A general view of the G20 logo at the NASREC Expo Centre in Johannesburg on November 4, 2025 where the upcoming G20 summit will be hosted.
JOHANNESBURG – A groundbreaking global report released ahead of the G20 Leaders’ Summit in Johannesburg warns that inequality is increasing the world’s vulnerability to pandemics, making them more deadly, more costly and longer lasting.
The report, Breaking The Inequality–Pandemic Cycle: Building True Health Security In A Global Age, draws on two years of research by the Global Council on Inequality, AIDS and Pandemics, convened by UNAIDS.
It shows that inequality and pandemics are locked in a self-reinforcing cycle: inequality fuels outbreaks, while pandemics in turn deepen inequality.
The report comes at a pivotal time, as South Africa readies to host the G20 Leaders’ Summit on 22–23 November under the theme Solidarity, Sustainability and Resilience - a moment that will test the country’s ability to turn global commitments into action on inequality and health security.
The study reveals that unequal access to housing, healthcare, education and employment leaves millions more exposed to disease.
It also finds that inequality undermines national and global responses, prolonging pandemics and amplifying their economic and social toll.
These patterns, the authors note, are visible not only in COVID-19, but also in HIV, Ebola, influenza and Mpox.
Co-chaired by Nobel Laureate Joseph E. Stiglitz, former First Lady of Namibia Monica Geingos, and leading epidemiologist Professor Sir Michael Marmot, the council’s report calls for a fundamental shift in what the world understands as “health security”.
Instead of focusing narrowly on emergency preparedness, it urges governments to tackle the structural inequities that determine who gets sick, who receives care, and who is left behind.
“Pandemics are not only health crises; they are economic crises that can deepen inequality if leaders make the wrong policy choices,” said Stiglitz.
“When efforts to stabilise pandemic-hit economies are paid for through high-interest on debt and through austerity measures, they starve health, education and social protection systems.
"Societies then become less resilient and more vulnerable to disease outbreaks. Breaking this cycle requires enabling all countries to have the fiscal space to invest in health security.”
A timely warning for South Africa’s G20 presidency
With the world still reckoning with the social and economic scars of COVID-19, and global debt at record highs, the report’s findings directly reinforce South Africa’s call for a fairer, more inclusive global order.
For South Africa (and the broader Global South), the message resonates deeply. High inequality continues to shape who has access to healthcare, education, and stable work.
An OECD survey earlier this year noted that “needs in education, healthcare and worker support are significant and largely unmet” in South Africa, with the country among the most unequal societies globally.
At the heart of the global issue is debt dependency.
According to the UN’s World of Debt Report (2025), global public debt has reached $102-trillion, with developing nations’ share - about $31-trillion - growing twice as fast as that of advanced economies. This imbalance leaves poorer countries trapped in a cycle of high borrowing costs and shrinking public investment in health and social services.
A blueprint for equitable health security
The council’s recommendations offer a concrete framework for action. They include removing financial barriers that limit countries’ fiscal capacity, investing in the social determinants of health, building local production for medical goods, and strengthening community-led pandemic infrastructure.
If endorsed by G20 leaders, these proposals could influence debt reform discussions, shape future pandemic preparedness frameworks, and position South Africa’s presidency as a defining moment for global justice.
“This report shows why leaders urgently need to tackle the inequalities that drive pandemics, and it shows them how they can do this," said UNAIDS executive director Winnie Byanyima. “Reducing inequalities within and between countries will enable a better, fairer and safer life for everyone.”
As South Africa steers the G20 toward its November summit, the report offers both a warning and a roadmap, reminding the world that true resilience begins with equity.