The COVID-19 pandemic transformed over the past five years from a catastrophic threat that has killed over 7 million people to what most people regard today as a tolerable annoyance that doesn’t require precaution. Nonetheless, COVID-19 continues to kill over 2,000 people per month globally and cause severe illness in the infirm or elderly.
The evolution of the COVID-19 pandemic – from devastation, to optimism for eradication, to persistent, uneven spread of disease – may seem unprecedented. As an infectious disease doctor and medical historian, however, I see similarities to other epidemics, including syphilis, AIDS and tuberculosis.
Vaccines, medications and other biomedical breakthroughs are necessary to eliminate epidemic diseases. But as I explore in my book, “Persisting Pandemics,” social, economic and political factors are equally important. On its own, medical science is not enough.
Syphilis, AIDS and TB have stuck around
Syphilis is a sexually transmitted disease first identified in 1495. It causes skin rashes and may progress to causing paralysis, blindness or both. For centuries, syphilis weakened nations by disabling parents, workers and soldiers in the prime of their lives. Innovative drugs – first Salvarsan (1909), then penicillin (1943) – offered a path toward eradication when used together with widespread testing.
Public health programs conducted from the 1930s through the 2000s, however, failed – not because of the efficacy of the treatments but because of socioeconomic conditions.
One challenge has been persistent stigma around getting tested for the disease and tracing sexual partners. Poverty is another; it can force women into commercial sex activities and prevent people from learning how to protect themselves from sexually transmitted infections. Population migration due to commerce or war can cause high-risk behaviors such as sexual promiscuity. Women in some cultures lack authority to negotiate for condom use. And governments have not consistently prioritized the sustained funding needed to support efforts to eliminate the disease.
Despite societal indifference toward syphilis, in the 2020s over 8 million new cases occur globally each year, particularly among racial minorities and low-income populations.
The history of HIV/AIDS is shorter than that of syphilis, but the trajectory has similarities. Doctors first described HIV/AIDS in 1981, when it was a nearly uniformly fatal sexually transmitted disease. Novel antiretroviral drugs introduced in 1996 offered medical scientists the hope of disease elimination through public health campaigns, centered on widespread testing and treatment, implemented in 2013.
But these programs, for reasons like with syphilis, are not meeting their treatment targets across all countries, especially among low-income populations and racial minorities. Sustaining funding for health care infrastructure and the multidrug regimens for 39 million people living with HIV poses an added challenge. Today, despite a cavalier public attitude toward the disease, AIDS causes over 630,000 deaths globally. That number will likely increase substantially given the Trump administration’s decision to cut funding for United States Agency for International Development programs.
Tuberculosis is a third disease that also depleted workforces and weakened nations, particularly in postindustrial revolution 19th-century cities. The disease spread widely because poverty placed people in poorly ventilated working conditions and crowded tenement dwellings. The development of new combination antimicrobial drug regimens offered an avenue for disease eradication in the 1960s.
Nonetheless, the inability to sustain funding to complete complex treatment courses, problems isolating people who could not afford suitable homes, and poor adherence due to homelessness, incarceration or migration during war or trade have compromised public health campaigns. Despite societal nonchalance, tuberculosis today kills up to 1.6 million globally yearly.
The COVID-19 case study
The trajectories of these epidemics show how campaigns based solely on biomedical approaches that target pathogens are not enough to eliminate disease.
COVID-19 provides the latest example. In the U.S., the pandemic and its lockdowns disproportionately affected low-income people and racial minorities, especially those employed in front-line jobs that did not allow remote work from home. These groups were more likely to reside in crowded residences with poor ventilation or no space for isolation.
Despite the rapid development of a breakthrough mRNA vaccine that offered hope for what President Joe Biden euphorically termed “independence from the virus,” the promise never fully materialized.
Too few people received shots, in large part due to socioeconomic factors.
Wealthy countries purchased vaccines that lower-income countries could not afford. Allocation difficulties kept vaccines from remote regions of the world.
Vaccine hesitancy due to mistrust in science, along with sentiment that vaccine mandates violated individual freedoms, also prevented people from getting the shot. Similar attitudes reduced rates of mask-wearing and isolation.
Consequently, surges that could have been avoided took more lives.
Drugs and vaccines can’t do it alone
Modern medical science is unmatched in treating pathogens and disease symptoms. But to stop disease, it’s also critical to address the social, economic and political conditions that enable its spread.
Public health officials have started to implement a variety of structural solutions:
- Stigma reduction programs to reduce the shame of having a disease and increase the number of people tested.
- Cash transfers to provide sex workers with capital to invest in less risky, alternative businesses.
- Peer education to empower sex workers with the authority to negotiate for condoms and safer sex practices.
- Health infrastructure expansion to enable access to testing and treatment facilities.
- Housing reforms to guarantee adequate air filtration and appropriate isolation facilities.
- Resistance to anti-science appointees to government positions to prevent the implementation of regressive public health measures.
- Sustained funding for public health efforts across political administrations that may have different priorities.
Early 20th-century public health officials had hoped that efficient scientific solutions alone could take the place of 19th-century, pre-germ-theory environmental sanitation efforts. COVID-19, syphilis, HIV/AIDS and tuberculosis show that while biomedical breakthroughs are necessary to eliminate epidemic diseases, sustained focus and resources aimed at helping the most socially and economically vulnerable are essential.
Powel H Kazanjian is Professor of Infectious Diseases and of History, University of Michigan.
The Conversation is an independent and nonprofit source of news, analysis and commentary from academic experts.
© The Conversation
22 Comments
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mikeylikesit
COVID was a creation of a cutting-edge biomedical breakthrough. It’s a little much to expect a second breakthrough to also eliminate it.
virusrex
No it was not, the scientific evidence clearly shows it was an introduction from nature, the same as every other pandemic in the history of humankind.
There have been many outbreaks that realistically could have caused pandemics and that have been controlled, this means that at least pandemics have been prevented even if the disease still exist.
Also important is that smallpox is a disease that was eliminated thanks to vaccination, which is a biomedical breakthrough, it may not be enough to eliminate every specific disease but at least it can be done.
Of course this depends on more than just the medical advances, polio was very close to being eradicated from the world but extremely bad decisions (specially from the US) allowed to persist and still cause victims. Looking at the current USA administration and their efforts to hinder the international efforts against AIDS and Tuberculosis (as well as other diseases) this seems like a pattern that will persist still in the future. Fortunately other countries with populations with better scientific literacy and human decency are beginning to plug the holes left by the Trump administration.
Raw Beer
What COVID-19 taught many people is the level of control that corporations have on the regulators, publishers, MSM, and governments; pushing them to censor/prohibit cheap safe and effective measures while promoting new expensive products of questionable safety and effectiveness. A poll taken in 2024 concluded that only about a quarter of the American public had faith in scientists to act in the people's best interests.
Raw Beer
The promise never materialized, not because "too few people received them", but rather because their safety, effectiveness, and duration were not as advertised.
virusrex
Not corporations but scientific evidence, which is desirable and correct. If corporations were the ones in control Musk would have gotten away with making workers stop isolating immediately for example, there were no measures that were safe and effective and at the same time prohibited, that was done with things that were worse than useless, things like HCQ that did nothing for the patients of covid but increase their risk and produce thousands of unnecessary deaths.
And research proved that those that had been manipulated into not trusting the scientists (specifically republicans) died more than those that had enough scientific literacy to listen to the experts,
1glenn
Biomedical breakthroughs were not enough to eliminate Covid 19, that is true. However, it is also a fact that biomedical breakthroughs saved millions of lives.
Similarly, biomedical breakthroughs have not eliminated cancer, but they have saved countless lives.
Scientific medical research seldom results in saving 100% of the people who are exposed to a disease. Saving 99+% is good enough.
virusrex
That a segment of the population was manipulated into rejecting the vaccines is a well known factor, also the vaccines were even more effective than what was said at the beginning, with immunity against variants that were theorized would make vaccination extremely ineffective. The "advertising" that was debunked was only the wild misrepresentations of antivaxxer groups that pretended the vaccines would be absolutely and perfectly effective forever and against any and all possible variants ever. This of course is not how the vaccines were actually described by the experts.
Zaphod
1glenn
Firstly you can never "eliminate" a virus completely, as they are moving targets. Secondly, I wonder where you get the "millions" from. As there is no control group, this is speculation.
Zaphod
virusrex
"Described" at what point? I remember how the expert opinion shift from "prevent infection" to "prevent death" to "lower the chances of death". Where on this moving scale are the experts of your respected institutions at this point? And what do they say about the PVS described in the recent Yale study?
falseflagsteve
Here’s an interesting Tweet made in 2021 which was common at the time and which any disagreement with was met with almost universal dismissal and abuse
https://x.com/albertbourla/status/1377618480527257606?s=61&t=uN0C24N9Jr3w-x-a-MONNw
Wick's pencil
To believe that you would have to completely ignore all the evidence that continues to pour out on the lack of effectiveness and the many serious adverse events.
virusrex
The smallpox/variola virus has been eliminated completely from nature, it had one single host and curing every member of the species eradicated the virus. That is a perfectly possible goal that could have been repeated with other pathogens like the polio virus.,
That you personally are not familiar with how epidemiology can make this kind of conclusions is a very poor argument, experts have validated scientific tools that allow for this to be said with proof. This has been known for years already
https://www.ncbi.nlm.nih.gov/search/research-news/10573/
Still false claims made principally by antivaxxer propaganda groups, from the very beginning the vaccines were said to greatly improve the chances of surviving the infection but they never were said to absolutely prevent infection or death by the experts. This is easy to see the moment the people making this false claim can never bring references where this was said. The vaccines were even feared to become completely ineffective for the inevitable variants, something that fortunately was not the case.
So, no moving scales, just false declarations that the experts never made from the beginning.
Justifiably since the people "disagreed" by lying about the reported results pretending this was said as a prediction of the vaccine would behave when used in the population at large (and specially forever and ever). If a study gives a specific result under controlled circumstances there is nothing wrong with reporting it exactly as it was found, the problem is people pretending this means it would apply the same outside of the study.
Completely false, what is necessary is to ignore the baseless accusations of antivaxxer groups that like to pretend problems are affecting millions of people based on shoddy science (or pure imagination) while ignoring the well characterized benefits that extended beyond the predicted during clinical trials. The most obvious was that vaccines still had protective effect against variants, a lack of which was a very clear possibility.
Wick's pencil
They subtract the number of deaths from faulty exaggerated model predictions and come up with "lives saved".
virusrex
False claim, can you demonstrate with scientific arguments (not just personal beliefs) the models are invalid? because if not then the only logical alternative is that the experts that do this kind of projections professionally and based on well described methods are correct, even if you believe differently.
Wick's pencil
They have a long history of massive over exaggerations in their models starting decades ago, especially from Imperial College London.
They use models to get desired numbers that can't be obtained experimentally.
virusrex
That is still not an scientific argument against the methods followed for the conclusion, just a personal belief.
If you are challenged to provide valid scientific argument instead of opinions and you just give more of that opinions that means you are implicitly accepting that you have no actual scientific arguments against the reports, so they remain valid and correct.
Raw Beer
Yes! A few years ago, Crowder did a good rundown of their history of modelling:
https://www.youtube.com/watch?v=OQeorYF9A-k
And since they are based on these faulty model predictions, estimates of "lives saved" are equally faulty.
virusrex
Still not a scientific argument against the methodologies of the model that support the claim that millions of lives were saved, which means you could not find anything wrong with them, so they are valid and correct.
You could not even argue with any arguments that the model are faulty, much less prove it, repeating a claim without proving it (specially when challenged) means you recognize your claim is false. After all there are many examples where models have proved to be precise and correct, like in climate change.
Paul Novax
Wealthy countries created the vaccines so naturally they should have access on this level.
Wealthy countries have also realized it is not certain the virus was not lab created and in fact the largest scientific institution in the world looks more towards the virus as having escaped from a lab.
virusrex
It was not only access but stockpiling and making deals with the companies that explicitly eliminated the possibility of selling to developing countries. A lot of those stockpiles were just discarded.
Completely false, the scientific consensus is clear on how this is the only explanation that fits the evidence, only deeply antiscientific bad actors continue with the debunked conspiracy theory of the lab origin, obviously without any evidence to support those claims.
Raw Beer
If those "methodologies" were as valid as you are implying, they would not have been so incredibly wrong in the past. How are the current "methodologies" any better?
virusrex
They have not, the simple fact that you have to endlessly repeat that claim without being able to support it with any kind of evidence, any kind of scientific argument easily demonstrate you yourself know the claim is false. This is someone coming here and accusing you of contradicting the science because you profit economically from doing it, would you accept as an argument if that person said "Other people have done it, so that proves this is the case here as well"?
Obviously not, that makes no sense.