After weeks of intense global coverage of the luxury cruise ship at the center of a deadly outbreak of the hantavirus, it turns out a far bigger and even deadlier simultaneous outbreak had been going undetected for more than a month in central Africa. On May 15, the Africa Centres for Disease Control and Prevention announced an epidemic of ebolavirus that by that time had already infected hundreds of people in the Democratic Republic of the Congo and spread across the border to Uganda’s capital and largest city, Kampala.
Both outbreaks are tragedies. Both should have been caught earlier. But the inequality at the heart of this story is stark: The death of three European passengers on an expensive Antarctic cruise was covered by wall-to-wall media. The British Army literally parachuted in a specialist team for one suspected case. Meanwhile in Mongbwalu, the Congo health zone at the epicenter of the Ebola outbreak, at least six people were dying every day, invisible to global disease surveillance systems as the outbreak grew (and now remains) out of control.
After weeks of intense global coverage of the luxury cruise ship at the center of a deadly outbreak of the hantavirus, it turns out a far bigger and even deadlier simultaneous outbreak had been going undetected for more than a month in central Africa. On May 15, the Africa Centres for Disease Control and Prevention announced an epidemic of ebolavirus that by that time had already infected hundreds of people in the Democratic Republic of the Congo and spread across the border to Uganda’s capital and largest city, Kampala.
Both outbreaks are tragedies. Both should have been caught earlier. But the inequality at the heart of this story is stark: The death of three European passengers on an expensive Antarctic cruise was covered by wall-to-wall media. The British Army literally parachuted in a specialist team for one suspected case. Meanwhile in Mongbwalu, the Congo health zone at the epicenter of the Ebola outbreak, at least six people were dying every day, invisible to global disease surveillance systems as the outbreak grew (and now remains) out of control.
The inequality this reveals is at the heart of a deep disorder in global governance that makes us all far more vulnerable to pandemics. There is a one in four chance of another pandemic as severe as COVID-19 within the decade, according to the Lancet Commission, a problem that is currently occupying the health ministers gathered in Geneva for the World Health Assembly. Yet despite the gravity of the threats and the remarkable science developed in just the last few years that could address them, current geopolitical decisions leave the globe significantly more vulnerable to pandemics than when COVID-19 hit in winter 2019.
The United States is the epicenter of the global disorder: U.S. President Donald Trump’s withdrawal of the United States from the World Health Organization (WHO) was premised on the idea the country could replace multilateralism with bilateral deals. After the Trump administration’s dismantling of the U.S. Agency for International Development, which assumed this money was doing little good and a more extractive approach would get the United States better information sharing and a greater health security, the new “America First” global health strategy has aimed to prevent dangerous outbreaks and pandemics by prioritizing “making America safer, stronger, and more prosperous.” So far, the Congo Ebola outbreak is proving these assumptions wrong.
The Trump administration halted millions of dollars in grants to Congo outbreak and surveillance projects. It also cut hundreds of millions of dollars to the health workers in malaria, HIV, tuberculosis, and maternal health efforts, who had been an informal surveillance network in past outbreaks. Congo was one of the first countries to agree to Trump’s new America First global health deals, yet instead of stronger information sharing and quicker responses the United States has found itself on the outside looking in, unable to coordinate with WHO and learning things not much sooner than headlines break.
But while the Trump administration’s moves are perhaps the most high-profile symptom of the geopolitics of inequality, these geopolitics were already wreaking havoc on a great many governments.
The ministers gathered in Geneva for the World Health Assembly had hoped, for example, to be celebrating the new WHO Pandemic Agreement, which would mandate signatories to establish multisectoral surveillance systems and new infrastructure for financing, supply chains, and sharing both virus samples and the tests, vaccines, and medicines developed using those samples. But the treaty is suspended until agreement is reached on sharing pandemic technologies.
During the COVID-19 pandemic, the global effort to achieve vaccine equity failed as high-income countries hoarded doses and gave boosters to their populations before many of the frontline health workers in low- and middle-income countries got their first dose. That prolonged the pandemic for the whole world, fueling continued transmission and contributing to the rise of variants such as Delta and Omicron as high levels of virus circulated in under-vaccinated populations.
The Pandemic Agreement is supposed to contribute at least modestly to fixing this inequality, but even after the United States left the table with its withdrawal from WHO, European governments continued to prioritize pharmaceutical interests and refused to create a meaningful, mandatory system for the sharing of technology, know-how, and commodities in a future pandemic. So the World Health Assembly this year is stymied, and the path forward is unclear.
Beyond the assembly, the Group of 20 could be a venue to address the core ways that inequality is making the world more vulnerable to the pandemics of today and unprepared for those of tomorrow, but it cannot currently do so effectively. When the COVID-19 pandemic hit, the G20 quickly became the central political platform for global response. While the global response was far from perfect, G20 ministers began coordinating with each other almost immediately after WHO declared a public health emergency on Jan. 30, 2020.
By March 2020, the G20 heads of state were meeting in an extraordinary session called by King Salman of Saudi Arabia. The G20 suspended repayment of debt for the world’s poorest countries to allow them to adequately respond to the crisis. Finance and health ministers established a task force that pushed the International Monetary Fund and the World Bank to take more aggressive action and birthed a new pandemic preparedness fund that came into being in 2022.
In 2025, South Africa, as G20 chair, built an agenda that centered “Solidarity, Equality, Sustainability” and laid out ambitious ideas to overcome pandemic-driving gaps in medicine and vaccine access and address key climate-driven pandemic threats. But this time around, in the words of Doctors Without Borders president Javid Abdelmoneim, the geopolitical context was “weaponized by powerful countries to weaken” meaningful action.
The Gulf states blocked climate; the European Union blocked sharing technologies. Trump very publicly skipped the Leaders’ Summit, in a major snub to South Africa, as did U.S. Health and Human Services Secretary Robert F. Kennedy, Jr. But Trump did send a political advisor to the summit, who teamed up with Argentina to block consensus on any declaration because it would have included references to equity and WHO.
Multiple states also blocked action on debt, which crowds out fiscal space to fight pandemics. During COVID-19, for example, while high-income countries spent on average 8 percent of their gross domestic product fighting the pandemic, low-income countries spent just 2 percent of their much lower GDPs because of debt and taxing capacity.
The problem is not a lack of potential solutions but of will. In 2024, the revised International Health Regulations gave WHO a new level of alert that it can declare: the pandemic emergency. But there are not yet powerful tools available once a pandemic emergency is declared.
There could be. A recent report from the Global Council on Inequality, AIDS, and Pandemics, which I co-authored, proposed that a pandemic emergency declaration could trigger opening of a surge financing facility, perhaps one based in the global south (such as the New Development Bank, established by Brazil, Russia, India, China, and South Africa) and one based at the International Monetary Fund. This facility would use special drawing rights as capital, as happened during COVID-19, albeit then too late and too piecemeal.
The report also proposed, in an idea led by Joseph Stiglitz, creating a patent-free system of prizes for pandemic technology to incentivize innovation without creating global monopolies that allow viruses to spread while factories sit idle in Africa, Asia, and Latin America.
Inequality is driving today’s pandemics, but there is currently no serious political venue in which to address it. The World Health Assembly is deadlocked on how to bring the Pandemic Agreement into force and whether to allow Argentina to withdraw from WHO. The G20 under its U.S. chair has eliminated its health track entirely. The BRICS countries considered the idea of a pandemic fund of their own based at the New Development Bank; but while such a fund could be more equitable, it has not materialized and the group has its own deep political divisions. Important work is happening at regional level in Africa and within the Association of Southeast Asian Nations, but when facing a global outbreak it will be hard to see how this work adds up to more than the sum of its parts.
There are multiple proposals being floated for reforming the architecture of global health governance—from WHO, African leaders, charitable foundations, and think tanks. But none would accomplish this major missing piece: generating a shared venue where genuine high-level political negotiation over the inequality drivers of pandemics occurs among powerful states. Until that happens, viruses will continue to triumph, no matter how well international organizations’ mandates are aligned and funding streams rationalized.
