Invited Commentary: To Make Long-Term Gains Against Infection Inequity, Infectious Disease Epidemiology Needs to Develop a More Sociological Imagination.

This article focuses on the application of fundamental cause theory (FCT) to understanding persistent inequities in infectious disease outcomes, emphasizing the need to address underlying social structures such as racism, socioeconomic inequality, and social stigma beyond proximal intervening mechanisms. Building on Noppert et al.'s framework linking structural social causes to infection risks, the authors argue that focusing solely on immediate mechanisms—like healthcare access or environmental factors—without confronting fundamental social causes risks perpetuating or exacerbating health inequities. They outline a four-stage cycle of how innovations in disease prevention diffuse unevenly across social strata, often widening disparities before eventually reducing them, and stress the importance of adopting a sociological imagination to connect individual infection outcomes to broader social systems. The article calls for infectious disease epidemiology to integrate this perspective to better understand and ultimately prevent recurring inequities across epidemics.