Table 17.1Notable Epidemics and Pandemics since the Middle Ages

Starting yearEventGeographic extentEstimated direct morbidity or mortalityEstimated economic, social, or political impact
1347Bubonic plague (Black Death) pandemicEurasia30–50 percent mortality of the European population (DeWitte 2014)Likely hastened end of the feudal system in Europe (Platt 2014)
Early 1500sIntroduction of smallpoxAmericasMore than 50 percent mortality in some communities (Jones 2006)Destroyed native societies, facilitating the hegemony of European countries (Diamond 2009)
1881Fifth cholera pandemicGlobalMore than 1.5 million deaths (9.7 per 10,000 persons) (Chisholm 1911)Sparked attacks on Russian tsarist government and medical officials (Frieden 1977)
1918Spanish flu influenza pandemicGlobal20 million–100 million deaths (111–555 deaths per 10,000 persons) (Johnson and Mueller 2002)GDP loss of 3 percent in Australia, 15 percent in Canada, 17 percent in the United Kingdom, 11 percent in the United States (McKibbin and Sidorenko 2006)
1957Asian flu influenza pandemicGlobal0.7 million–1.5 million deaths (2.4–5.1 deaths per 10,000 persons) (Viboud and others 2016)GDP loss of 3 percent in Canada, Japan, the United Kingdom, and the United States (McKibbin and Sidorenko 2006)
1968Hong Kong flu influenza pandemicGlobal1 million deaths (2.8 deaths per 10,000 persons) (Mathews and others 2009)US$23 billion–US$26 billion direct and indirect costs in the United States (Kavet 1977)
1981HIV/AIDS pandemicGlobalMore than 70 million infections, 36.7 million deaths (WHO Global Health Observatory data, http://www​–4 percent annual loss of GDP growth in Africa (Dixon, McDonald, and Roberts 2001)a
2003SARS pandemic4 continents, 37 countries8,098 possible cases, 744 deaths (Wang and Jolly 2004)GDP loss of US$4 billion in Hong Kong SAR, China; US$3 billion–US$6 billion in Canada; and US$5 billion in Singapore (Keogh-Brown and Smith 2008)
2009Swine flu influenza pandemicGlobal151,700–575,500 deaths (0.2–0.8 per 10,000 persons) (Dawood and others 2012)GDP loss of US$1 billion in the Republic of Korea (Kim, Yoon, and Oh 2013)
2012MERS epidemic22 countries1,879 symptomatic cases, 659 deaths (Arabi and others 2017)US$2 billion loss in the Republic of Korea, triggering US$14 billion in government stimulus spending (Jun 2015; Park and Kim 2015)
2013bWest Africa Ebola virus disease epidemic10 countries28,646 cases, 11,323 deaths (WHO 2016a)US$2 billion loss in Guinea, Liberia, and Sierra Leone (World Bank 2014)
2015Zika virus pandemic76 countries2,656 reported cases of microcephaly or central nervous system malformation (WHO 2017)US$7 billion–US$18 billion loss in Latin America and the Caribbean (UNDP 2017)

Note: List of events is illustrative rather than exhaustive. All U.S. dollar amounts are rounded to nearest billion. GDP = gross domestic product; HIV/AIDS = human immunodeficiency virus/acquired immunodeficiency syndrome; MERS = Middle East respiratory syndrome; SARS = severe acute respiratory syndrome.


Studies of the effects of HIV/AIDS on per capita gross national product have found smaller effects.


The West Africa Ebola virus outbreak occurred from 2013 to 2016, but the peak and international response efforts began in 2014.

From: Chapter 17, Pandemics: Risks, Impacts, and Mitigation

Cover of Disease Control Priorities: Improving Health and Reducing Poverty
Disease Control Priorities: Improving Health and Reducing Poverty. 3rd edition.
Jamison DT, Gelband H, Horton S, et al., editors.
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