it again in 2021, when high-income countries secured almost all the vaccine supply and low-income countries were told to wait their turn.”

The report proposes removing that discretion: automatic intellectual-property waivers the moment a pandemic is declared, and a shift from monopoly patents to “prizes for innovation” that would allow vaccines, diagnostics and therapeutics to be manufactured in Africa, Asia and Latin America. “It wasn’t only about price,” Geingos said. “Namibia had the money to buy vaccines but still could not access supply. That is what happens when the world leaves knowledge in the hands of a single patent holder.”

The council identifies three other structural risks: debt, social conditions and voice.

Marmot pointed out that “if you have no water, hand-washing campaigns are useless. If ten people share two rooms, social distancing is a fantasy. If your income depends on daily movement, lockdowns are starvation.” Pandemics, he said, do not invent inequality. “They weaponise it.”

South African Health Minister Dr Joe Phaahla described the country as “a microcosm of the report”. “We have two health systems. One for the wealthy 14%, and another for the remaining 86%. A pandemic does not respect that divide. It punishes it.” During COVID-19, he said, communities without clean water could not comply with public-health messaging, informal workers lost all income overnight, and HIV and TB services “collapsed because clinics assumed everyone could simply stay home”. For him, universal health coverage is not ideological: “It is a pandemic-prevention tool. That is why NHI matters.”

The fourth variable is voice — who speaks and who is spoken for. Nomonde Ngema, a 22-year-old youth activist born with HIV, reminded the room that the “inequality-pandemic cycle” is not an academic construct. “Pandemics show who matters,” she said. “I lost friends who could not get ARVs during lockdown, not because the medicine didn’t exist, but because taxis stopped running, stigma increased and families were already in crisis.” Her challenge to global leaders was blunt: “You either choose conviction or convenience.”

While Johannesburg hosted the council launch, Cape Town saw a parallel move. The G20 Task Team on Inequality — chaired by Stiglitz and set up by President Cyril Ramaphosa — delivered its report warning that the current concentration of wealth and income is now a direct threat to global growth, democratic stability and pandemic readiness. The task team is proposing the creation of an International Panel on Inequality, modelled on the IPCC, to produce annual data, track country commitments and make inequality a formally monitored global risk. If endorsed, it would be the first time inequality is given a standing regulatory mechanism rather than being treated as a policy preference or advocacy theme.

Attention now shifts to Limpopo, where G20 health ministers are meeting to debate the same unresolved questions raised in Johannesburg: who will control vaccine production, how debt will continue to shape public-health capacity, and whether universal health coverage will be treated as a central pillar of pandemic preparedness or left as a political afterthought. The outcome will reveal whether South Africa can convert agenda-setting into policy, or whether the momentum dissipates once negotiations reach states resistant to IP reform, debt restructuring or binding inequality metrics.

South Africa is not limiting itself to advancing just one policy call. It is moving several linked processes at once, including the Global Council report, the G20 Task Team findings, the health ministers meeting in Limpopo and the G20 Leaders’ Summit later this month. Together, they are meant to turn inequality into something that can be measured, compared and acted on. The aim is to give inequality the same status that climate risk gained once it became quantifiable and formally tracked.

The underlying goal is to move inequality out of being labelled as only social policy and into being recognised in the category of measurable risk, where it would be tracked and responded to in the same way financial markets respond to credit ratings or climate exposure. If that approach is adopted, the Johannesburg meeting will stand as the point where inequality began shifting from advocacy language into a system of formal accountability.

If it fails, the report will join the archive of post-crisis analyses issued after HIV, H1N1, Ebola and COVID-19 — read, quoted, praised, and ignored until the next emergency begins.

Stiglitz closed the room on a warning. “We have the knowledge. We have the money. We have the science. What we do not have is the political will. And political will is the one resource no country can import, borrow or vaccinate itself into.”

The world is not short of data. It is short of decision. Until that changes, inequality will not just predict the next pandemic. It will design it.