Laura Spinney’s Pale Rider is a portrait of the life and science of the Spanish flu epidemic of 1918.

Did you get your flu shot this year? Statistics say you probably didn’t. To most of us, the flu is nothing more than a few days off work with a fever. Although headlines about bird flu or swine flu briefly create panic, a sense of Impfmüdigkeit (vaccination fatigue) unfortunately pervades each flu season.

It was very different a century ago, when coming down with the flu struck terror into people’s hearts, much as Ebola does today. This is the nightmare of Pale Rider: The Spanish Flu of 1918 and How it Changed the World, Laura Spinney’s masterful retelling of one of the world’s greatest tragedies.

pale rider
Pale Rider: The Spanish Flu
of 1918 and How it
Changed the World
Jonathan Cape
June 2017
pp 352
€16.99

Spinney paints a portrait of a time before commercial airplanes, when long-distance communication was by telegraph, and literacy was low in many countries. This was a time when people overwhelmingly died of now preventable infectious diseases like tuberculosis. More than 50 years after Germ Theory became mainstream, the average person in 1918 still didn’t realize that bacteria caused disease. There were no antibiotics, no antiviral drugs, and no effective influenza vaccines. The Wundermittel (miracle cure) aspirin was often fatally prescribed as it seemed to offer a cure but actually only suppressed the symptoms.

At the end of the first World War, an estimated 50 to 100 million people worldwide died of the Spanish flu, making it by far the greatest tragedy of the 20th century. And it happened in a historical blink of an eye – a mere 13 week period between September and December of 1918.

People blamed the flu epidemic on everything from angry gods to biological warfare. And doctors were helpless to treat it, leaving a post-pandemic anti-science backlash in its wake. It was not even clear that the flu was caused by a virus until the 1930s, and the virus itself was not seen until the invention of electron microscopy in the 1940s.

Anatomy of Contagion

Pale Rider is structured not by time but by theme, to help the reader understand the context in which the flu pandemic took place, answering questions that have puzzled researchers for decades. Spinney’s narrative freely mixes quirky personal accounts from remote parts of the world with recent advances in epidemiology and genetics. It is a page-turner for scientists and history lovers alike – a rare glimpse into places where 1918 is not remembered as the end of the war, but as the year of influenza.

And yet, Pale Rider is not just a book about our past. It is also about our future. Today, the flu still kills about 1,000 people each year in Austria alone, according to a study published in January by the National Vaccination Council of the Federal Ministry of Labor, Social Affairs, Health and Consumer Protection (BMASGK). The flu virus is tricky, rapidly accumulating so many genetic changes that vaccines constantly need updating. Even worse, major genetic rearrangements (through the wonders of viral sex) can create a whole new strain quicker than we can counter it, evading our best defenses.

We have learned a lot about the flu since 1918, but the facts remain sobering. The Spanish flu is estimated to have killed just 2.5 per cent of those infected, compared to 0.1 per cent in other historical flu pandemics. In contrast, the H5N1 bird flu that made headlines throughout the 2000s is estimated to kill 60 per cent of those infected and ranks today among the world’s greatest pandemic threats. Understanding the effects of the 1918 flu is not a historical side note, but essential preparation for our future.

Now, how about that flu shot?