A major international study published in the New England Journal of Medicine has challenged conventional pandemic preparedness thinking, concluding that economic inequality, rather than the strength of a country’s laboratories or healthcare infrastructure, is the strongest predictor of how severely nations suffer during pandemics.

The research, led by Nobel laureate economist Joseph Stiglitz and conducted by the Global Council on Inequality, AIDS and Pandemics, found that countries traditionally ranked among the best prepared for pandemics, including the United States and United Kingdom, recorded some of the highest COVID-19 infection and death rates despite advanced medical systems, while countries with lower conventional preparedness rankings but lower inequality, such as Vietnam and Ethiopia, performed significantly better. The study found every one point increase in a country’s income inequality measure was associated with about 12.5 additional COVID-19 deaths per 100,000 people, with a similar relationship observed for AIDS related deaths even after accounting for poverty and existing health infrastructure.

The researchers proposed a new framework for pandemic preparedness that shifts attention beyond hospitals and laboratories toward broader economic and social policy, recommending expanded paid sick leave and cash transfers during health emergencies, reformed global financial systems including emergency debt relief, and expanded regional production of vaccines and medicines. Stiglitz said the findings show that counting laboratories and stockpiles is not enough, since high economic inequality can leave even wealthy, well equipped nations dangerously exposed, while UNAIDS Executive Director Winnie Byanyima described inequality as the ground in which pandemics take root, saying tackling it could help prevent future pandemics as well as end AIDS as a public health threat.