The Woolcock Institute of Medical Research

For the Ann Woolcock Lecture 2021, Professor Grant Waterer looked back over the great plagues and pandemics from the past, how they shaped history, how they might put the COVID-19 pandemic into historical context, and what lessons we can draw from the past to deal with COVID-19 and future pandemics.

Past pandemics Professor Waterer explores include:

• The Antonine smallpox plague, which raged through the Roman world from 165 to 180 CE. The plague is estimated to have killed between 7 and 10 percent of the Empire's population.
• The Plague of Cyprian in the Mediterranean from 250 to 262 CE, a viral haemorrhagic fever that killed 10 to 20 percent of the Roman Empire.
• The bubonic plague (the 'black death'), probably the most well-known of past pandemics, which was first documented in Egypt from 541 CE and still exists today.
• Cocolizti, a little-known pandemic that raged through Central America from 1545 to 1576, killing around 80 percent of the population. 
• Influenza outbreaks, including the 'Spanish flu' pandemic of 1918, which have killed millions of people worldwide.
• HIV, which is estimated to have killed more than 36 million people around the world.

Professor Waterer draws two broad conclusions from his review of past pandemics: that pandemics are often triggered by significant environmental upheaval, such as changes in weather and the movement of animals; and that their impacts have led to the collapse of societies, economies and empires.

The current state of play

Professor Waterer looks at data on a range of infectious diseases, including tuberculosis, malaria, and influenza. He shows that data understate the health impacts of respiratory infections.

For example, figures suggest that heart attack and stroke are the two leading causes of death worldwide. However, research also shows that as many as 1 in 4 heart attacks or strokes may be precipitated by a respiratory infection. If a quarter of heart attack and stroke deaths were attributed in the data to respiratory tract infections, then this would bring the true impact of respiratory diseases into the spotlight.

"The ongoing endemic cost of pneumonia, influenza and respiratory viruses is so large, that we need a much greater effort put into researching and understanding these diseases. The potential health benefit is absolutely enormous," he says.

Professor Waterer presents data on how effective influenza vaccines are in reducing the chance of dying from heart disease. And he presents data from Perth about the impact of lockdown rules. Over winter in Perth, lower admissions for winter respiratory illnesses have been associated with a 20 percent reduction in heart attacks and strokes, as well as bone fractures.

Lessons learnt

Professor Waterer pulls together the various strands of his review to outline some important lessons.

"When you put COVID into context of what has happened around the world over history, how impactful infection has been in shaping history, we got relatively lucky with COVID in that it has an overall mortality rate of probably 0.3 or 0.4 percent. We could have had a mortality rate of 5, 10 or 15 percent."

"We need to be much much better prepared than we have been. My fear is that when COVID disappears we'll forget about all the lessons learnt until the next pandemic, and we may not be lucky next time. We may get a Plague of Cyprian or Cocolizti. We need better antivirals. We need better vaccines for influenza. We need to understand better how to stop people getting these secondary complications like heart attacks and strokes."

"And we need the community to say, 'You know what, it isn't OK if you're unwell and you're coming to work or going to school'."

"The positive message is that vaccination is good for you, and there are simple things we can do to prepare for, and minimise the impact of, future pandemics."

Professor Waterer summarises the key points of his lecture:

• Infections have had a massive impact on human evolution
• Pandemics and epidemics have been major turning points in world history
• Long after we solve cancer and heart disease, infections will remain a threat – they continue to mutate and challenge us
• Infections drive heart attacks, strokes and many other ills – so get vaccinated!

Professor Waterer then fields a number of questions, including whether there are any positives to be taken from the COVID pandemic. He replies with three possible positives:

1. Our ability to produce vaccines quickly, particularly mRNA vaccines and how that technology can be adapted to other viruses.
2. Our quick uptake and use of rapid diagnostic testing.
3. The enormous amount of work being conducted into antivirals.

About Professor Waterer

Professor Grant Waterer, MBBS, PhD, MBA, FRACP, FCCP, serves as Professor of Medicine at Royal Perth Hospital Unit and The University of Western Australia as well as being an adjunct Professor of Medicine at Northwestern University, Chicago and adjunct Professor of Medicine at Curtin University. He is a respiratory specialist seeing general respiratory diseases but with a particular interest in pulmonary infectious diseases.

The Ann Woolcock Lecture

The Ann Woolcock lecture is held every year to promote medical research in respiratory health. Invited researchers share their ideas with industry, policy makers, fellow academics, doctors, specialists and patients with a view to prompting new collaborations to improve respiratory health.

The Lecture honours Professor Ann Woolcock, who founded our Institute in 1981. Find out more about Ann and our history.

Find out more

• Our COVID-19 research
• Our respiratory research