Preparing for an influenza pandemic in the 21st century: Lessons learned from the 1918 epidemic

Recent events reveal how ill-prepared our national and global communities are for emergencies ranging from bioterrorism to pandemic influenza. Leading infectious disease experts acknowledge that the pandemic scenario is a question of “when”, not “if” an Avian flu pandemic will take place. The missing epidemiologic element is transmission, specifically, human to human transmission. When this is accomplished, the world will be at risk for experiencing what occurred in the early 20th century across the globe. Indeed, the need to examine historic emergency preparedness tactics has become more urgent as the threat of global epidemics and disasters increases. Since 2003, 270 cases of Avian flu in humans have been confirmed by the World Health Organization (WHO) in 10 countries worldwide. Of these, 164 have resulted in death. Considering increased globalization and taking the proportion of the population killed by the 1918 influenza pandemic, in 2007 this equates to potentially 175 to 350 million deaths worldwide with human to human transmission of Avian flu. This historical analysis and reflection identifies public health lessons learned from the 1918 pandemic and offers subsequent recommendations for Avian flu preparedness in the 21st century. Political censorship, militarization and poor socioeconomic conditions are discussed as common factors contributing to vulnerability in both 1918 and today. Recommendations, informed by the Health Belief Model, include 1) recognition of a healthy fear response, 2) capitalizing on technological capabilities and 3) maximum utilization of resources to reach the public. Additionally, there is an imperative need to balance public and personal responsibility for preparedness and to recognize their interdependence. The unique contributions of public health nurses make them critical designers and implementers of preventive strategies that address anticipated suffering and death amidst an impending pandemic. It is only in seriously considering and remembering past oversights and mistakes that communities, with the leadership of public health nurses, can best prepare for future public health emergencies.