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What Can We Learn from the Deadly 1918 Spanish Flu Pandemic?

What Can We Learn from the Deadly 1918 Spanish Flu Pandemic?


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Covid-19 might be filling the column inches right now, but we’ve been here before. Jai Breitnauer looks to history for a solution.

Whether you’ve been stock piling toilet roll or had to cancel your holiday, Covid-19 will be on your radar. With a mortality rate of 3.4% and its rapid spread through business communities and among holiday makers, this novel Coronavirus certainly seems quite scary.

But we’ve been here before, pandemics aren’t new, and if we look at the deadly Spanish flu outbreak of 1918 – 1920, we can find both useful info and comfort in how far we’ve come in a century.

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Spanish flu is a much more ‘catchy’ name than Covid-19

In fact, the scientific name for Spanish flu is H1N1, and is related to the Swine flu outbreak of 2009. The reason we call it Spanish flu is because at the time of the outbreak in Europe, most countries were knee-deep in the trenches of World War One.

They were practising media suppression of anything that might make the enemy think they were weak; massive killer flu outbreaks included.

Spain was not involved in the Great War, so when people started coming down with a mystery bug, including King Alfonso XIII, the national media had a field day.

In other countries, this outbreak in Spain was reported in the news with no mention of what was happening locally, which made it seem unique to that country, and the name Spanish flu was born.

As you can imagine, the Spanish aren’t too happy about this. In Spain, it was referred to as Soldado de Napoles or ‘Soldier of Naples,’ after a song in a popular opera playing in Madrid.

The flu was said to be ‘as catchy’ as that tune by one reporter. But in reality the deadly H1N1 virus that swept the world had nothing to do with Spain, and could well have come from China like Covid-19, although there is also evidence it may have started in America, or even in the trenches in France.

Demonstration at the Red Cross Emergency Ambulance Station in Washington, D.C (Credit: Library of Congress).

I think we can all agree that sticking to the scientific name is best, as it avoids accidental racism, the blame-game and fear mongering that can come with these more casual monikers.

Something else we should all agree on is that information is a good thing. While many believe some media outlets are scaremongering, in 1918 many people caught and died of flu before their friends and family even knew what was happening.

At least none of us can say we are ignorant when it comes to Covid-19, and being well prepared is essential.

Like Covid-19, Spanish flu came from animals

In 1918, we didn’t even know what virus’ were. It wasn’t until the electron microscope was invented in the 1930s that we were able to see them for the first time.

Many medical types had hypothesized that there was something smaller than bacteria out there, with Russian botanist Dmitry Ivanovsky and Dutch microbiologist Martinus Beijerinck successfully demonstrating the existence of a such a pathogen with an experiment using tobacco plants in the late 1800s.

However, it was still unclear what a ‘virus’ actually was, and there was no way to identify it or treat it.

When people began falling foul of Spanish flu, all eyes turned to German bacteriologist Richard Pfeiffer, who had theorised that human flu was the result of a bacteria he modestly named Pfeiffer’s bacillus.

He undertook some research on samples, and hastily developed a vaccine. It is likely that the bacteria, present in lots – but not all – of the throats of flu victims sampled was a secondary infection.

Richard Pfeiffer.

Confusingly then, the vaccine actually had mixed results with the positive responses fuelling support for its use. Now, 100 years later, we know the best way to treat a virus is with rest and fluids, and virologists have managed to map how the flu virus originated from birds.

In his memoir Flu Hunter, virologist Robert Webster remembers seeing birds, animals and humans in close quarters in Hong Kong back in the 1970s.

He had already identified flu virus’ in Mutton Birds off the coast of Australia, and had noted how although the birds remained largely unaffected by flu, they could easily spread it to animals who in turn could spread it to humans in a much more deadly form.

This is because virus’ adapt to survive, and over time make small changes to allow them to live in a new host, or avoid detection from the host’s immune system.

When Webster saw the bird and animal markets in China, he realised that this could be a place where virus’ could incubate, change and spread. In fact, his advice changed the way animals and birds were kept and sold in many markets across China and the rest of the world.

But we are a society that relies on farming, which means birds, animal and humans will always live in close quarters which increases the risk of novel virus’ developing.

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Social distancing reduced cases

During the Spanish flu pandemic, there was no global unified approach to fighting the spread. In fact, most countries had no public health system at all, and information was scarce and often misleading with a focus on continuing the war effort.

The way Spanish flu spread through the trenches on both sides is a key indicator of how crowded locations suffered more severe outbreaks.

On 12 October, a week after New York authorities had accepted they were in the midst of a mass outbreak of flu, President Woodrow Wilson was allowed to lead a procession of 25,000 people through the city to raise money for the war effort; 2000 people died from flu in New York city that same week.

Emergency hospital during the Spanish flu in Kansas (Credit: Otis Historical Archives, National Museum of Health and Medicine)

Over in Western Samoa, a ship was allowed to dock with sick people on board, and 22% of the island population subsequently died.

Meanwhile, Japan notably had a much lower death toll than many other countries. This has been put down to the use of herbs to reduce fever and pain, a focus on fluids, and the cultural preference for people to rest when sick rather than the European notion you should ‘push through’.

Most Japanese self-isolated when symptoms came on, reducing the spread.

If Spanish flu has taught us anything, it is to look out for others. In 1918 we saw desperation, confusion and grief at the hands of Spanish flu, but we also saw communities pulling together and a move, politically, toward social care.

We saw how disease cuts through barriers of class, language and culture, leaving just our innate humanity behind.

We may have been raised on a Hollywood diet of movies and books that show society crumbling at the hands of a virus, but in reality all we have is each other.

We’ve achieved so much, together, in the last 100 years. Our ability to help and support our communities is what will see us through the next century.

Jaime Breitnauer is a British born writer and editor who divides her time between the UK and New Zealand. A graduate in History and Sociology, she has contributed to a wide variety of newspapers, magazines and journals. This is her first book. The Spanish Flu Epidemic and its Influence on History, £19.99, published by Pen and Sword.


What we can learn from the deadly second wave of the 1918 pandemic

As experts warn of a third wave of the coronavirus pandemic this winter, some historians are getting the feeling that we’ve been here before.

An estimated 50 million people died during the 1918 influenza pandemic, about 675,000 of which were in the United States, according to the Centers for Disease Control and Prevention (CDC) . And while the coronavirus death toll — now at about 1 million globally and more than 227,000 in the United States — isn’t anywhere close, it’s also not over yet. The second and third waves of the influenza pandemic were significantly more deadly than the first wave in early 1918 and it wasn’t until the summer after that the outbreaks subsided.

BREAKING NEWS ON THE CORONAVIRUS PANDEMIC

"My guess is it wasn't great at infecting people in the spring and had to sort of adapt," John M. Barry, author of "The Great Influenza: The Story of the Deadliest Pandemic in History," told CNN . "Then a mutation took over that was very good at infecting people and also more virulent."

Scientists had already tracked more than 30 mutations of SARS-CoV-2 in April and preliminary research in September suggested a dominant strain of coronavirus may be more contagious than others. As flu season begins, doctors are also concerned about the added strain on immune systems. Last flu season, the CDC estimated an estimated 35.5 million people got sick with influenza, 490,600 of whom were hospitalized and 34,200 died.

Our country is in a historic fight against the Coronavirus. Add Changing America to your Facebook or Twitter feed to stay on top of the news.

But more than six months into the current pandemic, many are leery of the warnings and recommendations. So were many Americans in 1918, when the flu pandemic arrived just as the United States was entering World War I. When the war ended, Americans hoped that was the end of all their troubles — but as people gathered to celebrate and soldiers began returning home, a third wave struck.

Whether or not the coronavirus pandemic follows the arc of the 1918 pandemic, history has proven one thing: Precautions such as face masks work and should be heeded.


What Did We Learn From the 1918 Influenza Pandemic? Not That Much.

They say we study history so that we may learn from the mistakes of the past and avoid repeating them in the future. The 1918 influenza pandemic took the lives of 675,000 Americans, and as of today, COVID-19 has led to the unnecessary deaths of 544,973. It is clear that the United States’ last administration clearly took no lessons from last century’s pandemic.

When the “Spanish Flu” first appeared in America, in March 1918, it took root in the army camps. (The “Spanish Flu,” by the way, is a misnomer, as the flu was of indeterminate origin. Spain, due to being neutral during WWI, was not under a war-induced media blackout and could freely report the spread of influenza within its borders. Since other countries were not publishing information about their own influenza outbreaks, this gave the false impression that the 1918 influenza began in Spain. In fact, the Spanish believed that the flu came from France, and called it the “French flu.”) The U.S. Army had, since June 1917, set up large army camps (about 32 in number) to train new draft recruits. These camps could house 25,000 to 55,000 soldiers each, which unintentionally helped diseases spread. So, after over a hundred soldiers in Camp Funston in Kansas fell ill with the 1918 influenza, the sickness managed to spread to about five times as many people within the space of a single week.

The first reported case of COVID-19 in America occurred in Washington state, though there is heavy speculation that the virus had been circulating in the U.S. months prior. The president’s Coronavirus Task Force began to meet daily starting Jan. 27, 2020, and on Feb. 2, former President Donald Trump set travel restrictions on China, with many exceptions.

Even after knowledge of the “Spanish Flu” was made public in an April 5 public health report, which detailed 18 severe cases and 3 deaths in Kansas, officials were slow to react. The 1918 Sedition Act made the publication of materials deemed “harmful” to the country, or to the war effort, illegal. This made it difficult for the press to properly inform the American citizenry of the true dangers around them, and many newspapers chose to downplay the pandemic or refuse to publish doctors’ cautionary letters. Thus, while the influenza spread rampant across the country, Philadelphia failed to cancel its “Liberty Loan March,” resulting in a “superspreader” event that led to 12,191 deaths in the city alone.

By mid-February, Europe provided the main inflow of people infected by the coronavirus to New York, rendering the travel ban on China irrelevant. Messaging from the White House and related governmental agencies was confusing and contradictory. In late February, the National Center for Medical Intelligence declared that COVID-19 posed an imminent pandemic threat, and a CDC director agreed, stating that spread was now inevitable and Americans would have to prepare for major disruption in their daily lives (look at us now). White House officials denied these statements, and on Feb. 29, Anthony Fauci said that risk was low and Americans had no present need to change daily habits.

State lockdowns to prevent influenza became prevalent in October 1918. Despite the massive death toll of the Philadelphia Liberty March only a month before, the federal government, distracted by an upcoming election and incentivized to downplay the effects of the influenza, left much of the quarantine and lockdown organization to state and local governments. These were widespread enough to force congressmen looking for reelection to turn to positive press and direct letters for their campaigning efforts, as in-person events were largely banned. Still, voting had to be done in person, so local lockdowns were lifted for Election Day, resulting in spikes of influenza cases.

By March 2020, it became clear that COVID-19 could no longer be ignored. On March 11, travel restrictions were extended from China to Europe. The following days would see the former president declare a national emergency, announce social distancing guidelines and institute southern border controls. Despite these actions being taken at the federal level, including the signing of the CARES Act, the former president extolled hydroxychloroquine as a treatment for COVID-19 and refused to nationalize the PPE supply chain. This resulted in states competing for PPE and launching haphazard, variegated quarantine procedures.

The federal government began taking relatively more serious action against influenza at the tail end of 1918. By October, Congress had already passed laws to boost the recruitment of sorely-needed doctors and nurses (many had gone overseas, as WWI was still ongoing). In November, Armistice Day and the end of WWI sparked public celebrations, which led to more infections. In December, public health officials spread information about disease transmission and instructions to more carefully dispose of contaminated nasal discharges. The Committee of the American Public Health Association, for its part, encouraged workplaces and working people to adapt their schedules so as to reduce transmission rates.

By late April, plans for a program to speed coronavirus vaccine development (“Operation Warp Speed”) became public. Since then, we’ve seen the 45th administration at once boast of vaccine development and promise total vaccination by the end of 2020 through military operations, and continue to downplay the need for mask-wearing and social distancing. The 46th administration currently promises total vaccination by the end of May 2021.


Lesson No. 2: Social distancing works

In 1918, as in 2020, travel swiftly spread the virus, with U.S. soldiers traveling to the East Coast and on to European battlefields and carrying it with them.

“The reason it was so deadly and passed so quickly across the entire world was that it took place during wartime,” Kent says. “That’s not unlike this moment of massive globalization we are living in now.”

Without the luxury of today’s high-tech microscopes and genetic sequencing, researchers wrongly assumed it was bacterial, and efforts to treat it or vaccinate against it failed. With no other tools to rely on, towns ultimately closed schools, theaters and libraries. The National Hockey League called off the Stanley Cup. Military leaders quarantined troops, and public servants were urged to wear masks.

In all, 675,000 people died in the United States, more than died in World War II. But it could have been more.

“The only way to prevent its spread was to isolate people from one another. Some communities did that and fared well. Others did not and suffered high death rates,” says Kent. “That lesson for us now is crucial. If we don't learn from it, shame on us.”


4. Washing Hands and Surfaces

Washing your hands to reduce the spread of disease is an accepted part of hygiene now, but frequent hand washing was a bit of a novelty during the early 20th century. To encourage the practice, "powder rooms," or ground-floor bathrooms, were first installed as a way to protect families from germs brought in by guests and ubiquitous delivery people dropping off goods like coal, milk and ice. 

Previously, these visitors would have traveled through the home to use the bathroom, tracking outside germs with them. (Typhoid Mary infamously spread the disease from which she earns her nickname by not properly washing her hands before handling food.)

Germ theory was a relatively new concept brought to light in the mid-1800s by Louis Pasteur, Joseph Lister, and Robert Koch that held that disease was caused by microorganisms invisible to the naked eye. Having a sink on the ground floor made it easier to wash your hands upon returning home.

Speaking of health and design, there’s a reason why hospitals, subways and 1920s bathrooms were often tiled in pristine white: White tiles are easy to clean and make any dirt or grime highly visible.


The 1918 Spanish flu: How lessons learned apply to today's COVID-19 pandemic

The 1918 H1N1 influenza pandemic, also known as the Spanish flu, was the most severe pandemic in modern history. About 675,000 deaths were reported in the United States.

Although we're only a few months into the COVID-19 pandemic, there are currently many similarities to what we saw then. Not only with the controversy regarding the wearing of masks and the closure of churches, but in the community's response to the pandemic as well.

"We have to be patient," said David Sloane, professor of history at the USC Price School of Public Policy. "It's not that we can't open a little, or slowly, or get back to work, but we have to think about social distancing, masks and gloves.

"We have to be careful about how we do this because this thing is nasty and it's not gone."

The Spanish flu pandemic began in the United States on a military base in Kansas in March 1918. Sloane said it started quietly because it spread slowly, and wasn't very deadly. But as soldiers went off to battle in World War I, the virus exploded.

"Somehow, in the amazing things that viruses do, it does what is known as a genetic shift, and that shift makes it much more virulent, and much more dangerous."

"It begins to spread rapidly in these closed, dense spaces that soldiers are in, and it begins to kill people pretty quickly. And when it comes home, it's a very different virus than when it left."

Around September 1918, the virus came home. Not on jumbo jets like we see today, but on ships full of soldiers returning to Baltimore, Philadelphia, Boston, New York and Los Angeles.

"They dock in San Pedro and try to quarantine them after five or six days, and it's too late. This is an incredibly contagious flu, and so it's into dock workers, into communities, and into Los Angeles. And this is how it happens all across the country."

And just like how health officials closed public spaces like theme parks and beaches in 2020, the same was done in September 1918.

"Concerts, big gatherings, processions and parades. They also closed dance halls, and controversially churches. But not so controversially, they also closed schools."

Many cities ordered that people wear masks. In one photograph, someone is shown wearing a sign that reads "Wear a mask or go to jail."

"They gave out hundreds, if not thousands of tickets for people unwilling to wear a mask. You still had freedom: you could stay home. That's your freedom. You could choose not to go out and infect people. But if you're going to go outside and join the public, then you're part of the responsibility of the public, just like today."

But while large public gatherings were ordered closed, many industries did not shut down entirely.

"They did worry about workplaces, but they didn't take the same type of draconian efforts that we have today."

Photographs show barber shops operating outside, and courtrooms moving to town squares as well. But only thing Sloane said you didn't see happening in 1918: physical distancing.

"Institutionally, they practiced social distancing because they closed churches, schools, saloons and dance halls. But on a personal level, if you look at the photograph, all of the people with masks, they're smushed up together. This is partly because they don't understand the flu."

The 1918 Spanish flu came in three waves: the first in March, which didn't spread that rapidly. The second wave in September, with countless soldiers returning from the battlefield, was the deadliest wave, and the one which resulted in the closures of large gatherings.

But like we're seeing now, the public grew wearisome of the shutdowns in 1918, and began reopening in November. Later that winter, the third and final wave hit the United States.

What lessons have we learned? Sloane said instituting changes in workplaces is something that was effective then - and can be again today.

"There is a possibility that we could learn something from the 1918 flu, that there's this idea of staggered work hours. Maybe not hours, but staggered work stations. Perhaps half the people go back to work on Monday, Wednesday or Friday, and half the people going back on Tuesday, Thursday and Saturday."

"I think we have to be innovative in our social thinking as well as our medical thinking."

While there are certainly differences between the Spanish flu and the current COVID-19 pandemic - such as availability of antibiotics and epidemiological advances - there are things we should keep in mind.

"We've always said those who forget history are doomed to repeat it," said Dr. Cameron Kaiser, Riverside County's public health officer. "And human nature is remarkably consistent unfortunately."

But Kaiser said there's reason to be optimistic.

"There certainly is a lot of controversy as to whether there's going to be a second wave of COVID-19 and what it's going to look like and how it's going to function. But everybody agrees you can't stay locked down forever," he said.

"If we do the right things and do what we know works: we're able to maintain social distancing, facial coverings, and making sure our most vulnerable members of the population are protected, we might be able to reopen safely and we might just get through it."


What Can We Learn from the Deadly 1918 Spanish Flu Pandemic? - History

One hundred years ago, a world recovering from a global war that had killed some 20 million people suddenly had to contend with something even more deadly: a flu outbreak.

The pandemic, which became known as Spanish flu, is thought to have begun in cramped and crowded army training camps on the Western Front. The unsanitary conditions – especially in the trenches along the French border – helped it incubate and then spread. The war ended in November 1918, but as the soldiers returned home, bringing the virus with them, an even greater loss of life was just around the corner between 50 million and 100 million people are thought to have died.

The world has suffered many pandemics in the years since – at least three serious flu outbreaks among them – but no pandemic has been as deadly, nor as far-reaching.

As the world reacts to a headline-grabbing – yet far, far less deadly – outbreak of Covid-19, caused by a new coronavirus, BBC Future looks back to our 2018 special marking the 100th anniversary of Spanish Flu to see what we learned from one of the most devastating diseases in recent history.

Pneumonia is often the killer

Many of the people dying from Covid-19 are succumbing to a form of pneumonia, which takes hold as the immune system is weakened from fighting the virus.

This is something that it shares with Spanish flu – though it must be said that the death rate from Covid-19 is many times lower than that of Spanish flu. Older people and those with compromised immune systems – who make up the majority of those who have been killed by the disease so far – are more susceptible to infections that cause pneumonia.

Few places escaped

Air travel was in its infancy when Spanish flu struck. But there are few places on Earth that escaped its horrific effects. Its passage across the world was slower, carried by railway and passenger steamer rather by airliners. Some places held out for months, or even years, before the flu arrived and wreaked its terrible toll.

The coronavirus, though capturing public attention, is significantly less lethal than Spanish Flu (Credit: Getty Images)


Spanish Flu: Herd immunity

Eventually, the frequency of the cases of Spanish Flu saw a gradual decline as people started developing herd immunity -- a phenomenon where more number of people in a community get infected, and in the process of recovery, develop antibodies against the virus.

It's what's being hoped today as well with COVID-19, where recovered patient's body would make them immune, and with them being immune, people who never got COVID-19 would automatically get saved from contracting the novel coronavirus.

Researchers have been waiting for herd immunity to get activated in our current fight with COVID-19 too, however, many claim that there is still time for that to happen.


Coronavirus: What India can learn from the deadly 1918 flu

The highly infectious Spanish flu had swept through the ashram in Gujarat where 48-year-old Gandhi was living, four years after he had returned from South Africa. He rested, stuck to a liquid diet during "this protracted and first long illness" of his life. When news of his illness spread, a local newspaper wrote: "Gandhi's life does not belong to him - it belongs to India".

Outside, the deadly flu, which slunk in through a ship of returning soldiers that docked in Bombay (now Mumbai) in June 1918, ravaged India. The disease, according to health inspector JS Turner, came "like a thief in the night, its onset rapid and insidious". A second wave of the epidemic began in September in southern India and spread along the coastline.

The influenza killed between 17 and 18 million Indians, more than all the casualties in World War One. India bore a considerable burden of death - it lost 6% of its people. More women - relatively undernourished, cooped up in unhygienic and ill-ventilated dwellings, and nursing the sick - died than men. The pandemic is believed to have infected a third of the world's population and claimed between 50 and 100 million lives.

Gandhi and his febrile associates at the ashram were lucky to recover. In the parched countryside of northern India, the famous Hindi language writer and poet, Suryakant Tripathi, better known as Nirala, lost his wife and several members of his family to the flu. My family, he wrote, "disappeared in the blink of an eye". He found the Ganges river "swollen with dead bodies". Bodies piled up, and there wasn't enough firewood to cremate them. To make matters worse, a failed monsoon led to a drought and famine-like conditions, leaving people underfed and weak, and pushed them into the cities, stoking the rapid spread of the disease.

To be sure, the medical realities are vastly different now. Although there's still no cure, scientists have mapped the genetic material of the coronavirus, and there's the promise of anti-viral drugs, and a vaccine. The 1918 flu happened in the pre-antibiotic era, and there was simply not enough medical equipment to provide to the critically ill. Also western medicines weren't widely accepted in India then and most people relied on indigenous medication.

Yet, there appear to be some striking similarities between the two pandemics, separated by a century. And possibly there are some relevant lessons to learn from the flu, and the bungled response to it.

The outbreak in Bombay, an overcrowded city, was the source of the infection's spread back then - this something that virologists are fearing now. With more than 20 million people, Bombay is India's most populous city and Maharashtra, the state where it's located, has reported the highest number of coronivirus cases in the country.

By early July in 1918, 230 people were dying of the disease every day, up nearly three times from the end of June. "The chief symptoms are high temperature and pains in the back and the complaint lasts three days," The Times of India reported, adding that "nearly every house in Bombay has some of its inmates down with fever". Workers stayed away from offices and factories. More Indian adults and children were infected than resident Europeans. The newspapers advised people to not spend time outside and stay at home. "The main remedy," wrote The Times of India, "is to go to bed and not worry". People were reminded the disease spread "mainly through human contact by means of infected secretions from the nose and mouths".

"To avoid an attack one should keep away from all places where there is overcrowding and consequent risk of infection such as fairs, festivals, theatres, schools, public lecture halls, cinemas, entertainment parties, crowded railway carriages etc," wrote the paper. People were advised to sleep in the open rather than in badly ventilated rooms, have nourishing food and get exercise.

"Above all," The Times of India added, "do not worry too much about the disease".

Colonial authorities differed over the source of infection. Health official Turner believed that the people on the docked ship had brought the fever to Bombay, but the government insisted that the crew had caught the flu in the city itself. "This had been the characteristic response of the authorities, to attribute any epidemic that they could not control to India and what was invariably termed the 'insanitary condition' of Indians," observed medical historian Mridula Ramanna in her magisterial study of how Bombay coped with the pandemic.

Later a government report bemoaned the state of India's government and the urgent need to expand and reform it. Newspapers complained that officials remained in the hills during the emergency, and that the government had thrown people "on the hands of providence". Hospital sweepers in Bombay, according to Laura Spinney, author of Pale Rider: The Spanish Flu of 1918 and How It Changed the World, stayed away from British soldiers recovering from the flu. "The sweepers had memories of the British response to the plague outbreak which killed eight million Indians between 1886 and 1914."

"The colonial authorities also paid the price for the long indifference to indigenous health, since they were absolutely unequipped to deal with the disaster," says Ms Spinney. "Also, there was a shortage of doctors as many were away on the war front."

Eventually NGOs and volunteers joined the response. They set up dispensaries, removed corpses, arranged cremations, opened small hospitals, treated patients, raised money and ran centres to distribute clothes and medicine. Citizens formed anti-influenza committees. "Never before, perhaps, in the history of India, have the educated and more fortunately placed members of the community, come forward in large numbers to help their poorer brethren in time of distress," a government report said.

Now, as the country battles another deadly infection, the government has responded swiftly. But, like a century ago, civilians will play a key role in limiting the virus' spread. And as coronavirus cases climb, this is something India should keep in mind.


What we can learn from the 1918 Spanish flu pandemic

One hundred years ago, the Spanish flu wreaked havoc on humanity and posed a threat to the entire world. The highly-contagious and rapidly-fatal disease killed anywhere from 20 to 100 million people . This World Immunization Week , we are reflecting on the advances in vaccines that have changed the world since this outbreak a century ago, and the areas where progress is still needed.

The Spanish flu appeared in the fall of 1918 at the end of World War I, adding immense danger to both the battlefield and the home front. During the war, approximately 40% of U.S. Navy and 36% of U.S. Army members became infected. More American soldiers died from the virus than in combat during the Great War.

The disease didn’t only cause harm to the infected. Businesses, health departments, and even some farms were closed due to sick workers. The disease hindered society as a whole, creating harsh conditions and obstacles for everyone.

In this time of crisis, governments turned to scientists for solutions. Multiple vaccines were developed and tested, though the vaccines developed at the time we not effective at preventing people from getting the disease.

Vaccines have improved over the years, and protect against a number of deadly diseases — which may be part of the reason we haven’t seen such a deadly outbreak over the last century. For example, smallpox wreaked havoc on the world for centuries, killing up to 500 million people, before becoming the first disease to be completely eradicated by vaccines. Polio may also soon join the list of eradicated diseases thanks to an effective vaccination currently, polio is 99.9% eradicated and only exists in three countries.

There is also hope that other diseases can meet the same fate of the Spanish flu in the decades to come. Though a vaccination currently exists for tuberculosis , scientists are working to create one that is more effective. Vaccinations for malaria and HIV/AIDS are also in development, each showing promising results so far.

Investing in the development and delivery of vaccines will continue to save countless people and could eventually put a stop to some of the world’s most deadly illnesses. Gavi, the Vaccine Alliance , is doing just that by providing access to vaccines in the poorest countries to ensure that each child has the opportunity to live a healthy life. Organizations like Gavi are vital to ending preventable diseases for those in vulnerable situations.

As history has shown us, diseases don’t just infect people whole communities suffer when its population faces illness. With hope, in one hundred years someone else will mark World Vaccination Week by recounting how we wiped out polio and some of the deadliest diseases of our generation with the help of vaccinations.

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