- COVID-19 is the latest in a long series of pandemics that have shaped the course of history and hold lessons for today.
- The 1918-19 Spanish flu is thought to have led to increased global cooperation around pandemic preparedness.
- The epidemic also led to an expanded role of the state in healthcare, which COVID-19 has also triggered.
- The Black Death of 1347-51 is thought to have stimulated major economic and technological changes.
- Pandemics throughout history show that the poorest suffer the most.
Did yellow fever change the course of US history? Would global cooperation on diseases exist today without the flu pandemic of 1918-20? Will COVID-19 reorder our world too?
While today’s pandemic is unique and the future is uncertain, the outbreaks of the past suggest ways we can respond now to achieve better outcomes tomorrow.
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With the geopolitical impacts of COVID-19 high on this year’s Davos Agenda, here are five key points from the pandemics of history today’s decision makers could learn from.
1. Increased global health cooperation
Between 1918-19, a deadly influenza epidemic known as “Spanish flu” swept the globe, infecting an estimated half a billion people. Around 50 million are thought to have died. Yet out of this tragedy emerged institutions that have supported us in this latest onslaught.
In the early 1920s the health division of the League of Nations was established in response to the devastation of the Spanish Flu. From this, and other smaller organizations, the World Health Organization was born, in 1946. In 1952 it set up a Global Influenza Surveillance Network. The successor of this today keeps a look out for diseases like COVID-19.
And according to geostrategist Professor Nayef Al-Rodhan, HIV, A/H1N1 and Ebola have all spurred international cooperation and preparedness. “As [with] other pandemics,” he writes in Global Policy, “the recent Covid-19 outbreak will bring significant transformations.”
Despite global divisions during the pandemic, the news that 2 billion doses have been secured for the equal-access COVID-19 vaccine initiative COVAX shows how global cooperation can occur, and what it can achieve.
2. Expect the unexpected
More unpredictable are the tectonic shifts in geopolitics that can occur after major global upheavals. According to Frank M. Snowden, professor emeritus of the history of medicine at Yale and author of Epidemics and Society: From the Black Death to the Present, the course of world history may have been profoundly shaped by the yellow fever epidemics of the 18th century.
“When Napoleon sent the great armada to restore slavery in Haiti, the slave rebellion succeeded because the slaves from Africa had immunity that white Europeans who were in Napoleon’s army didn’t have,” Snowden told The New Yorker. “It led to Haitian independence.”
“This was what led to Napoleon’s decision to abandon projecting French power in the New World and therefore to agree, with Thomas Jefferson, in 1803, to the Louisiana Purchase, which doubled the size of the United States.”
Further back is the Antonine Plague (165-180 AD). This pandemic hit the Roman Empire hard, killing an estimated 5 million inhabitants, and is thought to have contributed to the collapse of the Pax Romana (the Roman Peace) – what had been the height of Roman power. It was in the period after this plague that Christianity gained an increasing hold.
3. An expanded state
Around the world, governments have spent around $12 trillion to fight COVID-19, increasing state intervention to support the unemployed, for example. But what of this state expansion is likely to remain when the pandemic is past?
According to Laura Spinney, author of Pale Rider: The Spanish flu of 1918 and How It Changed the World, there are precedents for state-led healthcare assuming a new-found importance.
“It gave a big boost to the concept of socialized medicine and healthcare, which no country had really got around to organizing yet,” Spinney told the Forum's podcast World Vs Virus. “There was a realization that a pandemic was a global health crisis you had to treat at the population level. You couldn't treat individuals and there was no point in blaming individuals for catching an illness or treating them in isolation."
“Russia was the first, followed by Western European nations, to put in place socialized healthcare systems. Along with that comes epidemiology, the search for patterns and causes and effects of patterns in healthcare.”
4. Accelerating technologies and economies
The bubonic plague – or Black Death – of 1347-51 was devastating. Considered the deadliest pandemic in human history, it is thought to have killed some 200 million people – as much as 50% of Europe’s entire population. It would take more than 200 years for the continent’s population to recover. And the changes it triggered and accelerated were profound – particularly for workers.
Before the plague, is it thought that a rising population in England kept wages low and rents high. By contrast, in the pandemic’s aftermath pay may have increased by up to 40%.
This may, in turn, have triggered a whole host of other changes, including an increased pressure for labour-saving industrial innovations that could balance out increased wage bills. This may have sown the seeds of the technological industrial revolution that would reshape the world – a longer-term version of COVID-19’s own acceleration of technology, from communications to healthcare.
In the 14th century, higher wages may also have reshaped lifestyles: more money for better food, and maybe greater expectations too. However, given the different economic and technological circumstances of 2021, it is unclear whether these particular patterns will be repeated. In fact the opposite looks more likely, at least in the short term.
5. The poor suffer the most
Pandemics can be a great leveller. In 1918, just weeks before the end of the First World War, the then British Prime Minister, David Lloyd George, fell sick with Spanish flu, and endured a week-long fever. In 2020 the current British PM Boris Johnson was taken to hospital after catching COVID-19.
Yet, as Laura Spinney observes, looking at the population level in 1918 reveals a different historical lesson. “There's a very clear disparity and basically the poorest, the most vulnerable, the ones with the least good access to healthcare, the ones who work the longest hours, who live in the most crowded accommodation, and so on, are more at risk
“That effect is strong in every pandemic and, unfortunately, it's likely that developing countries are the ones that are going to bear the burden of this pandemic.”