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Visualizing the History of Pandemics

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The History of Pandemics

Pan·dem·ic /panˈdemik/ (of a disease) prevalent over a whole country or the world.

As humans have spread across the world, so have infectious diseases. Even in this modern era, outbreaks are nearly constant, though not every outbreak reaches pandemic level as COVID-19 has.

Today’s visualization outlines some of history’s most deadly pandemics, from the Antonine Plague to the current COVID-19 event.

A Timeline of Historical Pandemics

Disease and illnesses have plagued humanity since the earliest days, our mortal flaw. However, it was not until the marked shift to agrarian communities that the scale and spread of these diseases increased dramatically.

Widespread trade created new opportunities for human and animal interactions that sped up such epidemics. Malaria, tuberculosis, leprosy, influenza, smallpox, and others first appeared during these early years.

The more civilized humans became – with larger cities, more exotic trade routes, and increased contact with different populations of people, animals, and ecosystems – the more likely pandemics would occur.

Here are some of the major pandemics that have occurred over time:

NameTime periodType / Pre-human hostDeath toll
Antonine Plague165-180Believed to be either smallpox or measles5M
Japanese smallpox epidemic735-737Variola major virus1M
Plague of Justinian541-542Yersinia pestis bacteria / Rats, fleas30-50M
Black Death1347-1351Yersinia pestis bacteria / Rats, fleas200M
New World Smallpox Outbreak1520 – onwardsVariola major virus56M
Great Plague of London1665Yersinia pestis bacteria / Rats, fleas100,000
Italian plague1629-1631Yersinia pestis bacteria / Rats, fleas1M
Cholera Pandemics 1-61817-1923V. cholerae bacteria1M+
Third Plague1885Yersinia pestis bacteria / Rats, fleas12M (China and India)
Yellow FeverLate 1800sVirus / Mosquitoes100,000-150,000 (U.S.)
Russian Flu1889-1890Believed to be H2N2 (avian origin)1M
Spanish Flu1918-1919H1N1 virus / Pigs40-50M
Asian Flu1957-1958H2N2 virus1.1M
Hong Kong Flu1968-1970H3N2 virus1M
HIV/AIDS1981-presentVirus / Chimpanzees25-35M
Swine Flu2009-2010H1N1 virus / Pigs200,000
SARS2002-2003Coronavirus / Bats, Civets770
Ebola2014-2016Ebolavirus / Wild animals11,000
MERS2015-PresentCoronavirus / Bats, camels850
COVID-192019-PresentCoronavirus – Unknown (possibly pangolins)6.9M (Johns Hopkins University estimate as of March 1, 2023)

Note: Many of the death toll numbers listed above are best estimates based on available research. Some, such as the Plague of Justinian and Swine Flu, are subject to debate based on new evidence.

Despite the persistence of disease and pandemics throughout history, there’s one consistent trend over time – a gradual reduction in the death rate. Healthcare improvements and understanding the factors that incubate pandemics have been powerful tools in mitigating their impact.

March 1, 2023 Update: Due to popular request, we’ve also visualized how the death tolls of each pandemic stack up as a share of total estimated global populations at the time.

Wrath of the Gods

In many ancient societies, people believed that spirits and gods inflicted disease and destruction upon those that deserved their wrath. This unscientific perception often led to disastrous responses that resulted in the deaths of thousands, if not millions.

In the case of Justinian’s plague, the Byzantine historian Procopius of Caesarea traced the origins of the plague (the Yersinia pestis bacteria) to China and northeast India, via land and sea trade routes to Egypt where it entered the Byzantine Empire through Mediterranean ports.

Despite his apparent knowledge of the role geography and trade played in this spread, Procopius laid blame for the outbreak on the Emperor Justinian, declaring him to be either a devil, or invoking God’s punishment for his evil ways. Some historians found that this event could have dashed Emperor Justinian’s efforts to reunite the Western and Eastern remnants of the Roman Empire, and marked the beginning of the Dark Ages.

Luckily, humanity’s understanding of the causes of disease has improved, and this is resulting in a drastic improvement in the response to modern pandemics, albeit slow and incomplete.

Importing Disease

The practice of quarantine began during the 14th century, in an effort to protect coastal cities from plague epidemics. Cautious port authorities required ships arriving in Venice from infected ports to sit at anchor for 40 days before landing — the origin of the word quarantine from the Italian “quaranta giorni”, or 40 days.

One of the first instances of relying on geography and statistical analysis was in mid-19th century London, during a cholera outbreak. In 1854, Dr. John Snow came to the conclusion that cholera was spreading via tainted water and decided to display neighborhood mortality data directly on a map. This method revealed a cluster of cases around a specific pump from which people were drawing their water from.

While the interactions created through trade and urban life play a pivotal role, it is also the virulent nature of particular diseases that indicate the trajectory of a pandemic.

Tracking Infectiousness

Scientists use a basic measure to track the infectiousness of a disease called the reproduction number — also known as R0 or “R naught.” This number tells us how many susceptible people, on average, each sick person will in turn infect.

Diagram showing R0, or how many people are infected on average by someone with a specific virus

Measles tops the list, being the most contagious with a R0 range of 12-18. This means a single person can infect, on average, 12 to 18 people in an unvaccinated population.

While measles may be the most virulent, vaccination efforts and herd immunity can curb its spread. The more people are immune to a disease, the less likely it is to proliferate, making vaccinations critical to prevent the resurgence of known and treatable diseases.

It’s hard to calculate and forecast the true impact of COVID-19, as the outbreak is still ongoing and researchers are still learning about this new form of coronavirus.

Urbanization and the Spread of Disease

We arrive at where we began, with rising global connections and interactions as a driving force behind pandemics. From small hunting and gathering tribes to the metropolis, humanity’s reliance on one another has also sparked opportunities for disease to spread.

Urbanization in the developing world is bringing more and more rural residents into denser neighborhoods, while population increases are putting greater pressure on the environment. At the same time, passenger air traffic nearly doubled in the past decade. These macro trends are having a profound impact on the spread of infectious disease.

As organizations and governments around the world ask for citizens to practice social distancing to help reduce the rate of infection, the digital world is allowing people to maintain connections and commerce like never before.

Editor’s Note: The COVID-19 pandemic is in its early stages and it is obviously impossible to predict its future impact. This post and infographic are meant to provide historical context, and we will continue to update it as time goes on to maintain its accuracy.

Update (March 1, 2023): We’ve adjusted the death toll for COVID-19, and will continue to update on a regular basis.

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Healthcare

Which Countries Have Universal Health Coverage?

Most of the world population has universal health coverage (UHC). This map shows which countries do and don’t provide public health coverage.

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Which Countries Have Universal Health Coverage?

This was originally posted on our Voronoi app. Download the app for free on iOS or Android and discover incredible data-driven charts from a variety of trusted sources.

According to the World Health Organization (WHO), Universal Health Coverage (UHC) means that everyone has access to a full range of health services—from emergency interventions to palliative care—without financial difficulty.

In this graphic, we use data from CEOWorld Magazine to visualize the countries that have UHC versus those that do not, along with how UHC coverage breaks down in terms of the global population.

The State of Universal Health Coverage in the World 

In 2024, 73 of the 195 countries worldwide had UHC, resulting in around 69% of the world’s population having some form of universal healthcare.

CountryUHC?
Albania 🇦🇱Yes
Algeria 🇩🇿Yes
Argentina 🇦🇷Yes
Australia 🇦🇺Yes
Austria 🇦🇹Yes
Bahamas 🇧🇸Yes
Belgium 🇧🇪Yes
Bhutan 🇧🇹Yes
Botswana 🇧🇼Yes
Brazil 🇧🇷Yes
Bulgaria 🇧🇬Yes
Burkina Faso 🇧🇫Yes
Canada 🇨🇦Yes
Chile 🇨🇱Yes
China 🇨🇳Yes
Colombia 🇨🇴Yes
Costa Rica 🇨🇷Yes
Croatia 🇭🇷Yes
Cuba 🇨🇺Yes
Czech Republic 🇨🇿Yes
Denmark 🇩🇰Yes
Egypt 🇪🇬Yes
Finland 🇫🇮Yes
France 🇫🇷Yes
Georgia 🇬🇪Yes
Germany 🇩🇪Yes
Ghana 🇬🇭Yes
Greece 🇬🇷Yes
Hong Kong 🇭🇰Yes
Iceland 🇮🇸Yes
India 🇮🇳Yes
Indonesia 🇮🇩Yes
Ireland 🇮🇪Yes
Israel 🇮🇱Yes
Italy 🇮🇹Yes
Japan 🇯🇵Yes
Kuwait 🇰🇼Yes
Liechtenstein 🇱🇮Yes
Luxembourg 🇱🇺Yes
Macau 🇲🇴Yes
Malaysia 🇲🇾Yes
Maldives 🇲🇻Yes
Mauritius 🇲🇺Yes
Mexico 🇲🇽Yes
Morocco 🇲🇦Yes
Netherlands 🇳🇱Yes
New Zealand 🇳🇿Yes
North Korea 🇰🇵Yes
Norway 🇳🇴Yes
Pakistan 🇵🇰Yes
Peru 🇵🇪Yes
Philippines 🇵🇭Yes
Poland 🇵🇱Yes
Portugal 🇵🇹Yes
Romania 🇷🇴Yes
Russia 🇷🇺Yes
Rwanda 🇷🇼Yes
Serbia 🇷🇸Yes
Seychelles 🇸🇨Yes
Singapore 🇸🇬Yes
South Africa 🇿🇦Yes
South Korea 🇰🇷Yes
Spain 🇪🇸Yes
Sri Lanka 🇱🇰Yes
Suriname 🇸🇷Yes
Sweden 🇸🇪Yes
Switzerland 🇨🇭Yes
Taiwan 🇹🇼Yes
Thailand 🇹🇭Yes
Trinidad and Tobago 🇹🇹Yes
Tunisia 🇹🇳Yes
Turkey 🇹🇷Yes
United Kingdom 🇬🇧Yes

The United States is the only developed country without health coverage for all of its citizens.

As of 2022, the Census Bureau estimated that only 36.1% of Americans were covered by public health insurance. Private health insurance covered 65.6% of the population. This along with other facts has led the U.S. having the world’s highest healthcare spending figure per capita.

The History of Public Health Coverage

Germany was the first country to establish a social health insurance system. Launched in 1883, the program began by covering only blue-collar workers, then slowly expanded its net of those covered.

The first international declaration underlying the need for adequate health care was the Declaration of Alma-Ata in 1978 at the International Conference on Primary Health Care in 1978. The conference’s target was to achieve global UHC by 2000.

The Ottawa Charter for Health Promotion of 1986 also reiterated the “Health for All by the year 2000” goal, ultimately paving the way for more countries to adopt UHC.

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