A Cycle Of Shock

Medical historian Mark Honigsbaum charts the lessons learned from outbreaks of disease.

By Abigail Fagan, published March 5, 2019 - last reviewed on May 7, 2019


Pandemics create surprise and hysteria—and nearly always catch the medical community off guard. In his book The Pandemic Century, medical historian Mark Honigsbaum charts the lessons learned from major outbreaks of disease.

1918: Influenza pandemic

Captive to prevailing views of disease, scientists are often blindsided by new pathogens. Influenza was long perceived as a mild annoyance, so its severity in 1918 stunned the world.  The pandemic proved how societal change could exacerbate disease. It flared up during wartime, and dense training camps and troop movement quickly spread the virus.

1976: Legionnaire's disease

Legionnaire's disease emerged from a bacterium that the medical community had never encountered. Experts were stumped. "A junior microbiologist made the breakthrough. He wasn't blinded by institutional knowledge and was prepared to think outside of the box," Honigsbaum  says. The outbreak occurred during the Bicentennial, prompting conspiracy theories such as sabotage by antiwar radicals—showing how political angst can heighten hysteria.

1980: AIDS

Overconfidence bungled the response to many epidemics, but not so with AIDS. Scientists had no knowledge of the virus but quickly deployed new technologies to identify, measure, and culture immune cells—even though the Reagan administration initially refused to discuss AIDS or fund research. Stigma, misinformation, and virulence combined to create panic.

2015: Zika

Previous outbreaks had occurred in Africa and Asia, so health officials were slow to conclude that Zika was responsible for the cases of microcephaly that began to appear in Brazil. The outbreak also showed that governments often choose fast, technological solutions (spraying a city with insecticides) over basic public health interventions (investing in proper sanitation systems) that could save more lives.

The Future

Epidemics are more frequent due to globalization and technological development. "No place is as remote as it once was," Honigsbaum says. When novel pathogens arise, the medical community should be able to muster a fast response—by stockpiling vaccines and creating frameworks to unite independent scientists—in expectation of the unexpected.