“Breaking the inverse laws”: Accelerating the health equity impact of prevention and control interventions for infectious diseases in Africa

Despite their potential to accelerate infectious disease prevention and control, health innovations often exacerbate rather than reduce health inequity, both between countries and within them. As researchers and practitioners working in the region most affected by infectious disease, sub-Saharan Africa, we are frustrated when richer countries and more advantaged groups are better enabled to take advantage of new technologies, compounding patterns of infectious disease risk and poorer access to health services among disadvantaged populations. We refer to the combined forces underpinning these repeated experiences as "the inverse laws". Determinants include structural factors, markets, health policies, programme implementation, behavioural and social factors and epidemiological dynamics. These determinants interact in complex ways, unique to infections, limiting the utility of existing health equity frameworks. But, the inverse laws are not inevitable. Counter-cases are found. The determinants are modifiable. We will use interdisciplinary, theory-informed analysis to interpret historical patterns and possible future trends, developing a new infectious disease health equity framework. We will conduct mixed-method, country-level case studies to investigate how to “break the inverse laws” for four major infectious diseases: HIV, HPV, measles and outbreak-prone infections. Findings will be actionable, disseminated through a cross-sectoral community of practice to ensure new advances benefit all.