2.1 Major pandemics in history Ngā mate urutā nui o mua
2.1. Major pandemics in history | Ngā mate urutā nui o mua
Table 1 details some major pandemics, what is known about where they emerged, the pathogen, likely vector and death toll.
During the outbreak of the Justinian Plague, the Byzantine historian Procopius of Caesarea traced the disease's origin (now known to be caused by the Yersinia pestis bacterium) to regions in China and northeast India. He described how it travelled along land and sea trade routes to Egypt, eventually entering the Byzantine Empire through its Mediterranean ports. Some historians argue that this pandemic may have undermined Justinian's ambitions to reunify the Eastern and Western Roman Empires and possibly marked the beginning of what would later be known as the Dark Ages.2
While disease and pandemics have persisted throughout history, scientific understanding and healthcare have greatly improved, particularly over the past century and a half. Whereas the 50 million deaths due to Spanish Flu represented approximately 1 in 40 (2.5%) of the world population, the more than seven million deaths from COVID-19 represent fewer than 1 in 1,000(0.1%) (Figure 1).
Table 1: Major pandemics in history
| Pandemic | Timeline | Area of emergence | Pathogen | Vector/origin | Death toll |
|---|---|---|---|---|---|
| Athenian Plague | 430–26 BCE | Ethiopia | Unknown | Unknown | Unknown |
| Antonine Plague | 165–180 | Iraq | Variola virus | Humans | 5 million |
| Justinian Plague | 541–543 | Egypt | Yersinia pestis bacteria | Rodents' associated fleas | 30–50 million |
| Black Death | 1347–1351 | Central Asia | Yersinia pestis bacteria | Rodents' associated fleas | 200 million |
| The Seven Cholera Pandemics | 1817–present | India | Vibrio cholerae | Contaminated water | 40 million |
| Spanish Flu | 1918–1919 | USA | Influenza A (H1N1) | Likely bird origin | 50 million |
| Asian Flu | 1957–1958 | China | Influenza A (H2N2) | Likely bird origin | >1 million |
| Hong Kong Flu | 1968 | China | Influenza A (H3N2) | Likely bird origin | 1–4 million |
| HIV/AIDS | 1981–present | Central Africa | HIV | Humans (from chimpanzees)3 | 36 million |
| SARS | 2002–2003 | China | Severe acute respiratory syndrome coronavirus | Likely horseshoe bat origin, spread to humans via civet cats | 774 |
| Swine Flu | 2009–2010 | Mexico | Influenza A (H1N1) | Pig origin4 | 148,000–249,000 |
| Ebola | 2014–2016 | Central Africa | Ebola virus | Multiple (likely fruit bat origin)5 | 11,000 |
| COVID-19 | 2019– | China | SARS-CoV-2 | Likely bat origin6 | 7.1 million (see notes) |
Source: Vanita Sampath and others, Vaccines and allergic reactions: The past, the current COVID-19 pandemic, and future perspectives. Allergy, Volume 76, Issue 6 (2021): 1640-1660. https://doi.org/10.1111/all.14840 updated by Phase Two of the Royal Commission
Notes:
1. World Health Organization estimate of COVID-19 deaths as of 13 July 2025. https://data.who.int/dashboards/covid19/deaths?n=o
2. The World Health Organization analysis suggests that the number of COVID-19 deaths could be as high as 20 million, given the number of excess deaths experienced over the period. We di Paul M Sharp ascuss the concept of excess deaths in section 4.3.2.
Figure 1: Death tolls from two millennia of pandemics
Death toll (millions) and as percentage of world population, selected pandemics, 165–2025
Source: Deaths: Shrinkath Sampath and others, 'Pandemics Throughout the History', Cureus, Volume 13, Issue 9, e18136 (2021). https://doi.org/10.7759/cureus.18136
Population: Our World in Data and Kees Klein Goldewijk and others, Anthropogenic land use estimates for the Holocene; HYDE 3.2, Earth System Science Data, Volume 9, Issue 2 (2017), 927–953. See Table 1 notes for COVID-19 data source.
2 William Rosen, Justinian’s flea: plague, empire and the birth of Europe (London: Jonathan Cape, 2007).
3 Paul M Sharp and Beatric H Hahn, ‘Origins of HIV and the AIDS pandemic’, Cold Spring Harbor Perspectives in Medicine. Sep;1(1):a006841 (2011), DOI: 10.1101/cshperspect.a006841
4 Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team, ‘Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans’, New England Journal of Medicine, Vol 360, No.25 (2009), 2605-15, https://www.nejm.org/doi/pdf/10.1056/NEJMoa0903810
5 World Health Organization, ‘Ebola disease’, 24 April 2025, https://www.who.int/news-room/fact-sheets/detail/ebola-disease
6 World Health Organization, Scientific Advisory Group for the Origins of Novel Pathogens: independent assessment of the origins of SARS-CoV-2. (Paris: World Health Organization, 2025), https://cdn.who.int/media/docs/default-source/documents/epp/sago/independent-assessment-of-the-origins-of-sars-cov-2-by-sago.pdf