Is Lyme disease a global pandemic?

Question

1. Avril Lavigne posted a video on Facebook featuring some celebrities talking about Lyme Disease. At the 0:13 mark, American singer/song-writer, Bebe Rexha, claims:

   Lyme disease is a global pandemic, but not a global priority.

2. (1) is also also claimed here in a page of the The Avril Lavigne Foundation site.

3. In the same page in (2), it is claimed similarly in a large title half-way down the page on the disease:

   Lyme disease, a global pandemic but not a global priority!

4. However, Wikipedia doesn't list it as a current or past epidemic (including pandemics).

Question: Is Lyme disease a pandemic, either globally or in some region?

Answer 1

TL;DR summary:

• There are indeed varying definitions of a pandemic; some emphasize (or even require) human-to-human transmission and some don't. It's difficult to apply a definition that emphasizes that human-to-human aspect to a vector-borne disease like Lyme disease. The WHO in particular has a more detailed, technical definition of an influenza pandemic, which is fairly easily applicable with minor changes to something like Covid-19, but would require more substantial modifications for it to apply to anything vector-borne. The WHO never uses the p-word even when discussing statistics of vector-borne disease that affect a lot of people worldwide (malaria, dengue etc.) Some researchers do use the pandemic (or epidemic) term(s) more loosely, and so one can find research papers referring to such widely spread vector-borne disease as pandemics. (The WHO has another related concept of a PHEIC [Public Health Emergency of International Concern], which they did apply for the first [and insofar only] time to a vector-borne disease--namely to Zika--in 2016.)

• As far as Lyme disease and national authrorities are concerned (which may declare an epidemic--in somewhat more techincal terms this requires a departure from an expected level of occurence, thus it is a matter of some judgement to declare one): Lyme disease has had a somewhat controversial status in the US recently, with e.g. the CDC apparently avoiding to speak of an epidemic but an HHS task force on Lyme referring to it in such epidemic terms (in a report to Congress). The technical issue here seems to be which interval to consider, e.g. there's more of an increase if one compares 2016 to 2001, but data over a shorter time span e.g. 2008-2015 is relatively flat. Although Canada has seen a sharper upward trend (probably due to climate change), Canadian authorities apparently have been more reluctant to speak of an epidemic, instead talking of an "outbreak" or "emerging disease". There's some data from the ECDC showing an upward trend in Europe (and despite this, the ECDC doesn't seem to speak of an epidemic [in Europe] either), but I couldn't really find out which countries were responsible for most of this increase. In Germany, an increase was noted due to a change in reporting standards in some German states (Länder), but it's unclear how much of this kind of technicality explains EU-level data. (There's seemingly not a common standard of diagnosis or reporting in the EU for Lyme disease.)

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Part 1.

Basically no, because the fairly standard definition of a pandemic requires human-to-human transmission

pandemic: An epidemic occurring over a very wide area, crossing international boundaries, and usually affecting a large number of people. Only some pandemics cause severe disease in some individuals or at a population level. Characteristics of an infectious agent influencing the causation of a pandemic include: the agent must be able to infect humans, to cause disease in humans, and to spread easily from human to human

Quoted from A dictionary of epidemiology, 6th ed. (2014), Miquel Porta (ed.).

The only human-to-human transmission of lyme disease mentioned in Wikipedia is across the placenta (i.e. in pregnancy).

Note that malaria is even more broadly spread (than lyme disease).

Now some scientists use the p-term much more loosely, e.g. a presentation by some Australian researchers calls Zika, Dengue, Japanese encephalitis, and scrub typhus "Pandemic Vector-Borne Diseases". Similarly a French & Canadian authors' paper on Zika calls it a pandemic. But this is a pretty non-standard usage of the p-word. I'm not sure how exactly to prove this last statement, but e.g. the WHO did not declare any of these to be pandemics.

The WHO has a consolidated page on vector-borne diseases (which mentions all of the above) and with stats like

Malaria is a parasitic infection transmitted by Anopheline mosquitoes. It causes an estimated 219 million cases globally, and results in more than 400,000 deaths every year. Most of the deaths occur in children under the age of 5 years.

Dengue is the most prevalent viral infection transmitted by Aedes mosquitoes. More than 3.9 billion people in over 129 countries are at risk of contracting dengue, with an estimated 96 million symptomatic cases and an estimated 40,000 deaths every year.

Despite these stats, they never call them pandemics or even epidemics, on that page, only "outbreaks". (You can argue this wrong, but that's how the pandemic terminology is [not] used, at least by the WHO.)

Outside of the disease that are even caused by infectious agents, there are papers that call obesity a pandemic. The WHO only seems to go as far as calling it an epidemic, but acknowledges its global scale as "an escalating global epidemic of overweight and obesity – “globesity”". (If you google that last term, it has more usage outside of the WHO.)

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Part 2.

The CDC (in their Principles of Epidemiology in Public Health Practice, 2012) however seems to give a less restrictive/qualified def, i.e. only that a:

Pandemic refers to an epidemic that has spread over several countries or continents, usually affecting a large number of people.

But they don't seem to talk of pandemics much; that book only mentions as an example "a pandemic of influenza". After defining an epidemic (in the usual way) "refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area", and discussing it in terms of infections, they also say that

The previous description of epidemics presumes only infectious agents, but non-infectious diseases such as diabetes and obesity exist in epidemic proportion in the U.S.

But with respect to vector-borne disease, they say e.g.

For example, an outbreak of malaria in the United States in 2006 would be an immediate threat, but malaria in Africa is a chronic problem.

The latter issue also applies to lyme disease in the northern hemisphere, i.e. to call even an epidemic, it would have be above "expected" levels.

On this angle, a 2017 NPR article which seems to stick fairly closely to the CDC definitions, notes

Epidemic: A sudden increase in the number of cases of a disease in a particular geographic area, beyond the number health officials typically expect. An increase that occurs in a relatively small geographic area or among a small group of people may be called an "outbreak."

For example, the Centers for Disease Control and Prevention calls HIV/AIDS, which affects 1.2 million people in the United States, an "epidemic." By contrast, the CDC called two cases of sickness from drinking raw milk (listeriosis) in the United States an "outbreak."

Pandemic: An epidemic spanning many countries and/or several continents. The difference between an outbreak, an epidemic and a pandemic can be murky and depends on the opinions of scientists and health officials.

The NPR page gives no examples of pandemics.

For some more examples of murkiness perhaps, although the WHO declared Zika a PHEIC (in 2015-2016), the CDC doesn't call it a pandemic in a long paper discussing it, although it does mention the PHEIC declaration. Likewise the ECDC only called it an "outbreak" even in pages that discussed the WHO's PHEIC declaration.

Following the 2009 H1N1 pandemic, the WHO was also criticized for not having a clear definition of a pandemic, although they do define "phases" of a pandemic in terms of geographic spread. Criticism included the fact that that phase approach did/does not take into account disease severity.

The ECDC also has a page delving on the issue (some of the critics of the WHO in the aforementioned regard were from the ECDC)

The internationally accepted definition of a pandemic as it appears in the Dictionary of Epidemiology is straightforward and well-known: 'an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people'.

It should be noted that this definition can apply to other infections subject to such global spread, e.g. cholera and HIV. There is no element of severity in it: while some pandemics are severe in the disease they cause in some individuals or at a population level, not all pandemics are severe.

WHO developed a more technical set of requirements for a pandemic:

The emergence of influenza A virus significant[ly] different genetically from circulating human influenza A viruses (i.e. many of the population are non-immune to the new virus) with the following three characteristics:

• Able to infect humans,
• Able to cause disease in humans,
• Able to spread from human to human quite easily.

Phases	Description
One	No animal influenza virus circulating among animals has been reported to cause infection in humans.
Two	An animal influenza virus circulating in domesticated or wild animals is known to have caused infection in humans and is therefore considered a specific potential pandemic threat.
Three	An animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks.
Four	Human-to-human transmission of an animal or human-animal influenza reassortant virus able to sustain community-level outbreaks has been verified.
Pandemic
Five	The same identified virus has caused sustained community level outbreaks in two or more countries in one WHO region.
Six	In addition to the criteria defined in Phase 5, the same virus has caused sustained community level outbreaks in at least one other country in another WHO region.
Post-peak	Levels of pandemic influenza in most countries with adequate surveillance have dropped below peak levels.
Seasonal influenza
Post-pandemic	Levels of influenza activity have returned to the levels seen for seasonal influenza in most countries with adequate surveillance.

As you can see this WHO def they quote is pretty specialized to influenza and not easy to translate to a vector-borne disease, although it is fairly easy to apply it to a zoonotic agent (i.e. that has jumped species) other than influenza, as long as it gets to human-to-human transmission (phase 4 and above.)

The Zika outbreak of 2015-2016 is the only time the WHO declared a PHEIC over a vector-borne disease. (cf. Wikipedia) Also, in regard to Covid-19, the WHO declared it a PHEIC on Jan 30, and a pandemic on March 11, so the bar for the latter is higher.

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Part 3.

Now if you want a purely declarative pronouncement... I did find one 1989 paper titled "Lyme disease. The hidden pandemic", but like with everything else vector-borne, you'll be hard pressed to find even national-level authorities that agree to even call it an epidemic in their own county.

Most countries don't even conduct very systematic surveys on lyme disease; the US seems to be the exception, but even there the numbers reported to the CDC (see table 2) appear to have been relatively stable over a decade (2005-2015), but the CDC also says that those numbers are probably underreported by an order of magnitude. On the other hand, you can find (more) papers calling it an epidemic in the US, albeit the CDC itself seems not to call it that in a 2017 survey of the 2008-2015 data. There is however a 2018 HHS report to Congress that says that "Tick-borne infections are an emerging public health epidemic in the United States". This documents points to a doubling of the number of cases in the north-east ("Upper Midwest, Northeast, and Mid-Atlantic States") from 2001 to 2016 and a tripling of the number of counties "considered to be of high incidence for Lyme disease" (presumably in the same time frame, although that's not terribly clear). Back in the early 1990s, when surveillance efforts were being ramped up in the US, more cases were being discovered each year sometimes at an accelerated pace e.g. in NY state "the number of reported cases has increased fourfold in the 4-year period from 1986 through 1989" and (so) one can find articles in prestigious journals that spoke of an epidemic. Even for more recent data, given the substantial uncertainty in estimating the true number of cases... there's room for interpretation. I mean compare the CDC graph with HHS one:

Climate change is expected to make lyme disease more prevalent in Canada (as it already happened in the north of New England and Maine), actually the official statistics in Canada show a clear upward trend already, but even in Canada the autorities (PHAC) don't seem to speak of an epidemic, but they call it an "emerging disease" in Canada. There is a different Canadian authority (NCCID) that does refer to the trend in their country as an "outbreak", though.

The ECDC has page on vector-borne diseases which talks of some epidemics (and outbreaks) of West Nile fever and outbreaks of chikungunya, but they only use the latter term (outbreak) when talking of tick-borne diseases and that with respect to Crimean-Congo hemorrhagic fever, which is also caused by a (different) virus carried by some ticks. About lyme disease they only say it is the most common tick-borne disease (in Europe) "with at least 85 000 cases yearly, and has an increasing incidence in several European countries such as Finland, Germany, Russia, Scotland, Slovenia and Sweden". And then they discuss how climate change may affect its spread. There's a longer 2006 report to the WHO on lyme disease in Europe. Some of the graphs there show annual variation but not a clear trend for the period considered, even in some Baltic countries e.g.

The ECDC however has a more up-to-date graph (in a 2014 publication) for lyme disease across Europe showing an upward trend, although they don't seem to detail which countries are responsible for the increase.

It's possible that some of this trend is due to a change in reporting standards, if Germany is any indication:

Number of notified LB [lyme disease] cases by year of notification and states grouped according to year of implementation or change in LB surveillance. Data from 2007 to 2012 was included to allow comparison. The following changes were made in the implementation: In 2009 LA [Lyme arthritis] was included as notifiable manifestation of LB in all notifying states, in 2011 notification was introduced in RP (July) and SL (August), in 2013 notification was introduced in BY (data included since 1st of April 2013) and extended in BE (data included in Figure 1 since 1st January 2013). *Thuringia (TH), Saxony (SN), Saxony-Anhalt (ST), Brandenburg (BB), Mecklenburg-Western Pomerania (MV), Rhineland-Palatinate (RP), Saarland (SL), Bavaria (BY), Berlin (BE).

Numbers from France in roughly the same time frame don't show any appreciable increase, although they are limited to hospitalizations.

There as has also been a 2018 call for the EU to regulate the reporting standards for Lyme disease.

I could not find an explicit discussion in this regard, but my guess is that because the incidence changes observed for lyme disease have been relatively slow over time (and there are some methodological issues as well) makes authorities reluctant to speak of an epidemic.

Answer 2

In brief, Lyme disease, although classed as being infectious, the albeit significant number of sufferers is insufficient for the illness to be called a global pandemic. It is a disease, and it is infectious like thousands of other diseases but it is neither contagious and nor widespread.

Lyme disease, also known as Lyme borreliosis, is an infectious disease caused by the Borrelia bacterium which is spread by ticks. The most common sign of infection is an expanding red rash, known as erythema migrans, that appears at the site of the tick bite about a week after it occurred.[…] Lyme disease is the most common disease spread by ticks in the Northern Hemisphere. It is estimated to affect 300,000 people a year in the United States and 65,000 people a year in Europe. Infections are most common in the spring and early summer.

Wikipedia

In 2014, the American Academy of Pediatrics stated:

Misinformation about chronic Lyme disease on the Internet and in popular media has led to publicity and anxiety about Lyme disease that is out of proportion to the actual morbidity that it causes (6)(7)(8)

Between 1999 and 2003, CDC research discovered 114 recorded deaths were attributed to Lyme disease in the U.S. However, there is disagreement on the accuracy of this data as LD has proven to worsen pre-existing conditions which may lead to death. “In these cases, Lyme is often not seen as the cause or even mentioned at all”.

The disease affects hundreds of thousands of people, especially in the US, but it does not necessarily infer those infected run the risk of dying nor does it imply these deaths are widespread and occur contemporaneously. Moreover, the number of infections rises during spring and summer, it is not constant all year round.

Lyme disease (Borrelia burgdorferi infection) is the most common vector-transmitted disease in the United States. The majority of human Lyme disease (LD) cases occur in the summer months, but the timing of the peak occurrence varies geographically and from year to year.
[…]
Like many vector-transmitted diseases in temperate regions, the occurrence of Lyme disease is highly seasonal. Approximately two-thirds of the cases from 1992 to 2006 had a reported onset date in June, July, or August. The seasonality of case occurrence varies geographically with the beginning of the main transmission season (and the peak) occurring earlier in southern endemic states (Virginia and Maryland) and later in the northern endemic states (Maine, New Hampshire, and Minnesota).
_{Meteorological Influences on the Seasonality of Lyme Disease in the United States published by The American Journal of Tropical Medicine and Hygiene in 2014}

Wikipedia also reports

A pandemic is an epidemic occurring on a scale that crosses international boundaries, usually affecting people on a worldwide scale. A disease or condition is not a pandemic merely because it is widespread or kills many people; it must also be infectious. For instance, cancer is responsible for many deaths but is not considered a pandemic because the disease is neither infectious nor contagious.

The following map clearly illustrates why Lyme disease cannot be classed as a global pandemic. There are numerous countries, and regions within the northern hemisphere, where Lyme disease is either unknown or the number of infections are negligible.

Countries with reported Lyme disease cases are mostly limited to the Northern Hemisphere where the climate is temperate.

Lyme disease in sub-Saharan Africa is presently unknown, but evidence indicates it may occur in humans in this region. The abundance of hosts and tick vectors would favor the establishment of Lyme infection in Africa. In East Africa, two cases of Lyme disease have been reported in Kenya

This map, albeit published in 2012, appears to disprove the claim made by the pop artist Bebe Rexha (who is a sufferer) that LD is a global pandemic.

One dot is placed randomly within the county of residence for each confirmed case. Though Lyme Disease cases have been in nearly every state, cases are reported based on the county of residence, not necessarily the county of infection.

As can be seen in the graphic above, the number of reported cases in 2012 were mainly concentrated in the upper Midwest regions and Northeastern coast of the USA.

The CDC does not class Lyme Disease as a pandemic.

It says the number of infections is rising among neighbouring states but it has not declared the situation to be an emergency.

Surveillance for Lyme Disease — United States, 2008–2015

Interpretation: Lyme disease continues to be the most commonly reported vectorborne disease in the United States. Although concentrated in historically high-incidence areas, the geographic distribution is expanding into neighboring states.

The report says

States with an average annual incidence during this reporting period of ≥10 confirmed Lyme disease cases per 100,000 population were classified as high incidence. States that share a border with those states or that are located between areas of high incidence were classified as neighboring states. All other states were classified as low incidence.

[emphasis mine] As previously mentioned in the Wikipedia article, the number of certified cases in the US is close to 300,000

During 2008–2015, a total 275,589 cases of Lyme disease were reported to CDC (208,834 confirmed and 66,755 probable)

Answer 3

Yes.

It 'is' a pandemic.
Or can be classified as one, since there is simply no widely agreed upon stable definitions to say otherwise.

A pandemic is simply an epidemic that affects a large area. This is true for common language definitions like from the Oxford English Dictionary:

General, universal. esp. Of a disease: Prevalent over the whole of a country or continent, or over the whole world. Distinguished from epidemic, which may connote limitation to a smaller area. (Epidemic: Of a disease: `Prevalent among a people or a community at a special time, and produced by some special causes not generally present in the affected locality')

Or from a medical English dictionary:

Pandemic: An epidemic occurring over a very wide area, crossing international boundaries, and usually affecting a large number of people. Only some pandemics cause severe disease in some individuals or at a population level.
— Oxford Dictionary of Epidemiology

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This is especially also true going by the terribly weak definition the WHO now occasionally likes to operate on:

A pandemic is defined as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people”. The classical definition includes nothing about population immunity, virology or disease severity. By this definition, pandemics can be said to occur annually in each of the temperate southern and northern hemispheres, given that seasonal epidemics cross international boundaries and affect a large number of people. (src)

Neither is any human-to-human transmission required, although in Lyme it is also observable. Nor is 'pandemic' necessitating 'a large number of people dying'.

The latter was a requirement for 'pandemic' influenza classifications but it hurt business too much so that criterion was dropped. Now pandemics can appear very frequently because of that move. A move that in 2009 was widely regarded as crossing the borderlines between intransparency, conflicts of interest and outright corruption. (As described in the British Medical Journal, the Parliamentary Assembly of the European Council, with a focus on declaring weak effects of a flu as pandemic with the consequence of pressuring the public into buying large numbers of ineffective medicines or administering rushed and not adequately tested vaccines with too many unpredicted side-effects to a public that didn't need them or couldn't benefit from them (like Tamiflu or Pandemrix)).¹

This criticism was on the one hand simply dismissed by the WHO with empty politician's phrases. On the other hand the lesson the WHO communicated it learned from these allegations to the public as recently as the start of this year was:

"The WHO no longer uses the category of pandemic" at all: "WHO says it no longer uses 'pandemic' category, but virus still emergency…"

And Lyme disease is frequently classified as a pandemic:

We further propose that vertical and horizontal intra-human transmission over generations has likely had a non-linear amplifying effect on human prevalence. […] this transmission mechanism now significantly exceeds the contribution of new cases from zoonotic vectors, and has reached pandemic proportion on all continents where humans reside. These conclusions strongly support our clinical experience. — W. T. Harvey, P. Salvato: "‘Lyme disease’: ancient engine of an unrecognized borreliosis pandemic?", Medical Hypotheses (2003) 60(5), 742–759, 2003. doi:10.1016/S0306-9877(03)00060-4.

— Marcus Davidsson: "The Financial Implications of a Well-Hidden and Ignored Chronic Lyme Disease Pandemic", healthcare, 2018, 6, 16; doi:10.3390/healthcare6010016

A seemingly stealthy pandemic of epic proportions, causing untold misery and suffering for millions, thrives amidst a culture of politics, greed, corruption, incompetence and arrogance. Endemic in many parts of the world Lyme disease and its associated co- infections doesn’t even exist in the minds of some in the medical community, can’t be easily diagnosed, treatment regimens are often confusing and not evidence based. When treatment is attempted it is often inadequate or substandard leaving many with chronic persistent infections. While not fitting a vaccine model, paradoxically the quest for finding a vaccine seems to have superseded all other priorities.
— Kenneth Paul Stoller: "Overview Of Lyme Disease: A Critique of an Ignored Pandemic", International Journal of Current Advanced Research Vol 4, Issue 10, pp 409-414, October 2015.

Lyme disease, the most common tick-borne infection in the north- ern hemisphere, is a serious public health problem. In North America, it is caused exclusively by Borrelia burgdorferi sensu stricto (hereafter referred to as B. burgdorferi), whereas in Europe it is caused by B. afzelii, B. garinii, B. burgdorferi, and occasionally by other species of borrelia.
— Henry M. Feder et al.: "A Critical Appraisal of “Chronic Lyme Disease”, The new england journal of medicine, 2007;357:1422-30.

— Raphael B Stricker & Marianne J Middelveen: "Sexual transmission of Lyme disease: challenging the tickborne disease paradigm", Expert Review of Anti-infective Therapy Volume 13, 2015 - Issue 11, Pages 1303-1306 | Published online: 26 Aug 2015.

Or listing lyme right among our currently most favorite 'pandemic' and even counting it as "new and important emergences and re-emergences":

— David M. Morens and Anthony S. Fauci: "Emerging Pandemic Diseases: How We Got to COVID-19", Cell. 2020 Sep 3; 182(5): 1077–1092. Published online 2020 Aug 15. doi: 10.1016/j.cell.2020.08.021 PMCID: PMC7428724 PMID: 32846157

Epistemologically the explanation for these differences in defining an infectious disease pandemic are

The examples given above suggest that the pandemic concept, as applied to important global events spanning many centuries, includes diseases of very different etiologies that exhibit a variety of epidemiologic features. There seems to be only 1 invariable common denominator: wide-spread geographic extension. However, most of the other epidemiologic features noted are common—for example, movement and high attack rates—whereas other variable features, such as noninfectiousness and severity, seem generally out of place. It should not be surprising that, in coming to terms with a new pandemic in 2009, different observers would invoke and emphasize different aspects of older pandemics with which they were familiar.

It is ironic that part of the recent problem with pandemic terminology arose not because of inherent vagueness but because of well-meaning attempts to eliminate ambiguities. Decades ago, influenza virologists began to use a highly restricted definition of pandemic that accepted only the introduction and global spread of novel hemagglutinin (HA) subtypes. […]
The WHO pointed out that the pandemic influenza phases emphasized geographic distribution of disease caused by the emergent virus, not its severity, […]

Outside of taxonomic considerations, scientific terminology often arises by habit and usage rather than by choice. Once we have a term, changing it may be difficult, and there is no consensus process for doing so. What are the implications of using a flexible and subjective term that means different things to different observers and varies when applied to different diseases? […]

In summary, simply defining a pandemic as a large epidemic may make ultimate sense in terms of comprehensibility and consistency. […]

— David M. Morens, Gregory K. Folkers, Anthony S. Fauci: "What Is a Pandemic?", The Journal of Infectious Diseases, Volume 200, Issue 7, 1 October 2009, Pages 1018–1021, https://doi.org/10.1086/644537

Thus we arrive at this 'expert' opinion

Lyme disease meets these eight characteristics that have been applied to pandemics by Morens. The disease has a worldwide distribution; is moved long distances by birds; has a high attack rate and explosive spread; offers minimal immunity; can lead to a wide range of chronic manifestations not previously described; is transmitted by a vector, and can lead to severe illness.
— Daniel J. Cameron, MD, MPH. "Time to designate Lyme disease as a pandemic?".

Whether anyone thinks of the last two examples as 'Fauci as a fraud' or 'Cameron as an expert' — or justthe other way around — they both share similar views on how to define and classify pandemics. And that makes lyme disease count as some form of pandemic.

And since

— Clara Chaisson: "The Lyme Epidemic Is Worse Than Ever. Prevention is the best medicine for this tick-borne disease—but we’ve got our work cut out for us.", April 09, 2018.

Such a classification has of course found its way into the market in form of a book that ticks a lot of other boxes: — Barbaros Çetin: "The New Pandemic of the 21st Century; Lyme Disease: The First Pandemic of Climate Change", 2020.

Bringing us back again to how even the WHO plays fast and loose with such panic inducing words like 'pandemic'. Even in official WHO publications we also find "obesity as a global epidemic", or: pandemic. (PDF)

Of course, other problems are seen as benefitting from this attention grabbing label:

• WHO: 10 facts on the global tobacco epidemic
• WHO: Unsafe abortion: the preventable pandemic

We also see heart disease called a pandemic, metabolic syndrome, cardiovascular or coronary heart disease (this even "in a true sense", hypertension and simply Vitamin D deficiency. As it is often used as just nothing more than "widespread disease", the list is practically endless.

Thus, if 'obesity' or 'abortion' can be called to be a pandemic by WHO officials, then lyme sure can be too.

There is no universally accepted proscriptive usage pattern that excludes lyme and the observational language usage pattern shows pandemic to be in use for lyme.

Lyme disease: What it is and why some are calling it the next pandemic

Parallel Pandemics: Covid-19 and Lyme Disease

1: Transparency Supports Cochrane Collaboration’s Request For Open Access To Clinical Trial Reports On Tamiflu — The BMJ questions transparency of information surrounding safety of Pandemrix “swine flu” vaccine — Corruption and the Coronavirus — Conflicts of interest. WHO and the pandemic flu "conspiracies" — Die Gesponserte Pandemie - Die Who Und Die Schweinegrippe — WHO and pandemic flu. Another question for GSK — Swine flu panic Vaccines to prevent influenza in healthy adults — Parliamentary Assembly Council of Europe, March 23, 2010: "The handling of the H1N1 pandemic: more transparency needed", 23 March 2010, PDF