Social inequality and global pandemic response plans
The European Union (EU), Norway, the World Health Organization (WHO) and the USA aim to reduce social inequality in health in a generation (13–17). The World Bank, the EU and the Centers for Disease Control and Prevention in the USA have adopted a ‘One Health’ strategy with a view to improving the preparedness for pandemic threats, with a particular focus on lowincome countries (18–20). The strategy is a transdisciplinary approach for the early identification, prevention and reduction of health threats to humans, animals and the environment. In addition to the aforementioned CEPI, the World Bank also launched a pioneering funding scheme – the Pandemic Emergency Financing Facility (PEF) in 2016 – aimed at the rapid prevention of the spread of pandemic threats in low-income countries (21). These measures can play an important role in the UN’s goal to eradicate poverty and ensure good health for all by 2030 (22).
In view of the international objectives of reducing social inequality in health and implementing measures to conquer pandemic threats that arise in low-income countries, it is striking that international documents do not address the question of how social disparities in mortality rates are to be reduced during the next influenza pandemic. This applies to the preparedness plans by WHO, the USA, Canada, Australia, the EU and its 28 member countries, Iceland, Norway, Switzerland, Turkey, Macedonia, policy documents by the World Bank, general sociodemographic projections, and plans to reduce the impact of pandemics on indigenous populations (23–30). The complete absence of discussion on social inequality in the pandemic response plan for England (12) has already been pointed out, but the failing in international pandemic plans is something that is only now coming to light.
Internationally, the biomedical target groups for pandemic vaccines are health workers, high-risk age groups, pregnant women and people with underlying diseases, while target groups defined on the basis of socioeconomic status are not mentioned (23, 27, 29)(29–31). However, indigenous populations are covered in pandemic plans for the USA, Canada and Australia in the same way as the biomedical target groups (29–31).
It is unclear why those who devise plans do not discuss how to avoid social inequality in mortality rates in the event of a new pandemic. Have the rich countries – who have prepared such plans – been most concerned about reducing social inequality in diseases that take the most lives in rich parts of the world, such as cardiovascular disease and cancer? Has this been at the expense of the interest in social inequality in infectious diseases that are rare or have little prestige, or which have been eradicated or have a low mortality rate in our part of the world? Could it be that those who devise pandemic plans consider influenza to be a disease which, beyond the biomedically defined risk groups, is random, and therefore socially blind? Is that the reason why there is little emphasis on research showing that social conditions have a bearing on who dies during a pandemic?