Do Pandemics Ever End

This NEJM Perspective explores the complex sociopolitical process by which pandemics are declared "over," highlighting that such declarations rarely reflect epidemiologic finality. The authors trace historical precedents from the 1720–1722 Marseille plague decree to modern Covid-19 emergency terminations, emphasizing that pandemics shift toward "endemicization" and routinization when societies deem the cost of sustained interventions economically or politically untenable. Examples include:

Influenza: 1918 pandemic virus persists as seasonal flu.

Tuberculosis and cholera: persist despite global "end" goals.

HIV/AIDS: now seen as chronic but reflects structural inequities in care. The piece argues that pandemics “end” when mortality becomes actuarially acceptable, with loss normalized and global health crises reframed around market dynamics and sociocultural tolerance.

This NEJM Perspective explores the complex sociopolitical process by which pandemics are declared "over," highlighting that such declarations rarely reflect epidemiologic finality. The authors trace historical precedents from the 1720–1722 Marseille plague decree to modern Covid-19 emergency terminations, emphasizing that pandemics shift toward "endemicization" and routinization when societies deem the cost of sustained interventions economically or politically untenable. Examples include:

Influenza: 1918 pandemic virus persists as seasonal flu.

Tuberculosis and cholera: persist despite global "end" goals.

HIV/AIDS: now seen as chronic but reflects structural inequities in care. The piece argues that pandemics “end” when mortality becomes actuarially acceptable, with loss normalized and global health crises reframed around market dynamics and sociocultural tolerance.