December 6, 2021

Covid-19: we’re in the thick of it now. But who decides when it ends?

Oxford has set up a multi-disciplinary centre to study the issue

Toward the end of his famous novel La Peste (The Plague), Camus remarks: “One of the signs that a return to the golden age of health was secretly awaited was that our fellow citizens, careful though they were not to voice their hope, now began to talk—in, it is true, a carefully detached tone—of the new order of life that would set in after the plague.”

There are similar stirrings now. Oxford’s Centre for the History of Science, Medicine, and Technology and Oxford’s Centre for Global History have established a multi-disciplinary project about “How Epidemics End”.

As Alberto Giubilini and Erica Charters point out on the Practical Ethics blog, declaring the end of an epidemic is an ethical and political issue, as well as a decision for public health authorities. There is a precise beginning – March 11, 2020, when the World Health Organization declared that Covid-19 had become a pandemic.

But, they write: “Historically, epidemics end not with the end of the disease, but with the disease becoming endemic – that is, accepted and acceptable as part of normal life. However, when and how a disease becomes normal or acceptable is primarily a social, cultural, political, and ethical phenomenon, rather than scientific or epidemiological.”

“What level is considered manageable and acceptable, particularly for a new disease, is not defined by epidemiology. Such levels vary throughout time, among regions, and among different societies – even between groups within one society.  What is an acceptable level of disease requires societal, cultural, and political agreement. Unlike the start of an epidemic, the end is a process of negotiation and its dynamics are often unclear and not explicit. This understanding of an ‘end’ to the pandemic must inform public health policy.”

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