Ideas | Alex Kingsbury

Why we haven’t gotten over the Spanish flu

Influenza victims at Fort Riley, Kan., during the 1918 epidemic.
Influenza victims at Fort Riley, Kan., during the 1918 epidemic.(National Museum of Health/AP/File)

One hundred years ago this year, the Spanish flu epidemic sickened one third of the global population and killed as many as 50 million people, including 675,000 in the United States. So it is little wonder that modern thinking about pandemics is still heavily influenced by this disease, which is still with us today in weaker, seasonal strains.

Reading the book “The Great Influenza,” for instance, prompted President George W. Bush in 2005 to strengthen major national and international efforts to prevent and contain pandemics. And many of those investments paid off in helping to manage swine flu, avian flu, Middle East respiratory syndrome, Ebola, and Zika.

But pandemic preparedness suffers from cycles of panic and neglect, once the immediate threat has passed. President Trump, for his part, has proposed massive cuts to global public health programs, and he’s not the only politician to target them.

In a new book, “The End of Epidemics: The Looming Threat to Humanity and How to Stop It,” Dr. Jonathan Quick says the global community is now sliding back into the neglect phase of the cycle despite the danger. “The risk makes the threat posed by ISIS, a ground war, a massive climate event, or even the dropping of a nuclear bomb on a major city pale by comparison,” he writes.

Ideas reached him at his home in Raleigh, N.C. Below is an edited transcript.


Q: Have you received your flu shot this year?

A: Yeah, I did! And I’d do it again. The flu vaccine is not perfect, even after all this time. But it is certainly better to get it than not to get it.

Q: I ask because it’s a particularly bad flu season, but also because flu shots are among the best preventive steps that Americans take against pandemics.

A: Pandemics start and end in local communities, from flu to Ebola. If we’re going to think about ending pandemics, it is going to be resilient health systems at the national and local levels that help do that. That’s true in Africa, but is also true in places with the best health systems in world. When Zika was poised to come here, the Southern states where it was most likely to arrive were some of the least prepared in terms of public health. Preparedness means washing your hands, getting a flu shot, but also having public health systems in place.


Q: A recurrent theme in the book is trust — in public officials, in medical professionals, in neighbors. Are you worried about how the country would respond to a pandemic today, given the level of distrust people express?

A: Trust is important, and the messenger is almost more important than the message. People tend to trust their local leaders. That’s true here and was true in 2014 in West Africa, where there’s real distrust of the central government. We hear a lot about how the government there mismanaged the Ebola outbreak. What we don’t hear about is how quickly they got the epidemic under control once they got the religious leaders on board, the traditional healers on board, the market women on board, the local business leaders on board. Those were channels that people trusted and that’s what turned it around.

Q: These epidemics can pull people together, but can’t they just as easily yank people apart?

A: When pandemics hit, conspiracy theories go wild, and there are cycles of blame and recrimination. When the Black Death killed almost a third of the world’s population, many communities blamed it on the Jews and massacred them. In Guinea, a team of health care workers and journalists were slaughtered and thrown into a community cistern when they tried to talk to villagers about Ebola. Yet at the same time, there are aid workers who contract the disease during their efforts to save their communities. It brings out the best and the worst.


Q: Social media outlets seem to exacerbate some of the best and worst of human nature during these crises.

A: Social media is a great way to see all the wrong ideas that are out in people’s heads. There have been several measles outbreaks in the United States that can be traced to the repeatedly disproven idea, spread on social media and other places, that vaccines cause autism. In West Africa there were rumors on social media that drinking large amounts of salt water could cure Ebola. Experts can monitor social media to see what people were thinking and respond to that directly to those ideas.

Social media also helps track epidemics. In Nigeria, more than 50 million citizens reported cases of Ebola on social media before the country’s ministry of health made a public announcement. On YouTube, a Liberian rapper named Shadow created a music video that warned against kissing and shaking hands. It garnered nearly 100,000 views.

Q: How is it that pandemics get so much attention, but we still slip into complacency?

A: We have a long history of spending a lot of money on clean-up for the prevention we haven’t done. And we’re falling into neglect right now. We need long-term preparedness, investment, innovation, and research that won’t fluctuate with the political winds. We need strong health systems at the local and national level. We need really good public communication. In most cases, the difference between a local disease outbreak and a catastrophic epidemic or pandemic is human action or inaction. In the case of influenza, it’s human inaction. We haven’t put in the attention and effort to develop a vaccine that works for all the strains of influenza and still works from season to season. That’s a major gap that’s left the world vulnerable.


Alex Kingsbury, the deputy editor of the Globe’s Ideas section, can be reached at alex.kingsbury@globe.com.