The Pandemic’s “Holy Grail”, the Elusive Vaccine: For the “Global Public Good” or an Inward-looking Assertion of Vaccine Nationalism?

Posted on by Sloane Snodgrasse
Commerce & Business, International Relations, Politics, Public health,, Science and society

At this point in the war on COVID-19 there are over 120 separate vaccination projects—involving Big Pharma, the public sector, academe, smaller biotech firms and NGOs—all working flat out worldwide trying to invent the ‘magical’ vaccine that many people believe will be necessary to bring the current pandemic to an end. While nothing is guaranteed (there’s still no cure for the HIV/AIDS virus around since the Eighties), the sheer weight of numbers dedicated to the single task, even if say 94% of the efforts fail, there’s still a reasonable chance of success for achieving a vaccine for coronavirus✱ [“Former WHO board member warns world  against coronavirus ‘vaccine nationalism’”, (Paul Karp), The Guardian, 18-May-2020, www.theguardian.com].

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(Source: CEPI)

If and when the vaccine arrives, will it get to those in greatest need? The way the coronavirus crisis has been handled between nations so far doesn’t exactly give grounds for optimism. Collective cooperation on fighting the pandemic has been sadly absent from the dialogue. We’ve seen the US attack China over coronavirus’ origins with President Trump labelling it the “China virus” and the “Wuhan virus”, and China retaliating with far-fetched accusations of America importing the virus to Wuhan via a visiting military sporting team, and the whole thing becoming entwined in a looming trade war between the two economic powers❂.
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(source: www.socioecomonics.net)

The advent of COVID-19 has introduced us to terms such as “contact tracing”, “social distancing”, “covidiot” and the like, but recently we‘ve been hearing a new term thrown about, one with more ominous implications – “vaccine nationalism”. As the scattered islands of scientific teams continue the hunt for the “silver bullet” that presumably will fix the disease, there is a growing sense that the country or countries who first achieve the breakthrough will adopt a “my nation first” approach to the distribution of the vaccine. There are multiple signs that this may be the reality…the US government has launched the curiously named “Operation Warp Speed”, aimed at securing the first 300 million doses of the vaccine available by January 2021 for Americans [‘Trump’s ‘Operation Warp Speed’ Aims to Rush Coronavirus Vaccine’, (Jennifer Jacobs & Drew Armstrong), Bloomberg, 30-Apr-2020, www.bloomberg.com]. In the UK Oxford University is working with biopharma company AstraZeneca to invent a vaccine that will be prioritised towards British needs.

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(Source: IndiaMart)

A “vac race”
Not to be outdone, China, operating through Sinovac Biotech, is at the forefront of testing potential cures for COVID-19. The pressing need for a vaccine to safeguard its own population aside, Beijing’s rationale includes a heavy investment in national pride and the demonstration of Chinese scientific superiority (cf. Trump’s motivation). The Sino-US rivalry over finding a cure for the pandemic has been compared to the Cold War era ”Space Race” between the US and the USSR (Milne & Crow). A political war of superpower v superpower on a new battlefield…noted as bring part of a longer trend of the “securitisation of global health “ where the health objective increasingly has to share the stage with issues of national security and international diplomacy (E/Prof Stuart Blume, quoted in ibid.).

An environment of competition in lieu of collaboration
Even prior to the start of serious talk about the vaccine, the coronavirus crisis was provoking an “everyone for themselves”, non-cooperative approach. With the onset of equipment shortages needed to combat the virus outbreak, an international bunfight developed over access to PPE (personal protection equipment). 3M masks destined for Germany were intercepted by the White House and re-routed to US recipients; French president, Emmanuel Macron, seized millions of masks that were on route to Sweden; Trump purportedly tried to buy CureVac, a German biopharma company working on the vaccine [‘Why vaccine ‘nationalism’ could slow the coronavirus fight’, (Richard Milne & David Crow), Financial Times, 14-May-20320, www.ft.com/]. India (under Hindu nationalist Modi), the world’s largest supplier of hydroxychloroquine (touted as a cure for the virus), withheld it from being exported. As part of this neo-protectionism of the corona medical trove, more than 69 countries banned the export of PPE, medical devices and medicines [‘A New Front for Nationalism: The Global Battle Against a Virus’, (Peter S Goodman, Katie Thomas, Sui-Lee Wee & Jeffrey Gettleman), New York Times, 10-Apr-2020, www.nytimes.com].

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Politics and economics over science and global health?
Will narrow self-interest and economic advantage prevail? Will Big Pharma sell the virus panacea to the highest bidders? A zero-sum game  in which those who can’t afford the cost fall by the wayside? There are precedents…the distribution of the H1N1 vaccine for the 2009 Swine Flu was predicated on the purchasing power of the higher-income countries, not on the risk of international transmission [‘The Danger of Vaccine Nationalism’, (Rebecca Weintraub, Asaf Britton & Mark L Rosenberg), Harvard Business Review, 22-May-2020, www.hbr.org/]. The availability of the vaccine is seen as integral to restarting the global economy (Milne & Crow).

The eclipse of multinationalism?
With WHO in the eyes of some international players seemingly tarnished by its relationship with China, and by Trump’s undermining of its effectiveness by threatening to withdraw American support, multilateralism is on the back foot. There have been some attempts to stem the tide, CEPI (Coalition for Epidemic Preparedness Innovations’)▣, with a mission of promoting a collective response to emerging infectious diseases, is trying to advance both the development of coronavirus vaccines and equitable access to them (http://cepi.net/).

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Getting to an “equitable distribution” of the vaccine
As CEPI recognises, and is committed to redressing, there is no formal mechanism in existence for fairly distributing vaccines for epidemics…one step being taken is to try to get  an equitable distribution strategy accepted by the G20 nations. The only way forward to ensure that allocation is fair and prioritised according to needs is through a coordinated global effort (Milne & Crow; Weintraub eg al).

The fear is thus well founded that if and when a vaccine is discovered and developed, the richer nations will secure a monopoly over it and prevent it getting to poorer nations where it would be urgently needed by the elderly, the immunocompromised and the “first responder” health workers. There are many who hope fervently that a different scenario will be played out, that a more enlightened type of self-interest will prevail. This would require the wealthier countries seeing the bigger picture – the danger that if they don’t redistribute the cures, the outcome will be an adverse effect on the global supply chain and on the world‘s economies. As Gayle Smith (CEO of “One Campaign“, a Washington-based NGO fighting extreme poverty) put it: it is in the richer countries‘ own interests ”to ensure that the virus isn’t running rampant in other countries” (Milne and Crow). “If an international deal can be reached“, CEPI CEO Dr Richard Hatchett said, ”Everyone will win, if not, the race may turn into a free-for-all” with the losers in plain sight [‘Why the race for a Covid-19 vaccine is as much about politics as it is about science’, (Paul Nuki), The Telegraph (UK), 10-Apr-2020, www.telegraph.co.uk].

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(Source: www.euroweeklynews.com)

PostScript: Its no done deal! – reining in the wave of vaccine optimism
Even some of the scientists working on developing a vaccine are less than sanguine about the prospects. As immunologist Professor Ian Frazer (UQld) explains: there is no model of how to attack the virus. Trying to come up with a vaccine for upper respiratory tract diseases is complicated due to “the virus landing on the outside of you”, as we have seen with the common cold. What’s needed is “an immunise response which migrates out to where (the coronavirus) lands” [‘No vaccine for coronavirus a possibility’, (Candace Sutton), News, 19-Apr-2020, www.news.com.au].

 

_______________________________________________________________________________
✱ a matter of getting “the maximum shots on goal” as Jane Halton, a former member of the WHO board, put it
❂ with Trump aided and abetted in this mission by Peter Navarro (who Bloomberg calls “Trump’s Trade Warrior”) enthusiastically leading the charge in the undeclared trade war with China
▣ with funding from the Bill and Melinda Gates Foundation

Covid/Ovid 2020: Crisis (Mis)Management – How the World’s Leaders are Responding?

Posted on by E Curb Nottus
Media & Communications, Medical history, Natural Environment, Politics

Lockdown immediately, quarantine everyone, isolate the virus? Close the borders! Go hard, go fast! Make haste slowly! Laissez-faire? Test as many as you can! Watch and wait, hold off, preserve the economy, keep people working! Half/half?Herd immunity? As the experts—both recognised and putative—come out of the woodwork, a plethora of different approaches to the 21st century’s greatest crisis are thrown up, causing ever deeper descent into confusion for those of us watching from the sidelines.

Sweden: Personal responsibility to do the right thing, fingers and toes crossed
At one extreme there’s the “hands-off” non-interventionist line adopted by Sweden…”a relatively relaxed strategy, seemingly assuming that overreaction is more harmful than under-reaction” – in other words, keep calm and carry on. The Swedish government’s goal being to build up a “herd immunity” of the population to (they hope) forestall further waves of infection. The blueprint involves letting the virus spread slowly while sheltering the old and weakest elements of society until the bulk of the population become naturally immune. So schools, restaurants, bars and gyms remain open, all places that many other countries have ’hot-spotted’ as potential petri dishes (to use of the media’s current favourite buzzword in the virus crisis). Critics of the Swedish voluntary approach have stressed the risks it is exposing itself to – a danger of overwhelming the health system’s capability and precipitating large numbers of premature deaths [‘Inside Sweden’s Radically Different Approach to the Coronavirus’, (Bojan Pancevski), Wall Street Journal, 30-Mar-2020, www.wsj.com; ‘Sweden under fire for ‘relaxed’ coronavirus approach – here’s the science behind it’, The Conversation, (PW Frank & PM Nilsson), 30-Mar-2020, www.mamamia.com.au]. While Sweden persists in it’s “long game”, Sweden’s death toll from coronavirus has reached 239❈, a far-from-inconsequential figure for a small population nation like Sweden (and more than double the next highest total of fatalities in the Nordic region, that of Denmark). Not happy, Scandinavian neighbours of Sweden!

🔺 Boris in isolation – self-sacrificing crash-test dummy for the nation, gauging the coronavirus level of virulence: “taking one for the nation!” (Picture: No 10 Downing Street/AFP)

Boris, not dancing
The UK government in the early stages of the crisis, along with the Netherlands, flirted with adopting Sweden’s herd immunity approach, but subsequently (and belatedly) opted for lockdown. The UK number of cases and mortality rates continue to rise alarmingly (2,352 dead❈) and it’s citizens can draw little reassurance from the antics of its erratic Conservative Party leader Boris Johnson. At the onset the insouciant Johnson downplayed the epidemic and declared that he was all for shaking hands with as many people as he could (his Churchillian bluff AKA confidence-building strategy?) This didn’t prove a good move, personally for the prime minister, as he was soon struck down with the virus (recalling wistfully whilst in self-quarantine that shaking hands with some people at a hospital, who with hindsight probably had coronavirus, probably wasn’t a good idea).

(Photo: AP)

China’s southern neighbours
Taiwan and Singapore both got early warning of the outbreak in China, which helped them get an early start on their countries’ protective measures. Taiwan, at the get-go, posted health workers at airports – incoming passengers from Wuhan (the virus’ origin-point) were checked for symptoms before they exited the planes. Singapore on January 3, inside four days of China’s notification to WHO of an unknown virus, which later was confirmed to be the COVID pathogen, was temperature screening passengers arriving from Wuhan. Taiwan and Singapore were also in a better state of preparedness (than say northern Asian countries bordering China like South Korea and Japan which initially struggled with their respective outbreaks) The two southeast Asian micro-states had learned invaluable lessons from the 2003 SARS and the 2009 swine epidemics. That the Singaporean and Taiwanese governments were upfront and transparent with the public, also got everyone in society quickly on board with the “national project”. The death toll for both Taiwan and Singapore stands well short of double figures❈ [‘How Taiwan and Singapore Have Contained the Coronavirus’, (Chloe Hadavas), Slate, 11-Mar-2020, www.slate.com].

(Photo: AP)

Continental contrast
The European comparison of how different countries have handled the virus focuses largely on a Germany v Italy correlation – unfortunately to the great disadvantage of the latter. Angela Merkel and Germany have been able to restrict their coronavirus fatalities thus far to 931❈, compared to Italy’s out-of-control, frighteningly catastrophic 13,155 deaths❈. The reasons for the size of discrepancy are manifold. First as with Taiwan Germany was ready at the outset, comparatively Italy wasn’t. Germany went to social distancing and lockdown early while Italy prevaricated, and Italy was also slow to seal it’s borders. Anticipation paid off for Germany, it had developed a favourable type of test for the virus before it hit. They then tested fast and widely. Italy was slower off the mark, and it’s testing regime was (and is) half or less that of Germany’s capacity. Integral to Germany’s edge is its medical infrastructure, the ratios are stark: Germany has 33.9 hospital beds for every 100,000 of population, cf. Italy, only 8.6 per 100,000. So, by the time Italy got its testing into full swing, the country was swamped with way too many corona-patients requiring critical and urgent treatment. Italy’s age demographic, skewed towards the geriatric end of the scale (second oldest population in the world after Japan) was also a decisive factor in the extremely high mortality rates it has experienced [‘How one country got months ahead of its neighbours in coronavirus fight’, (AP), Yahoo!News, 02-Apr-2020].

Life on Planet Trump 
In the US a reasonable expectation the citizens of the world’s leading democratic-capitalist state might normally entertain in such a disastrous crisis, would be to have mature, insightful national leadership. Instead, they have Trump! Countless reems of pages of news-copy have been wasted on the US president, but to briefly summarise his Covid-19 performance: at the start in January we got the glib and blasé Trump – “the virus was one person coming from China and we’ve got it under control”; by February it was, we had “pretty much shut it down” (somehow he thought it was over before it had hardly started taking root!?!); next he opined “warm weather will kill it in April”; “the numbers are going down” (said after public health officials had advised the White House that the virus was spreading); by late February it was “we have lost nobody to coronavirus” (there had already been US fatalities). In March Trump, rebuked for repeatedly spreading misinformation, resorted to “it’s the Democrats’ new hoax”; then, “it will disappear one day – like a miracle!” which perhaps demonstrates one of Trump’s rare threads of consistency, drawing a link to the president’s later assertion (completely tone-deaf to the message of social distancing and ignorant of realistic timeframes) that he wanted to see the churches in America full at Easter!✪ [‘Coming Soon: Donald Trump As the Hero of COVID-19”, (Richard North Patterson), The Bulwark, 23-Mar-2020, www.thebulwurk.com].

(Photo: CBS News)

Perhaps the most striking and alarming example of Trump’s off-the-cuff and off-the-rails raves is his wilful and flagrant ignoring of the professional advice of his top medical advisers, eg, “anyone who wants a test can have one” (wrong); “we’ll have vaccines relatively soon…they’re coming” (even the non-scientific layperson knows it will take at least one to one-and-a-half years to be publicly available); “we have tremendous control of the virus”, completely contradicting Dr Fauci’s starkly realistic warning that the worst is ahead of us. The consequences of Trump’s disregarding scientific truths provided by medical experts in favour of convenient misinformation has been downright dangerous. His advocacy of an unproven coronavirus treatment (chloroquine phosphate) still being scientifically reviewed was a causal factor leading to the death of a man who tried to self-medicate using the ‘treatment’.

Trump, master of the ad hominem at the lectern, recently on TV seems bored with the subject, maybe looking round for a new focus (Iran?). Trump as president takes no responsibility. When he should be uniting all the key cogs in a coherent national response to the corona-crisis which is killing hundreds of Americans every day, he has been his divisive worst, brawling with the media, attacking medical workers for supposedly hoarding supplies, shifting blame to state governors. Fortunately, governors like New York’s Andrew Cuomo, California’s Gavin Newsom and Washington’s Jay Inslee, recognising the gaping gap in leadership and the lack of support coming from the White House, have risen to the mammoth and increasingly desperate challenge facing the country and taken the lead in the crisis [‘History’s verdict on Trump will be devastating’, (Michael D’Antonio), CNN, 30-Mar-2020, www.cnn.com].

(Photo: Jeff Gritchen, Orange County Register/SCNG)

The “Trump of the Tropics” 
Trump’s abject performance, his “epochal incompetence” (to quote Michael D’Antonio), in the crisis, is bad enough for the risks he has exposed Americans to, but his influence as a “role model” for far-right leaders in other countries, is helping to undermine those countries’ fight against the virus. One such leader is Brazil’s authoritarian president Jair Bolsonaro who expresses profound admiration for Trump (hence his nickname above), whose skepticism for the virus’ threat Bolsonaro mirrors. Bolsonaro has publicly dismissed the coronavirus as “a little cold”, refuses to isolate and continues to attend public events, irresponsibly mingling with crowds of his supporters, shaking hands with all❖. Bolsonaro, like Trump, has tended to “flip-flop” on the epidemic, lunging erratically from urging Brazilians to show caution in avoiding transmission of the disease (do as I say, not do as I do!) to calling for an end to the quarantine restrictions and removal of the shackles on the economy.

When confronted with the danger of the virus to Brazilian society, Bolsonaro rivals Trump in loopy explanations, eg, Brazilians possess a “natural immunity” which means that they cannot be infected by diseases❅ (part of the Bolsonaro fantasy playbook!) So far, despite these unique ‘antibodies’ claimed by Bolsonaro, some 244 Brazilians have died from coronavirus❈. The Brazilian president has also exhibited the Trump trait of disbelieving the medical experts and the official statistics. When São Paulo recorded a sharp spike in deaths from the virus, Bolsonaro was quick to cast doubts on the numbers. The governors of São Paulo and Rio are two of the most vocal critics of his lax approach to the crisis, in return Bolsonaro blames the state governors for their concerted measures to halt the disease, labelling their efforts ‘criminal’ [‘Brazil’s Bolsonaro makes life-or-death coronavirus gamble’, (David Biller), Sydney Morning Herald, 29-Mar-2020, www.smh.com.au].

🔺 Bolsonaro, unsafe at any distance?

Some analysts have noted the element of political calculation in Bolsanaro’s hard line on the epidemic. The Brazilian leader’s may feel that if he can take the economy (still feeling the severe effects of the 2015/16 recession) to the next elections in good health, the voters may be less concerned about the country’s death toll from coronavirus (David Biller). Mexico’s president, López Obrador, is singing from a similar hymn-sheet as Bolsonaro. Obrador contends that the severity of the virus has been overstated, and has been quoted as saying that personally he would rely on his (lucky) amulets to keep him safe [‘In Brazil and Mexico, Leaders Downplay Dangers of Virus Outbreak’, Latino USA, 26-Mar-2020, www.latinousa.org].

🔺 President Lukashenko, national leader, sportsman, tractor enthusiast

Belarus, 2020 global sporting capital
Belarus president Alexander Lukashenko is another head of state professing an admiration for the US president and similarities in style can be observed. Lukashenko has launched the small East European country on a novel path to (supposedly) combat the deadly virus – a cocktail of sport, cold, vodka and saunas. The Belarus government has vetoed lockdowns and social isolation to counter coronavirus, and it is just about the only place in the world that hasn’t discontinued sporting events. The Tokyo Olympics have been canned for 2020 but crowds still flock to football matches in Belarus. The remarkable leader himself, leading by example, recently participated in an ice hockey game. Likewise, the annual victory parade scheduled for May is still all systems go! In addition to spruking sport (and would you believe, “tractor-riding” in the countryside⊞) as antidotes to the virus, the Belarusian president recommends drinking vodka and taking saunas, whilst reassuring Belarusian citizens that God will protect the country from the global pandemic, adding the rider that Belarus’ icy cold climate will also do the job [‘“Reckless” World Leader says vodka and saunas will protect people from coronvirus’, (James Hawkins), The Mirror, 30-Mar-2020, www.mirror.co.uk].

Postscript: Crisis climate – encroaching on democratic rights? 
While the pandemic continues to rage, the politics don’t abate. All countries trying to restrict the movements of their citizens have enacted emergency measures to try to confine the pathogen. Most countries have closed their borders and some have legislated the power to detain people. The fear for advocates of civil liberties is that the more authoritarian states may use the new arrangements to move towards martial law. Regimes cross the globe have enacted new powers, ostensibly to protecting the public, but at the same time with the effect of protecting themselves from public and press scrutiny and accountability [‘”Coronavirus” profound threat to democracy’, (Noah Millman), The Week, 01-Apr-2020, www.theweek.com]. In Hungary the right-wing Orbán government has suspended existing laws, by-passing the parliament to allow president Viktor Orbán to rule by decree (with no end date). Thailand has taken the opportunity to censor the nation’s news media (suing and intimidating journalists who criticise the government’s handling of the crisis). Turkmenistan has taken the unusual approach to the pandemic of banning all use of the word ‘coronavirus’ by it’s citizens and state-controlled media✧. According to Radio Free Europe‘s Turkmenistan watch group, people talking about the virus or wearing masks in public could be arrested by the authoritarian regime which claims to have had no confirmed cases of the virus…as Turkmenistan shares a border with coronavirus-ravaged Iran this claim is viewed from outside with extreme skepticism. President Berdymukhamedov✜, not to be outdone for whacky coronavirus remedies, has recommended inhaling smoke from a burning desert-region plant (Vanguard) [’For Autocrats and Others, Coronavirus Is a Chance to Grab Even More Power’, (Selma Gebrekidian), New York Times, 30-Mar- 2020, www.nytimes.com; ‘Coronavirus: The unusual ways countries are managing lockdowns’, BBC News, 01-Apr-2020, www.bbc.co.uk].

🔻 President Berdymukhamedov, safe distancing not on the agenda here! (Photo: AFP/Igor SAFIN)

 

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❈ as at 1000 hours, Greenwich M-T, 02-Apr-2020
◘ faced with an overwhelming dose of reality, “Flip-Flop Man” Trump has been forced to pivot 180° away from this…now the White House is acknowledging the health authorities’ dire, nightmarish predictions, (‘US predicts up to 240,000 deaths even with social distancing’, ABC News, 01-Apr-2020, www.abc.net.com.au)
✪ the secular and materialistic lifestyle Trump follows, nay revels in, contrasts conspicuously with the image he tries to sow in the minds of the American public and especially the Religious Right, of him as piously religious
❖ Bolsonaro himself has apparently tested twice for coronavirus but won’t publish the results
❅ including the notorious assertion by Bolsonaro that they “can swim in raw sewerage and not catch a thing” – in effect this is what he is doing to Brazilians with his cavalier policy
⊞ the Belarusian president was quoted as saying: “There, the tractor will heal everyone. The fields heal everyone.” (tractors are apparently something of a fetish item in Belarus!)(‘Belarusian president proposes ‘tractor’ therapy for coronavirus’, Vanguard, 16-Mar-2020, www.vanguardngr.com)
✧ Turkmenistan is ranked by Paris-based RSF (Reporters Without Borders) as the country with the least press freedom in the world
✜ Berdymukhamedov has an exalted status in Turkmenistan, being seen as the Arkadag (protector of the people)

The 1918 Spanish Flu: History’s Most Deadly Pandemic

Posted on by funambulator@live.com
Environmental, International Relations, Medical history, Military history, Public health,, Regional History, Science and society

The ongoing fight to contain the outbreak of COVID-19, the Coranavirus—now entering a new stage of transforming itself into a global epidemic—gives rise to recollection of another virus that swept the world just over one hundred years ago, the so-called Spanish Flu✺. For most of the rest of the 20th century, the Spanish Flu (sometimes known as La Grippe) was largely neglected by researchers and mainstream historians, and study confined to actuaries, specialist epidemiologists and virologists and medical historians [Laura Spinney, Pale Rider: The Spanish Flu of 1918 and How it Changed the World, (2017)].

(Credit: CNN International)

Why did such a devastating pandemic fly under the radar for so long? The timing of the outbreak goes a good way to explain this. After having suffered four long years of a unique world war, people tended to treat the Spanish Flu as a footnote to the Great War conflagration. Moreover, the war, concentrated in Europe and the Middle East, had a limited geographical focus for people, contrasting with the pneumonic influenza outbreak which was truly global [The Spanish Flu Pandemic’, (L Spinney), History Today, 67(4), April 2017]. As catastrophic events go, the two stand in stark contrast. With today’s scientific and medical advances experts estimate that the Spanish Flu killed at least 50 million people worldwide, some estimates put it as high as 100 million [NP Johnson & J Mueller 2002;76: 105-115 (‘Updating the accounts: Global mortality of the 1918-1920 “Spanish” Flu pandemic’, Bull Hist Med)]. Estimates of World War I casualties—military and civilian–—sit somewhere in the range of 20 to 22 million deaths [‘WW1 Casualties’, (WW1 Facts), http://ww1facts.net]⌖. By the late 20th century and early 2000s outbreaks of new viruses like SARS, Asian Bird Flu, Swine Flu, etc, spurred mainstream historians◙ to look afresh at the great global influenza of 1918-20.

An abnormal spike in morbidity and mortality
The Spanish Flu was truly global, like the Coronavirus its lethal reach touched every continent except Antartica, both are novel (new) respiratory illnesses. Similarities have been noted between the responses to the two outbreaks, eg, the issuing of instructions or recommendations by the authorities for the public to wear masks, avoid shaking hands (part of social distancing), good hygiene, quarantine, an alarmist overreaction by the media [‘Coronavirus response may draw from Spanish flu pandemic of 100 years ago’, ABC News, (Matt Bamford), 05-Mar-2020, www.amp.abc.net.au]. The great flu of 1918’s morbidity and mortality rates were frighteningly high and far-reaching…one in three people on earth were affected by it✪. Between 2.5 and 5% of the world’s population perished, including India a mind-boggling 17M-plus, Dutch East Indies 1.5M, US (up to) 675,000◍, Britain 250,000, France 400,000, Persia (Iran) (up to) 2.4M, Japan 390,000-plus, Ghana (at least) 100,000, Brazil 300,000, USSR (unknown, but conservatively, greater than 500,000)⊞.

While densely crowded communities were thought the biggest risk of mass infection, the Flu caused human devastation even in remote, isolated corners of the world, eg, in Oceania, Samoa bereft of immunity, lost 22% of its population in two months, the Fijian islands lost 14% in a 16-day period⌀. The kill rate was something around 2.5% cf. a ‘normal’ flu outbreak a rate of no more than 0.1% would be expected [‘The Spanish Flu Pandemic’, (Spinney, History Today ; ‘The Spanish Flu’, Wikipedia, http://en.m.wikipedia.org/].(Source: National Library of Australia)

If the Spanish Flu didn’t originate in Spain, where did it originate?
No one knows for sure is the short answer…but there has been much speculation on the topic. At the time of the epidemic a popular notion was that the Flu started in China, but China experienced low rates of infection compared to other regions of the world. The explanation for this perhaps lay in that China was subjected to an initial, mild flu season which gave its citizens an acquired immunity to the disease when the more severe strain of the virus hit them.

🔺 Red Cross volunteers: caring for the sick during the Spanish Flu fell overwhelmingly on women (volunteers and professional nurses) who bore the brunt of the work at quarantine stations and camps, as well as exposing themselves to great personal risk

Influenza-ravaged Ft Riley soldiers in hospital camp 🔻

The military, mobility and zoonosis
Another theory attributes the Spanish Flu’s beginnings to the movements of the combatants in WWI. Virologist John Oxford favours the village of Étaples in France as the centre of the 1918 influenza infection. From a hospital camp here, 10,000 troops passed through every day…with their immune systems weakened by malnourishment and the stresses of battle and chemical attacks they were susceptible to the disease which was probably transmitted via a piggery and poultry on the same site. Once contracted, it’s dissemination was likely facilitated by mass transportation of troops by train.

Another view that has gained wide currency locates the Flu’s genesis in America’s Midwest. In recent times, historians led by Alfred W Crosby have supported the view that the epidemic started not in Europe but in a US Army base in Kansas in 1917 (America’s Forgotten Pandemic). According to adherents of this theory soldiers training at Fort Riley for combat in Europe contracted the H1N1 influenza virus which had mutated from pigs. The infected troops, they contend, then spread the virus via the war on the Western Front. Whether or not the virus started with WWI fighting men in France or in the US, it is undeniable that the soldiers moving around in trains and sailors in ships were agents of the Flu’s rapid dissemination [‘Spanish Flu’, History Today, (Upd. 05-Feb-2020), www.historytoday.com]. A recent, alternative origin view by molecular pathologist Jeffrey Taubenberger rejects the porcine transference explanation. Based on tests he did on exhumed victim tissue, Taubenberger contends that the epidemic was the result of bird-to-human transmission [‘Spanish flu: the killer that still stalks us, 100 years on’, (Mark Honigsbaum), The Guardian, 09-Sep-2018, www.theguardian.com].

(Image credit: Guia turístico)

Demographics: differential age groups
The pattern of Coronavirus mortality points to the disease being most virulent and most fatal to elderly people (the seventies to the nineties age group). This accords with most flu season deaths, although unlike seasonal flu outbreaks Coronavirus contagion has (thus far) had minimal impact on children, in particular the under-fives (Honigsbaum). But the pattern of Spanish Flu was markedly different, the records show a targeting of young adults, eg, in the US 99% of fatalities in 1918-19 were people under 65, with nearly 50% in the 20 to 40 age bracket (‘Spanish Flu’, Wiki). Statistics from other countries on the 1918 outbreak conform to a similar trend.

🔺 Conveying the health message to the public (Source: www.shelflife.cooklib.org)

The Flu in a series of varyingly virulent waves
The first wave of the Flu in early 1918 was relatively mild. This was followed by a second, killer wave in August. This mutated strain was especially virulent in three disparate places on the globe, Brest in France, Freetown in Sierra Leone and Boston in the US. There were myriad victims, some died (quickly) because they had not been exposed to the first, milder wave which prevented them from building up immunity to this more powerful strain [‘Four lessons the Spanish flu can teach us about coronavirus’ (Hannah Devlin), The Guardian, 04-Mar-2020, www.msn.com]. The second wave was a global pathogen sui generis. The bulk of the deaths occurred in a 13-week period (September to December). The lethality of the disease, and especially the speed with which it progressed, was the scariest part✧.

2nd wave curve in the US, 1918: note the different mortality peaks during Oct-Dec 1918 for St Louis (imposed a stringent lockdown) vs Philadelphia (much less restrictive approach)
(Source: Proceedings of the National Academy of Sciences, 2007)

The symptoms of this murderously effective strain were unusual and extreme, eg, haemorrhaging from mucous membranes, bleeding from the eyes, ears and orifices, etc. The extreme severity of the symptoms were thought to be caused by cytokine storms (overreaction of the body’s immune system) (‘Spanish Flu’, Wiki) [‘Spanish Flu’, History, 12-Oct-2010, www.history.com]. The third and last strain of the Flu, in 1919, was markedly milder by comparison to the second, but still more intense than the first.

Many parallels exist between the 1918 flu outbreak and the present pandemic – of a positive nature, the widespread advocacy of wearing masks to limit the spread of disease and mandatory lockdowns. Plenty of negative parallels too – the disregarding of science and medical expertise on how to tackle the outbreak; countries engaging in playing the “blame game” against each other rather then co-operating on a united approach to the pandemic. There was especially, but not only in the US, a repetition by some of the denial at the national leadership level to square up to the pandemic and give it the complete seriousness it demanded.

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In 1919 in the middle of the flu crisis, Irish poet WB Yeats wrote in a poem the line for which he is perhaps best remembered: “Things fall apart; the centre cannot hold; mere anarchy is loosed upon the world…”

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Footnote: The health authorities’ inability to check the juggernaut of the 1918 virus was exacerbated by misdiagnosis – at it’s onset the Spanish Flu was widely believed to be a bacterium like the Black Death, not a virus. Misreading the symptoms, the influenza outbreak was variously and erroneously diagnosed as dengue, cholera or typhoid (Spinney, ‘History Today’; ‘Spanish Flu’, History).

(Photo: State Archives & Records, NSW)

PostScript: The upside of a global catastrophe
The Spanish Flu in it’s vast human decimation rammed home lessons for post-WWI governments and health practitioners in its wake. Being helpless to prevent or halt the virus once in full swing, the vital need to develop vaccines to counter pandemics was subsequently understood. Advanced countries started to restructure their public health systems to try to cope (such as the United States’ NIH – National Institutes of Health, which emerged about 10 years after the Spanish Flu) [‘The great influenza The epic story of the deadliest plague in history‘ (JM Barry), Reviewed by Peter Palese, (JCI), www.ncbi.nim.nih.gov]. And of course the 1918 flu virus had other, indirect, outcomes…it led to universal healthcare, alternative medicine, intensive care facilities and a modern preoccupation with the benefits of healthy exercise under clean, clear skies (‘Pale Rider’).

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✺ the name is a misnomer. The Spanish association came about thus: with the Great War still raging other combatant European nations such as France and Germany had imposed censorship restrictions on the reportage of the flu outbreak, whereas Spain being neutral in the war did not. When the Spanish press freely reported a serious eruption of the Flu, people outside the country unquestioningly assumed that the influenza came from Spain
⌖ to further break that down, more American troops died from the Spanish Flu than in combat during WWI (‘Pale Rider‘)
⊞ the numbers cited tend to be approximations given the paucity of adequate record-keeping at the time
◙ part of a new multidisciplinary approach to the subject including economists, sociologists and psychologists
◍ consequently life expectancy for Americans dropped by 12 years in 1918, and for the first time since Britain commenced recording data, the death-rate in 1919 exceeded the birth-rate (Honigsbaum)
✪ Pandemic: pan ⤑ all ║ demos ⤑ the people (not literally but fairly close)
⌀ although isolation did prove beneficial in some instances, such as in Australia where the virus didn’t arrive until 1919 and entry was closely monitored with a maritime quarantine program. As a result Australia’s death-rate of 2.7 per 1000 of population was one of the lowest recorded [‘Influenza pandemic’, National Museum of Australia, www.nma.gov.au]
✧ Philadelphia alone experienced 4,597 influenza deaths in a single week