We need to an *Inequality-Informed PPR* The IHRs require all states to build core capacities to reduce systemic pandemic risk. Inequity IS a systemic risk. So we build out a set of achievable inequality-informed measures that could counter inequality instead of having it fuel disease… /fin

@josephestiglitz.bsky.social noted today, his econ work shows inequality->less trust, captured policy, insufficient pub goods provision These same factors are disastrous in a pandemic—so even the best surveillance program, health workforce, countermeasure logistics cant be effectively deployed.. 4/5

…in our accompanying quantitative analysis finds that economic inequality predicts which countries did better or worse on: ☑️COVID mortality ☑️COVID infection ☑️AIDS deaths ☑️HIV incidence Global Health Security capacity did not. Neither did poverty. Why? 3/5

Launched in Rio: We show a major gap in global definitions of pandemic preparedness. Health Security capacity is necessary but, we show, insufficient in real world b/c economic inequality blocks countries' ability to deploy even strong technical capacities 🧵Thread... www.nejm.org/doi/full/10....

Even after COVID-19, why is the world still so vulnerable to pandemics? That's the question I'm taking on at the Breaking the Inequality Cycle session at #AIDS2026, with our new research on why preparedness keeps falling short. (hint, it's not 'global health security' capacity)

Congratulations to Mariangela Simao , long time champion on aids, rights, access to medicines. Excited to work with you in this exciting new role

Definitely just made plans to go to the wrong DC airport. Forgot I have layover. Signs of too many planes

The heart of broken global health right now: research on disease in Congo that will result in vaccines and meds over which global North researchers have monopoly control. Under what theory of good public health (let alone justice) does that make any sense? www.bloomberg.com/news/article...

So, is this UN decl everything wanted/needed? No. Caveats, missing commitments, words v action. But on balance it made genuine progress over 2021. Any UN document is only what govts, communities make of it, but there's a lot to make here. And in this context, that's a surprising ray of light. /fin

Funding crisis + visa denials meant that, where past UN HIV meetings were full of amazing leaders from around the world making demands directly, participation was much smaller. BUT powerful speeches in GA hall by PLHIV and CS brought HIV movement. @itpc.bsky.social Solange + Midnight 11/12

On policy: What’s in there that’s good? ✔️Access to medicines language is strong, w explicit commitment to transfer of technology and “on mutually agreed terms” is removed, which makes it more progressive than what was in the pandemic agreement or resolutions passed at WHA. (para 80, 82, 84) 8/12

Ultimately, though, the US pulls only Isreal to no. Burundi, Burkina, Niger had been opposing along with Russia and N Korea. A few more abstain. But 149 governments vote yes including most of Africa group and EU who had been on opposite sides, most progressive gov'ts get big win. 6/12

US takes floor. Strong statement on continued commitment on AIDS but slams access/pharma + “divisive social issues” inclusion. And calls for a vote. Everyone holds breath…. 5/12

Overnight negotiation. Brazil, SA back both. In morning Pres of GA allows both, asks if they can be adopted… one by one they are adopted. EU doesn’t oppose Africa group, Right wing govts don’t oppose EU! Wow. Moment of truth: Will really positive, but resisted, changes tank the resolution? 4/12

Ammends: ✏️Europe: Add key populations to the para committing to end stigma & discrimination and to reform laws + set targets. Right govts oppose. 🖍️Africa: Strike “on mutually agreed terms” so sharing HIV medicines technology is not subject to monopoly veto by pharma and govts have free hand. 3/12

First politics: Coming to HLM, surprisingly strong draft declaration, but friction from multiple corners: Rich govts vs Africa&DevCos on technology transfer & affordable meds; Right wing govts over gay&trans rights, gender. Activists push. Negotiation but no consensus. 2 dramatic amendments... 2/12

My Reflection from UN on HIV yesterday. Remarkable, paradoxical, dramatic. At turbulent moment, multilat'lism stuck on many fronts, Political Decl. is STRIKINGLY good on many issues. Fascinating political bedfellows. Signs of HIV crisis biting for com'ities. A thread on politics & policy: 🧵1/12

First politics: Coming to HLM, surprisingly strong draft declaration, but friction from multiple corners: Rich govts vs Africa&DevCos on technology transfer & affordable meds; Right wing govts over gay&trans rights, gender. Activists push. Negotiation but no consensus. 2 dramatic amendments... 2/x

... at last minute EU proposed language on key population and gender-based violence and Africa Group removed "on mutually agreed terms" as a caveat around the sharing of technology. This came after a lot of negotiation and ultimately, both passed and overall resolution passed backed by most of world

Very sad to see the US aligning w only a handful of governments opposed because of references to sharing technology justly and “social issues” they disagree with the vast majority of the world on. That is indefensible.

At the UN member states adopt new high level political declaration on HIV. surprise: it passed with amendments that made it significantly stronger on access to medicines and human rights than original. big deal in a moment where multilateral cooperation is in short supply. Some thoughts…

Janeese has been both classy and canny. She tapped deeply into a sense across DC that the neoliberal bargain of developer-centered politics in DC hasn't delivered for *most* people. Our ward, most mulit-racial in the city, voted hardest for her, while the wealthiest were the hold outs. Striking.

Proud to vote early today for @janeese4dc.bsky.social for a more affordable, more just, more bold DC

Def opportunity dc… and the fact that we both got it makes me really confused

Ebola, COVID-19, AIDS still continues, the world is failing to tackle pandemics. We've issued an urgent call from global experts at @theindpanel.bsky.social, @theelders.bsky.social Global Council on Inequality, AIDS, and Pandemics

Thank you, @chathamhouse.org for hosting us today to talk about the pandemic–inequality cycle. Brilliant event where we talked preparedness, national policymaking, and shifting the global financial and trade architecture to address, rather than fuel, pandemics.

Ok Skoll, I didn’t expect the Francis Collins panel was gonna morph into a concert

Honored to be @skollfoundation.bsky.social Forum this week at with @drtlaleng.bsky.social talking to change makers, funders, about inequality as a threat to global health security and what we can do about it. Brilliant folks here giving me hope. @ghpp.georgetown.edu @gtownsoh.bsky.social

Court strikes down “Kennedy Declaration” on transgender care, calling arguments “bald-faced lie” and “gaslighting” RFK can’t unilaterally set standards of care and cannot exclude providers from Medicare/caid for offering care consistent w medical guidelines storage.courtlistener.com/recap/gov.us...

File under: Institutions captured by our epic levels of inequality.