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Pandemic of Inequality: Scoping the development of an ethical framework and policy guideline for addressing inequalities in pandemic preparedness and response

Urban subway showing three people in masks.

Evidence from previous pandemics, such as TB and HIV/AIDS, show that death and disease from infectious agents derive not simply from the nature of the contagion. They also reflect wider societal factors that shape individuals’ exposure and susceptibility.

Covid-19 is no exception. Pre-existing inequalities have affected Covid testing and transmission in disadvantaged groups. This pandemic is an example of a syndemic, characterised by biological and social interactions that magnify susceptibility and worsen health outcomes.

The unequal impact of Covid-19 has also deepened these pre-existing inequalities. Measures taken to control the virus have had differential impacts on people’s lives and livelihoods, which will have immediate and long term implications on people’s health.

Yet policy responses to the pandemic in countries like the US and UK have largely centred on the biological and not the social determinants of ill health. Pandemic preparedness and response in these two countries has also primarily involved a ‘crisis management’ approach rather than an a priori understanding of vulnerabilities and potential outcomes.

This project will explore questions including:

  • How has the experience of the Covid-19 pandemic among disadvantaged groups differed in the US and the UK?
  • What can we learn from these experiences about the potential ethical implications for pandemic preparedness and response (PPR)?
  • What does a conceptual model for preparedness and response look like for a syndemic rather than a pandemic?

Project team

  • Zackary Berger Berman Institute of Bioethics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Medicine, USA
  • Mehrunisha Suleman Ethox Centre, University of Oxford, UK

1 Suleman M, Sonthalia S, Webb C, Tinson A, Kane M, Bunbury S, Finch D, Bibby J. Unequal pandemic, fairer recovery: The COVID-19 impact inquiry report. The Health Foundation; 2021 (https://doi.org/10.37829/HF-2021-HL12)

Photo by Şahin Sezer Dinçer on Unsplash