German Law Journal 1637 increased income inequality after the pandemic.6 All of these factors add up to a poor outcome for many members of these communities, in terms of the impact of both the disease itself and the “pandemic conditions” to which it has given rise.7 COVID-19 also highlights differences between countries in the Global North and Global South as to the resources available to combat the spread of a virus which requires social and physical distancing, to provide effective therapies, and to enable the equitable distribution of effective vaccines, not to mention differences as to the availability of comprehensive healthcare and frameworks for social protection. The latter are unattainable for lower income countries. Yet the younger age profile of populations in many lower income countries seems to have had significant implications for the mortality rate, at least in some places and at some points, despite the delays in vaccine distribution in the Global South. However, it will be many years before it is possible to draw firm conclusions on the direct and indirect outcomes of the pandemic as virus and of the responses to the pandemic across different countries8 or to benchmark with certainty the effectiveness of different responses.9 One way of articulating the differential impact of SARS-COV-2 and other viruses across communities and countries is to employ the term syndemic alongside that of pandemic.10 According to Merrill Singer, who pioneered this term, A syndemic . . . involves a set of enmeshed and mutually enhancing health problems that, working together in a context of noxious social and physical conditions, can significantly affect the overall disease burden and health status of a population.11 Singer argues that COVID-19 should be characterized as a syndemic. As quoted in the Financial Times, he states that “we have to consider not just biological issues but the social structural forces that propel disease interaction, population vulnerability and unequal access to healthcare, including [. . .] Covid-19 vaccines.”12 In other words, we will only fully understand the nature and effects of the pandemic, and especially the documented inequality of outcomes, when we study the virus 6 Angus Deaton, Covid Shows How the State Can Address Social Inequality, THE FINANCIAL TIMES (Jan. 5, 2021), https://www. ft.com/content/caa37763-9c71-4f8d-9c29-b16ccf53d780; Francisco Ferreira, Inequality in the Time of COVID-19, IMF FIN. AND DEV. 20 (Summer 2021), https://www.imf.org/external/pubs/ft/fandd/2021/06/inequality-and-covid-19-ferreira.htm. 7 Ali Cheshmehzangi, Vulnerability of the UK’s BAME Communities During COVID-19: The Review of Public Health and Socio-economic Inequalities, J. HUM. BEHAV. SOC. ENV’T (2021); Clarence C. Gravlee, Systemic Racism, Chronic Health Inequities, and COVID-19: A Syndemic in the Making?, AM. J. HUM. BIOLOGY 32:e23482 (2020), https://www.ncbi.nlm. nih.gov/pmc/articles/PMC7441277/. On the relationship between COVID-19 and settler colonialism, see Monika Batra Kashyap, U.S. Settler Colonialism, White Supremacy, and the Racially Disparate Impacts of COVID-19, 11 CAL. L. REV. ONLINE 517-529 (2020), https://digitalcommons.law.seattleu.edu/faculty/830/. See also Luis Alberto Martinez-Juarez, Ana Cristina Sedas, Miriam Orcutt, & Raj Bhopal, Governments and International Institutions Should Urgently Attend to the Unjust Disparities that COVID-19 is Exposing and Causing, 23 ECLINICALMEDICINE 100376 (2020). 8 Jonathan M. Clarke, Azeem Majeed, Thomas Beaney, Measuring the Impact of COVID-19, BMJ 373, 1239 (2021), https:// www.bmj.com/content/373/bmj.n1239. On the distinction between the virus and responses to the pandemic, see J. Michael Ryan, The SARS-CoV-2 Virus and the COVID-19 Pandemic, in COVID-19: VOL. II: SOCIAL CONSEQUENCES AND CULTURAL ADAPTATIONS 9 (2020). 9 Sheila Jasanoff & Stephen Hilgartner: A Stress Test for Politics: Insights from the Comparative Covid Response Project (CompCoRe) 2020, VERFBLOG (May 11, 2021), https://verfassungsblog.de/a-stress-test-for-politics-insights-from-the-comparative-covid-responseproject-compcore-2020. 10 In any event, a pandemic is easier to describe—for example, by reference to the spread of a particular disease across borders—than it is to define. See Peter Doshi, The Elusive Definition of Pandemic Influenza, Bulletin of the World Health Organization 89.7, 532-8 (2011). The outbreak of COVID-19 was confirmed as a pandemic by the World Health Organization on March 11, 2020, by which time there were cases in more than one hundred countries across the world. See Coronavirus Confirmed as Pandemic by World Health Organization, BBC NEWS (Mar. 11, 2020), https://www.bbc.co. uk/news/world-51839944. 11 MERRILL SINGER, INTRODUCTION TO SYNDEMICS: A CRITICAL SYSTEMS APPROACH TO PUBLIC AND COMMUNITY HEALTH xiv (John Wiley & Sons, Inc. 2009). 12 Anjana Ahuja, Covid-19 is Really a Syndemic—and That Shows Us How to Fight It, FIN. TIMES (Oct. 9, 2020), https://www. ft.com/content/34a502b1-5665-42ff-8a8d-1298b71f1eb. https://doi.org/10.1017/glj.2021.77 Published online by Cambridge University Press