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.