By Atanu Biswas
Pandemics are certainly not black swan events, although they are often perceived so. In his 2019 book The Pandemic Century: One Hundred Years of Panic, Hysteria and Hubris, Mark Honigsbaum, a medical historian at the City University of London, focused on nine large-scale outbreaks since 1900—from the Spanish flu to the 1924 outbreak of pneumonic plague in Los Angeles to the 1930 ‘parrot fever’ pandemic, through the more recent SARS, Ebola, and Zika epidemics. The book, at times, offers a gloomy assessment of how in today’s era of international travel, ecological disturbances, and human behaviors have tipped the scales in favor of pathogens. However, it did not include Covid-19 for obvious reasons. But, an updated version of the book came up quickly in 2020 with a new chapter and epilogue on the novel coronavirus. In the future, Honigsbaum might need to update his book further with more new chapters, who knows! Covid-19 will not be the last pandemic in our lifetime, even though ever since the 1918 Spanish flu pandemic, scientists have dreamed of preventing catastrophic outbreaks of infectious disease.
The effect of Covid has been tremendous. A ‘new normal’ has been induced on this planet. More than 6.1 million official death tolls have been recorded so far worldwide, while the actual figure might be a few times more. The global growth contraction for 2020 is estimated at 3.5% and, according to a Statista report, it was expected to lose nearly $8.5 trillion in output over 2021-2022 due to the pandemic. How inevitable are future pandemics? For a century, two new viruses per year have spilled from their natural hosts into humans and their number is likely to be skyrocketed in the next decade or so. Connections between deforestation, wildlife trade, and the rise of infectious diseases have been well-documented. Climate change, for example, is directly linked to a higher risk of a pandemic as rising temperatures enable disease-carrying insects to proliferate, adapt to different seasons, and invade new territories. An August 2021 article in the Proceedings of the National Academy of Sciences studied the intensity and frequency of extreme novel epidemics. It was found that the yearly occurrence probability of extreme epidemics such as the Spanish flu was 0.27% in 1600, while it became 1.9% in today’s world. It implies that extreme epidemics are now relatively likely. The probability of a pandemic with a similar impact to Covid-19 is found to be about 2%. The authors, alarmingly, estimated that the yearly probability of occurrence of extreme epidemics can increase up to threefold in the coming decades.
Is it then possible to reduce the risk of future pandemics? In Aesop’s fable ‘The Ant and the Grasshopper’, a hungry grasshopper begs for food from an ant when winter comes and is refused. Well, like the ant in the fable, we could learn from Covid-19, stock up, prepare, build resilient systems, and keep watch as a global community to combat future pandemics. An editorial in Lancet Respiratory Medicine in March 2022 opined that failing to prepare for future pandemics means preparing to fail. It quoted a recent Perspectives article—“The pandemic exposes weaknesses of current leadership of global public health systems, inequities of resource allocation to Africa, and broken promises by wealthier nations for vaccine equity and resource allocation. This status quo is unacceptable.”
During the last two years, Covid-19 has taught us how to combat a pandemic—being prepared, taking public health seriously, and responding quickly, including border controls. Taiwan was probably the quickest to respond against Covid-19—perhaps because of its proximity to China. South Korea was also an early responder. New Zealand’s response came later but was still quick enough to significantly limit the pandemic’s spread. A study titled ‘Ecology and Economics for Pandemic Prevention’, published in Science in July 2020, outlined a groundbreaking plan to decrease the risk of future pandemics by 27% or more—with a 10-year investment. It was calculated that preventing disease spillover from wildlife costs way less than trying to respond to such a disease once it has spread. In fact, the costs of preventing future zoonotic outbreaks like Covid-19 are as little as $22 billion a year, 2% of Covid’s economic and mortality costs—which was predicted to be $10-20 trillion. These expenditures on preventive measures include annual funding for monitoring wildlife trade, the annual cost of programs to reduce spillovers, for early detection and control, to reduce spillovers via livestock, reducing deforestation by half, and ending wild meat trade in China.
In Ingmar Bergman’s 1957 film, The Seventh Seal, a disillusioned knight Antonius Block returned from the Crusades to find the country ravaged by the plague epidemic ‘Black Death’. The knight encounters the personification of Death, whom he challenges to a chess match, believing he can survive as long as the game continues. Well, such resistance against pandemics is inscribed in our lifestyle. And this is our destiny too. The game, however, continues till date and beyond.
The author is Professor of statistics, Indian Statistical Institute, Kolkata