Ebola, cholera and Chikungunya: Health risks of the past, the present and the future
François Grünewald & Hugues Maury
It is highly probable that in the decades ahead, epidemics will spread faster because of increased and accelerated social and geographical mobility. This was the case with the most recent pandemics. The fact that “national” epidemics become cross-border epidemics and sometimes move from the “epidemic” stage to the “pandemic” alert stage, or even become “public health emergencies of international concern” (PHEICs), with major economic and security-related impacts, shows that health issues should be an integral part of geopolitical analysis.
- Epidemics and pandemics: thoughts on health (...), p1
- Old infectious agents which present new (...), p2
- Breeding grounds and the propagation of H1N1 (...), p3
- Contemporary epidemiological dynamics, p4
- Public health issues in congested environments, p7
- Conclusion: Health problems and security (...), p8
Epidemics and pandemics: thoughts on health risks 
Major pandemics are not a new phenomenon. Some of them form part of the collective memory of humanity such as the plague, cholera and Spanish influenza, which ravaged certain regions of the world including Europe at various times in the past. The history of these major epidemics is closely linked to the increase in mobility of goods and people: diseases transported by explorers and traders (tuberculosis, syphilis, measles, etc.) had a devastating effect on native populations. The demographic impact of these epidemics on entire regions like Latin America and the Caribbean has shaped history with the disappearance of the “original inhabitants”.
During the Middle Ages, the plague, which had spread throughout Europe, disappeared both in the West and in the East. In 1346, having disappeared for six centuries, it re-appeared in the region of the Black Sea. The battle between the Mongols and the Genovese in Constantinople led to the contamination of communities who fled, thus spreading Yersinia pestis to Messina, then Marseille via the galleys which landed there in November 1347. The plague reached Paris in June 1348, then England and Flanders. From the Muslim world to Western Europe, the plague decimated populations and weakened social structures. In a few months, the plague wiped out between one third and a half of the population of Europe. It is difficult to make a more precise estimation. We can only get an idea of the scale of the disaster from registers of baptisms and burials. But all calculations reach a figure of at least 40% of deaths in each village. The economic consequences of the plague were also huge. Lack of labour led to the disruption of production. Fields remained uncultivated and entire villages were abandoned. It was not until the second half of the 15th century that the impact of the epidemic was partially repaired.
 This article follows on from an initial publication on “Hots spots” (http://www.urd.org/IMG/pdf/DiploHS04.pdf) and various evaluations on Haiti which include the response to the outbreak of cholera. It includes elements from a multi-disciplinary research project on future non-intentional risks which was carried out in 2010.