Over the past few months, COVID-19 has ravaged health systems and economies in countries across the world. While many would argue that a pandemic of respiratory disease was predictable, the systematic failures of the response came as a surprise. From the shortage of hospital beds and medical equipment to the gross insufficiencies in national surveillance systems, supply chains and laboratory capacity, COVID-19 has laid bare the health care limitations that ‘global north’ and ‘global south’ share. A stark set of differences, however, run across the parallels in our collective predicament: indeed, what has become ever-more apparent is the radically uneven distribution of the health, social and economic risks associated with the pandemic—and the public health measures implemented in response—both within and between societies. As concerns grow over a prolonged period of COVID-19 waves, further insights are needed into who bears the largest share of COVID-19 burden and why. The pursuit of health equity is widely held to be global health’s raison d’être; and yet, the deep inequities laid bare by the current pandemic underscore that the field must do more and we must do better. This article identifies five key domains for equity research and action going forward. These ‘equity frontiers’ are not meant to be exhaustive. Rather our emphasis here is on drawing lessons from the COVID-19 pandemic as a prompt for a revived—if not rethought—equity agenda for an evolving global health field.

David McCoy and colleagues critique the dominance of “lives saved” models of assessing the impact of health programs, using The Global Fund as a case study. Please see later in the article for the Editors' Summary

The pursuit of health equity is foundational to the global health enterprise. But while moral concerns over health inequities can galvanise political commitment, how such concerns can or should translate into practice remains less clear. This paper reviews evolving ways that equity goals have featured in key World Health Organization (WHO)-related policy documents, before discussing the heuristic value and empirical traction that the concept of equity can bring to the health system strengthening (HSS) agenda. We argue that while health equity is often presented as the overarching goal of HSS, in practice this is typically circumscribed to the provision of healthcare services. Although health care equity is important, we suggest that this narrow focus risks losing sight of the structural political, social and economic drivers of health and health inequities, as well as the broader contexts of care and complex socio-political mechanisms through which health systems are strengthened. Drawing on new lines of empirical inquiry, we propose that broadening the equity lens for HSS ­offers exciting opportunities to put health systems at the heart of a more ambitious equity agenda in global health.

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