From smallpox to the Spanish Flu, the microbes have forced societies to mend ways and invest in healthcare. The results have been quite transformational
Infectious diseases, especially epidemics and pandemics, were considered God’s wrath in the past. “Come, my people, enter thou into thy chambers, and shut thy doors about thee: hide thyself as it were for a little moment, until the indignation be overpast,” says the Bible (Isaiah 26:20). “For, behold, the Lord cometh out of his place to punish the inhabitants of the earth for their iniquity..”
From the Justinian plague of 541–542 AD, the first recorded plague in history, to Covid-19 now, epidemics and pandemics wreaked havoc on the world. And most of the changes were calamitous. Empires fell. Governments withered away. Riots started and spread like wildfire. Communities were decimated en masse. It seemed nothing stood in the way of the humble but mighty microbe.
But miseries from repeated plagues and the rise of science and research prompted people to change their perspectives around pandemics. The ostensible shift from the belief of Gods and spirits inflicting diseases to more meaningfully mundane causes has gradually started shaping global public health for good. Among the many epidemics, smallpox, cholera and the Spanish flu played a pivotal role in steering the future course of public health.
Smallpox, big gains
Smallpox today is a medical success story. Nevertheless, the extremely infectious disease — ‘democratic’ in nature in comparison with many other cataclysmic, epochal events as it killed the rich and poor alike and wiped out several communities as such — claimed 30% of the infected.
The numbers were much worse for children so much so that there existed even a custom in ancient days to not name children until they inevitably contracted the disease and survived. But over time, doctors and scientists observed that those who had once survived the disease never contracted it for a second time. The idea of inoculation, which was already in existence (in some parts) to create immunity, was then widely considered for more scientific study and led to the discovery of the world’s first vaccine by Dr. Edward Jenner. This was a milestone in medical history and by 1980, smallpox became the first eradicated disease.
Cholera, with no love and mercy
In contrast to other ‘egalitarian epidemics’, cholera, which broke out first in Calcutta in 1817, was primarily a disease of urban slums. Since then, multiple bouts of cholera outbreak occurred in different parts of the world, claiming millions of lives, until in 1854 when Dr. John Snow, an English physician, identified the source of the outbreak — a contaminated public water pump in a community (Broadwick Street in England). He conducted a study relying on geography and statistical analysis, which brought out path-breaking findings that propelled public health all over the world.
After the initial controversies over Dr. Snow’s findings owing to their radical observations, the government and authorities were prompted to invest in building better sewer and sanitation systems, clean up the streets and ensure efficient drainage of water. Despite these measures, cholera continues to thrive in many developing countries, killing around 100,000-120,000 people every year globally. (The most recent mass outbreak was in the war-torn Yemen where more than a million people were infected since 2016 and over 2,500, half of them children, died).
Spanish flu, the 1918 virus war
The influenza of 1918, commonly known as ‘Spanish flu’ was one of the most horrendous epidemics in history as it has killed a population of 50 million or more in three waves. The name of the pandemic is a bit of a misnomer as its origin or spread has got nothing to do with Spain. It broke out during the final phase of First World War and played a big role in Germany’s defeat in the war.
The influenza virus contradicted the usual pattern of old-age being the more vulnerable age group. Those who were in the prime of life were more prone to its vagaries. All over the world, the poor and marginalised suffered the most, not because of their ‘inherent reasons’ as eugenicists claimed (which was a mainstream view back then), but due to substandard living conditions, malnutrition and overwork. The pandemic proved that no one was immune to infectious diseases. The biggest take-away from the 1918 catastrophe was that it was no longer plausible to blame individuals for contracting infectious diseases.
These revelations started to reflect in adopting new public health strategies. Many countries revamped their health ministries, and endorsed the concept for ‘healthcare for all’. The Soviet Union showed the way for other nations to follow, by implementing a centralised public healthcare system. Importance of global public health was recognised and in 1919 an international bureau for fighting epidemics was opened in Austria.
A hundred years from the 1918 pandemic, the world is once again amid an unprecedented pandemic, fighting with all its might and ingenuity. Although the novel coronavirus showed an “egalitarian” behaviour initially, without much discrimination, like any other infectious diseases, eventually the poor and marginalised bear the brunt. Times like these should be utilised to rethink the progress we made in our public health systems, and measures we undertook to bridge the socio-economic disparities.
Throughout human history, epidemics and pandemics have killed more number of human beings — not wars or natural disasters. Yet, funding for public healthcare remains skewed and glaringly low. From the US to India, healthcare spending as a share of GDP remains abysmally low. Reforms that hinge more on humane approaches is the need of the hour, and for the future, authorities should bolster global public health, to ensure that when the next virus emerges, we’ll restrain it faster, with minimal casualties and more resilience.