A century since the 1918 flu pandemic — any lessons learned?

This year marks the 100th anniversary of the 1918 flu pandemic, known as the “Spanish flu”. Strangely enough, this pandemic did not originate in Spain, nor was Spain the country most affected. The name of that nightmare is thought to have been associated with Spain simply because the nation was not involved in World War I raging then, and, therefore, had a more liberal press to discuss the magnitude of the crisis, while other nations taking part in the war had strict orders to keep things in the dark.

Many government officials and politicians at the time chose to downsize the pandemic’s health threats, leading to more deaths and much worse management outcomes. Sadly, a significant number of politicians in today’s world still follow similar tactics, achieving equally bad results in both gaining people’s trust and compliance and in managing pressing health crises. 

So, how bad was this “Spanish flu”? Let me draw an analogy to answer this question. Imagine one out of every five people living on this earth catching the nasty flu. Think of a population equivalent to that of the US, 323 million people, wiped out in one winter season! Try to picture major cities with empty streets, schools, pubs, and restaurants. Sick people dying of hunger, not because there were not enough food, but because those unaffected were too scared to approach the sick to feed them out of fears of catching the disease. This is how bad the 1918 flu pandemic was!

Despite huge losses, the pandemic finally came to an end. But, was that the end of our troubles? The influenza virus gave us a clear answer to this question and on multiple occasions. The virus has shown an impressive ability to reassemble and mutate its genetic material in a way that allowed it to create new versions of itself able to infect humans and pose a significant challenge to their sophisticated immune system, beating it on several occasions. As a matter of fact, the 1918 pandemic was followed by three more in 1957, 1968, and 2009. 

Given our unfortunate history with the influenza virus, the questions that immediately come to mind are, why have not we designed an effective flu vaccine yet, like the ones we have for other viral diseases, such as measles or polio? Why do not we have effective vaccines that we can take few times at most and that would grant us lifetime protection from the disease?

Clearly, our failure to develop such vaccines to influenza suggests that the flu virus is playing a different game to trick our immune systems than that played by the measles and polio viruses. Indeed, the influenza virus has been shown to be able to go undercover, changing its surface molecules often enough to render our vaccines ineffective in triggering our immune system to fight the virus for a long period of time.

Well then, is that the end of the story? Is a universal long-lasting flu vaccine a dream beyond reach? Any well-informed scientist would disagree. Even though outer surface proteins of flu viruses are rapidly changing, causing a headache to the immune system, the inner parts of these surface proteins or “stalks” are quite evolutionarily conserved, and the virus cannot alter them easily without compromising its ability to survive. This makes these “stalks” excellent targets for ongoing vaccination trials to produce a universal flu vaccine, a vaccine we will only have to take once or twice and is capable of conferring life-long protection against all Influenza A and B strains, no matter how creative they decide to get mutating their outer molecules genes! 

It is time now for the question most feared, can another “Spanish flu” pandemic hit us hard and catch us unawares? Given how little information and lessons we drew out of previous pandemics, I find myself obliged to burst many people’s bubble and say, yes, another pandemic is a very serious possibility! 

Many will, therefore, justifiably ask what is there to do to prevent that from happening? Humility, the mother of all virtues, is not a bad starting point. Admitting to our vulnerability and to the serious possibility of another pandemic taking place. 

It is without doubt that acknowledging the graveness of the challenge will drive us to work hard to promote national and international systems that adopt a transparent multi-disciplinary approach that aims to create efficient health, educational, political, and socio-economical systems that place combatting the influenza virus as one of the top priorities. Only then will we manage future flu outbreaks effectively and bring our universal flu vaccine into reality. Hoping that one day, and it should not be long, we can turn much-feared flu pandemics into nothing more than few days of a manageable seasonal health inconvenience.

The writer is head of immunology department at Biolab diagnostic laboratories and a part-time lecturer at the Faculty of Medicine in the University of Jordan