Could a deadly pandemic like the Spanish flu of 1918 catch us unprepared? The 1918 flu killed tens of millions of people in less than a year, and nearly everyone who did survive lost loved ones.


We may take some comfort from the fact that rapid and decisive action by both the Mexican and Chinese governments recently succeeded in preventing possible outbreaks of H1N5 and H1N1 in their countries. There is now a level of global cooperation dedicated to preventing the spread of disease that did not exist in the wartime environment of 1918. Furthermore, Presidents Bush and Obama have both developed preparedness plans for a pandemic of influenza. The focus of their plans has been on stockpiling vaccines and antiviral drugs, while increasing our ability to quickly produce vaccines against a new flu, if necessary, and to speed the delivery of medications to outbreak sites.


Antibodies to flu viruses, whether derived by vaccine or past exposure, recognize and tag the viruses, and then destroy them. These antibodies apparently recognize the viruses only by means of two proteins the viruses wear on their surfaces. These two proteins are the H and N used in the name of a flu virus. The problem is that there are at least 16 major types of just the H protein and, to make matters worse, subtypes within each of the 16 groupings.


Although an antibody to H1 should protect against H1N1 virus, it would be of no help against the H2N2 virus, the one that kindled the pandemic of 1957. So what happens if we have stockpiled a lot of vaccine against H1 and the source of the pandemic is a virus that has a protein on its surface that isn’t H1? The answer is we will have a lot of vaccine that isn’t very useful and, in all likelihood, we will not be able to produce and distribute the right vaccine in time to stop the wholesale spread of the disease.


Perhaps it is also worth knowing in this context that we have more than 300 million people in the U.S. but have only “ordered” enough H1N1 vaccine to inoculate fewer than 100 million people.


Our next line of defense is anti-viral drugs, but the scientific evidence to support their effectiveness is still in question. They do seem to limit the duration of the illness. If they also reduce the period during which the virus is transmittable from one person to the next they will be important. The usefulness of antiviral drugs is questioned for several reasons. First, they don’t seem to lower the death rate. Second, the virus rapidly becomes resistant to the drugs. Third, we don’t know the shelf life of these drugs and so it is not clear whether stockpiled medicine will be still be potent after a period of storage.


H1N1 and H1N5 are just two of the dangerous characters that we know; there are many other sinister microbes lurking in the world. We cannot create vaccines and drugs for every imaginable variation of the flu, let alone for every possible mutation of the other infectious diseases that threaten us, but there may be some fairly simple actions and easily produced materials that would go a long way toward containing a pandemic of potentially monstrous proportions. It was, in fact, largely non-pharmaceutical methods of control that were successfully employed in Mexico and China.


I would put the following questions high on my list of queries for public officials:


1) Do we already have tools that would ameliorate the effects of a flu pandemic, regardless of the virus type?


2) What can we learn from those who dealt with epidemics before the development of flu vaccines and the discovery of antibiotics?


3) Is it enough to address each contagious disease individually or should we also more generally prepare for controlling the spread of any infectious disease that may arise?


A majority of scientists believe that influenza-related deaths are more often the result of secondary bacterial infections than the virus itself. There are three forms of bacterial pneumonia that often accompany the flu and they are the leading cause of death among influenza victims. We have effective vaccines that work against all three. In my opinion, the nation should be spending at least part of its vaccine budget on producing pneumonia vaccines. In any event, getting the pneumonia vaccine now may be the most important thing that you can do to protect yourself.


Among the possible solutions offered by history books include restricting peoples’ movement in affected areas and enforcing quarantines to prevent the spread of the disease. It is likely that the availability of massive quantities of masks, gloves and disinfectants would serve the same purpose if laws requiring their use were strictly enforced. Such an approach would serve to prevent the spread the flu, regardless of its variety, as well as many other diseases that have the potential to cause pandemics.


The Center for Disease Control claims that another flu pandemic is inevitable. The people we look to for advice are all too often those who have invested a lifetime of work in the development of drugs and vaccines. It is now time to ask what other ways we can prepare ourselves and our families in the event a catastrophic event such a the flu pandemic of 1918. The need to develop vaccines for seasonal flu and childhood diseases is unquestionable. The issue here is whether it is wise to depend solely on the kind of shots and pills used for seasonal flu when confronting a far more deadly, fast-moving infection.


Tom McCutchan lives in Union and is retired from a 30-year research career with the National Institutes of Health. His articles have appeared in many medical and scientific journals, and in 2005 he was awarded a Fulbright Scholarship to study the parasitic infections of endangered species in South Africa. In 2010, he received an Orise Fellowship to develop diagnostics for newly emerging diseases in the U.S.