Causes and Solutions of Pandemics
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This report has dealt with pandemics, the causes of pandemics and the solutions that can be used to prevent pandemics now and in the future. If not managed properly, pandemics can cause huge mortalities and lead to high healthcare costs.
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Causes and Solutions of Pandemics 1
CAUSES AND SOLUTIONS OF PANDEMICS
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CAUSES AND SOLUTIONS OF PANDEMICS
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Causes and Solutions of Pandemics 2
Introduction
A pandemic is the spread of a new disease within the world’s population (WHO 2010). In
contrast, an epidemic is the sudden occurrence of a disease above the expected normal levels of
the people living in a specific area. An example of an epidemic is Ebola which commonly occurs
in the Democratic Republic of Congo (CDC 2010). With the 1889 and 1918 influenza
pandemics, the word pandemic began to be associated with large-scale occurrences of diseases
characterized by; a wide geographic coverage of the outbreak, high rates of attack by a new
disease, low population immunity, severity, infectiousness and contagiousness (Morens, Folkers
& Fauci 2009). The purpose of this assignment will be to look at the causes of pandemics by
analyzing various diseases and the best solutions to overcome these pandemics.
2.1. Cause of Pandemic and Two Diseases
Most of the world’s pandemics have originated from cross-species transmission between
animal pathogens and human beings. The pathogen evolves into one that infects humans and
maintains a long-term human-to-human infection without having the host reintroduce it (Johnson
et al. 2015). This process is further broken down into five stages. The first stage involves animal
pathogens that don’t exist in human beings under natural circumstances but once they evolve,
humans contract them. However, the pathogen cannot maintain human-to-human transmission
which is when it moves to stage 2. Examples include the West Nile Virus, rabies and the
tularemia bacilli (Pike et al. 2010).
The change from stage 2 to 3 occurs when there is a sustained transmission of the disease
between human beings with the pathogens in stage 3 going undergoing cycles of secondary
transmission in humans. Diseases in phase three include Ebola and Marburg (Pike et al. 2010). In
Introduction
A pandemic is the spread of a new disease within the world’s population (WHO 2010). In
contrast, an epidemic is the sudden occurrence of a disease above the expected normal levels of
the people living in a specific area. An example of an epidemic is Ebola which commonly occurs
in the Democratic Republic of Congo (CDC 2010). With the 1889 and 1918 influenza
pandemics, the word pandemic began to be associated with large-scale occurrences of diseases
characterized by; a wide geographic coverage of the outbreak, high rates of attack by a new
disease, low population immunity, severity, infectiousness and contagiousness (Morens, Folkers
& Fauci 2009). The purpose of this assignment will be to look at the causes of pandemics by
analyzing various diseases and the best solutions to overcome these pandemics.
2.1. Cause of Pandemic and Two Diseases
Most of the world’s pandemics have originated from cross-species transmission between
animal pathogens and human beings. The pathogen evolves into one that infects humans and
maintains a long-term human-to-human infection without having the host reintroduce it (Johnson
et al. 2015). This process is further broken down into five stages. The first stage involves animal
pathogens that don’t exist in human beings under natural circumstances but once they evolve,
humans contract them. However, the pathogen cannot maintain human-to-human transmission
which is when it moves to stage 2. Examples include the West Nile Virus, rabies and the
tularemia bacilli (Pike et al. 2010).
The change from stage 2 to 3 occurs when there is a sustained transmission of the disease
between human beings with the pathogens in stage 3 going undergoing cycles of secondary
transmission in humans. Diseases in phase three include Ebola and Marburg (Pike et al. 2010). In
Causes and Solutions of Pandemics 3
stage 4, diseases have gone through very many cycles of secondary transmission between
humans without having the disease reintroduced. Examples include Influenza A and the dengue
virus. Stage 5 covers diseases that were originally introduced by animal hosts but have now
become exclusive to human beings and these are Human Immunodeficiency Virus (HIV),
tuberculosis and smallpox (Pike et al. 2018).
The influenza A viruses are constantly changing and there is always a new virus
circulating that is different from current or previous strains. In 2009, a new influenza A virus
known as the H1NI virus was first detected in the US, spreading very quickly throughout the
country and then to the rest of the world (CDC 2018). This new virus contained a new and
unique combination of the influenza genes which had not been identified in either animals or
human beings. Very few people had an immunity to this disease and the seasonal flu vaccines
offered very little protection against the virus. The CDC estimated that between April 2009 and
April 2010, there were 60.8 million cases of the H1NI virus with 151,700 and 575,400
succumbing to the virus (CDC 2018).
HIV/AIDS is a disease that is a global pandemic worldwide. Three decades ago, an
outbreak of a new opportunistic infection was discovered in a small group of homosexual men in
both California and New York. It was later referred to as the acquired immunodeficiency
syndrome (AIDS) because it caused a complete loss of the CD4 T-lymphocytes which are
important in cell immunity (Piot & Quinn 2013). A year after it was discovered, needle drug
users, hemophiliacs and blood transfusion patients were diagnosed with the disease. The disease
then became an epidemic in Central Africa soon after that. Two years after the AIDS virus
emerged, a retrovirus later referred to as HIV was identified to cause AIDS (Piot & Quinn 2013)
stage 4, diseases have gone through very many cycles of secondary transmission between
humans without having the disease reintroduced. Examples include Influenza A and the dengue
virus. Stage 5 covers diseases that were originally introduced by animal hosts but have now
become exclusive to human beings and these are Human Immunodeficiency Virus (HIV),
tuberculosis and smallpox (Pike et al. 2018).
The influenza A viruses are constantly changing and there is always a new virus
circulating that is different from current or previous strains. In 2009, a new influenza A virus
known as the H1NI virus was first detected in the US, spreading very quickly throughout the
country and then to the rest of the world (CDC 2018). This new virus contained a new and
unique combination of the influenza genes which had not been identified in either animals or
human beings. Very few people had an immunity to this disease and the seasonal flu vaccines
offered very little protection against the virus. The CDC estimated that between April 2009 and
April 2010, there were 60.8 million cases of the H1NI virus with 151,700 and 575,400
succumbing to the virus (CDC 2018).
HIV/AIDS is a disease that is a global pandemic worldwide. Three decades ago, an
outbreak of a new opportunistic infection was discovered in a small group of homosexual men in
both California and New York. It was later referred to as the acquired immunodeficiency
syndrome (AIDS) because it caused a complete loss of the CD4 T-lymphocytes which are
important in cell immunity (Piot & Quinn 2013). A year after it was discovered, needle drug
users, hemophiliacs and blood transfusion patients were diagnosed with the disease. The disease
then became an epidemic in Central Africa soon after that. Two years after the AIDS virus
emerged, a retrovirus later referred to as HIV was identified to cause AIDS (Piot & Quinn 2013)
Causes and Solutions of Pandemics 4
With HIV information, tests were developed to identify infected people and prevention
measures were introduced to reduce the spread of the disease. However, this was an exercise in
futility because 10 million people were infected within the first decade it was discovered. The
second decade saw a rapid spread of the disease around the world with Asia, the Soviet Union
and the southern parts of Africa experiencing an explosion of the pandemic (Sharp & Hahn
2011). The introduction of antiretroviral drugs led to a significant decline of transmissions
especially in high-income countries but in the low to middle-income countries, mortality rates
rose to 2.4 million while new infections increase to 3 million (Piot & Quinn 2013).
2.2. Cause of Pandemic and Two Diseases
Pandemics can also be caused by harmful germs or bacteria found in contaminated
sources of food or water. The cholera bacteria commonly found in contaminated water infects a
person’s intestines causing severe diarrhea and vomiting which if left untreated can cause death
(Stille 2011). Cholera affects one to four million people in developing countries such as Africa,
South America, Asia and it kills an estimated 142,000 people every year. This disease is
common in places that lack proper sanitary facilities and where natural disasters have destroyed
sanitation systems (Lewnard et al. 2016). Cholera is caused by a bacterium known as the Vibrio
Cholerae which is usually killed by stomach acid in normal circumstances (Pratt 2011, p.40).
However, if large quantities of the bacteria are ingested, they survive and enter the small
intestine where they multiply. Human-to-human transmission occurs by touching the victim’s
feces or food/water with their fecal matter (Pratt 2011, p.41).
Bacteria can also be transferred from one person to another leading to outbreaks such as
the tuberculosis pandemic. TB spreads by coming into contact with contagious moisture droplets
generated from coughing or sneezing. Before antibiotics were developed, Tuberculosis was one
With HIV information, tests were developed to identify infected people and prevention
measures were introduced to reduce the spread of the disease. However, this was an exercise in
futility because 10 million people were infected within the first decade it was discovered. The
second decade saw a rapid spread of the disease around the world with Asia, the Soviet Union
and the southern parts of Africa experiencing an explosion of the pandemic (Sharp & Hahn
2011). The introduction of antiretroviral drugs led to a significant decline of transmissions
especially in high-income countries but in the low to middle-income countries, mortality rates
rose to 2.4 million while new infections increase to 3 million (Piot & Quinn 2013).
2.2. Cause of Pandemic and Two Diseases
Pandemics can also be caused by harmful germs or bacteria found in contaminated
sources of food or water. The cholera bacteria commonly found in contaminated water infects a
person’s intestines causing severe diarrhea and vomiting which if left untreated can cause death
(Stille 2011). Cholera affects one to four million people in developing countries such as Africa,
South America, Asia and it kills an estimated 142,000 people every year. This disease is
common in places that lack proper sanitary facilities and where natural disasters have destroyed
sanitation systems (Lewnard et al. 2016). Cholera is caused by a bacterium known as the Vibrio
Cholerae which is usually killed by stomach acid in normal circumstances (Pratt 2011, p.40).
However, if large quantities of the bacteria are ingested, they survive and enter the small
intestine where they multiply. Human-to-human transmission occurs by touching the victim’s
feces or food/water with their fecal matter (Pratt 2011, p.41).
Bacteria can also be transferred from one person to another leading to outbreaks such as
the tuberculosis pandemic. TB spreads by coming into contact with contagious moisture droplets
generated from coughing or sneezing. Before antibiotics were developed, Tuberculosis was one
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Causes and Solutions of Pandemics 5
of the main killer pandemics in the world because there was no cure for it (Stille 2011). After
antibiotics were developed in the 1950s, the disease was kept under control but for a short time
because the bacteria became resistant to antibiotics. Because the medication was ineffective,
cases of drug-resistant TB grew especially in people with weak immunities (Stille 2011, p.9). It
especially spread in people who had been diagnosed with HIV/AIDS. WHO estimated that 1.7
million people a year were dying because of tuberculosis with the majority of these casualties
being in Africa and Asia (Stille 2011, p.10).
3.1. Solution to Overcome Pandemics and Their Effectiveness
The US Agency for International Development came up with the Emerging Pandemic
Threats program to rapidly identify and predict the emergence of pandemics and increase threat
levels in countries so that they can deal with them effectively. This approach draws from efforts
to deal with the H5N1 virus and from the fact that human beings, animals and the environment
are intertwined (Morse et al. 2012). The approach makes use of predictive modelling, PREDICT,
to identify areas where animal hosts and human beings are likely to propagate the emergence of a
new disease. It is therefore effective in managing disease outbreaks caused by animal to human
transmission (Morse et al. 2012).
Experts such as epidemiologists, ecologists, virologists and veterinary doctors are used to
build an early warning system that detects and reports emerging diseases on a global level. They
obtain timely and reliable data by surveilling unusual events in hotspot countries and analyzing
whether animal pathogens have the capacity to emerge and spread diseases into human
populations (Morse et al. 2012). PREDICT is currently being used in 20 countries to detect
emerging disease hotspots by surveilling human-animal interactions where disease transmission
is highly likely. Within the first two years of the program, samples from 20,000 animals
of the main killer pandemics in the world because there was no cure for it (Stille 2011). After
antibiotics were developed in the 1950s, the disease was kept under control but for a short time
because the bacteria became resistant to antibiotics. Because the medication was ineffective,
cases of drug-resistant TB grew especially in people with weak immunities (Stille 2011, p.9). It
especially spread in people who had been diagnosed with HIV/AIDS. WHO estimated that 1.7
million people a year were dying because of tuberculosis with the majority of these casualties
being in Africa and Asia (Stille 2011, p.10).
3.1. Solution to Overcome Pandemics and Their Effectiveness
The US Agency for International Development came up with the Emerging Pandemic
Threats program to rapidly identify and predict the emergence of pandemics and increase threat
levels in countries so that they can deal with them effectively. This approach draws from efforts
to deal with the H5N1 virus and from the fact that human beings, animals and the environment
are intertwined (Morse et al. 2012). The approach makes use of predictive modelling, PREDICT,
to identify areas where animal hosts and human beings are likely to propagate the emergence of a
new disease. It is therefore effective in managing disease outbreaks caused by animal to human
transmission (Morse et al. 2012).
Experts such as epidemiologists, ecologists, virologists and veterinary doctors are used to
build an early warning system that detects and reports emerging diseases on a global level. They
obtain timely and reliable data by surveilling unusual events in hotspot countries and analyzing
whether animal pathogens have the capacity to emerge and spread diseases into human
populations (Morse et al. 2012). PREDICT is currently being used in 20 countries to detect
emerging disease hotspots by surveilling human-animal interactions where disease transmission
is highly likely. Within the first two years of the program, samples from 20,000 animals
Causes and Solutions of Pandemics 6
collected in 20 countries produced 150 new viruses from animals that harbored disease
pathogens. This shows the approach is effective because the samples will be used to refine
hotspot mapping globally and develop strategies to prevent pandemics. The ultimate goal of
PREDICT will be to prevent pandemics in the future at the animal source before they affect
humans (Morse et al. 2012).
3.2. Second Solution to Overcoming Pandemics
Oral cholera vaccines have been used to effectively manage cholera outbreaks globally.
These vaccines are given in two doses that are 14 days apart and they provide protection that can
last for five years. A 2015 study conducted by Azman et al. (2016), looked at the effectiveness of
using a single dose cholera vaccine in managing an outbreak of cholera in Juba, Sudan. They
found that the one dose vaccine had a similar effect to the two-dose vaccine which meant that
treatment costs would go down considerably and more people would get access to the vaccine.
The current global shortage of the oral vaccine and the difficulty of administering two doses to a
larger population also made the one dose oral vaccine a better option (Azman et al. 2016).
Because the country was facing a cholera outbreak with limited vaccines, the local public
health office together with Medecins Sans Frontieres decided to use the single dose oral vaccine.
The study found that this vaccine had an 87.3% effectiveness in reducing cholera for a period of
up to 2 months. These results showed that the one dose oral vaccine was effective in preventing a
cholera outbreak in Juba and that this new strategy was going to be useful in managing outbreaks
in areas where vaccines were limited and rapid protection was required (Azman et al. 2016).
collected in 20 countries produced 150 new viruses from animals that harbored disease
pathogens. This shows the approach is effective because the samples will be used to refine
hotspot mapping globally and develop strategies to prevent pandemics. The ultimate goal of
PREDICT will be to prevent pandemics in the future at the animal source before they affect
humans (Morse et al. 2012).
3.2. Second Solution to Overcoming Pandemics
Oral cholera vaccines have been used to effectively manage cholera outbreaks globally.
These vaccines are given in two doses that are 14 days apart and they provide protection that can
last for five years. A 2015 study conducted by Azman et al. (2016), looked at the effectiveness of
using a single dose cholera vaccine in managing an outbreak of cholera in Juba, Sudan. They
found that the one dose vaccine had a similar effect to the two-dose vaccine which meant that
treatment costs would go down considerably and more people would get access to the vaccine.
The current global shortage of the oral vaccine and the difficulty of administering two doses to a
larger population also made the one dose oral vaccine a better option (Azman et al. 2016).
Because the country was facing a cholera outbreak with limited vaccines, the local public
health office together with Medecins Sans Frontieres decided to use the single dose oral vaccine.
The study found that this vaccine had an 87.3% effectiveness in reducing cholera for a period of
up to 2 months. These results showed that the one dose oral vaccine was effective in preventing a
cholera outbreak in Juba and that this new strategy was going to be useful in managing outbreaks
in areas where vaccines were limited and rapid protection was required (Azman et al. 2016).
Causes and Solutions of Pandemics 7
Conclusion
This report has dealt with pandemics, the causes of pandemics and the solutions that can
be used to prevent pandemics now and in the future. If not managed properly, pandemics can
cause huge mortalities and lead to high healthcare costs. While they have become more
manageable now, more preventive measures are needed to reduce the high number of mortalities
that occur when a pandemic breaks out.
Conclusion
This report has dealt with pandemics, the causes of pandemics and the solutions that can
be used to prevent pandemics now and in the future. If not managed properly, pandemics can
cause huge mortalities and lead to high healthcare costs. While they have become more
manageable now, more preventive measures are needed to reduce the high number of mortalities
that occur when a pandemic breaks out.
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Causes and Solutions of Pandemics 8
References
Azman, AS, Parker, LA, Rumunu, J, Tadesse, F, Grandesso, F, Deng, LL, Lino, RL, Bior, BK,
Lasuba, M, Page, A, Ontweka, L, Llosa, AE, Cohuet, S, Pezzoli, L, Sodjinou, DV, Abubakar, A,
Debes, AK, Mpairwe, AM, Wamala, JF, Jamet, C, Lessler, J, Sack, DA, Quilici, M, Ciglenecki, I
& Luquero, FJ, ‘ Effectiveness of one dose of oral cholera vaccine in response to an outbreak: a
case-cohort study,’ Lancet Global Health, vol. 4, viewed 26 November 2018,
<https://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(16)30211-X.pdf>
CDC 2012, Introduction to epidemiology; epidemic disease occurrence, viewed 24 November
2018, <https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section11.html>.
CDC 2018, Influenza (Flu); past pandemics, viewed 24 November 2018,
<https://www.cdc.gov/flu/pandemic-resources/basics/past-pandemics.html>
Johnson, CK, Hitchens, PL, Evans, TS, Goldstein, T, Thomas, K, Clements, A, Joly, DO, Wolfe,
ND, Daszak, P, Karesh, WB & Mazet, JK 2015, ‘Spillover and pandemic properties of zoonotic
viruses with high host priority,’ Scientific Reports, vol. 5, no. 14830, viewed 25 November 2018,
<https://www.nature.com/articles/srep14830>
Morens, DM, Folkers, GK & Fauci, AS 2009, ‘What is a pandemic,’ The Journal of Infectious
Diseases, vol. 200, no. 7, pp. 1018-1021, viewed 24 November 2018,
<https://academic.oup.com/jid/article/200/7/1018/903237>
Morse, SS, Mazet, JAK, Woolhouse, M, Parrish, CR, Carroll, D, Karesh, WB, Zambrana-
Torrelio, C, Lipkin, WI & Daszak, P 2012, ‘Prediction and prevention of the next pandemic
zoonosis,’ Zoonoses, vol. 380, no. 9857, pp. 1956-1965, viewed 25 November 2018,
References
Azman, AS, Parker, LA, Rumunu, J, Tadesse, F, Grandesso, F, Deng, LL, Lino, RL, Bior, BK,
Lasuba, M, Page, A, Ontweka, L, Llosa, AE, Cohuet, S, Pezzoli, L, Sodjinou, DV, Abubakar, A,
Debes, AK, Mpairwe, AM, Wamala, JF, Jamet, C, Lessler, J, Sack, DA, Quilici, M, Ciglenecki, I
& Luquero, FJ, ‘ Effectiveness of one dose of oral cholera vaccine in response to an outbreak: a
case-cohort study,’ Lancet Global Health, vol. 4, viewed 26 November 2018,
<https://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(16)30211-X.pdf>
CDC 2012, Introduction to epidemiology; epidemic disease occurrence, viewed 24 November
2018, <https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section11.html>.
CDC 2018, Influenza (Flu); past pandemics, viewed 24 November 2018,
<https://www.cdc.gov/flu/pandemic-resources/basics/past-pandemics.html>
Johnson, CK, Hitchens, PL, Evans, TS, Goldstein, T, Thomas, K, Clements, A, Joly, DO, Wolfe,
ND, Daszak, P, Karesh, WB & Mazet, JK 2015, ‘Spillover and pandemic properties of zoonotic
viruses with high host priority,’ Scientific Reports, vol. 5, no. 14830, viewed 25 November 2018,
<https://www.nature.com/articles/srep14830>
Morens, DM, Folkers, GK & Fauci, AS 2009, ‘What is a pandemic,’ The Journal of Infectious
Diseases, vol. 200, no. 7, pp. 1018-1021, viewed 24 November 2018,
<https://academic.oup.com/jid/article/200/7/1018/903237>
Morse, SS, Mazet, JAK, Woolhouse, M, Parrish, CR, Carroll, D, Karesh, WB, Zambrana-
Torrelio, C, Lipkin, WI & Daszak, P 2012, ‘Prediction and prevention of the next pandemic
zoonosis,’ Zoonoses, vol. 380, no. 9857, pp. 1956-1965, viewed 25 November 2018,
Causes and Solutions of Pandemics 9
<https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61684-5/fulltext>
Pike, BL, Saylors, KE, Fair, JN, LeBreton, M, Tamoufe, U, Djoko, CF, Rimoin, AW & Wolfe,
ND 2010, ‘The origin and prevention of pandemics,’ Clinical Infectious Diseases, vol. 50, no.
12, pp. 1636-1640, viewed 24 November 2018,
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874076/>
Piot, P & Quinn, TC 2013, ‘The AIDS pandemic: a global health program,’ The New England
Journal of Medicine, vol. 368, no. 23, pp. 2210-2218, viewed 24 November 2018,
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3777557/>
Pratt, MK 2011, Pandemics, ABDO Publishing Company [online], viewed 25 November 2018,
<https://books.google.co.ke/books?
id=fBAYYX_r8NYC&printsec=frontcover&dq=causes+of+pandemics&hl=en&sa=X&ved=0ah
UKEwibgeWG2-_eAhVI1BoKHWNQBzAQ6AEILjAB#v=onepage&q=causes%20of
%20pandemics&f=false>
Sharp, PM & Hahn, BH 2011, Origins of HIV and the AIDS pandemic, Cold Spring Harbor
Perspectives in Medicine [online], viewed 24 November 2018,
<http://perspectivesinmedicine.cshlp.org/content/1/1/a006841.full.pdf+>
Stille, DR, Outbreak: the science of pandemics, Compass Point Books [online], viewed 25
November 2018, <https://books.google.co.ke/books?
id=VLp_u0pIAyUC&printsec=frontcover&dq=causes+of+pandemics&hl=en&sa=X&ved=0ahU
KEwihmfGl3O_eAhXszIUKHTzaDJg4ChDoAQhPMAc#v=onepage&q=causes%20of
%20pandemics&f=false>
<https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61684-5/fulltext>
Pike, BL, Saylors, KE, Fair, JN, LeBreton, M, Tamoufe, U, Djoko, CF, Rimoin, AW & Wolfe,
ND 2010, ‘The origin and prevention of pandemics,’ Clinical Infectious Diseases, vol. 50, no.
12, pp. 1636-1640, viewed 24 November 2018,
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874076/>
Piot, P & Quinn, TC 2013, ‘The AIDS pandemic: a global health program,’ The New England
Journal of Medicine, vol. 368, no. 23, pp. 2210-2218, viewed 24 November 2018,
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3777557/>
Pratt, MK 2011, Pandemics, ABDO Publishing Company [online], viewed 25 November 2018,
<https://books.google.co.ke/books?
id=fBAYYX_r8NYC&printsec=frontcover&dq=causes+of+pandemics&hl=en&sa=X&ved=0ah
UKEwibgeWG2-_eAhVI1BoKHWNQBzAQ6AEILjAB#v=onepage&q=causes%20of
%20pandemics&f=false>
Sharp, PM & Hahn, BH 2011, Origins of HIV and the AIDS pandemic, Cold Spring Harbor
Perspectives in Medicine [online], viewed 24 November 2018,
<http://perspectivesinmedicine.cshlp.org/content/1/1/a006841.full.pdf+>
Stille, DR, Outbreak: the science of pandemics, Compass Point Books [online], viewed 25
November 2018, <https://books.google.co.ke/books?
id=VLp_u0pIAyUC&printsec=frontcover&dq=causes+of+pandemics&hl=en&sa=X&ved=0ahU
KEwihmfGl3O_eAhXszIUKHTzaDJg4ChDoAQhPMAc#v=onepage&q=causes%20of
%20pandemics&f=false>
Causes and Solutions of Pandemics 10
WHO 2010, What is a pandemic? viewed 24 November 2018,
<http://www.who.int/csr/disease/swineflu/frequently_asked_questions/pandemic/en/>
WHO 2010, What is a pandemic? viewed 24 November 2018,
<http://www.who.int/csr/disease/swineflu/frequently_asked_questions/pandemic/en/>
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