The 1918 influenza pandemic, often referred to as the ‘Spanish Flu,’ remains one of the deadliest pandemics in history, infecting an estimated one-third of the global population and claiming the lives of over 50 million people1. Beyond its staggering death toll, the pandemic had profound effects on public health policies, patient behaviors, and the way medications and treatments were administered—particularly in an era with limited treatment options and widespread fear2. Although the world of healthcare has experienced many changes since then, the 1918 pandemic offers valuable insights into the challenges of medication adherence during times of public health crises
Medical Limitations That Shaped the Spanish Flu
In the early 1900s, there were no antiviral drugs, no vaccines, and no antibiotics to treat secondary bacterial infections like pneumonia, which often proved fatal for influenza patients1,2. Medical professionals largely relied on basic supportive care, such as bed rest, hydration, and rudimentary methods to manage symptoms1. The scarcity of effective treatments meant that patients had to rely on less scientifically proven remedies– herbal concoctions, tonics, and patent medicines flooded the market, and many were touted as ‘cures’ for influenza, despite having little to no proven efficacy2. The overwhelming sense of fear and uncertainty during the pandemic drove people to seek out anything that might alleviate their symptoms or protect them from the disease, even if it was not scientifically validated1,2.
How a Pandemic Transformed Public Health
The lack of effective treatments for influenza pushed public health authorities to focus on containment and prevention strategies. Early in the pandemic, cities and governments quickly implemented a range of public health measures, such as infected individuals being isolated from the general public, and public gatherings being restricted1. In many cities, schools, theaters, and places of worship were closed to prevent the spread of the virus, and the widespread use of face masks was implemented to reduce transmission1,2. These policies were one of the first instances of public health mandates influencing individual behaviors on a large scale2.
Although the influenza virus was not fully understood, there were attempts to produce a vaccine2— the first successful mass influenza vaccine was developed after the pandemic, but there were efforts to immunize populations with rudimentary vaccines during the outbreak itself1,2. These measures aimed to slow the virus’s spread, but they also had significant effects on patient behaviors. The fear of infection and the perceived importance of prevention led to a greater willingness to comply with public health recommendations, including wearing masks, social distancing, and seeking help from medical authorities1. However, individuals’ adherence to treatments or preventive measures was not always consistent, especially as the virus spread quickly and overwhelmed healthcare systems3.
For patients, medication adherence during such a tumultuous time often meant following unverified advice from local newspapers, word of mouth, or community leaders3. People were desperate to protect themselves and their families, and as a result, they were more likely to try various medications and health practices, even if they weren’t backed by medical evidence2,3. This heightened sense of fear also meant that patients, especially those with mild symptoms, were likely to ignore public health warnings or avoid seeking medical help altogether, either out of fear of the disease or because they believed they could manage it on their own with over-the-counter treatments3. In some cases, individuals adhered to home remedies more strictly than to any formal medical treatment offered by healthcare providers1,2.
What Can We Learn From The Spanish Flu a Century Later
One of the lasting lessons from the Spanish Flu is the inherent difficulty humans have with adhering to medication and health guidelines. During the 1918 pandemic, many individuals did not consistently follow prescribed treatments, social distancing measures, or quarantine protocols, often due to a lack of understanding, mistrust, or the natural tendency to relax once symptoms improved1,2. This issue of nonadherence is not unique to the past; it has carried into the present, as seen with the COVID-19 pandemic. Despite widespread health campaigns, many still struggled with following public health guidelines, taking medications as prescribed, or getting vaccinated4, highlighting that despite a century passing, adherence does not appear to be an innate characteristic for humans5. Both pandemics underscore the importance of clear communication, trust in health authorities, and ongoing support to ensure people stay compliant with medical advice, as nonadherence can exacerbate the spread of disease and hinder efforts to control public health crises5.
The 1918 pandemic served as a critical turning point in how patients viewed medication adherence and public health directives3. In future health crises, including the emergence of vaccines, patients would become more familiar with the importance of following prescribed treatments and public health guidance, though not without continued challenges related to misinformation and fear4. For medication adherence, the pandemic underscored the critical role of clear public health guidance in ensuring that individuals adhered to preventive measures and treatments3. It also highlighted the need for education and communication to overcome misinformation—an issue that continues to be a challenge today3,4.
While the immediate response to the 1918 pandemic was chaotic, it ultimately provided valuable lessons that continue to influence how we approach public health crises today. From the role of fear in medication adherence to the need for clear communication and trusted medical guidance, the pandemic of 1918 shaped the future of public health, helping to establish the policies and frameworks we rely on to manage infectious diseases and ensure better patient outcomes during times of crisis.
References
- Martini, M, et al. “The Spanish Influenza Pandemic: A Lesson from History 100 Years after 1918.” Journal of Preventive Medicine and Hygiene, vol. 60, no. 1, 29 Mar. 2019, pp. E64–E67, www.ncbi.nlm.nih.gov/pmc/articles/PMC6477554/, https://doi.org/10.15167/2421-4248/jpmh2019.60.1.1205.
- Tomes, Nancy. ““Destroyer and Teacher”: Managing the Masses during the 1918–1919 Influenza Pandemic.” Public Health Reports, vol. 125, no. 3, Apr. 2010, pp. 48–62, www.ncbi.nlm.nih.gov/pmc/articles/PMC2862334/, https://doi.org/10.1177/00333549101250s308.
- CDC. “1918 Pandemic (H1N1 Virus) | Pandemic Influenza (Flu) | CDC.” Archive.cdc.gov, 31 Aug. 2023, archive.cdc.gov/www_cdc_gov/flu/pandemic-resources/1918-pandemic-h1n1.html.
- Dowling, Stephen. “Coronavirus: What Can We Learn from the Spanish Flu?” Www.bbc.com, BBC, 3 Mar. 2020, www.bbc.com/future/article/20200302-coronavirus-what-can-we-learn-from-the-spanish-flu.
- Reach, Gérard. “How Is Patient Adherence Possible? A Novel Mechanistic Model of Adherence Based on Humanities.” Patient Preference and Adherence, vol. Volume 17, 1 July 2023, pp. 1705–1720, https://doi.org/10.2147/ppa.s419277. Accessed 13 Nov. 2023.