We are moving towards the end of our seminar series on pandemics, but are we moving towards the end of the Covid-19 pandemic? Do pandemics actually have an end, and how do we know when they are over? These are some of the questions that Erica Charters, Professor of the Global History of Medicine at the University of Oxford and Sanjoy Bhattachargy, Professor in the History of Medicine, University of York, explored on 3 March 2022 with Reuben College.
The beginnings of epidemics are sharply noted; communities are thrown into turmoil by shock as a crisis mounts. However, the ending of epidemics, argued Professor Charters, is less certain. For a start, less attention is paid to the endings of epidemics, so there are fewer studies of the tail ends than the starts of outbreaks – after all, we are keen to look to the future beyond the pandemic. Thucydides’ account of the Plague of Athens gives us a historical example where the end of the plague is not reported, rather it disappears from the narrative, superseded by other events of greater importance and interest. The histories of epidemics, such as cholera in the UK, ebola in West Africa, swine flu and HIV/AIDs, similarly offer a narrative arc which starts with a process of revelation, moving through stages of uncertainty towards collective action, but that drift towards closure rather than coming to a clear end. The end of an epidemic is not a single event, rather it is a process.
Professor Bhattachargy further expanded on the messy and contested nature of the end of epidemics, with discussion of the eradication of smallpox, and who has the authority to declare the end of an epidemic. For smallpox, the initial ‘death’ of the disease was followed by further cases, and eradication was declared twice more. There are, therefore, political and social ends to epidemics as well as scientific ends. Declaration of the end of a pandemic is a political act, and indeed, epidemics can be ‘useful’ to lever funding or interest in a disease which might otherwise be overlooked by global health policy.
The contested nature of the end of epidemics points to the necessity of interdisciplinary work, such as the How Epidemics End research project lead by Professor Charters. Whilst biological knowledge is critical to identifying and managing outbreaks, the end stages of epidemics require assessment in terms of economic and societal impact. If we think about the end of epidemics as processes, rather than singular events, we start to challenge the historical framework of pandemics as having clear contours with attributable deaths (visualised as discrete events on a historical path, separated from endemic diseases). Instead, Professor Charters offers a new way of conceptualising epidemics, visualised more like sound waves, which interact with endemic conditions in changing ways over time. If we think about epidemics as being political and social, not just as functions of disease, we can better understand the co-evolution of diseases and societies.
Gemma Hughes is a Research Fellow at Reuben College and a researcher in the Interdisciplinary Research in Health Sciences Group at the Nuffield Department of Primary Care Health Sciences
