Pandemics throughout history have shaped societies - not only in the loss of life but through social, economic, and political shifts. The impact of infectious diseases on society has been evident since the Justinian Plague of the sixth century (although the degree of its influence remains contested), as well as the Black Plague that ravaged Europe during the 14th century.
Through the 20th and early 21st centuries, there were numerous pandemics that changed individual lives, government functions, and public health practices around the world. Illness and death serve as immediate consequences of infectious disease, but how epidemics affect the economy and other aspects of the world can take years or decades to fully understand.
The pandemics that shaped the modern world wrought devastation, but they also offer lessons on how to rectify the mistakes of the past and create a healthier future.
- Photo: Armed Forces Institute of Pathology/National Museum of Health and Medicine / Wikimedia Commons / Public Domain
More People Died From The Spanish Flu Than In WWI
Where: The first reported cases of the Spanish Flu came out of the United States. The disease spread quickly throughout Europe and, subsequently, around the world.
How It Was Handled: In some parts of the United States, as the disease spread and mortalities increased, public health officials encouraged Americans to wear masks, implemented educational programs about the dangers of sneezing and coughing, and encouraged people to stay at home. Quarantines, surveillance, and new regulations accompanied these isolation and information campaigns.
One of the most notable efforts involved spitting. Reportedly, Boy Scouts passed out cards to spitters that read, "You are in violation of the Sanitary Code" to try to stop the practice.
In Europe, the WWI effort hindered what could be done to address the pandemic. According to British official Arthur Newsholme, "the relentless needs of warfare justified incurring [the] risk of spreading infection."
After WW1 came to an end, the newly established League of Nations attempted to address disease prevention and public health information campaigns. The League also fostered research and testing programs, a response to the Spanish flu as well as other infectious diseases that continued to spread, such as typhus and yellow fever.
How It Impacted The World: The term "Spanish Flu" reveals how the disease was initially received, with European countries limiting the extent to which they acknowledged its impact. As WWI raged, Spain - and its neutrality - meant news of the disease was not subject to information blackouts by and among WWI participants. As a result, there was more known about the flu in Spain than anywhere else.
The first reported cases of the Spanish flu actually came out of Kansas in March 1918. In Europe, where hundreds of thousands of US troops arrived in March and April 1918 alone, close confines and unsanitary conditions perpetuated the spread of the flu.
There were several waves of the Spanish flu, the second of which resulted in the largest number of deaths in the autumn of 1918. Over its 18-month run, roughly 500 million people were infected, and somewhere between 20 and 50 million people died of the disease.
It wasn't until decades later that researchers came to understand the cause of the Spanish flu. As an H1 virus, the flu had essentially been replaced by H2 flu viruses during the late 19th century. This prevented humans from building immunities to H1 viruses, making the Spanish flu especially fatal.
Now known as H1N1, the virus that brought about so much devastation in 1918 and 1919 recurred at various times during the 20th and 21st centuries, most recently in 2009. The outbreak of the Spanish flu did facilitate an understanding of viruses, airborne diseases, and the need for containment. A lack of trust by the general public and an inability to enforce the measures needed to stop the spread of the disease, however, ultimately extended the length of the catastrophe.
HIV And AIDS Spurred Universal Precautions To Reduce Stigma
When: 1981 to the present
Where: The United States is where the first cases appeared, but the virus is believed to have originated in Africa.
How It Was Handled: Initial reports of rare lung infections and skin cancers in 1981 prompted researchers and medical professionals to find the root cause of these conditions. In 1982, the term AIDS, or Acquired Immune Deficiency Syndrome, entered the lexicon, with the virus that caused the disease - the human immuno-deficiency virus, or HIV - identified several years later.
As an infectious disease that destroys the body's immune system, AIDS spread worldwide by the end of 1985. During the mid 1980s, the Centers for Disease Control (CDC) and its international counterparts determined HIV and AIDS were spread through bodily fluids, bringing some clarity to questions about casual transmission. Public health initiatives to promote safe sexual contact and clean needle use were among the first steps taken to try to stop the spread of HIV and AIDS.
High instances of both HIV and AIDS in the context of intercourse and substance use, combined with inaccurate information, prompted individuals with the virus and the disease to remain quiet out of fear of a growing stigma. Through the late 1980s and 1990s, the World Health Organization and the CDC instituted campaigns to combat the stigma, the virus, and the disease, while the scientific community worked to better produce effective tests and treatments.
Similarly, the medical community began to adjust their practices, adopting universal precautions when dealing with bodily fluids. The CDC introduced universal precautions during the mid-1980s, honing standards and formally establishing body substance isolation protocols in 1987.
How It Impacted The World: Prevention strategies, testing guidelines, and medicine developed to treat HIV all lowered instances of HIV and AIDS during the early 21st century. Efforts to inform the public around the world about symptoms, transmission, and risk factors similarly helped reduce AIDS cases - which peaked in 2005 - by half.
Millions of people around the world continue to live with HIV and AIDS, a reality that puts healthcare professionals at great risk. Universal precautions were mandated by the Occupational Safety and Health Administration in the United States, essentially requiring healthcare workers to treat all blood and bodily fluids as though they contained an infection. Canada implemented similar protocols. In parts of the world like Nigeria, there are continued concerns about consistent use of universal precautions.
Gowns, masks, and gloves became standard practice for infection control. This not only reduced transmission of HIV and AIDS, but were applicable to prevent the spread of other diseases like hepatitis.
Where: It's believed smallpox was present in Athens in the 5th century BC, wiped out millions in the Roman Empire from 165-180 AD, extended through Europe and Asia during the Middle Ages, and was spread throughout the world from the 15th century forward as a result of European colonization.
How It Was Handled: Until the late 18th century, there were no real effective ways to combat smallpox. Early attempts at variolation - introducing smallpox into a healthy person's skin or nose intentionally - alleviated some of the severity of the disease but didn't prevent it. During that century alone in Europe, 400,000 people succumbed to smallpox each year. Surviving smallpox could leave scars, disfigurements, or result in blindness.
In 1796, Dr. Edward Jenner used a form of variolation to prevent smallpox, after noticing milkmaids who'd had cowpox seemed immune to the disease. By 1801, Jenner's continued experiments proved successful, and he was hopeful his efforts would lead to "the annihilation of the smallpox, the most dreadful scourge of the human species."
Smallpox didn't disappear and, during the 20th century, there were widespread global efforts to eradicate the disease. The World Health Organization (WHO) introduced a worldwide initiative in 1959, but it wasn't until the late 1960s that a smallpox vaccine was widely available in South America, Asia, and Africa.
How It Impacted The World: Once Jenner used cowpox as a way to vaccinate (from variolae vaccinae or "smallpox of the cow") against smallpox, his technique slowly gained support. During the 19th century, cases of smallpox declined but the disease continued to be problematic. It became clear that revaccination might be necessary and that, in hot climates, applying the vaccine to one's skin was subject to evaporation. This prompted development of a freeze-dried version and more efficient needles.
In the United States, the last case of smallpox was seen in 1949. North America and Europe both eradicated smallpox during the early 1950s. After nearly two decades, the WHO eliminated smallpox worldwide in 1977 (there remain stockpiles in several laboratories around the world, however).
The WHO released a resolution in 1980, declaring, "The world and all its peoples have won freedom from smallpox... [an] unprecedented achievement in the history of public health."
As the coordinated efforts of the WHO and health organizations in individual countries vaccinated large numbers of people, investigated new cases, and standardized pandemic response. Jenner also popularized vaccination, a practice that would later be used against diseases such as polio, yellow fever, and measles, among others.
When: Perhaps present in Egypt during the 14th century BC, polio was clinically described for the first time in 1789 and defined as a condition in 1840 in Europe. Polio became widespread in the United States after 1894.
How It Was Handled: Polio - short for poliomyelitis - proliferated as urbanization increased during the early 20th century. Unsanitary conditions prompted cities to implement sanitation measures which, ironically, prevented children from developing natural immunities to one of the viruses that caused polio. As a result, polio was synonymous with infantile paralysis during the first half of the 20th century.
In 1929, Philip Drinker and Louis Shaw created "iron lung" treatments for individuals suffering from the disease.
Public health officials in the United States implemented quarantines to try to prevent the spread of polio, and individuals around the country kept their children inside to try to prevent exposure. In 1938, President Franklin D. Roosevelt, suffering from polio himself, fostered the National Foundation for Infantile Paralysis, as well as the March of Dimes.
Collectively, the scientific community and the March of Dimes pushed to create a vaccine for polio. Dr. Jonas Salk developed the first vaccine in 1952 - the same year more than 3,000 children in the United States perished from polio. Three years later, vaccinations began on a grand scale and, by the end of the decade, it was distributed to 90 countries around the world.
How It Impacted The World: The rapid reduction of polio cases during the late 1950s and early 1960s demonstrated the efficacy of vaccines to the global community. In the United States, where more than 15,000 individuals were afflicted with paralysis stemming from polio each year prior to the vaccine, there was a 90% decrease in cases between 1955 and 1962. By the 1970s, there were fewer than 10 people in the US with polio, and no cases after 1979.
Polio has not been eradicated worldwide, however, a fact that engaged the private sector during the 1980s. In 1985, Rotary International pledged millions of dollars to try to rid the world of polio. Partnered with the WHO, the CDC, the United Nations Children's Fund, the Bill & Melinda Gates Foundation, and Gavi, the Vaccine Alliance, Rotary continues to fund the Global Polio Eradication Initiative, with contributions of more than $1.2 billion as of 2013.
The World Health Organization (WHO), national governments, and international aid agencies continue to administer vaccines to children around the world, limiting its scope to parts of Nigeria and the Afghanistan-Pakistan border region. Nearly 60 years after Salk's vaccine was introduced, collective action remains essential to try to rid the world of polio.