Influenza pandemic in the 1950s and 1960s in France: another era, other responses

Coronavirus, Covid-19 ... Because of its heavy human toll and its socio-economic consequences, the current pandemic, which has caused more than 258,000 deaths worldwide and forced more than half of the planet to confine itself , is at the center of international attention and the concerns of scientists.

Given the scale of the current health crisis, there is a parallel with the recent history of the pandemics that have reached France. A few decades after the deadly Spanish flu of 1918-1919, two pandemics raged in the world in the second half of the 20th century: the Asian flu of 1957-1958, followed by the flu of Hong Kong, in 1968-1969. Each, type A, has made between 1 and 4 million deaths, according to WHO. In France, despite a few tens of thousands of deaths (the balance sheet is still discussed by historians), neither the public authorities, nor the media, made much noise at the time.

>> To see: The great pandemics of history

Having not led to the paralysis of the national economy, or to containment measures, they remain today little known and forgotten. While it is difficult to compare two very different periods, not only because there was no media coverage and the current role played by social networks, we can explain the differences in perception and the discrepancy between the measures taken at the time and those today designed to counter the Covid-19.

France 24 interviewed Frédéric Vagneron, historian of medicine and infectious diseases and researcher attached to the Alexandre-Koyré Center (EHESS-CNRS).

France 24: How do you explain the difference in perception between the Asian and Hong Kong flu pandemics, and that of the Covid-19?

Frédéric Vagneron : It should be remembered that the flu, whether seasonal or pandemic, is a disease which has been historically very studied, in particular its epidemiological and clinical manifestations. There are accounts of influenza pandemics and descriptions of the disease from the 18th century onwards, and the clinical description of influenza and its various respiratory effects or certain characteristic symptoms such as early depression is very well known. infection.

The two influenza pandemics that occur in an interval of 10 years, between 1957-1958, then 1968-1970, have marked the spirits. The episode of the Spanish flu of 1918-1919 was still remembered by the population and by the doctors who had been confronted with this major health disaster at the end of the First World War. In 1957, the flu is perceived as an "old" acquaintance, with seasonal forms often mild, but it is also a disease that scientists associate for the first time with the circulation of its various viruses, a knowledge still uncertain but unknown three decades earlier.

With the Covid-19, we are in a radically different situation: we are facing a disease of which no doctor was aware six months ago. So there are all the unknowns of a rapidly spreading disease. It will take time to describe and stabilize its own characteristics, including over time, in populations.

How do you perceive the discrepancy between the measures taken at the time and those taken to curb the spread of the Covid-19?

Even if absenteeism problems arose during these pandemics, with a slowdown in economic life, or a congestion in hospital services, it is true that at the time the country was not stopped like today. From a health point of view, the recommended measures did not differ fundamentally from those pronounced at the end of the 19th century or at the beginning of the 20th century, despite the new virological knowledge.

With the appearance of the flu, we knew at the time that it was a very contagious disease, that we had to avoid going out and pay attention to convalescence. There were still fears of bacterial complications. The public health recommendations published in the reports of debates of the Academy of Medicine, even if they were not implemented massively, signal for example the interest of wearing a mask. The discrepancy with current measures, including the containment of the population, is certainly important, but that does not mean that there was not an awareness of the risk at the time. Moreover, the influenza pandemic of 1968-1969 gave rise to an international mobilization orchestrated by the WHO, which had warned against a new virus, as in 1957, and as today.

However, the era of these pandemics and that of today are quite distinct. In the years following World War II up to and including the 1970s, there is widespread confidence in Western countries in technical and scientific progress, despite more cautious voices. A certain confidence which is justified by therapeutic advances with the commercialization of new drugs, such as antibiotics against bacterial infectious diseases, or the development of vaccinations thanks to new techniques of molecular biology and genetics. Previously pervasive diseases like tuberculosis are a thing of the past. Until the appearance of HIV in the 1980s, Western societies believe they have got rid of the great epidemics of infectious diseases or which are still raging in "developing" countries.

Can studying these so-called forgotten flu pandemics help fight Covid-19?

From a medical and scientific point of view, influenza pandemics, caused by constantly evolving viruses, are a kind of model for understanding what is happening today. The term "wave", among epidemiologists, is thus intimately linked to a phenomenon of successive reappearance of the epidemic over time during historic pandemics, in particular that of 1918-1919. But, like all models, it has its limits, and the doctors and researchers working on Covid-19 know very well that the behavior of this new coronavirus is irreducible to what we know about influenza strains.

However, from the end of the 1990s, pandemic preparedness policies developed at the international level, from WHO recommendations to national preparedness policies, and the threat model adopted was very largely that of pandemic influenza. The relevance of these preparation plans raises the question today: did focusing on the influenza model make it possible to anticipate the challenges imposed by the Covid-19? In these plans, for example, there is almost the certainty of having a fairly effective vaccine even if it requires time and considerable technical, logistical and financial means.

This pattern is called into question today by the uncertainty surrounding the Covid-19 pandemic. Despite the rapid identification and sequencing of this virus, the researchers have no treatment experience, despite having 70 years of experience in influenza vaccination. Not to mention that from the 1990s, other pharmaceutical tools were used against the flu, such as specific antivirals. In the case of Covid-19, a new prophylactic and therapeutic panoply must be sought and tested, including by testing the efficacy of drugs prescribed for other diseases.

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