Another Deadly Pandemic is Coming — And the US Is Not Ready

Lambert here: We’re ready for the Jackpot, though…

By Christine Crudo Blackburn, Postdoctoral Research Fellow, Scowcroft Institute of International Affairs, Bush School of Government and Public Service, Texas A&M University; Andrew Natsios, Director of the Scowcroft Institute of International Affairs and Executive Professor, Texas A&M University, and Gerald W. Parker, Associate Dean For Global One Health, College of Veterinary Medicine & Biomedical Sciences; and Director, Pandemic and Biosecurity Policy Program, Scowcroft Institute for International Affairs, Bush School of Government and Public Service, Texas A&M University. Reposted from Alternet.

One hundred years after the Great Influenza pandemic of 1918, global health leadership stands at a crossroads. The United States continues to expand its policy of isolationism at a time when international cooperation in health could not be more important. The state of pandemic preparedness and the necessary steps for protecting the people throughout the world was the topic of The Scowcroft Institute for International Affairs’ 2nd Annual White Paper.

As pandemic policy scholars, with two of us spending the majority of our career in the federal government, we believe that it is essential to prepare the country and the world for the next pandemic. It is not a matter of if, but when, the next disease will sweep the world with deadly and costly consequences.

There are many topic areas that national leaders must address to create better preparedness and response capabilities, but we believe three are most urgent. These include targeting the resistance to antimicrobial agents that has come about because of overuse and misuse of antibiotics; ensuring continuity of supply chains; and improving and strengthening leadership.

Overuse of a Wonder Drug

Prior to Alexander Fleming’s discovery of penicillin, even the smallest scratch could be deadly. Its discovery, however, helped contribute to the perception that man had conquered disease, despite Fleming’s warning that “the thoughtless person playing with penicillin treatment is morally responsible for the death of a man who succumbs to infection with the penicillin resistant organism.” Now, 70 years later, society is quickly reaching the precipice of that reality.

The problem of antibiotic overuse and misuses is extensive. In fact, in the United States, 80 percent of all antibiotic use occurs in the agricultural sector and the majority of this use is nontherapeutic, meaning it is not medically necessary. Misuse of antibiotics also occurs frequently in the human health sector, however. The Review on Antimicrobial Resistance estimated that if changes are not made, the world could witness 10 million deaths annually due to antimicrobial resistant infections.

To help prevent this public health threat from reaching that level of crisis with potential catastrophic implications, we recommend four actions.

First, an increase of investment needs to be made by the federal government and the private sector into research, development and production of new antimicrobials. In 2014, WHO also called for greater investment in discovering new antimicrobials, but ain the last 50 years, only one new class of antibiotics has been discovered.

Second, governments throughout the world need to create stronger internationally harmonized regulatory systems for agriculture production and veterinary use of antimicrobials. For example, in the United States, antibiotics cannot be purchased without a prescription from either a medical doctor or a veterinarian (for the agricultural sector). But many countries in the developing world have no oversight for animal or human use of antibiotics. In some places, particularly African countries, many antibiotics can be purchased over the counter.

You may already have experienced the third recommendation, if your doctor has sent you home from an appointment without an antibiotic prescription because your illness was viral. Health care providers and consumers need to decrease misuse and overuse of antimicrobials in human health by only prescribing antibiotics in cases of bacterial infection. The Centers for Disease Control and Prevention has issued guidelines for this, including recommendations for patients.

Last, governments throughout the world need to understand that fighting antimicrobial resistance requires a collaboration between animal health, human health and environmental health. This idea, known as One Health, works to bring together researchers and professionals from these three areas to address disease-related challenges. While these actions require monetary and time investments, they are essential. Without taking these actions society may find itself in a post-antibiotic world. This world, as former Director-General of the World Health Organization Margaret Chan explained in 2012, means “the end of modern medicine as we know it. Things as common as strep throat or a child’s scratched knee would once again kill.”

Will Global Supply Chains Collapse?

Modern society is able to function and flourish in large part because of the global supply chains transporting parts, equipment and supplies with speed, efficiency and just-in-time delivery, which allows business to keep carrying costs low because they can order what they need and have it shipped quickly, or “just in time.” Global supply chains, which consist of production specialization through comparative advantage, has enabled great economic development, but their just-in-time structure also leaves them exceedingly vulnerable. Components of the critical medical infrastructure, such as components essential to running life support machines or insulin for diabetics, arealways in transit.

This means that even a localized disease could deprive people of needed medical supplies. For example, if an epidemic hits a town in Asia where N95 masks, which are used to protect people from hazardous substances, are manufactured, there may no longer be any N95 masks to be shipped to the United States or elsewhere. The United States experienced supply chain breakdown when Hurricane Maria caused a disruption in the supply of small bag IV saline. A manufacturer in Puerto Rico that produces nearly half of all the saline utilized in the U.S. had to halt production because of the hurricane.

This interconnectedness of the global economy and the expansiveness of medical supply chains means that a disruption anywhere along the line could spell disaster worldwide. To help prevent such a disaster, the federal government needs to understand the United States’ critical supply chains. The federal government and private sector should be aware of likely points of breakdown.

Once there is understanding, the U.S. must implement new policies that enable private sector innovation to diversify production and transportation where possible. Diversification of production and transportation means that there is not just one production source for critical supplies. Thus, a disruption in one geographical location would not cripple the entire supply chain.

Centralized, Involved Leadership

Diseases do not respect borders, and for this reason, pandemics are a global threat. Therefore, the U.S. must address the threat of pandemics in cooperation with all other nations and with multilateral institutions such as the World Health Organization, the U.N. Security Council, UNICEF and more. We believe that investment in global health security, such as the establishment of a permanent fund for influenza preparedness and response, and remaining engaged with the international community to prevent an outbreak from becoming a pandemic is the best way to protect the American people.

Additionally, we believe that the U.S. should commit to pandemic preparedness by creating a position of authority within the White House that transcends administrations and elevates pandemics as existential threats to a national security priority. There is a need to have decision-making authority and oversight vested at the highest levels of government.

In the midst of a pandemic, decisions must be made quickly. Quick decision-making can often be hindered by the absence of high-level leadership. The need for high-level leadership, coordination and a new strategy are essential to mitigate the threat of pandemics, but these fundamental pandemic preparedness gaps persist.

The next great pandemic is coming. The true question is: Will we be ready when it does? Right now, that answer is no, because the country lacks the sufficient safeguards we have outlined. But if the United States chooses to elevate the issue of pandemic preparedness and biosecurity as a national security priority, we could be. Outbreaks are inevitable, but pandemics are not if we take action now.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


  1. Larry

    This is a fine piece, though I would not look to the private sector to guide new antimicrobial developments. The large firms continue to divest as their is no good profit motive and it’s quite clear that the easy to discover and bring to market compounds have all been discovered. The public sector can bring new ideas to bear, but this is often an uncoordinated and half baked process. In my opinion, this project would be better solved by a large federal project akin to the Human Genome Project. Granted, the problem is more complicated that sequencing DNA en masse, but we need large amounts of federal dollars to really attack the problem. Funding individual labs bit by bit just want move progress in a long neglected field fast enough.

    1. Plenue

      “The large firms continue to divest as their is no good profit motive”

      Why though? Surely there is massive potential profit in possessing a viable germ killer when all the others cease to work.

        1. Plenue

          An untreatable infection most likely means there won’t be any more life at all. Without a way to kill germs even minor surgeries become unfeasible. If nothing else the people running pharmaceutical companies have to know they themselves are going to wind up under the knife sooner or later.

          1. KWesson

            You forget that quarterly balance sheets ignore long term. The profit motives embedded in Healthcare don’t care about anything but making as much money as possible in the next week, month, quarter.

  2. DorothyT

    A close friend vacationed with family in rural Northern Florida who live on a small, gorgeous, crystal clear, spring fed river. It’s like a movie set: cypress trees dripping with Spanish moss, birds many have only seen in books if you’re an urban creature, an occasional alligator, turtles. Nearby are agricultural and ranching acres whose runoff affects nearby streams and waterways — and irrigated crops, a la the recent romaine lettuce illnesses and deaths.

    After said friend’s especially persistent sinus infection that lasted for months and interfered with his profession, and, after blood tests and courses of antibiotics that didn’t help, a doctor finally ordered a sputum (culture) test that revealed the antibiotic resistant bacterial infection pseudomonas aeruginosa. His bacterium needed to be cultured against various antibiotics to see which, if any, were responsive. Response was minimum and he underwent an ineffective sinus surgery that made things worse. Said friend visited his relatives two years running and was diagnosed after returning both times. Suggest readers look up the many ways one can be infected with this and other antibiotic resistant infectious bacteria.

    He is middle aged, otherwise healthy and an athlete. The severe effects of this bacterium can go unnoticed in a healthy person. The very young and aged, as well as those who are immune suppressed, are most at risk.

    The reader can do their own research on antibiotic resistant bacterial (and fungal) infections. Note that even if one seems to have recovered from symptoms, ‘persistent cells’ and/or biofilms can persist (many say “do” persist) and cause serious medical problems later on. I’ve sent links about this to many who don’t take this seriously. Yet taking antibiotics as they are presently over-prescribed (and requested by patients who can become irritated at their doctors who refuse such prescriptions without proper testing) grossly affects our immune systems by targeting good as well as diseased cells.

    What you will learn if you research this for yourself, and if you take this article seriously, is that the over-prescription of antibiotics and (inclusion in the foods we eat) can put you at risk if you have a resistant infection or need surgery or dental work (elective or necessary). Infections like this that reach the bloodstream are called “sepsis” — blood poisoning.

    I’ve wondered about the involvement of antibiotics since reading about the recent flu deaths attributed to sepsis among younger and previously healthy people. The dangers — and pandemic risk, as this article indicates — require public health researchers to coordinate world-wide as to causes and best practices. The danger is that illnesses that have been treatable are becoming life threatening.

  3. Samuel Conner

    In recent years I’ve done quite a bit of reading in the literature on anti-microbial peptide-based drugs. Some of these attack specific intracellular targets or processes. Others permeabilize the plasma membrane.

    A concern that I occasionally saw raised in these papers is that it might be unwise to try to develop AMPs which mimic the activity or employ the mechanism of action of the peptides that are involve in innate immunity (for example the molecules that macrophages use to destroy engulfed pathogens). If this kind of agent was to actually get into clinical use and, horror of horrors, resistance to them was to evolve in pathogens, such resistant pathogens might have cross-resistance to the molecules involved in native immunity.

    That might be much worse than the present resistance crisis.

    On a more positive note, it looks like the people who are doing the basic research into new antimicrobial molecules are increasingly incorporating “propensity to elicit resistance” into their research protocols.

    Another note — it looks to me like most of this research is taking place in university laboratories, funded by national governments. Let’s hope that the “less is more” national budget shrinkers don’t prune these projects. Of course, the Pharma corporations will happily license the new molecules as they pass regulatory review and mark them up terrifically, with the stated justification that it is necessary to recover (LOL) the cost of development.

  4. Tom Stone

    It’s not news, Laurie Garrett wrote a best selling book about it years ago.
    And preparation is not going to happen, it’s not politically feasible given our current political system.
    On the plus side, housing will be more affordable…

    1. Tomonthebeach

      Recent events tarnishing Tom Friedman, who turned CDC into a results-for-hire agency might help to turn things around. A Bluer Congress might make it a bit more permeable to medical concerns. It is not that NIH (still relatively independent of political pressure) is unaware of the problem and being proactive in pursuing the antibiotics problem.

  5. Steven Greenberg

    Scowcroft Institute of International Affairs, Bush School of Government and Public Service, Texas A&M University? Really?

    1. NotTimothyGeithner

      A job is a job. Would you dismiss Duke University? The Duke family bought the naming rights around 100 years ago, and their past time is polluting rivers.

  6. TG

    “Diseases do not respect borders, and for this reason, pandemics are a global threat.” That’s not quite true. To a great extent diseases do respect borders -when those borders are enforced. It’s just that with an open-border policy, the entire world is a giant petri dish.

    The problem is that our government and the corporate press are in an official state of denial. Consider Chagas disease. It used to be confined to Central and South America, but with mass immigration from these places into the United States, it is starting to become endemic here. Now, regardless of whether you feel that this mass immigration is a moral necessity and will prevent us from running out of workers, or if you think that this is an abusive policy of flooding the labor market so that wages can be driven down and profits up, if we are going to accept all these people from places where Chagas disease is endemic, surely we could have prepared?

    Given our immigration policy, it was predictable that Chagas would spread to the United States. We could have developed vaccines and new treatments, screened and treated immigrants from these places, and educated physicians about what to look for. But we did nothing. The reason is simple: the elites don’t want any downside of our ongoing massive immigration policy to be discussed. Therefore we cannot prepare as you suggest in your piece. Whether it is the spread of disease, or running short of fresh water, or traffic congestion, or anything, government policies aimed at maximizing population growth simply cannot be acknowledged to have any down side at all. And thus we cannot prepare for what are mostly inevitable challenges.

    Although another partial explanation, of course, is that our elites just plain don’t care about public health any more. Why should they? They live in gated communities, their kids don’t go to school with unscreened third-world refugees, they have the best medical care that other people’s money can buy. And investments in public health could be expensive: every billion spent on public health is a billion less to shovel at Wall Street.

    1. jrs

      “We could have developed vaccines and new treatments, screened and treated immigrants from these places, and educated physicians about what to look for.”

      How do you do that if they are afraid they will be deported for seeking treatment? Not that developing vaccines is that easy anyway.

      1. JBird

        That is a feature, not a bug. Stigmatized, ostracized, sickly, and often dying people who can and will still work in near slave like conditions are more easily created if they have horrible diseases. Why worry as you will be in those gated communities making profit.

    2. Synoia

      every billion spent on public health is a billion less to shovel at Wall Street.

      There is a missing prevention multiplier:

      every billion spent on public health is 10? 100? billion less to shovel at Wall Street.

  7. DorothyT

    Not to be missed from the article is this link: “Global Leadership at a Crossroads”

    It would be helpful to have a conversation in this regard re: single payer health systems and the aggregation of critical health research and information in one place. I heard Dr. Jesse Steinfeld, Nixon’s surgeon general, say that many years ago. And here we are, once again, still struggling with less government in this sphere. More money for weapons and war preparation. Less for health and ecology.

  8. The Rev Kev

    I don’t think that people understand what it means to have a global pandemic and I don’t blame them. The last full-fledged one in 1919 was so devastating that the entire episode dropped down a memory hole and was omitted from biographies, medical histories as well as other books that should have covered it. In the US alone about 675,000 died which is tens of thousands more than died in every war in the history of the United States, omitting the Civil War, up to the present war on terror. I did the figures and if the same attack happened now, that would be over two and a quarter million dead – probably mostly in mass graves.
    People were barred from gathering together which meant cinemas, restaurants, churches, public meetings, picnics, etc. Can you imagine that now? Would you be confident about handling money? How about the buttons on an ATM? Or a public door? The possibilities for things to be stuffed up are enormous. What if it was turned into a political effort with one party denying the seriousness – lest it effect consumer confidence and spending – while the other one tried to score political points? What part would the media play in all this? What if the government withdrew medical staff from cities so that they would not suffer too many casualties in the first wave of infections? I hope that we never have to find all this out.

    1. drumlin woodchuckles

      I have often wondered about that society-wide Consensual Cone of Silence dropped over the 1918 Flu. The Medieval Black Death is well known and much discussed. I think it because it happened long enough ago that the social trauma dissipated. The 1918 Flu is still recent enough that the nationwide trauma prevents much thinking about it at all.

      The next Big Disease pandemic could well be one of those respiratory viruses, like Return of the Spanish Flu, or SARS, or MERS, or something like that.

      There may be parts of the Global Overclass which view the “next Pandemic” as a prospect rather than a problem. Maybe just the American Overclass is that depraved at this point in time. Maybe it is only the American Overclass which is working its hardest to LIHOP the Jackpot. And if LIHOP won’t do it, they’ll move on to HIHOP and then MIHOP.

      1. Jack Parsons

        “Cone of Silence”-
        Any war history natters on and on about this battle and that battle, but until ww2 more soldiers died of disease than from violence. I truly believe that westerners, in particular, do not want to think about being speared by the Fickle Finger of Fate (another 60s reference for you). The lack of human agency is the most frightening, and as a culture we don’t talk about Bad Things.

      2. Anon

        My mother was five years old in 1918. Her older sister died from that pandemic. My mother was scared stiff for her children during flu season while I was growing up. A pandemic could occur quite rapidly today with modern travel capability. Flu season scares me stiff.

    2. Big River Bandido

      I’m not at all surprised by the silence surrounding the 1919 pandemic. First, there’s the role that war always plays in the spreading of disease, and I have personal experience with this. In early 1992 I was diagnosed with a very nasty strain of mononucleosis (caused by the Epstein-Barr virus). My doctor had treated dozens of patients with the exact same (unusual) symptoms, and she was absolutely certain the symptoms and timing identified the virus as something from Iraq, brought back to the U.S. by soldiers returning from the first Gulf War.

      World War I itself caused the mass movement of millions of people over a huge expanse of the globe, exposing them to viruses from other parts of the world, against which they had built up no natural immunity. American soldiers began returning home in mid-1919. Just as the First Nations suffered far more deaths from viruses Old World viruses brought by the conquistadors, it’s a logical guess that the First World War was what allowed the pandemic to spread in the first place.

      How this figures into the writing of history: repression is a powerful motivator — even in historiography, if the writer has reason to expect being charged with a crime for writing the truth. And the Wilson Administration was one of the most repressive this nation has ever endured; I’m not sure even George W. Bush was worse than Wilson in that regard. The felonies and anti-constitutional measures of the Wilson Administration had more than a chilling effect on political discourse — they deep froze it. Anything that may have remotely seemed critical of the war or designed to obstruct the war effort was stringently punished, and it’s easy to see how this could stifle scientific discourse. Indeed, the Scopes Monkey Trial occurred only a few years later, with Wilson’s Sec. of State William Jennings Bryan arguing on behalf of the religious fundamentalists. In that sort of climate, somewhat like our own, even daring to make a connection between “the war” and its evils would have been construed as “treason”.

      I think the side effects of World War I were more traumatic for the United States than the war itself — race riots, evisceration of civil liberties, destruction of German-American culture, deep economic recession — and all this long after “the war” was over. In her 1921 play, Susan Glaspell has this exchange between Felix Fejevary and the heroin, Madeline:

      MADELINE: [In a smoldering way.] I thought America was a democracy.
      FEJEVARY: We have just fought a great war for democracy.
      MADELINE: Well, is that any reason for not having it?

      All this serves as a reminder that making war always unleashes unintended consequences, and that even wars sparing your own country a high combat toll don’t guarantee you won’t get burned another way. In fact, it’s guaranteed that some way or another, the instigator of a war will face some kind of consequence for it. Even “victors” who never suffer invasion suffer greatly — usually after the fact, quietly, and without acknowledgement or even recognition of the root cause.

      Sorry for the overlong post but this inspired lots of different thoughts, hard to synthesize.

      1. Prairie Bear

        No need to apologize; this was a good and very interesting comment. I would only add that WWI, aside from all the bad effects you mention, only set up conditions for the Nazis and Third Reich, Holocaust and WWII.

        Do you know of any good, single book on Wilson and the things you mention that is not too huge, like multivolumes but more concise that would cover the basics?

  9. Don Cafferty

    The first thing that jumped out at me in reading this article is “The United States continues to expand its policy of isolationism at a time when international cooperation in health could not be more important.” The article left me wondering how serious is this concern. What is the current situation? The link to the 2nd Annual White Paper provides detail. “To date, the United States has been the largest contributor to the initiative [Global Health Security Agenda], but other countries are also making significant contributions. However, with only one year left before coming to the end of a five-year milestone, there is no sign that the Trump Administration plans to renew the initiative.” For me, this is the key issue.

    1. tegnost

      President Donald Trump has emphasized the importance of the GHSA, including at the U.N.
      General Assembly in September 2017, by highlighting that the GHSA is one of several programs
      that promote better health and opportunities all over the world. In July 2017, Secretary of State
      Rex Tillerson stated, “The United States’ commitment to working in multi-sectoral partnerships
      to counter infectious diseases through the Global Health Security Agenda will remain constant.”
      In October 2017, at the GHSA Ministerial Meeting, the National Security Council Senior Director
      for Global Health Security and Biodefense, Rear Admiral Tim Ziemer (U.S. Navy, retired),
      emphasized U.S. support for GHSA going forward, by stating, “The United States believes that
      extending GHSA beyond 2018 will allow us to continue our collective progress toward the
      original vision of GHSA. We see opportunities to work together, to build on the successes, and
      focusing in addressing those most pressing needs in the next five years.”

      This from the ghsa website may alleviate your fears, however for me this looks an awful lot like public resources/private profit, which is what led me to search their site, and in classic misdirection…
      “The Global Health Security Agenda (GHSA) is a partnership of nations, international organizations, and stakeholders to help create a world safe from infectious ”
      nary a mention of those “stakeholders”, I’m thinking gates foundation, clinton foundation? Can anyone with better search skills get to the point of this “security agenda” …hmm. On a related note, still waiting for the alleged return of the starfish in the salish sea.

  10. Enquiring Mind

    Upon reading the article I thought of a related item. Hand disinfectants such as Purell seem to be ubiquitous. Over-treating real or imagined conditions by nervous people may have many unintended consequences such as inducing resistance to what should have been more benign factors. Whatever happened to a little soap and water without additives?

    By way of disclosure, I am a veteran of a Free-range Kid youth where some dirt and grime was routine, so am an old fogey. Modern environmental factors like polluted soil (PCBs, lead, etc), water (usual suspects, and many unusual ones) and air (a bright spot by comparison) seem more insidious now.

    1. Amfortas the Hippie

      late to the party, again/
      anyhoo—I was free range, too…and the better for it.
      I insisted on the same for my boys—go on and kiss the dog– but something’s changed, even way the hell out here—wasp sting turns into cellulitis or fascitis…because said hymenoptera dragged her stinger in the mud when collecting building materials….and the streptococcii and other sundry soil microfauna have developed resistance and are more robust than they used to be.
      I think it’s sadly funny, and telling, that every article I’ve seen about this major problem always says “80% of this is due to the way we do meat”…and then is quick to include the lecture on a few humans, here and there, not finishing their course of treatment.
      The former is the major cause…but CAFO would be impossible without prophylactic antibiotics…the conditions are so close and filthy that it’s really the sin qua non of that kind of meat production.
      so the obvious answer…in addition to putting a lot more money and effort into finding new antibiotics…is to move away from the CAFO Model(there are alternatives, after all…just not conducive to the needs of ConAgra).
      but trump said something insensitive…and republicans in general are hateful humans…and we must light our hair on fire and run around in circles.
      The people who own and run the Machine figger they’ll be OK…so what if the Poors have a little die-off…so much the better!
      That just means more Earth for them.

  11. Mary Wehrheim

    The total silence about the flu epidemic of 18 is amazing. As I was growing up, I I heard all about my parents’ experiences during the Depression and WWII. My mom was born in 23 in Detroit. She said she heard nothing about that horrible epidemic from any of her older relatives. She went to nursing school in the early 40s…no mention. She only read about it when she started teaching at the local school of nursing in the 60s. Perhaps people were so traumatized by it that they couldn’t talk or write about it. People were told to wear masks which did nothing to help. It started at the military base at Fort Riley Kansas. Troop movements sent it to Europe where it mutated into the deadly form and then came back over the ocean and around the world. Those who refused to wear protective masks (which were useless) were called “mask slackers.” It was thought everyone was going to die and yet they continued to have war rallies. Lots of sad stories like a doctor who surrounded himself with his dead family and shot himself. Asia was especially hard it. “Trains left one station with the living. They arrived with the dead and dying, the corpses removed as the trains pulled into the station.” It ran its course after it had finally killed off the most genetically vulnerable or mutated again to a more mild form. I only knew about it from my mom. Nothing in my history books until I got to college. WWI usually overshadowed it. Yeah…add plague to our possible trifecta of poverty, forever war and environmental degradation.

    1. Prairie Bear

      Now that you mention this, I’m thinking the same thing — I might have expected to hear something about it from my maternal grandmother, born in 1892. My parents were born in the late nineteen-teens and I heard lots of fascinating stories about the Great Depression. Very little talk about the flu epidemic.

      That thing about Fort Riley — I had heard that too; it was in a documentary about the epidemic. I don’t remember where I saw it or when. It might have been PBS, probably 30 years ago or more when I still watched TV. Hard to recall many details, but was a weird creepy bit about how the soldiers there were ordered to burn something. Maybe animal manure that had piled up, or a bunch of hog carcasses that had died of some disease, don’t remember. But it made a very foul cloud of pollution over the base and some guys got sick. Mostly they recovered, but the theory was that they then went to WWI and it mutated, or something, and came back here with the survivors, like you said.

      There was another segment, a talking-head interview with an old man who had survived. He had been maybe 10 when his mother died of the 1918 flu. He said it destroyed his father, who was just never the same and it cast a pall over the remaining family. This old survivor talked about how he grew up, went to college, had a career and so forth, but he never really felt happy again. I could believe it from watching him. It was painful even to watch.

  12. McWatt

    When visiting relatives grave sites in cemeteries, as I walk along, I always look for the graves where people died in 1918. There is always a number of them. Particularly children’s graves. You can sometimes see Father, Mother and children dying the same year.

    1. HotFlash

      Yes, heartbreaking. You see stones marked things like James Roweland McCausland, aged 3 years, 2 months and 14 days. Life is so fleeting, but every precocious day carved in stone.

    2. Scott1

      I was going to say that more people ought walk in the local cemeteries for if you do you will see that many people died of the Spanish Flu in 1918.
      It has pretty much been generally known that the livestock industry has been feeding cows and pigs antibiotic laced food to for 40 years when that ought be banned as a practice.
      “Greed is not good.”
      The National Health Service is or was one of the 7 uniformed Defense of the Nation Services. It was unique for being entirely composed of officers. The CDC ought be more viewed as part of the DOD.
      There is an excellent “History Guy” youtube video about the National Health Service and the part it played during the Spanish flu pandemic.
      I feel as though we are forced to make a “Federal Case” about everything anymore. I feel as if the spirit of American Pragmatism has been quashed for the dystopian philosophy of Objectivism.
      Scratch a problem and the next thing you know is that some lobbyist has been successful at buying off our Congressional and Senate representatives.
      Post Civil War in the US during the Grant administration this sort of thing was out of control. Now it feels more institutionalized, and impossible to stop.

  13. Shane

    Antibiotic use is only relevant to bacterial infections, and not many serious epidemic candidates are bacteria. Common forms of the plague is still readily treated with antibiotics but resistant strains are emerging. Tuberculosis is also developing broad spectrum resistance but tends to be a slow grind through populations rather than a hot burning epidemic.
    Viruses are much more likely to be responsible for a hot burning epidemic, so antibiotics aren’t relevant. Some broad spectrum antivirals are emerging to at least manage symptoms though their stocks are probably too low for wide spread use during an epidemic. There are plenty of known candidate viruses that could go epidemic through a mutational shift (possibly one that allows them to evade vaccines for older strains), or some viable small pox could turn up again (live virus was found in scabs tucked in an old diary not long ago).
    In some ways a fast burning epidemic might be the best thing for a society struggling with resource constraints and facing environmental collapse if business as usual continues. The alternatives (e.g. high tech/nuclear war) are distinctly less appealing.

  14. Jonathan T McPhee

    And we live in a world with “scientists” and ordinary geeks who have ready access to devices that let them assemble complex molecules into stuff like virus particles, and also “edit” (is there a Strunk and White manual available for this?) genetic and cellular material with their Gilbert’s CRSP-R kit they got for Christmas or a birthday… “Scientists” who have revived that 1918 influenza virus in their labs,, because doing that was “really cool” and I guess they believe that is necessary to develop a vaccine (and bugs NEVER escape from Level 4 bio labs), and other scientists, scoffing at concerns of still other scientists, have developed pathogens that are coded to elude any of the “natural immunity” and immune-system defenses we have left, after a century of being dosed with all kinds of debilitating chemicals and stressors?

    And of course the whole, completely out-of-, and beyond-control apparatus of the military-industrial Thing, seeking always for more lethal and preferably hegemony-producing weaponry, where EVERYTHING is weaponizable — “Say Uncle, give us your wealth, or we will kill you all and you can’t kill us back!” . Thousands of credentialed, unsocialized dudes and dude-ettes, applying their individual and collective genius, and ever-growing knowledge of materials and methods and the stuff of life, in that fascinating and self-propelling search for the Ultimate Weapon, an unanswerable process or device — weather control, whatever they are doing with that HAARP thing, a virus that “our” important citizens could be vaccinated against that is maybe even tailored, thanks to the people who give their DNA code to 23andme or the Mormons, to just kill people in particular areas with particular genetic characteristics. Stuff like that.

    And how evil are Big Pharma companies? Would the kind of C-Suite-ers that push medications that they know will sicken and kill a bunch of people, but will loop in a yuuuge profit before regulators or tort lawyers can catch up, knowing that the C-Suite-ers will have cashed out and be gone, or like all the Elite be immune from personal consequences, recoil from starting plagues that they have the only antidote or vaccine or treatment for? Speaking of “manufacturing demand,” and “pricing leverage…”

    I mean, it’s not like “our government” has not infected and exposed lots of “citizens” to various pathogens and chemicals, “just to see what would happen.”

    The search is on, folks — Re-read Dr. Seuss’s “The Butter Battle Book,” to see how it turns out…

    We are one effing stupid species.

    1. Prairie Bear

      … and bugs NEVER escape from Level 4 bio labs …

      Plum Island! (although I don’t know if it’s “Level 4” or what)

  15. BoyDownTheLane

    The accurate link to the Alternet article is

    I’ve been studying this topic on and off since just after 2001 — if you remember, we had a major disaster event on a severe clear day in September in New York that year — and the big boys with the bucks downtown decided to explore a wide variety of ideas. I’d been thinking about the idea of simulation gaming as a teaching tool since 1980 (and have the published article and more to back this up) when DARPA and the TSWG (terrorist studies working group) contracted with the University of Georgia’s Colllege of Agricultgural and Enviuronmental Scients and the Georgia Tech Research Institute to design the educational components of a game to teach civilians how to handle the outbreak of avian influenza in Georgia. Do you know how mnany chickens there are in Georgia and how important they are to the economy? I do. But DARPA needed someone to create the software for the gaming comnponent, and so they turned to the company that was already engaged in the creation of a platoon-to-White Housed system of wargaming and which had created MAGTF, the training simulation for the use of a Marine Amphibious Group Tactical Force. That company was an offshoot of the Bolt, Beranek and Newman effort that taught armored-brigade strategy and tactics in time for Desert Storm (about which there is a book by the late Tom Clancy called Into The Storm). The two software gurus Morrison and Katz ran MAK Technologies and they hired me as their content expert on civilian emergency management. (Among other things, I was NIMS-certified in exercise design.) We designed a game system that would train people to contain the spread (by vectors and fomites) of a viral pandemic among the chickens in as little as 48 hours. DARPA and its twin lead agency, USDA, killed the project.

    But community-level biosurveillance is discussed in the white paper I wrote on the suggestion of a physician whom I dissuaded from driving to New Orleans during Katrina and which has been posted publicly on the website of the International Association of Emergency Managers since December 2005. See I also served on a mayor’s committee to look at the issue of a pandemic outbreak. The major focus at the time was the work of Michael Osterholm at CIDRAP (se: http/ ); many of Osterholm’s articles are here: A copy of my white paper on communities of practice was sent to Lambert last week.

    Here is a CDC presentation on connected bio-surveillance showing the hospitals in 19 major cities that were on the BioSense system in 2006 (

    See also:
    Evaluating Systems for the Early Detection of Biological Threats
    [an abbreviated version (210 pages) of a book from 2010]

    A related article from 2010 called “Landscape of International Event-Based Surveillance” in the Emerging Health Threats Journal · June 2010
    Improving the Nation’s Ability to Detect and Respond to 21st Century Urgent Health Threats: Second Report of the National Biosurveillance Advisory Subcommittee
    April 2011

    Here’s an expert on predictive medicine and “Designing adaptive public health monitoring systems that allow public health officials to maintain situational awareness during times of increased risk and uncertainty, including pandemics and major public events.”
    And his article from 2003
    Using temporal context to improve biosurveillance
    Ben Y. Reis, Marcello Pagano, and Kenneth D. Mandl
    PNAS February 18, 2003. 100 (4) 1961-1965;

    The idea that it is urgent for the US to take action looks like its fifteen years behind the times.

  16. The Rev Kev

    The worse thing about the great flu pandemic of 1919 was that it targeted those with the strongest immune systems so that instead of killing off the weak and old, it tended to kill off the young and healthy. Children at the time, with their dwindling numbers, starting singing a simple rhyme-

    I had a little bird, it’s name was Enza
    I opened up the window and in flew Enza.

    Creeps me the hell out that.

  17. AbateMagicThinking But Not Money

    Eminent possibilities:

    Salutary articles like this can only have real effect when the appropriate political climate or culture exits.

    The effects of malware in information technology infrastructures illustrates the lack of Plan B in wealthy societies. Seemingly no matter how false the chimera of internet security is, the elites are sold on the digital fix. The same culture infects body politics where it comes to health – the reliance on the prospect of a magic bullet.

    If a pandemic really hits, martial law will be the order of the day and very quickly there will be autarky by default.

    Good luck to those fighting the pandemics, but while ‘convenience at any cost’ is the unspoken mantra, I’m putting my money on the cat in hell as a better bet.


    1. JTMcPhee

      Think of all those Amazon boxes handled by “distribution center” serfs with zip health care and coming to work sick because they “can’t afford and don’t dare to stay home.” Loading pathogen-laden packages onto one-day-delivery trucks and airplanes, to contact and be handled by other serfs and postal people, delivering death and disease to your porch or package drop.

      The vulnerabilities we have built for ourselves —- the stupid rule us, the stupid are us…

  18. Ignacio

    My personal opinion is that the possibility of a pandemic originated from a virulent superbug (Say a virulent multiresistant E. coli or S. aureus, the typical multiR found in hospitals) has very low probability. I mean a pandemic. More or less deadly outbreaks occur and will still do so even more frequently but a pandemic is another thing. This is not to say that the points of this article are very important and relevant from a clinical point of view. They are! Yes, superbugs arise in conditions where antibiotic use and abuse puts selection pressure on the abundant microflora present in our body. Yet, virulence and resistance come at a cost and those superbugs not only have to outperform our protection systems but compete with other microorganisms and they tipically succeed in inmunodepressed/weak patients.

    Nevertheless a viral flu-like pandemic migth occur again and we have already seen new flu strains spreading around the world although not with the same virulence as the spanish flu.

  19. KWesson

    It would be worth addressing the promise of bacteriophages. They are targeted and expensive and not available in the US. For-profit sick care has no interest in developing these miracles, so the government must take control and dump sales and marketing for pharma. Innovation comes from public dollars anyway; not pharma as they like to lead us to believe.

  20. BoyDownTheLane

    Altandmain is correct about cytokine storms, the presence of which will opverhwlem quickly any ICU or hospital (actually, all of them) because medical response ot them is staff-and-respirator intensive. See also this article

    and these:

    and consider the fine art of biological warfare. Consider reading Albarelli’s “A Terrible Mistake”, for openers.

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