In the next influenza pandemic, be it now or in the future, be the virus mild or virulent, the single most important weapon against the disease will be a vaccine. The second most important will be communication. History has shown that to cut vaccine production time, minimize economic and social disruption, deliver health care and even food, governments need to communicate well--both between themselves and with the public.
The US response to the 1918 flu offers a case study of a communication strategy to avoid. The world response to the threat of an emerging flu in recent weeks shows that we have learned from the past. And there is much to learn.
The pandemic that began in January 1918 and ended in June 1920 killed an estimated 35 million-100 million people worldwide, or 1.9-5.5% of the entire population (1). Although an estimated 2% of people died in Western countries, some large subgroups were affected disproportionately. The Metropolitan Life Insurance Company, based in New York, found that the disease killed 3.26% of its insured US industrial workers aged 25-45. Given that 25-40% of the population contracted the disease, case mortality would have been 8-13% in that population (2).
The flu started slowly. In the United States, a small wave of the disease sputtered across the country in the spring of 1918, but went largely unnoticed except in military training camps. The effects were more noticeable in Europe, where many soldiers in the armies of the First World War fell ill. By the end of summer, a more lethal wave had surfaced in Switzerland. On 3 August, the US military received an intelligence report comparing the Swiss epidemic to the Black Death.
The US government used the same strategy for communicating about the disease that it had developed to disseminate war news. The essence of that strategy was described by its main architect, writer Arthur Bullard: "Truth and falsehood are arbitrary terms ... There is nothing in experience to tell us one is always preferable to the other ... The force of an idea lies in its inspirational value. It matters very little if is true or false." Fellow adviser Walter Lippman, another architect of this strategy, sent President Woodrow Wilson a memo saying that most citizens were "mentally children" and advising that "self-determination" had to be subordinated to "order" and "prosperity". In 1917, the day after receiving Lippman's memo, Wilson issued an executive order to control all government communication strategy during the war that was premised on keeping up morale.
As a result, when the full-blown and lethal pandemic wave arrived in the United States in September 1918, Wilson never made a single statement about it, and lesser public figures provided only reassurance. US surgeon general Rupert Blue declared: "There is no cause for...
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