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.
A 1940s poster focuses on the medical cure for the disease.
National Archives, CC BY
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…
