The keys to a preventable pandemic

The historical and epidemiological context of COVID-19.

pandemia multitud persones ciutat

Most probably, the current coronavirus1 pandemic represents the uncertain epilogue of an epidemiological period marked by the renewed prominence of the infectious disease in the last decades of the twentieth century. The climate of euphoria surrounding the fight against infectious diseases – especially since the emergence of antibiotics and the spread of vaccination programmes – was hampered by the emergence of AIDS and other new viral diseases, in addition to the reappearance of old infectious pathologies. In 1996, the World Health Organization (WHO) recognised the existence of a global crisis in all matters relating to infectious diseases, stressing that no country could ignore the threat.

«To explain the appearance of new infectious diseases and, public health experts insist on the influence of climate change on the spread of parasites and viruses»

Just as in previous historical stages, this new epidemiological period was linked to a breakdown in the balance between human beings and the environment, triggered by an unsustainable model of economic growth and social development. To explain the appearance of new infectious diseases and the reappearance of old ones, public health experts insist, among other factors, on the influence of climate change on the spread of parasites and viruses, or the increase in zoonoses among humans – as a result of the invasion of new ecological spaces. In addition, human agglomerations caused by poverty, wild urbanisation, and migration must be taken into account.

On the occasion of the 2003 epidemic – known as Asian Pneumonia or Severe Acute Respiratory Syndrome (SARS) – Gro Harlem Brundtland, director-general of WHO, said that people’s ability to travel has removed physical barriers between poor and rich countries, thereby facilitating the spread of infectious diseases if adequate health systems were not established.

SARS was followed, among other emerging diseases, by influenzavirus A (H1N1), which was responsible for more than 18,000 deaths in 2009, or, more recently, by the re-emergence of Ebola virus outbreaks in Africa, zika in Latin America, and the current coronavirus pandemic, starting in China in 2019.

«Emerging infectious diseases and the re-emergence of other communicable diseases acquired the status of national disasters in developing countries»

In the case of the COVID-19 pandemic, many factors that have marked the course of emerging diseases over the past fifty years are once again present. In this time, controlling and preventing all these pathologies should have been one of the priority objectives of international health action. This was the time to address the causes and act on the origin of new diseases and associated health problems, particularly poverty and social inequalities. Instead, action was taken on the consequences.

Considering that the most disadvantaged countries were those most at risk of suffering from contagious diseases, as well as the most ill-equipped in terms of epidemiological surveillance systems and response capacity, it was decided to provide them with personnel specialising in early warning and rapid response systems to epidemics. Thus, emerging infectious diseases and the re-emergence of other communicable diseases acquired the status of national disasters in these countries. In addition to the large number of people affected and deaths caused, the economic costs involved and the socio-sanitary resources to be provided are often non-existent or very limited.

The coronavirus has reinforced the idea that we are all at risk and that no country can ignore the threat. As with the 1918 flu, both the degree of spread and the virulence of the virus behind the current pandemic have given it a global dimension that forces us, beyond local efforts, to seek an equally global solution. The pathogenesis of COVID-19 is very complex and will have to be addressed, as in the past, from a biological, health, socio-economic, and environmental interaction perspective.

In addition to focusing on the role of social inequalities, it will be necessary to improve epidemiological surveillance systems at the international level, to develop global health policies and, most importantly, to incorporate sustainability into health approaches and actions.

«We are living longer, but we do so with an increasing burden of diseases that diminish our health and make us more vulnerable to pathogens»

In this sense, the fact that the older population has become a risk group in the current pandemic cannot be dissociated from the sociodemographic and epidemiological reality marked by the increase in longevity in countries such as Spain. We are living longer, but we do so with an increasing burden of diseases that diminish our health and make us more vulnerable to pathogens such as the coronavirus. The key lies in the avoidable condition of many of the diseases that accompany the elderly; most of them are linked to unhealthy lifestyles, as is the case with eating habits. Correcting this situation and seeking alternative models of social and health care in the elderly population, such as home care, can help prevent situations such as those generated by the coronavirus.

We must take advantage of the window of opportunity that this health crisis offers us to claim a proper role for public health and for prevention and health promotion policy. In Spain, it is time to implement the General Law of Public Health approved in 2011, which has not been developed until now.

Health must be implemented in all policies. As happened in the nineteenth century with the cholera epidemics or in the inter-war period – after the 1918 flu pandemic – we must assess the social and health shortcomings that have become apparent and rethink the development model that led us to this situation. We need to act based on scientific evidence, both locally and in collaboration with a global governance led by supranational bodies and agencies striving, without conflict of interest, towardensuring the health of all humanity.

1. For more information and context on the reflections presented herein, check Josep Bernabeu-Mestre. Epidemias y globalización: nuevos y antiguos retos en el control de las enfermedades infecciosas. Revista de Historia Actual 2004; 2(2): 127-136. Available in Spanish in Recuperable en: (Go back)

© Mètode 2020

Doctor en Medicina i catedràtic d’Història de la Ciència de la Universitat d’Alacant. És membre del Grup Balmis d’Inves­tigació en Salut Comunitària i Història de la Ciència de la Universitat d’Alacant.