Pandemic preparedness has traditionally been assessed through technical capacity, yet COVID-19 revealed a persistent gap between preparedness on paper and outcomes in practice. This paper examines how structural inequalities, rather than scientific limitations, shaped transmission dynamics and mortality, arguing for a reframing of preparedness around equity and implementation. Drawing on epidemiological evidence, case studies, and policy analysis, we introduce the concept of “social niches” as key transmission engines: structurally defined environments (e.g., occupations, housing, mobility constraints) that concentrate exposure risk and connect otherwise separate contact networks. We show that disparities in COVID-19 outcomes were primarily driven by differential exposure rather than intrinsic biological susceptibility, with transmission amplified in high-contact, resource-constrained settings such as migrant worker housing, informal labour sectors, and care institutions. Early ‘one-size-fits-all’ pandemic response further magnified these effects, as delays in targeted interventions within high-risk groups led to widespread seeding across populations. We also highlight limitations in prevailing metrics, which prioritised laboratory and epidemiological indicators without sufficient integration of social context, leading to misaligned policy responses. We argue that preparedness frameworks must incorporate auditable equity metrics, disaggregated data, and operational strategies capable of reaching high-exposure populations. In conclusion, effective pandemic preparedness is defined not by assets alone, but by equitable reach and timely implementation. Embedding equity into preparedness planning is essential to prevent recurrent patterns of concentrated transmission and disproportionate impact in future pandemics.
Pan et al. (Wed,) studied this question.