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:
|Name||Time period||Type / Pre-human host||Death toll|
|Antonine Plague||165-180||Believed to be either smallpox or measles||5M|
|Japanese smallpox epidemic||735-737||Variola major virus||1M|
|Plague of Justinian||541-542||Yersinia pestis bacteria / Rats, fleas||30-50M|
|Black Death||1347-1351||Yersinia pestis bacteria / Rats, fleas||200M|
|New World Smallpox Outbreak||1520 – onwards||Variola major virus||56M|
|Great Plague of London||1665||Yersinia pestis bacteria / Rats, fleas||100,000|
|Italian plague||1629-1631||Yersinia pestis bacteria / Rats, fleas||1M|
|Cholera Pandemics 1-6||1817-1923||V. cholerae bacteria||1M+|
|Third Plague||1885||Yersinia pestis bacteria / Rats, fleas||12M (China and India)|
|Yellow Fever||Late 1800s||Virus / Mosquitoes||100,000-150,000 (U.S.)|
|Russian Flu||1889-1890||Believed to be H2N2 (avian origin)||1M|
|Spanish Flu||1918-1919||H1N1 virus / Pigs||40-50M|
|Asian Flu||1957-1958||H2N2 virus||1.1M|
|Hong Kong Flu||1968-1970||H3N2 virus||1M|
|HIV/AIDS||1981-present||Virus / Chimpanzees||25-35M|
|Swine Flu||2009-2010||H1N1 virus / Pigs||200,000|
|SARS||2002-2003||Coronavirus / Bats, Civets||770|
|Ebola||2014-2016||Ebolavirus / Wild animals||11,000|
|MERS||2015-Present||Coronavirus / Bats, camels||850|
|COVID-19||2019-Present||Coronavirus – Unknown (possibly pangolins)||2.7M (Johns Hopkins University estimate as of March 16, 2021)|
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.
September 2, 2021 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.
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.
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.
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 15, 2020): We’ve adjusted the death toll for COVID-19, and will continue to update on a regular basis.
Visualizing the World’s Biggest Pharmaceutical Companies
The world’s biggest pharmaceutical companies are worth $4.1 trillion. Here we map the top 100 companies based on their market cap value.
Who are the World’s Biggest Pharmaceutical Companies?
Some of the world’s biggest pharmaceutical companies have played a central role in the COVID-19 pandemic.
However, it’s likely no surprise that the pandemic has also been great for many healthcare businesses. In fact, in 2020 alone, the world’s 50 largest pharmaceutical companies still combined for a whopping $851 billion in revenues.
In this graphic, using data from Companies Market Cap, we list the largest pharmaceutical companies in the world by market capitalization. It’s worth noting this list also includes healthcare companies that work closely with pharmaceuticals, including biotech, pharmaceutical retailers, clinical laboratories, etc.
Editor’s Note: A previous version of this graphic was missing some key companies such as GSK and AbbVie. They were unfortunately not included in the original source and we are now working to make sure there were no other smaller omissions. Thanks to all that sent in corrections.
The Pharmaceutical Leaders
To start, here are the top five biggest pharmaceutical companies in the world at the moment by market capitalization:
1. Johnson & Johnson
The pharmaceutical and consumer goods giant is worth $428.7 billion in market cap. They developed the third vaccine authorized for use in the U.S. and were named among the TIME100 Most Influential Companies List in 2021.
The Swiss pharmaceutical giant is at the forefront of oncology, immunology, infectious diseases, ophthalmology, and neuroscience. In 2019, Roche’s pharma segment sales rose by a healthy 16% to $53 billion.
Despite being the leading COVID-19 vaccine manufacturer in North America, Pfizer slid in the rankings to third place. The company has recently gained momentum, especially in the past quarter, with Q2’2021 revenues of $19.0 billion, reflecting a 86% operational growth from 2020.
4. Eli Lilly
Eli Lilly has taken a significant step towards establishing itself as a pharmaceutical industry leader. Having a market cap value of $125 billion in 2019, Eli Lilly has jumped to a current value of $214.9 billion, a significant growth of 72%.
The second-biggest pharmaceutical company out of Switzerland, Novartis has been the face of the pharma industry for about 25 years. The primary manufacturer for the most recognizable drugs on the market pulled in a revenue of over $48 billion in 2020, a 3% increase compared to 2019.
Here’s how all the biggest pharmaceutical companies in the world stack up against each other:
|Company Rank||Company Name||Market Cap Value||Country|
|1||Johnson & Johnson|
|$428.66 B||🇺🇸 USA|
|$320.41 B||🇨🇭 Switzerland|
|$219.39 B||🇺🇸 USA|
|$208.99 B||🇺🇸 USA|
|$207.70 B||🇨🇭 Switzerland|
|$202.60 B||🇺🇸 USA|
|$191.67 B||🇺🇸 USA|
|$187.83 B||🇩🇰 Denmark|
|$152.28 B||🇬🇧 UK|
|$145.80 B||🇺🇸 USA|
|$136.50 B||🇺🇸 USA|
|$130.37 B||🇫🇷 France|
|$110.49 B||🇺🇸 USA|
|$104.30 B||🇬🇧 UK|
|$103.10 B||🇦🇺 Australia|
|$83.62 B||🇺🇸 USA|
|$83.25 B||🇺🇸 USA|
|$80.61 B||🇩🇪 Germany|
|$59.43 B||🇩🇪 Germany|
|20||Jiangsu Hengrui Medicine |
|$58.51 B||🇨🇳 China|
|$55.83 B||🇺🇸 USA|
|$55.00 B||🇺🇸 USA|
|$54.23 B||🇩🇪 Germany|
|$52.67 B||🇯🇵 Japan|
|$52.16 B||🇨🇭 Switzerland|
|26||Walgreens Boots Alliance|
|$45.05 B||🇺🇸 USA|
|$33.80 B||🇰🇷 S. Korea|
|$33.42 B||🇯🇵 Japan|
|$31.65 B||🇨🇳 China|
|$31.20 B||🇯🇵 Japan|
|$26.59 B||🇺🇸 USA|
|32||Hansoh Pharma |
|$26.00 B||🇨🇳 China|
|$25.97 B||🇺🇸 USA|
|34||Otsuka Holdings |
|$23.15 B||🇯🇵 Japan|
|35||Horizon Therapeutics |
|$21.13 B||🇮🇪 Ireland|
|36||Alnylam Pharmaceuticals |
|$20.42 B||🇺🇸 USA|
|$18.85 B||🇯🇵 Japan|
|$18.74 B||🇺🇸 USA|
|$18.48 B||🇭🇰 Hong Kong|
|$17.25 B||🇺🇸 USA|
|$16.26 B||🇺🇸 USA|
|$16.03 B||🇳🇱 Netherlands|
|$15.29 B||🇯🇵 Japan|
|$11.88 B||🇮🇳 India|
|45||Teva Pharmaceutical Industries|
|$11.21 B||🇮🇱 Israel|
|46||Ono Pharmaceutical |
|$11.12 B||🇯🇵 Japan|
|$11.09 B||🇮🇪 Ireland|
|48||Bausch Health |
|$10.47 B||🇨🇦 Canada|
|$10.42 B||🇨🇭 Switzerland|
|$10.33 B||🇩🇪 Germany|
|51||Hualan Biological Engineering|
|$10.31 B||🇨🇳 China|
|$9.49 B||🇨🇭 Switzerland|
|53||Neurocrine Biosciences |
|$9.45 B||🇺🇸 USA|
|$9.42 B||🇨🇳 China|
|55||BridgeBio Pharma |
|$8.89 B||🇺🇸 USA|
|56||Cadila Healthcare |
|$8.59 B||🇮🇳 India|
|57||Sumitomo Dainippon Pharma |
|$8.16 B||🇯🇵 Japan|
|$7.89 B||🇨🇦 Canada|
|59||Ascendis Pharma |
|$7.51 B||🇩🇰 Denmark|
|$7.19 B||🇩🇪 Germany|
|61||Lupin Limited |
|$7.04 B||🇮🇳 India|
|62||Gland Pharma |
|$7.01 B||🇮🇳 India|
|$6.95 B||🇺🇸 USA|
|64||GW Pharmaceuticals |
|$6.81 B||🇬🇧 UK|
|$6.78 B||🇯🇵 Japan|
|66||Torrent Pharmaceuticals |
|$6.61 B||🇮🇳 India|
|$6.43 B||🇮🇳 India|
|$6.32 B||🇯🇵 Japan|
|69||Sarepta Therapeutics |
|$6.25 B||🇺🇸 USA|
|$6.21 B||🇮🇪 Ireland|
|$6.11 B||🇫🇮 Finland|
|$6.04 B||🇩🇰 Denmark|
|$5.87 B||🇨🇦 Canada|
|74||Adaptive Biotechnologies |
|$5.69 B||🇺🇸 USA|
|75||Intellia Therapeutics |
|$5.62 B||🇺🇸 USA|
|76||Santen Pharmaceutical |
|$5.49 B||🇯🇵 Japan|
|$5.46 B||🇯🇵 Japan|
|78||Beam Therapeutics |
|$5.43 B||🇺🇸 USA|
|79||Reata Pharmaceuticals |
|$5.15 B||🇺🇸 USA|
|80||Swedish Orphan Biovitrum|
|$5.13 B||🇸🇪 Sweden|
|81||BB Biotech |
|$5.08 B||🇨🇭 Switzerland|
|82||Alkem Laboratories |
|$5.00 B||🇮🇳 India|
|$4.69 B||🇮🇳 India|
|84||Laurus Labs |
|$4.44 B||🇮🇳 India|
|85||Taisho Pharmaceutical |
|$4.39 B||🇯🇵 Japan|
|86||Hanmi Pharmaceutical |
|$4.22 B||🇰🇷 S. Korea|
|$3.87 B||🇮🇪 Ireland|
|$3.71 B||🇺🇸 USA|
|$3.65 B||🇰🇷 S. Korea|
|$3.55 B||🇺🇸 USA|
|91||Ipca Laboratories |
|$3.41 B||🇮🇳 India|
|92||Nektar Therapeutics |
|$3.02 B||🇺🇸 USA|
|93||BioCryst Pharmaceuticals |
|$3.01 B||🇺🇸 USA|
|$2.96 B||🇺🇸 USA|
|$2.84 B||🇺🇸 USA|
|96||Rocket Pharmaceuticals |
|$2.74 B||🇺🇸 USA|
|97||Axsome Therapeutics |
|$2.65 B||🇺🇸 USA|
|98||Natco Pharma |
|$2.63 B||🇮🇳 India|
|$2.59 B||🇮🇳 India|
|100||Editas Medicine |
|$2.54 B||🇺🇸 USA|
World’s Largest Pharmaceutical Exporters and Importers
According to the World Trade Organization (WTO), these countries exported the most number of pharmaceuticals in the year 2019:
|Rank||Country||Export Value (US$B)|
In contrast, here are the biggest importers over the same period.
|Rank||Country||Import Value (US$B)|
This position is hardly surprising for the U.S., where six of the world’s top 10 pharmaceutical companies are headquartered. The country also captures 45% of the global market.
The Future of Pharmaceutical Companies
If the response to the COVID-19 pandemic has taught us anything, it is that in building a patient-centered future, the pharmaceutical industry plays a key role. It has to constantly find new ways to customize medicines while researching and developing new tools and drugs.
By embracing disruptive technologies like 3D printed drugs, artificial intelligence guided therapies, and preventive medicine while working with regulatory agencies, the pharmaceutical companies will benefit from having a digital revolution.
Furthermore, emerging markets will have a more significant say in the global pharmaceutical market in the coming years. Even though ‘big pharma’ will keep raking in the massive profits they do every year, their reliance on countries like Brazil and India for research and drug production will significantly impact the years to come.
When Will Your Country Recover from the Pandemic?
The path to COVID-19 recovery varies worldwide—some countries have already recovered, while others will not be back to normal for years.
What started as a novel virus in China quickly became a sweeping disease that shut down the world and put a 1.5 year halt on the global economy.
But while some countries’ economies are already back to normal, others are lagging far behind.
COVID-19 Recovery Timelines, by OECD Country
This chart using data from the OECD anticipates when countries will economically recover from the global pandemic, based on getting back to pre-pandemic levels of GDP per capita.
Note: The categorization of ‘advanced’ or ‘emerging’ economy was determined by OECD standards.
The Leaders of the Pack
At the top, China and the U.S. are recovering at breakneck speed. In fact, recovering is the wrong word for China, as they reached pre-pandemic GDP per capita levels just after Q2’2020.
On the other end, some countries are looking at years—not months—when it comes to their recovery date. Saudi Arabia isn’t expected to recover until after Q1’2024, and Argentina is estimated to have an even slower recovery, occurring only after Q2’2026.
|🇧🇪 Belgium||After Q4 2022||Advanced|
|🇸🇪 Sweden||After Q4 2021||Advanced|
|🇸🇰 Slovakia||After Q4 2021||Advanced|
|🇳🇿 New Zealand||After Q4 2021||Advanced|
|🇩🇪 Germany||After Q4 2021||Advanced|
|🇪🇪 Estonia||After Q4 2021||Advanced|
|🇩🇰 Denmark||After Q4 2021||Advanced|
|🇮🇸 Iceland||After Q3 2023||Advanced|
|🇸🇮 Slovenia||After Q3 2022||Advanced|
|🇵🇹 Portugal||After Q3 2022||Advanced|
|🇫🇷 France||After Q3 2022||Advanced|
|🇦🇹 Austria||After Q3 2022||Advanced|
|🇵🇱 Poland||After Q3 2021||Advanced|
|🇳🇴 Norway||After Q3 2021||Advanced|
|🇱🇺 Luxembourg||After Q3 2021||Advanced|
|🇱🇻 Latvia||After Q3 2021||Advanced|
|🇯🇵 Japan||After Q3 2021||Advanced|
|🇫🇮 Finland||After Q3 2021||Advanced|
|🇪🇸 Spain||After Q2 2023||Advanced|
|🇬🇧 United Kingdom||After Q2 2022||Advanced|
|🇳🇱 Netherlands||After Q2 2022||Advanced|
|🇮🇹 Italy||After Q2 2022||Advanced|
|🇬🇷 Greece||After Q2 2022||Advanced|
|🇨🇿 Czech Republic||After Q2 2022||Advanced|
|🇨🇦 Canada||After Q2 2022||Advanced|
|🇺🇸 United States||After Q2 2021||Advanced|
|🇰🇷 South Korea||After Q2 2021||Advanced|
|🇮🇪 Ireland||After Q2 2021||Advanced|
|🇨🇭 Switzerland||After Q1 2022||Advanced|
|🇮🇱 Israel||After Q1 2022||Advanced|
|🇭🇺 Hungary||After Q1 2022||Advanced|
|🇦🇺 Australia||After Q1 2022||Advanced|
|🇱🇹 Lithuania||After Q1 2021||Advanced|
|🇿🇦 South Africa||After Q4 2022||Emerging|
|🇮🇩 Indonesia||After Q4 2021||Emerging|
|🇮🇳 India||After Q4 2021||Emerging|
|🇲🇽 Mexico||After Q3 2023||Emerging|
|🇨🇴 Colombia||After Q3 2022||Emerging|
|🇧🇷 Brazil||After Q3 2022||Emerging|
|🇨🇱 Chile||After Q3 2021||Emerging|
|🇹🇷 Turkey||After Q3 2020||Emerging|
|🇦🇷 Argentina||After Q2 2026||Emerging|
|🇨🇷 Costa Rica||After Q2 2023||Emerging|
|🇷🇺 Russia||After Q2 2021||Emerging|
|🇨🇳 China||After Q2 2020||Emerging|
|🇸🇦 Saudi Arabia||After Q1 2024||Emerging|
Most countries will hit pre-pandemic levels of GDP per capita by the end of 2022. The slowest recovering advanced economies—Iceland and Spain—aren’t expected to bounce back until 2023.
Four emerging economies are speeding ahead, and are predicted to get back on their feet by the end of this year or slightly later (if they haven’t already):
- 🇷🇺 Russia: after Q2’2021
- 🇨🇱 Chile: after Q3’2021
- 🇮🇳 India: after Q4’2021
- 🇮🇩 Indonesia: after Q4’2021
However, no recovery is guaranteed, and many countries will continue face setbacks as waves of COVID-19 variants hit—India, for example, was battling its biggest wave as recently as May 2021.
Why are some countries recovering faster than others? One factor seems to be vaccination rates.
|Country||Doses Administered per 100 People||Total Doses Administered||Percent of Population Fully Vaccinated|
|🇬🇧 United Kingdom||122||81,438,892||53%|
|Trinidad and Tobago||27||375,924||11%|
|Saint Vincent and the Grenadines||23||25,509||–|
|West Bank & Gaza||20||958,519||9%|
|São Tomé and Príncipe||18||37,716||5%|
|Bosnia and Herzegovina||14||470,218||5%|
|Republic of the Congo||3||163,742||–|
|Central African Republic||1.7||78,685||–|
|Papua New Guinea||0.6||51,170||<0.1%|
As of July 16th, 2021.
The higher the rate of vaccination, the harder it is for COVID-19 to spread. This gives countries a chance to loosen restrictions, let people get back to work and regular life, and fuel the economy. Additionally, the quicker vaccines are rolled out, the less time there is for variants to mutate.
Another factor is the overall strength of a country’s healthcare infrastructure. More advanced economies often have more ICU capacity, more efficient dissemination of public health information, and, simply, more hospital staff. These traits help better handle the pandemic, with reduced cases, less restrictions, and a speedy recovery.
Finally, the level of government support and fiscal stimulus injected into different economies has determined how swiftly they’ve recovered. Similar to the disparity in vaccine rollouts, there was a significant fiscal stimulus gap, especially during the heat of the pandemic.
Recovering to Normal?
Many experts and government leaders are now advocating for funneling more money into healthcare infrastructure and disease research preventatively. The increased funding now would help stop worldwide shut downs and needless loss of life in future.
Time will tell when we return to “normal” everywhere, however, normal will likely never be the same. Many impacts of the global pandemic will stay with us over the long term.
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