Recently, the United States, Canada, Portugal, Spain, Sweden, Italy and other countries have reported new confirmed or suspected cases of monkeypox. In the context of the Omikron sweeping the world, another highly contagious and terrifying infectious disease has appeared. There i

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2025-12-13

Recently, the United States, Canada, Portugal, Spain, Sweden, and Italy have successively reported new confirmed or suspected cases of monkeypox . In the context of Omicron sweeping the world, another highly contagious and terrible infectious disease has appeared. There is a sense of panic that one wave has not subsided and another wave has arisen. Various viruses are coming one after another, like a scene from a doomsday movie.

At the beginning of the 20th century, the rapid advancement of modern medicine and technology made mankind confident that it could easily defeat epidemics. However, when we look at the history of the development of human civilization, we will find that plagues and humans seem to have always been together. As stated in the book "Plagues and the Paradox of Development", "None of the various historical developments in the past few hundred years, whether it is world wars , the Internet, or the spread of democratic ideas, has had such a broad and revolutionary impact on the development of human beings as the reduction of infectious diseases. "Infectious diseases, the "potential killers" in urban life, are diseases caused by microorganisms such as viruses, bacteria, mycobacteria, fungi, protists and parasites. Given the high prevalence of infectious diseases in low-income countries, one might assume that plagues are unique to less developed societies. Yet for most of history, the opposite has been true.

The growing burden of infectious diseases began with a range of behaviors in human societies, including farming, domesticating animals, and developing trade and easier transportation, characteristics that have traditionally been more closely associated with developed societies.

Most diseases carried by flies, mosquitoes, rodents, lice, etc. were restricted by geography and climate in prehistoric societies and did not spread over large areas, or they existed in the form of current low-virulence diseases. Tuberculosis, Whooping cough, and many infectious diseases such as typhoid fever lurked secretly in primitive society. As humans began to farm, domesticate animals, and move to cities and towns, these diseases gradually developed into major killers of humans.

Indoor living brings people closer together, and because bacteria and viruses cannot be removed through direct sunlight and air circulation, humans begin to suffer from diseases such as tuberculosis, leprosy, and influenza. Storing food allows humans to obtain nutrients stably, but if it is stored improperly, it can also lead to infections by bacteria and fungi such as salmonella, botulinum toxin, etc., causing physical discomfort. The more people there are, the more waste there is, whether inside the body or produced elsewhere.

Diseases similar to tuberculosis, typhus, bubonic plague, smallpox, and leprosy appear in early written records of Sumerian as early as around 2000 BC. The Old Testament was written around 700 BC, and one of the books, Deuteronomy, records that God promised the Hebrews that if they returned to their sparsely populated homeland from the crowded cities of Egypt , he would "make all sickness depart from you, and every evil disease that you know in Egypt... will not be brought upon you."

Infectious diseases spread through food and feces, such as dysentery and typhoid, may have been the most common major killers in early urban life, but what is truly remembered in history is the prevalence of plague.

The plague that changed the direction of human history

In the second year of the Peloponnesian War, a plague arrived at the port of Piraeus via Egypt and Libya, killing a quarter of the officers and soldiers of the Athenian army and countless residents. Thucydides's record stated that the plague plunged Athens into an "unprecedented

state of chaos."

In 165 AD, Marcus Aurelius and his legions brought back a still-unidentified infectious disease from Mesopotamia. The "Antonine Plague" caused by the disease killed 1/3 of the residents of Rome, including Aurelius' co-emperor.

In the following decades, the disease continued to return, causing the Roman Empire to be hit hard, the population plummeted, and eventually it was occupied by nomadic tribes.In 541 AD, an outbreak of the "Justinian Plague", now considered the bubonic plague, spread throughout Egypt and along the empire's sea supply lines to Constantinople. Plague swept the Mediterranean world as many as 18 times, with an average pandemic occurring every 12 years, causing the population of Rome to drop to 20,000.

By the end of the 7th century, repeated raging plagues and successive wars combined, causing Europe to lose half of its population and accelerating the collapse of the Byzantine Empire . The same disease reached China's seaports in AD 610, wreaking its greatest havoc in the densely populated southern and coastal counties. The weakened Tang Dynasty lost control of the Silk Road, and trade between Europe and Asia almost ceased to exist.

During the subsequent era known as the "Dark Ages," Europe degenerated into a poor agricultural society with few large towns and little written records, but during this period, people's health actually improved. Warm, stable climate conditions have allowed agriculture to flourish. For six centuries, there was little contact between Europe and Asia, and the disease reservoirs in each place existed largely independently.

But as populations grew and trade among settlements flourished, infectious diseases returned as deadly threats, ravaging Europe again starting in the 1430s. A plague broke out in Central Asia, which later became the frightening "Black Death". The exact origin of

's popularity in Europe is uncertain, but some historians attribute it to the 1346 Tatar siege of Genoa the trading town of Caffa (now the Crimean regional city of Feodosia). During the war, the siege party used trebuchets to throw corpses carrying the germ into the city. This practice may have led to the infection of the defenders. There is no doubt that once the plague broke out, it began to spread along the maritime and overland Silk Road trade routes.

The great historian of the Arab world Ibn· Khaldun lost his parents when the Black Death swept through Tunisia . A few years later, he wrote:

"The plague has dealt a devastating blow to the civilizations of both East and West, leaving the country exhausted and the population decimated. It has devoured civilization. "

However, as the plague improved and stopped spreading, human civilization and urbanization developed further, and infectious diseases posed greater and more widespread threats. After the beginning of farming, herding, settlement and trade, human beings struggled to survive through hard farming work and barely survived in the cracks of death and infectious diseases. People began to believe the view in Genesis: "Cursed is the land because of you. You will toil all the days of your life, so that you can get food from the land. The land will bring out thorns and thorns for you, and you will eat the herbs of the field. In the sweat of your face you will eat your bread until you return to dust."

Anthropologist, Pulitzer Prize winner Jared Diamond Diamond agreed with this pessimistic assessment, arguing that agriculture had led to shortened lifespans, tyranny, and war, calling it "the worst mistake in human history."

There is no doubt that the plague caused dramatic changes in civilization in Europe and the affected areas of Asia and Africa, but it is undeniable that not all changes were negative. For example, as Europe's population declined, labor became scarce, which led to rising wages and living standards in places like Northern Europe, and led to the breakdown of feudalism. People began to invest more in inventions that could save labor, and the printing press was one of them. Capitalism began to flourish, land distribution was further optimized, and power became more concentrated within nation-states. Rulers had greater administrative power and were able to collect higher taxes, thus financing voyages and expeditions of a commercial nature.

Plague and the Paradox of Development

In the past few centuries, with the investment of various countries in the field of medical and health and the continuous development of science and technology, people have witnessed one miracle after another in the fight against infectious diseases. The incidence and mortality of infectious diseases have dropped significantly, and the global health situation has been improved. However, the reduction of infectious diseases has not generally led to improvements in income, employment opportunities and governance. On the contrary, the rapid increase in population and unprecedented urbanization are pushing the limits of ecosystems, exacerbating migration, unrest, and the risk of global pandemics and infectious diseases.

The reduction of infectious diseases gave birth to new economic empires, changed the regional distribution and characteristics of human settlements, and inspired people to initiate large-scale population migration for a better life. But some changes are more concerning. Many of the new poor metropolises have expanded far faster than their infrastructure, leaving nearly a billion people living in slums. cities are therefore no longer the preserve of wealthy and developed countries - as never before. This urbanization trend is only possible if the incidence of infectious diseases and child mortality decline sharply.

After visiting large, sprawling cities in low-income countries, many people would consider them overcrowded, unattractive, and intimidating. Many cities in the developing world are dotted with slums and shantytowns, either visible near urban centers or hidden beneath highway overpasses.

In many of Africa's "poor metropolises", the lack of jobs for the youth population breeds instability, prompting young people to embark on desperate attempts to immigrate. Pressures from demographic changes have already escalated conflicts, while climate change and growing hostility between European and American countries over trade and immigration are adding fuel to the fire. It is not difficult to imagine that the next 20 years may be even more uneven than the past 20 years. In short, the impact of reductions in infectious diseases has been as great as the impact of infectious disease outbreaks in history.

People's concerns about poor metropolises are understandable. Atiq Rahman, director of the Bangladesh Center for Advanced Studies and a researcher on climate and migration, calls the explosive growth of poor metropolises like Dhaka a "cascade of demographic chaos." Overpopulation, pollution, poverty, and extraordinary demands for energy and water have created an extremely strong impression that these bulging cities risk collapsing under the weight of their local residents.

While social and demographic pressures in many poor metropolitan areas can lead to chaotic and even violent emergencies, this is not necessarily a bad thing in the long run.

The connections and social movements that are more easily formed in densely populated urban areas will eventually force democratic reforms and better government institutions in countries that have long been missing these elements. The social unrest and protests in Western cities over the past 250 years were sometimes painful, but they led to the establishment of institutions and laws that laid the foundation for fighting corruption, improving labor conditions, breaking down racial segregation, and, as we have seen, reducing urban infectious diseases. Ed Glazer, an economist obsessed with urban studies, called the above phenomenon the "Boston effect" because of the role cities played in setting off the American Revolution.

Likewise, historian Christopher Hamlin Hamlin reminds us to be wary of the fallacy of promoting the "benefits of plague". Because some who hold this view claim that new outbreaks of infectious diseases such as cholera and tuberculosis may stimulate necessary investment in sanitation and other positive government reforms, as has happened in the past.

How to prevent the next pandemic?

The challenges faced by low-income countries make it easy to be pessimistic about their prospects.However, we should not lose sight of the fact that the decline in infectious diseases provides a historic opportunity for these developing countries to invest in the large youth populations that are flooding into rapidly growing cities, providing the best hope for creating a more inclusive economic prosperity.

Cities can improve people's productivity and health compared to rural environments. As long as they are not hampered by traffic congestion and a severe lack of infrastructure, urban productivity and the health of residents will improve as population size and education levels increase. Governments in developing countries must develop context-specific solutions to these challenges, but when faced with the paradox of progress in fighting infectious diseases, they should consider investing resources in the following three areas.

First, in many developing countries, urban residents lack clear property rights to their homes, especially those living in slums. Establishing easily enforceable land titles can promote investment in formal housing, allowing workers to move freely in search of job opportunities and access urban services, while laying the foundation for a property tax system.

Secondly, focus on improving enrollment rates and teaching quality, and prevent possible inequality in educational opportunities in privately operated schools.

Finally, developing and implementing evidence-based localized health policies and building strong primary care systems may be a cost-effective way to control many diseases, including timely detection of new epidemics.

In their efforts to improve health outcomes in low-income countries, many governments and non-profit organizations fail to think clearly. Infectious disease mortality is regarded by many as the primary indicator of progress. If low-income countries fail to simultaneously make greater gains in areas such as economic development, governance, education and infrastructure construction when this indicator declines, they will also face huge challenges. Only by better understanding the difficulties that exist on the path chosen to reduce infectious diseases can we more realistically perceive the serious challenges ahead, overcome these future obstacles, and be prepared before the next pandemic arrives.

The plague that changed the direction of human history

Plague and the Paradox of Development

How to prevent the next pandemic?

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