Why is the U.S. still unprepared for a pandemic?

A century ago, Labor Day in Northern Utah was about as quiet as this past Monday, except that people were obsessed with the grim news of the world war.

The Salt Lake Telegram featured an Associated Press report that the government had spent $57 million per day in August, mostly because of the war effort. Obviously this was considered outrageous at the time (although, for comparison’s sake, Washington spends $11.4 billion per day today, or $690 million in 1918 dollars).
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Near that was a story about how Salt Lake candy makers were gearing up to bid for a government contract to supply soldiers with lemon drops and other “compact candies” to help morale while fighting in Europe.

People had no idea what was coming to their own doorsteps.

In Boston on that early September day, a “win the war for freedom” parade of about 4,000 military personnel and civilian contractors wound through the city. The Boston Globe said the parade took 28 minutes from start to finish and the weather was ideal.

The next day, Sept. 3, was when the first civilian case of what became known as the Spanish influenza was reported at a Boston hospital, like the first ball of snow in an avalanche.

By November, Salt Lake City, Murray, Ogden and a lot of Utah cities were in quarantine, as were cities around the world. All public assemblies, including church services, theater performances and sporting events were canceled indefinitely.

The Telegram published an editorial with a tone that reflected the public’s sense of desperation. “If it is necessary to go still further,” the editors demanded, “the health officials should not hesitate. The health authorities should consider themselves all powerful at this time and demand whatever is necessary to prevent the further sacrificing of lives.”

Democratic institutions and due process fly out the window when people are dying in bunches. People readily appoint health officials to be dictators.

Why bring this up 100 years later, other than to note the anniversary? Because, as former Health and Human Service Secretary and Utah Gov. Mike Leavitt told me years ago, pandemics are "just a part of biologic fact. ... And what's occurred in previous centuries is it always catches people by surprise." He also said he expects them to happen in the 21st century.

Also, because an op-ed in theconversation.com by medical scholars concerning a recent white paper published by The Scowcroft Institute for International Affairs has made it clear the United States is no more ready to handle a widespread, fast-moving deadly disease today than it was in 1918.

We have a lot more effective medicines today, but we can’t react any faster to a global pandemic because we’re not planning for it. And, most troubling of all, the United States seems to be turning inward at a time when it needs to take the lead in international cooperation among health officials.

Specifically, the authors pointed to a few troubling problems. One is that we’re over-using antibiotics. Most of this is in agriculture, but humans are over-prescribed, as well. As a result, bacteria are becoming resistant to what once were considered wonder drugs. Millions could die as a result.

Another is the lack of international rules for the use of these drugs. You need a prescription for antibiotics in this country, but not in some parts of the world.

Third, governments have failed to understand the need to combine the animal, human and environmental health industries into a united effort to stave off a “post-antibiotic world.”

Finally, governments need to promote a more diverse supply chain. The authors site protective masks as an example. The N95 mask is made in only one Asian city. If that city were hit by an epidemic, no one could get masks, just as Hurricane Maria wiped out production of an important IV saline bag in Puerto Rico.

While the flu isn’t the only disease to pose a global threat, its annual mutation poses a troubling challenge. A number of groups are at work on a universal flu vaccine that would put an end to annual shots.
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All of these needs require more government spending and a sense of urgency.
But, just as on Labor Day a century ago, it’s hard to drum up urgency when other things seem so much more important. Humans, unfortunately, are predictable that way.