Humanity is Winning the Fight Against Infectious Disease

One of my favorite things about living in the 21st century United States is how so few people die of infectious disease. Here’s a graph of deaths showing how infectious diseases decreased by an order of magnitude between the turn of the century and Salk’s Polio Vaccine.

In 1900, 12% of deaths were caused by pneumonia and influenza. 11% were caused by tuberculosis. 8% were caused by of diarrhea. A hundred years ago infectious diseases killed over one third of everyone. In contrast, not a single person in my extended social circle has ever died of an infectious disease. I know more people who were killed by airplane crashes than by infectious diseases.

The raw 10× reduction undersells the progress we’ve made against infectious disease. We have more people overall and we live together in cities. Death due to infectious disease should have skyrocketed over the last century. We would have been fortunate if medicine and sanitation merely kept infectious disease at 1900 levels.

The emergence of new diseases like HIV and COVID-19 has had a tiny impact compared to the overall trend.

In 2019, there were 15,815 deaths among adults and adolescents with diagnosed HIV in the United States and 6 dependent areas. These deaths may be due to any cause.

2,855,000 Americans died in 2019. Those with HIV were 0.5% of the total. Even if we are maximally pessimistic and attribute to HIV every single death of every single American with HIV, this is a tiny fraction compared to how many people used to die of the plagues of 1900.

As of July 20, 2021, COVID-19 killed 600,000 Americans over the course of 1.5 years. That’s 400,000 deaths per year. At 13% of total deaths, COVID-19 temporarily increased deaths due to infectious disease back to what we had in the 1940s. But the increase is temporary. We have vaccines. Even if we didn’t have vaccines, deaths due to COVID-19 would decrease naturally after it burned through the vulnerable population.

If new diseases emerged while technology stagnated then we’d be living in a temporary golden age―and maybe we are. But biotechnology is advancing faster than any technology ever.

The COVID-19 vaccines were invented and deployed with unprecedented speed. Civilization will only get better at inventing vaccines. I mean, can you plausibly imagine a worse response to COVID-19 than what we experienced in the West?

With biotechnology advancing so quickly, a deliberately engineered bioweapon (or gain-of-function research) will soon become a greater threat than naturally-occurring pandemics (if it hasn’t already).

A bioterror attack is scary, but I don’t think it’s likely to kill as many Americans in a single year as did ordinary 1900-level tuberculosis. COVID-19 got as bad as it did because we lacked the will to respond appropriately. (China took the pandemic seriously and is doing fine despite being patient zero.) If COVID-19 had been a terrorist attack, the American population would have rallied behind contact tracing and pandemic prevention would have gotten a blank check.

The World

The United States is better protected against infectious disease than ever before. What about the rest of the world? Here is a graph of deaths due to childhood infectious diseases.

Unlike the United States where deaths due to infectious diseases leveled off several decades ago, global childhood deaths due to major infectious diseases have decreased for decades. I predict they will continue to do so. Global deaths due to infectious disease for all people (not just children) have decreased too, especially in the poorest countries. Deaths from to the worst infectious diseases in the poorest counties halved in just fifteen years.

If you look at things on time horizons of centuries―or even just decades―humanity is freer from infectious disease than it has ever been. The situation is rapidly improving too!