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What Does it Take For a Pandemic to End?

Former Managing Director of Ahmedabad Stock Exchange
Oct 29, 2020 8:07 AM 4 min read

We are in the grip of a healthcare crisis like none other in living memory. COVID-19 is affecting all countries and territories around the world. While people are pinning their hopes on a vaccine to wipe it out, the fact is that most of the infections faced by our ancestors are still with us.

Whether bacterial, viral or parasitic - virtually every disease pathogen that has affected people over the last several thousand years is still with us because it is nearly impossible to fully eradicate them.

Even though the biological agents of the 6th century Plague of Justinian (541-542), the 14th century Black Death (1346-1353), and the early 20th century Manchurian Plague (1910-1911) were almost certainly not identical, the epidemics themselves share common features that link historical actors to present experience. 

“As a social phenomenon,” the historian Charles Rosenberg wrote in 1989, nearly a decade into the HIV/AIDS epidemic, “an epidemic has a dramaturgic form. Epidemics start at a moment in time, proceed on a stage limited in space and duration, following a plotline of increasing and revelatory tension, move to a crisis of individual and collective character, then drift towards closure.”

What Have Past Epidemics and Pandemics Shown Us?

It's been 40 years since the first HIV/AIDS cases were noticed. Even now, every year 1.7 million people are infected with HIV. Indeed, in the absence of a vaccine, the World Health Organisation (WHO) does not expect to close curtains on it before 2030. From a strictly biological perspective, the AIDS pandemic never ended. But while HIV continues to pose a health threat, it does not inspire the same fears as it did in the early 1980s.

The history of epidemic or pandemic endings has taken many forms, and only a handful of them have resulted in a complete elimination of the disease. Epidemics are not merely biological phenomena. They are inevitably framed and shaped by our social responses to them, from beginning to end. Two faces of an epidemic - the biological and the social - are closely intertwined but are not the same. Epidemics colonise our social lives and force us to learn to live with them, in some way or another, for the foreseeable future. 

Just as the post-colonial period continued to be shaped by structures established under colonial rule, so too are our post-pandemic futures indelibly shaped by what we do now. There will be no simple return to the way things were: whatever normal we build will be a new one.

Diseases such as tuberculosis, leprosy and measles have been with us for several millennia. While tuberculosis is the target of concerted international disease control efforts, the course of this affliction has been spread out so long. Sub-Saharan Africa, South Asia and Southeast Asia continue to be afflicted by tuberculosis, even as Europe and North America are largely spared of this chronic disease.


 What Does it Take For a Pandemic to End?


Are Vaccines Really the Panacea?

The only epidemic that has been eradicated completely through vaccination is smallpox. Mass vaccination campaigns led by the WHO in the 1960s and 1970s were successful, and in 1980, smallpox was declared the first – and still, the only – human disease to be fully eradicated.

Since vaccines are in part technologies of trust, ending outbreaks depends on maintaining confidence in national and international structures through which vaccines are delivered. Wherever that often-fragile trust is fractured or undermined, immunization rates can drop to a critical level. The oral poliovirus vaccine became the tool of choice for the Global Polio Eradication Initiative in the late 1980s. In Kano, Nigeria, for example, a ban on polio vaccination between 2000 and 2004 resulted in a new polio epidemic that soon spread to neighbouring countries. As late as December 2019, polio outbreaks were still reported in fifteen African countries.


What Can We Say About COVID-19?

COVID-19 has frequently been compared to the 1918 Spanish Flu. Strangely enough, in 1918 there was no vaccine. The virus just went around unchecked. And the pandemic continued in some places until 1921, after which there was enough herd immunity or pre-existing immunity that it was reduced to a seasonal flu strain.

In order for a pandemic to end, the disease in question has to reach a point beyond which it is simply unable to successfully find enough hosts to catch it and spread it. There is no evidence for lasting “herd immunity” to the coronavirus following natural infection yet. Rather than ending the pandemic, scientists writing in Lancet argue, uncontrolled transmission in younger people could merely result in recurrent epidemics.

The promise of a COVID-19 vaccine is inching closer to reality, with some candidate vaccines approaching the last hurdle in the clinical trial process. But it's not like a switch will flip and the pandemic will end the moment a vaccine is available, epidemiologists say. Once we get vaccines out, the number of cases will go down. Once the treatment therapies improve, the mortality rates will fall. But the virus could stay with us for a long time, even after the pandemic phase has passed.

The history of pandemics suggests that diseases fade...but are almost never truly gone.


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