1 | Pandemics and Cities
Covid 19 is not the first pandemic to strike cities. Nor will it be last. Cities all over the globe have witnessed many dreadful diseases such as malaria, leprosy, tuberculosis, smallpox, plague, cholera, and influenza over the course of their evolution. In fact, they have been shaped by interactions with and responses to epidemics and pandemics to protect the human race, society, and economy. Contagious diseases crossing national boundaries have mainly taken the forms of cholera, plague, and influenza variants. Densely populated, congested, and well-connected cities have facilitated the spread of contagions apart from the movement of susceptible and infected people. Urban expansion has also led to the destruction of natural habitats, increasing man-animal interface, and the spread of zoonotic diseases. In this era of globalization and urbanization in full swing in developing countries, humanity is interconnected within and between cities across continents. This connectedness may lead to future pandemics of severe dimensions if we do not put enough effort into preventing them. Paradoxically, developing countries have not learned lessons from the history of pandemics and how many world cities became great by effectively handling diseases and nurturing health, productivity, and economic growth. This paper is an attempt to draw lessons from history to build healthy, inclusive, and pandemic-resilient cities in developing countries like India.
The oldest reported pandemic in history was the plague of Athens. This occurred from 430-426 BC during the Peloponnesian War, fought between the city-states of Athens and Sparta. Believed to have originated from Ethiopia, the disease spread throughout Egypt and Greece. War-induced packing of the population in Athens resulted in the death of more than one-fourth of its residents. Since the plague of Athens, epidemics and pandemics have attacked cities at periodic intervals. Recent outbreaks include acquired immune deficiency syndrome (AIDS), severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), avian influenza, Ebola, Zika, and novel coronavirus disease (COVID-19). Such diseases have led to grave consequences for urban and national economies: spatial, economic, social, political, medical, psychological, etc., including death, disability, unemployment, human capital erosion, and loss of GDP. Besides leading to more than 6 million deaths, COVID-19 has caused economic downturn, learning losses, and fiscal stress in many countries. It has disproportionately affected the poor and marginalized in cities of the developing world. These groups are weeded out of the mainstream development process. They are subjected to sub-human living conditions, abysmal shelter and sanitation, polluted water and toxic air, malnutrition, and utter lack of capacity to incur out-of-pocket expenditures on health.
While pandemics have caused disastrous consequences for cities, they have also triggered public health revolution, planning and management innovations, urban rejuvenation, redevelopment, and scientific advances. They led to partnerships between national, provincial, and local governments and the private sector to collectively fight for survival, growth, development, and welfare. They spurred investment in public health and led to the development of vaccines to prevent killer diseases. They also promoted social movements that propagated an understanding of social and environmental determinants of health. Well-governed cities not only tackled dreadful diseases but also nurtured creativity, entrepreneurship, human capital accumulation, and growth. They played a key role in national policy changes, institutional reforms, and investments in medical and health infrastructure for the masses. Earliest efforts by city governments to prevent and control infectious diseases include the first sewage system in ancient Rome, created to defend against dysentery and typhoid. Baron Haussmann’s renovation of Paris, which included a massive extension of sewers and the enlargement of boulevards/streets during 1853-70, was in response to a resolve to prevent cholera. Older timber constructions were rebuilt with brick to control the rat menace and overcome the plague in 17th-century London. Cholera outbreaks in London led to the creation of the Metropolitan Board and the execution of modern sanitation systems. New York City invested heavily in sewage and sanitation systems, park and green spaces, and promulgation of zoning ordinances, including building rules to combat tuberculosis, cholera, and other infectious diseases. In 1896, the Bombay Plague, fueled by congested living and working, compelled the British to reclaim land to join the seven islands that makeup today’s Mumbai.
COVID-19 joins the long list of dreadful diseases, including the notorious 1918 Spanish flu that impacted the urban environment permanently. The periodic occurrence of pandemics in the face of impending dangers of climate change warrants timely government policy and action to develop resilient cities. Ironically, cities in developing countries like India are not disaster-resilient. In particular, the poor and low-income groups residing in these cities, especially slums and squatter settlement dwellers, are most vulnerable to pandemics. These cities are not prepared to manage pandemics in the future, which could be novel variants of cholera, plague, influenza, or a different type of disease. They have not built the public health infrastructure needed to prevent and control disease while catalyzing growth, inclusion, and human development. This paper delves into the history of pandemics and how slum-infested, overcrowded, and disease-ravaged cities shaped their urban morphology, building a strong public health foundation, undertaking spatial planning innovation; housing, legal, and institutional reforms, and heavily investing in science, including epidemiology, disease control, and management. The objective of the paper is to learn lessons for cities in the developing world to become pandemic-resilient and sustainable so that they can act as locomotives of growth, as did developed countries during the urban transition. It suggests broad directions for urban policy reforms, covering planning, financing, governance, public health, and disaster management dimensions.
This paper is guided by the observation in the literature that viruses, germs, and parasites that cause diseases have killed more people throughout history than either wars or natural disasters and that the urban poor are the worst affected by pandemics. It also recognizes that numerous pathogenic diseases have always been present in our surroundings; some cause mild to severe symptoms, while others have no conspicuous effect. Infection risk is influenced by many factors, such as urbanization, poverty, immunity status, health management, community effort, availability of and access to medical infrastructure, and pursuit of precautionary measures. The remaining parts of the paper are organized as follows: Section 2 dwells on the trends of urbanization in the world, accompanied by disease. Section 3 provides a chronology of pandemics that have occurred over the course of history and devastated cities, most of which recovered sooner or later and bounced back. This section throws light on how different pandemics originated, spread, and impacted cities and their economies. Section 4 deals with responses by governments towards managing pandemics and preparing cities to be disaster-resilient and become catalysts of growth. Section 5 dwells on lessons for developing countries to promote resilient cities with reforms in urban planning, financing, and governance with a focus on public health, disaster management, empowerment of the poor, and strengthening local institutions delivering public health. Section 6 concludes.