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AIDS to Surpass Plague as History's Worst Pandemic

Expert: It will exceed benchmark in death rate, social devastation

THURSDAY, Jan. 24, 2002 (HealthDayNews) -- AIDS is likely to achieve the dubious distinction of overtaking the Black Death as the worst pandemic in human history, a new report predicts.

An American public health expert says the death toll and the social impact of the disease will exceed that of the plague's deadly march during the Middle Ages.

"Throughout public health history, the Black Death has been seen as the benchmark," says author Dr. Peter R. Lamptey of the Family Health International AIDS Institute in Virginia. Now, he says, AIDS is set to surpass it, despite advances in modern medical care.

An expert on plague from the Centers for Disease Control and Prevention agrees.

"The impact of HIV on populations in Africa and some populations in Asia is potentially as great, or greater, than the plague was in Europe in the Middle Ages," says Dr. David T. Dennis.

Webster's® Dictionary defines pandemic as a disease "occurring over a wide geographic area and affecting an exceptionally high proportion of the population." During the 14th century, the Black Death swept through Asia and Europe, killing more than 40 million, and altering society and the global economy. It began in Mongolia, decimating the population, then spread through China and the Middle East. By the mid-1300s, it had reached Europe, and burned through Italy, France, Spain and Germany before crossing into Britain.

The Black Death actually came in three forms. Bubonic plague attacked the lymphatic system and had a mortality rate of around 60 percent. Pneumonic plague and septicemic plague, meanwhile, targeted the respiratory systems and blood, respectively, and were almost universally fatal.

It was estimated that 25 million people died from the plague in Europe. Its grip didn't ease until the 16th century, when population levels started to recover.

In the Jan. 26 issue of the British Medical Journal, Lamptey compares the modern AIDS crisis to the historical impact of the Black Death.

AIDS, he says, has already killed 25 million people worldwide, and another 40 million are living with the disease. Of those, 28.1 million people live in sub-Saharan Africa and 6.1 million live in South and Southeast Asia.

Almost 95 percent of new infections, of which there are an estimated 14,000 every day, occur in the world's poorest countries.

Most infections occur through heterosexual transmission, and programs to promote the use of condoms and increase awareness of sexually transmitted diseases have been shown to be successful, says Lamptey. But they have failed in most poor countries because of inadequate resources and a lack of international commitment.

Previous gains in life expectancy have been reversed, and infant and adult mortality has risen by 50 percent in some countries. In the worst-affected nations, demographers expect AIDS to kill half of the countries' young adults, and more than 13 million children -- most of them in Africa -- have lost one or both parents to AIDS.

Lamptey says that despite advances in medical technologies and public health programs, AIDS is still likely to become the standard by which other epidemics are judged.

"This is likely to be a much more devastating epidemic," says Lamptey, although he notes that, proportionately, the impact will differ because the global population is now so much larger.

Some severely affected countries are approaching a flat or negative population growth rate because of AIDS deaths, he says. While a growth rate of between 1 and 1.5 percent was desirable for these countries, not one achieved that goal because of millions of AIDS deaths. Worst of all, he notes, "the people who are dying are the productive segments of the population."

Dennis, a medical epidemiologist and plague expert at the National Center for Infectious Diseases, says that although the impact of plague was more sudden, there are many similarities between the plague and the spread of AIDS in the developing world.

In both cases, he says, this unknown illness sparked fear and confusion. The inability of authorities to protect the population from disease shattered faith in government and struck the very roots of civilization, says Dennis.

The sudden and catastrophic death toll from the plague killed roughly one-quarter of the population of Europe, says Dennis.

"In Africa now, there are populations where 25 to 30 percent of the young adult population and 15 percent of the children are infected," he says. "That's pretty similar."

Lamptey says that the initial momentum to fight AIDS has been lost because it's become a chronic disease. And although recent initiatives by the United Nations will help improve the situation, it's a small fraction of what will be needed, he says.

"We need the resources, we need the political commitment and will to be able to reverse this situation," he says. "History will judge us on that."

What To Do

To learn more about the plague -- and fears about its potential as a bioterrorism weapon -- check out the Centers for Disease Control and Prevention or the Bloomberg School of Public Health. Also, read this article from History Magazine.

SOURCES: Interviews with Peter R. Lamptey, M.D., Dr.P.H., senior vice president, AIDS Prevention and Care, Family Health International, Arlington, Va.; David T. Dennis, M.D., chief, Bacterial Zoonoses Branch, Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colo.; Jan. 26, 2002, British Medical Journal
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