For most of modern medical history, scientists have framed infectious diseases as having two possible outcomes: recovery or death. Either you get better or you don’t survive. However, this dualism does not fully capture reality.
For a significant number of people, the illness does not simply end, but lingers, reshaping and even permanently changing the trajectory of their lives.
Vaccines are important tools to avoid these debilitating conditions, as they not only help individuals prevent disease, but also prevent a number of post-infectious conditions that can occur months or years later. By undermining public confidence in vaccines and cutting research funding, the second Trump administration is not only increasing the risk of infectious diseases but also expanding the population with chronic post-infectious diseases. Now is the time to mobilize science to prevent, diagnose, and treat both.
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The coronavirus disease (COVID-19) pandemic has brought the concept of post-infectious states into the public eye.
Long-term COVID-19 infection, characterized by persistent fatigue, malaise after exertion or exertion, cognitive dysfunction (‘brain fog’), headaches, and many other systemic symptoms, affects an estimated 10-20% of adults and children after initial infection. For many people, these symptoms are not a mild annoyance, but rather a life-altering disorder, interfering with their ability to work, attend school, or fully participate in daily life.
A long-lasting coronavirus infection may feel unprecedented, but it is by no means new. What is new is our collective recognition that such situations exist and the opportunity to intervene.
History tells a consistent story. Large-scale infectious disease outbreaks are often followed by a wave of chronic disease among some survivors. After the 1889-1890 pandemic, often referred to as the “Russian flu,” doctors documented a prolonged postviral syndrome they called “flu fatigue.” Affected patients reported fatigue, muscle pain, anxiety, sleep problems, depression, and neurological symptoms for months to years. This phenomenon was so widespread that entire medical texts were devoted to explaining it.
Decades later, the 1918 H1N1 influenza pandemic left an even darker legacy. This was followed by the emergence of atonic encephalitis, a devastating post-infectious condition characterized by encephalitis (inflammation of the brain) and catatonia (a state of unresponsiveness to the world around you). Severe neurological deficits and coma were also present in some of those affected.
The British Department of Health recorded nearly 16,000 cases between 1919 and 1927, with an estimated mortality rate approaching 50%. Of those who survived, only a small percentage made a full recovery. Many were left with lifelong disabilities. Children were disproportionately affected: in 1924 alone, more than 1,000 British schoolchildren developed the condition, two-thirds of whom never returned to basic health.
This pattern repeated itself throughout the 20th century. During the poliovirus outbreak that swept through the Northern Hemisphere, most people infected had mild symptoms, but some developed paralysis. However, the story did not end with the acute infection. Years or even decades later, some polio survivors develop post-polio syndrome, regardless of the severity of their initial infection. It was characterized by progressive muscle weakness, severe fatigue, debilitating pain, and in some cases paralysis. The unpredictability of who will get sick and when remains one of the most disturbing features of polio.
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More recently, survivors of the 2002-2004 SARS epidemic experienced what is now known as “prolonged SARS,” with persistent lung disease, muscle wasting, sleep disturbances, fatigue, and cognitive impairment lasting more than a year. SARS, a close relative of SARS-CoV-2, was a harbinger of the postviral syndrome that follows COVID-19.
And after the 2014-2016 Ebola outbreak in West Africa, many survivors reported chronic eye complications, musculoskeletal pain, neurocognitive deficits, and extreme fatigue, even though they had already survived the virus, which had a mortality rate of over 40%.
Regardless of time, geography, or pathogen, this lesson is surprisingly consistent. Surviving an infection does not necessarily mean recovering from the infection. Knowing that history repeats itself makes it clear that prevention is not just a tool to avoid acute disease, but the most powerful strategy for preventing chronic disease. Simply put, vaccines are essential.
Vaccination does more than just reduce hospitalizations and deaths. By preventing infection in the first place, vaccines can also prevent downstream risks of long-term medical problems that cannot yet be reliably predicted, treated, or reversed. The only proven way to eliminate the risk of chronic disease after infection is to avoid infection altogether.
But public trust in the foundation is steadily eroding. Conflicting messages from Secretary of Health and Human Services Robert F. Kennedy Jr., politicized health decisions, and policies that diverge from the evidence have left families, especially families with children, struggling to know who to trust. This confusion causes real harm. It weakens vaccine uptake, increases the circulation of preventable diseases, and sets the stage for future waves of chronic disease.
Modern medicine didn’t become special by accident. This situation became unusual because scientists and doctors emphasized data, rigorous research designs, and prevention. Vaccines are one of its greatest achievements. Because vaccines not only save lives today, they also prevent lives tomorrow from being forever changed.
While any medical intervention carries some degree of risk, the risks associated with vaccines are minor and the significant benefits to human health are unparalleled.
We are at a pivotal moment, with an unprecedented ability to unify and advance research in post-acute conditions. Modern technology and communication have made it possible to examine their ecology in ways previously unimaginable. If we have learned anything from over a century of pandemics, it is that history repeats itself. Abandoning vaccines and evidence-based medicine will not make us freer or healthier. Simply put, it will make us sicker.
Opinion on Live Science provides insight into the most important issues in science that affect you and the world around you today, written by experts in the field and leading scientists.
This article is for informational purposes only and does not provide medical advice.
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