Better Prepare Than React: Reordering Public Health Priorities 100 Years After the Spanish flu Epidemic

Michael Greenberger, JD

Disclosures

Am J Public Health. 2018;108(11):1465-1468. 

In This Article

Abstract and Introduction

Abstract

This commentary argues that 100 years after the deadly Spanish flu, the public health emergency community's responses to much more limited pandemics and outbreaks demonstrate a critical shortage of personnel and resources. Rather than relying on nonpharmaceutical interventions, such as quarantine, the United States must reorder its health priorities to ensure adequate preparation for a large-scale pandemic.

Introduction

The lethal consequences of the onset of a modern full-blown pandemic cannot be ignored. Overreliance on the reactive and blunt use of nonpharmaceutical interventions (NPIs), such as quarantine, indicate the need for a serious and commonsense reordering of our public health priorities. If we continue on our current path and fail to make changes to meet the almost certain likelihood of future critical public health needs, we may, by virtue of policy negligence, be right back where we were in 1918.

The Spanish influenza of 1918–1919, a pandemic flu estimated to have infected more than 500 million people worldwide, likely caused between 50 and 100 million deaths globally.[1] In the United States alone, the Spanish flu devastated families, businesses, and communities, leaving approximately 670 000 Americans dead in its wake. Cities such as Philadelphia, Pennsylvania, came to a grinding halt, with Spanish flu killing nearly 12 000 of its residents, almost all of them within a six-week period.[1]

Because of its time and place in history, the common and untutored wisdom is that medical science and public health have so advanced in the intervening years that the scope of a pandemic such as the Spanish flu cannot be repeated. In truth, 100 years after the deadly Spanish flu, the public health emergency community's responses to much more limited pandemics and outbreaks demonstrate a critical shortage of personnel and resources as the United States continues its recent trend of cutting back on infectious diseases funding and research.

Thus, despite technological and pharmaceutical advances, our public health defenses and countermeasures have not strengthened but withered. Relatively recent onsets of Ebola, Zika, Middle East respiratory syndrome, and a host of other emerging infectious diseases—as well as the 2017–2018 flu season—have made it clear that we are not adequately prepared for a large-scale pandemic. In fact, experts have reported that

"[e]ven with modern antiviral and antibacterial drugs, vaccines, and prevention knowledge, the return of a pandemic virus equivalent … to the virus of 1918 would likely kill [more than] 100 million people worldwide. [2]"

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....