**1. Introduction**

This chapter aims to reveal the role of architecture and urbanism in the prevention and mitigation of pandemics. Although since the 19th century the built environment traditionally had a decisive role in mitigating pandemics, such as tuberculosis, the emancipation of medicine, after the discovery of antibiotics, gradually excluded architecture and urbanism from the strategies against pandemics. In the context of COVID-19, there are relevant reasons for an interdisciplinary scientific approach of pandemics including the built environment and for a reevaluation of the future international strategies.

## **2. The limits of the contemporary healthcare system response to pandemics**

In the second half of the 20th century, a complex set of measures was set in place that successfully fought against pandemics. Pharmaceutical interventions brought substances such as antibiotic drugs against tuberculosis or such as vaccine products against influenzas. In 1997, International Coordination Group (ICG) was established by the World Health Organization (WHO) "to manage and coordinate the provision of emergency vaccine supplies and antibiotics to countries [1]". Unfortunately, although existing influenza vaccines are among the most effective protections and strategic stockpiles for several influenza types are gathered, they are ineffective against new strains. Developing and distributing a new vaccine takes several months, delaying the pharmaceutical response. As for antibiotics, WHO started, since the 1990s, to strengthen the surveillance of the drug resistance for the tuberculosis.

Lack of pharmaceutical means, non-pharmaceutical interventions "should be put in place, at the early stage of a pandemic [1]". The foreseen interventions included hygiene, social distancing, using facemasks and schools' closures. The non-pharmaceutical interventions were established as part of the international response interventions: anticipation, early detection, containment, control and mitigation as well as elimination or eradication. These measures were regulated, since 1969, by the International Health Regulations that aimed to "prevent, protect against, control and respond to the international spread of disease". Events that might have international consequences were supposed to be promptly reported by the states to WHO for assessment.

The COVID-19 pandemic showed the limits of the existing healthcare system strategies. By the end of 2020, lack of adequate response, the pandemic led to a dramatic health impact, with more than 1.5 million deaths by December 2020 [1], to a huge social disruption and an economic result that brought to the biggest global recession since the 1930s Great Depression.

**Without an effective treatment for COVID-19, governments adopted the 19th century traditional measures concerning people and the built environment**. The 2020 approach was contrary to the WHO politics of 2018, which stated that "many traditional containment measures are no longer efficient" and that "measures such as quarantine, for example, once regarded as a matter of fact, would be unacceptable to many populations today [1]". People oriented measures in 2020 addressed individuals, like hygiene or wearing face masks, or were related to contacts with people, like the social distancing (or physical distancing), curfew, isolation, quarantine and confinement (lockdown). Building oriented measures were also adopted by interior air control through ventilation.

The COVID-19 pandemic brought into attention other **non-pharmaceutical methods** that may prevent or mitigate the effects of pandemics. One of the directions concerns the environmental approaches. As for the role of the built environment in fighting against pandemics, scientific studies undergone during 2020 concerning pollution, urban heat islands, land use, green areas, urban density and interior air quality suggest that the buildings and the built environment may play a decisive role in the international strategies against future pandemics.

## **3. The One Health system response to pandemics and the role of the built environment**

In the 1980s, after increased outbreaks of zoonoses, human healthcare system became aware of the benefits in approaching human and animal diseases together *The Role of Architecture and Urbanism in Preventing Pandemics DOI: http://dx.doi.org/10.5772/intechopen.98294*

with the unifying concept of One Medicine [2]. In the 1990s, due to the alteration of the ecosystems which led to new ways of diseases spread, the role of the environment in human health became relevant [3]. During the decade of the 2000s, the unification was extended to the humans, animals and environment resulting the One Health system in the 2000's [4, 5]. A broader spectrum of professions was brought together, gathering **veterinarians, ecologists, economists, sociologists or wildlife managers**.

The 2010 decade brought an increased awareness of the urbanization risks for pandemics. The approaches were quantitative and focused on the **overlapping of habitats, the heat that provide high-risk habitats for animals and the high density of people**. As for the building health, there is also consistent literature about its role in supporting physical, social or psychological health. One of the key aspects is the indoor environmental quality, focused on the **air quality**.

Despite these advances in understanding the role of the built environment in human health, by the end of 2020 the was still not international strategy that included buildings and the built environment in the fighting against pandemics.
