Registering for Epidemics and Society in the Fall, I did not expect to learn what I did. Looking back, I thought of it more as Epidemics ‘in’ Society rather than Epidemics ‘and’ Society; I thought that we would be discussing epidemics that have occurred and their biological bases. What I did not realize was that we would look at the intersection of society and these epidemics – that is, how society gave rise to these diseases, how the diseases impacted society, etc. In doing so, I was amazed by how many societal factors were at fault for these epidemics.

For example, the very first artifact, The Sedentary Lifestyle, discussed how societal changes in lifestyle led to the rise of plagues. Initially, while we were a hunting and gathering society, our spaced-out, on-the-move, limited population lifestyle hindered the ability of infections to spread and plagues to develop. However, with the rise of the agricultural revolution and animal domestication, people were thereby allowed to be more sedentary, and populations thus grew and became denser. The animals provided an additional risk, as they attracted disease-carrying insects and left their feces anywhere and everywhere. Other factors such as using a common water source with the animals and relying on a single crop also led to the development of infections and eventually plagues.

Likewise, the second artifact, Emerging Infectious Diseases, discussed anti-vaccination and the effects of such behavior. Anti-vaccinationists pose a threat not only to themselves, but to everyone else around them. It also discussed outbreak culture, which is “driven by multiple factors, from political motivation and life-threatening fear to personal gain and isolation. Behaviors as a result of outbreak culture can lead to confusion, collusion, and culpability amid an already chaotic situation” (outbreak culture article). This response to outbreaks has hindered efforts towards AIDS in the 1980s, SARS in 2002, flu in 2006, Zika, and Ebola. More recent technology has also allowed rapid transmission of infections. For example, compared to the 1970s, modern planes now hold 10x more passengers (Is America Ready for the Next Pandemic Article), many of whom are coming from and traveling to different areas from one another, and thus coming into contact with germs to which they have not adapted and then spreading it to other people who may not be prepared, either.

Societies do not only impact the rise of disease; rather, the rise of disease impacts societies just as much, as learned through artifacts 3 and 4. For instance, the bacterium Yersinia pestis, responsible for the Justinian Plague, Black Death, and the Modern/Bubonic Plague, resulted in around 100 million Eurasian deaths. This led to the use of quarantine, plague hospitals, and even abusive treatment of certain cultures. For example, in the U.S., immigrants often lost personal freedom and were forced into quarantine and given experimental vaccines (Artifact 3 – Plague Yesterday and Today). Furthermore, without smallpox, the Revolutionary War would have gone differently, African slaves would not have been as necessary, and America may have even been able to capture Canada (artifact 4 – Smallpox and Effects on History).

As for today, society continues to impact the development and rapid transmission of diseases, and diseases continue to impact the development of societies. Income inequality and poor city infrastructure has increased incidences of disease, particularly among the poor. Substance abuse poses another problem, as abusers can use dirty needles as well as because some substances can weaken one’s immune system. Moreover, an increasingly concerning topic is that of disease as a weapon of war. Though prohibited by numerous universal laws, including by the Geneva Convention, water treatment facilities and medical facilities have been bombed around the world (Artifact 1 – The Sedentary Lifestyle). In Yemen, specifically, war has allowed for the emergence of cholera. Devastating the economy and infrastructure, war has led to poor sanitation and over 15 million Yemen citizens do not have access to clean water. In addition, just shy of 2 million children are malnourished (Artifact 8 – Cholera).

On top of the fact that it is illegal, biological warfare needs to be avoided at all costs due to increased globalization. Societies all around the world are affected by incidents in one area. No longer are many communities isolated from the rest of the world – introduce disease to one area, and it will soon thereafter travel to an untargeted region, as well. So, that is where we stand today. We have gained access to technology never before imagined, and with such technology has come an unthinkable ability to devastate countries with biological weapons such as disease. The impact of such a concept is monstrous and would be difficult to contain. In addition, with humans’ natural inclination to one-up another when provoked and/or attacked, the answer to “what would come next after large-scale biological warfare in the form of disease?” is currently unknown, though incredibly frightening.

The notion that culture is the sole cause of HIV has been scientifically rebutted (HIV and social aspects article). Nonetheless, there are some cultural and social factors that do in fact contribute to greater risk for HIV in certain groups. For one, unsafe medical practices such as using unsterilized materials can lead to transmitting HIV/AIDS. Additionally, lack of education in many minority groups negatively impacts their understanding of safe sexual practices, such as the use of condoms (HIV and social aspects article). On a similar note to lack of education, scientific ignorance led to the shaming of specific groups, stigma, shame, and moral insinuations. Thus, groups such as MSM felt too uncomfortable and scared to seek testing, treatment. Moreover, impoverished communities have less access to health care, hindering their ability to be tested and receive treatment, as well. (https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/todaysepidemic-508.pdf)

With that said, over time, science and medicine improved, limiting the ability of HIV to spread further. For example, testing procedures improved and infected people were more likely to be diagnosed than they previously were. Additionally, new treatments were introduced to limit the levels of the organism living in the body. For instance, antiretroviral therapy (ART) is recommended for all infected individuals (https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treatment/hiv-treatment-overview). PrEP is also often used for high-risk individuals who have not yet contracted the virus.

Using such technologies and medicine, progress has been made in many groups in the US (African Americans, MSM, people who inject drugs, heterosexuals, bisexual men, etc.). Nevertheless, some groups, such as the ones aforementioned, are still far from successes. There is a long road to go. According to the CDC, “most new HIV infections occur among men who have sex with men (MSM) of all races and ethnicities, followed by African American heterosexual women. By race/ethnicity overall, African Americans are the most heavily affected population, followed by Latinos” (https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/todaysepidemic-508.pdf). Additionally, populations in urban areas are at higher-risk than are populations in rural areas. The CDC also stated, “The rate (number of diagnoses per 100,000 people) is highest in the South (18.5 per 100,000 people), followed by the Northeast (14.2), West (11.2) and the Midwest (8.2)” (https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/todaysepidemic-508.pdf).

In conclusion, progress has been made and science is continuing to improve. However, there is still a long road ahead for the prevention, detection, and treatment of HIV. Increased political will is necessary to increase funding in the area, as well as to improve access to education (such as education on preventive measures such as using condoms). As increased funding is provided, hopefully scientific progress will lead to earlier detection and earlier treatment (conquering HIV in the US article). Specific attention needs to be placed on urban populations and minorities, to include African Americans and MSM.

Cholera, a water- or food-borne disease caused by Vibrio cholerae (slide 10), has had profound effects as a disease that spreads rapidly and kills within a day or two. Death is exacerbated to an extreme rate when introduced to cholera (slides 2,3). Symptoms include muscle cramps, diarrhea, and vomiting, which lead to severe dehydration and death (slide 7). Having been responsible for seven pandemics in the last two centuries, cholera is responsible for millions of deaths as well as economic devastation (slide 9).

With trade and urbanization increasing rapidly in the 19^th and 20^th centuries, cholera became much more widely spread. For examples, cholera was transmitted along trade routes to China, Japan and the Philippines, Persian Gulf, Africa, and central Asia all by 1820 (slide 24). This marked the first cholera pandemic. The second began soon thereafter, beginning in Russia and spreading throughout Europe. Immigration then created an even bigger pandemic, with Irish immigrants carrying cholera to Canada and the US (slide 26). Urbanization didn’t help either, whereby populations were extremely dense and many people use a common source of water (slides 41, 42). The third pandemic, taking place from 1852 to 1863, took place in Africa, the US, Middle East, Europe, and India (slide 30).

Meanwhile, in London, John Snow studied the disease extensively, claiming and eventually providing evidence that it was related to water contamination (slides 33, 34). With the help of Reverend Henry Whitehead, a Church of England Priest, Snow was able to identify the epidemic’s starting point and convince the authorities to act based on this information (slides 67, 68). The two were able to have removed the handle of the Broad Street pump, the primary pump behind the transmission of cholera.

The actual cause of cholera, Vibrio cholerae, was discovered by Italian researcher Filippo Pacini around the same time. However, since his published paper was ignored until 82 years after Pacini’s death, Snow was completely unaware of his findings (slide 76). Also unaware of Pacini’s findings was Robert Koch, who reached similar conclusions. Koch’s findings, however, were more widely recognized in the press, and he thus became known as the discoverer of the cholera organism, and received the Nobel Prize for Physiology/Medicine (slide 81).

Thankfully, this information helped to limit the lethality of future cholera outbreaks. The final serious European cholera outbreak was in 1892 in Hamburg and killed 8,600 people. Thanks to improved sanitation and water systems, Europe would not face another cholera outbreak like this again (slide 93). However, as other regions of the world did not make such improvements in sanitation, a sixth pandemic occurred and particularly affected India, Arabia, Italy, Greece, Turkey, and Northern Africa. The Americas and Western Europe remained safe due to their improvements in public health sanitation (slide 96).

Once again in areas with poor water quality and poor sanitation, a seventh pandemic occurred, continuing into the 21^st century. By February 2009, sub-Saharan Africa had 128,548 cases of cholera and 4,053 fatalities by cholera (slide 99). Cholera is still endemic in Haiti after being brought there in 2010 by members of the UN (slides 107, 129). Poor access to clean water and poor sanitation has made the situation harder to deal with (slide 128). So far, there have been over 665,000 cases and 8,813 deaths, and the CDC notes that a priority lies in helping to improve Haiti’s water and sanitation infrastructure (cdc.gov).

Today, war has enabled the emergence of cholera in areas like Yemen. War has devastated the economy and infrastructure, thereby leading to poor sanitation and unclean water (slides 136, 140). In fact, over 15 million Yemen citizens do not have access to clean water, and around 2 million children are malnourished (slide 140). Thus, the problem of cholera, though slowing, is still ongoing.