In the next few sessions,

my colleagues and I will discuss with you the question

"How epidemics of infectious diseases arise and why?"
The specific learning objectives for these next few
sessions are firstly to define the term 'epidemic',
secondly, to describe the historic transitions
that contributed to the emergence of epidemic infections,
and thirdly to explain why novel emerging
infectious diseases continue to arise in our time
and to describe the factors pre-disposing to such emergence.
First, let us describe define the term 'epidemic'.
An epidemic, sometimes also called an outbreak,
is the occurrence in a community or region
of cases of an illness, specific health-related behaviour,
or other health-related event
clearly in excess of normal expectancy.
You can see that the term epidemic
does not only apply to infectious disease,
the term can be used to describe the rapid increase
in non-communicable diseases.
For example, we talk of the current epidemic of diabetes.
In this module, however,
we will focus on epidemics of infectious disease.
You will also note in this definition
the phrase "in excess of normal expectancy".
For example, even a single case of smallpox today
would, by definition, constitute an epidemic
because our current expectancy
for the occurrence of smallpox is zero.
This 17th century painting done by Nicolas Poussin
now displayed in the Louvre gallery in Paris
depicts the Plague of Ashdod, a plague of antiquity.
Looking at this painting, we do not see
the cause of the epidemic
but the artist captures the terror
of the population at large
when confronted with such events.
Next, we see images of some familiar
epidemics of the recent past.
The plague epidemic in Hong Kong in 1894.
This scene comes from a place
not far from where I am talking right now.
Smallpox, a disease of the past,
the first infectious disease to be eradicated.
The consequences of polio,
the second human infectious disease
targeted for eradication,
and the 1918 influenza pandemic.
Pandemic influenza, of course, is a health threat
that is continuing with us today.
We now come to our second learning objective.
That is to describe the historic transitions
that contributed to the emergence of infectious diseases.
You might ask why we want to understand the drivers
of emergence of past epidemics.
Well, when we want to understand the present
and aim to anticipate the future,
it is always very useful to learn from the past.
Prior to 10,000 years ago or so,
humans were largely hunter-gatherers
living off the land with familial group sizes of 20 to 30.
While this was a hazardous life in many respects,
infectious diseases were the least of their concerns.
Small population sizes cannot sustain any of
the major epidemic diseases
which require a large population
to maintain these infections
in a chain of human-to-human transmission.
Thus, our hunter-gatherers did not have to face
the epidemics we are familiar with today.
We know now that hepatitis B virus,
which can lead to prolonged or even lifelong infection
appears to be a virus that entered the human population
between 22,000 to 47,000 years ago,
a time that coincides with the emergence
of our hunter-gatherer ancestors
as they spread out of Africa.
The major event in human civilization
relevant to the emergence of
we are familiar with today

to a pastoral and agricultural existence

around 10,000 years ago.
This led to concentrations of humans within settlements
and later in cities
and provided three major factors
that facilitated epidemic disease emergence.
Firstly, the numbers of humans
interacting with each other in close proximity
grew large enough to allow infectious diseases
to be transmitted exclusively from human to human.
Secondly, the numbers of
domesticated livestock also grew large
allowing infections to be maintained
in these domesticated animals.
The close interaction between
domestic animals and humans
provided opportunities for microbes to cross species
leading to human disease outbreaks.
For example, the human infection measles
emerged from the cattle disease rinderpest
around 7,000 years ago.
Similarly, smallpox is believed to have originated
from camelpox around 4,000 years ago.
Many of the familiar human infections
such as influenza, rotavirus, mumps
originated in a similar manner.
Thirdly, large human agricultural settlements
and the storage of surplus grain
led to rodent infestations
and contact between humans and rodents
led to the emergence of diseases
such as the plague and typhus.
The next major transition of human civilization
was movement of humans over long distances
for trade, conquest, or colonization.
The spread of the plague through the routes out of Asia
are now well-documented.
Long-distance sea voyages,
such as the discovery of the Americas,
led to the introduction of new infections
in both directions,
the so-called 'Columbian interchange'.
Smallpox and measles were carried to the New World
with devastating impact
on nonimmune populations there.
The decline of the Aztec population
from 15 million to 2 million
and the downfall of the Aztec civilization
during this period was largely due
to the consequence of epidemics
rather than the invading European armies.
Syphilis is believed to have been carried
in the opposite direction
and introduced to Europe via returning travellers.
Epidemics continued to exact a heavy toll
on mankind over the centuries
and the mechanisms of their emergence
or causation remained unknown
until the 19th century
when Louis Pasteur and others
provided evidence for the Germ Theory of Disease
and to the identification and isolation
of some of the microbes that caused
these infectious diseases.
This in turn led to rapid advances in development
of anti-microbial therapy and methods of immunization
and these, together with improvements
in sanitation, the provision of clean water,
and good housing in the 20th century
were to dramatically reduce the burden of epidemics.
Diseases such as smallpox were eradicated.
polio is now close to eradication,
and measles is now eliminated from some continents.
The global increase in life expectancy
during the 20th century
owed much to the containment
of infectious diseases.
In the 1950s and '60s these successes
led to the illusion that the scourge
of infectious diseases had been conquered for good
and the focus of medical research turned
to non-communicable diseases.
However, now nature is striking back
and we see newly emerging infectious diseases,
examples being HIV/AIDS, SARS, and others.
To summarize, in this session we talked about
the major transitions
in human socio-economic development
and how these impacted on the emergence
and spread of communicable diseases.
Understanding this is very pertinent
to understanding the drivers
of novel emerging infections confronting us today
which we will discuss in the next sessions.