There have been a handful of major pandemics since 1918: in 1957, 1968, and 2009. Like the 1918 pandemic, these infections came in waves. Moreover, each wave was different. Influenza viruses mutate rapidly to infect as many hosts as possible.

Are we prepared for an influenza outbreak like the 1918 pandemic? A former Center for Disease Control director says that an influenza pandemic is still, hands down, the worst case scenario for public health. Medicine and infrastructure have improved throughout the world over the past century, which would probably save the majority of those infected, but if we encountered a virus as vicious as the 1918 strain, it would likely still take out tens of millions of people globally.

We now know a great deal about influenza, but all our knowledge doesn’t help us much. A universal vaccine is the best hope for a pandemic-resistant humanity, but that cure is still a ways off.

Okay, but here’s what we have going for us: For one, global health surveillance is much better, and there are organizations that track and update health situations by country in real time. Time is of the essence in quashing or responding well to a pandemic, so global surveillance is a helpful tool for the world. The problem is that it’s still incomplete, and there are some countries whose governments are not forthcoming about what’s happening in their nations. In 2003, this global health surveillance system got wind of SARS (severe acute respiratory syndrome caused by the coronavirus) that was spreading in China. The spread was easier to quell than an influenza outbreak would have been, but it showed China’s opacity as the nation declined to share accurate, critical information. While China has become more forthright on matters of health over the years, its government still routinely withholds health information. And, unfortunately, China is not the only country to hamper our best attempts at vigilance. 

In addition to a global surveillance system, investment into influenza research is increasing. West Nile at its worst killed fewer than 300 people in one year. But there was a time when more funds were allocated to West Nile research than influenza research—even though influenza was killing over 50,000 a year around that same time. Priorities are changing for the better, and there are promising leads that scientists are pursuing—a universal vaccine among them.