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| Influenza victims crowd into an emergency hospital near Fort Riley, Kansas, in this 1918 file photo. AP |
Spanish flu wiped out up to 100 million lives. Experts warn it could happen again
By Jung Min-ho
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| Hakim Djaballah |
At minimum, the Spanish flu killed three times as many as died in World War I (17 million). At worst (100 million), it was more lethal than World War II (60 million) ― and even both wars put together.
As historians mark the centenary of the flu outbreak, two important questions arise today: is any similar outbreak possible and, if so, how much are we prepared?
According to Hakim Djaballah, former CEO of Institut Pasteur Korea, it is foolish to think that the world is now safe from another pandemic on that scale.
"As an example, there are still many war-torn regions in the world, where the viral/pathogen landscape must be thriving and evolving," Djaballah told The Korea Times. "Many people are being pushed out of their lands to other countries, which could potentially launch a global pandemic. If it happens, it will be much more devastating than the 1918 pandemic."
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| Michael Gale |
Michael Gale, microbiology professor at the University of Washington in Seattle, also believes such a scenario could certainly happen again.
"We have seen several flu pandemics since the 1918 Spanish flu pandemic (1957, 1968, 1977, 2009, for example)," he said. "The 2009 global flu pandemic is considered to have resulted in up to over 200,000 deaths, so flu remains a major public health threat."
"There are new strains of flu that continue to emerge from water fowl (ducks and geese) into humans, from poultry into humans, and likely from other birds to humans. These flu strains represent emerging threats to humans and should be the focus on new vaccine campaigns that will lead to the development of a universal flu vaccine that will prevent infection from a wide-range of avian and contemporary human flu strains."
He noted that other viruses, including MERS, SARS, Ebola, Zika, dengue, and West Nile were also of high concern as they emerge in new regions.
In a world more connected than ever, another Spanish flu has the potential to be much more devastating. Crowded urban areas, where around 55 percent of the world's population lives, add more to the risk.
Are we better prepared now?
Over the past century, much progress has been made. Today, scientists and clinicians have a far better understanding of infectious disease processes and how to intervene with them to treat patients and protect people in advance.
"In case of influenza A virus infection, we know that intervention at early stages of infection has a huge impact on patient health," Gale said. "We have made progress in surveillance to track where the flu is, what time it is, and to predict where it is heading geographically to impact various population centers around the globe."
"We have also made progress in vaccine design to build better vaccines."
But he said improvement in vaccine development was still needed. Scientists had discovered much about how to make vaccines that could neutralize flu once it infected a person who had been vaccinated, but these new types of vaccines were still in development phase.
Djaballah noted that despite all this progress, scientists were struggling to fight some of the infectious diseases and had not made enough impact on the viral and pathogen landscape.
"We are also very concerned about those emerging viruses/pathogens, which we know little about," he said. "The threat remains high and, unfortunately, we don't have a superior arsenal of drugs and vaccines to fight them."
Dengue fever is one of those tough diseases. The dengue virus, for which has no cure, is still a leading cause of illness and death in the tropics and subtropics and infecting people in new regions despite much effort.
Some infectious diseases are more difficult to fight than others because they are zoonotic ― meaning that they are introduced to humans through transmission from animals ― or constantly change themselves (or both).
"Viruses such as MERS undergo rapid evolution to change their features such that vaccine or antiviral drugs become less effective with each new outbreak," Gale said. "This presents hurdles to public health actions aimed at controlling outbreaks."
But the good news is that governments and experts across the world increasingly collaborate to make progress, which was almost non-existent 100 years ago. It would allow, if there was a need, for rapid global mobilization and intervention to mitigate global pandemic risks.
International organizations such as the World Health Organization also play a pivotal role in bringing governments together to establish essential policies on coping with major disease outbreaks.
"As we are pausing for a moment to reflect on the 100 years since the Spanish flu pandemic, it is admirable to see world leaders commit additional funds for tuberculosis (TB) research, care and prevention," Djaballah said. "I believe that TB is a high candidate on the list of potential initiators of a global pandemic."
"Speaking at the recent Munich security conference, Bill Gates said, 'Bioterrorism could kill more than nuclear war' and 'no one is ready to deal with it' ― a sentiment felt by many of us. Now more than ever, governments must be more vigilant and working together, so such events never happen."
