Pandemic or Syndemic?

Usually the first steps in dealing with a pandemic are identifying the microbial pathogen, how it infects us, and how it moves globally from one host to another, before ultimately calculating the pathogen virulence and mortality rate of the host. A pandemic initially has one dimension, the biomedical or epidemiological dimension. However, as soon as we try to understand the pathogen’s global spread and its differential virulence and mortality, we also start discovering new dimensions of the pandemic.

For example, the COVID-19 pandemic is teaching us that understanding the virus’s lethality depends on a whole set of factors extrinsic to the virus itself. Clearly, the next logical step is pointing to the host, where comorbidities, pre-existing conditions, and the immune competence of the host help us to understand the increased mortality risk. However, understanding the immune competence of the host is not unidimensional, and it does not only imply a biological approach.

The immune competence of each human is a complex construct that implies the full capacity of each individual to mount a proper immune response. Biology needs help from other disciplines and it needs to explore each human in time and space. Ecological immunology, an emerging discipline, is helping us understand how the ecological and social factors we have encompassed since birth affect and reshape our immune system.

That takes us to a syndemic approach. As described by M. Singer and S. Clair, at its simplest level, syndemic refers to two or more epidemics interacting, which exacerbates the burden and clinical outcome of a disease in a population. Though the biological synergism among co-dwelling diseases (i.e., pathogens) exists, a more comprehensive definition of syndemic embraces the social and environmental conditions, past and present, in the health of individuals and populations. Basically, syndemics highlights the adverse interaction of diseases exacerbated by environmental and social factors, where differential disease outcomes emerge under conditions of health inequality caused, among other factors, by poverty, stress, and stigmatization.

Today, both news and peer review articles alike are exploring the syndemics of COVID-19 and illustrating how pre-existing conditions, social groups, and social inequalities can help explain differential outcomes or mortality. The holistic nature of our discipline, which combines social and biological approaches in time and space, is challenging us to deeply explore a syndemic approach to study this pandemic and establish a stronger foundation that invites other disciplines to help us understand the multiple dimensions and lessons of all pandemics in human history.

Fabian Crespo is a professor of anthropology at the University of Louisville.

Cite as: Crespo, Fabian. 2020. “Pandemic or Syndemic?” Anthropology News website, September 11, 2020. DOI: 10.14506/AN.1489

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