以鼠疫为例,天花,艾滋病毒/艾滋病,本文主张纳入病原体进化史的好处,除了人群中可见的流行病高峰,我们对流行病实际上是流行病学现象的理解。大流行弧-将病原体作为大流行中的定义“演员”,从出现到地方扩散再到全球化——提供了一个框架,不仅能够汇集疾病表现的不同方面,而且能够汇集人类参与大流行进程的不同方面。病原体可能不同,但是疾病的出现和扩散有一些共同的模式来区分那些流行的疾病,分散在区域或全球人类社区中。允许追踪SARS-CoV-2等现代病原体的进化发展的相同基因组分析方法也使我们能够追踪过去的大流行。这些大流行弧线的重建带来了这些故事的新元素,恢复迄今为止被以欧洲为中心的叙事所忽视的地区和人口的经历。这扩大了传染病的全球历史,反过来,为重新实现真正的全球健康目标奠定了基础。
Using the examples of plague, smallpox, and HIV/AIDS, the present essay argues for the benefits of incorporating the evolutionary histories of pathogens, beyond visible epidemic spikes within human populations, into our understanding of what pandemics actually are as epidemiological phenomena. The pandemic arc - which takes the pathogen as the defining \"actor\" in a pandemic, from emergence to local proliferation to globalization - offers a framework capable of bringing together disparate aspects not only of the manifestations of disease but also of human involvement in the pandemic process. Pathogens may differ, but there are common patterns in disease emergence and proliferation that distinguish those diseases that become pandemic, dispersed through human communities regionally or globally. The same methods of genomic analysis that allow tracking the evolutionary development of a modern pathogen such as SARS-CoV-2 also allow us to trace pandemics into the past. Reconstruction of these pandemic arcs brings new elements of these stories into view, recovering the experiences of regions and populations hitherto overlooked by Eurocentric narratives. This expanded global history of infectious diseases, in turn, lays a groundwork for reconceiving what ambitions a truly global health might aim for.