Estructura de la Tesis

3.6.0. Conclusion: History of 1918 Pandemic Influenza: Past, Present and Future

This chapter has reviewed the history of the 1918 pandemic in the Gold Coast and Nyasaland.

Some ethical concerns have been highlighted e.g. the prioritisation of the white population over the natives, and the lack of available treatment. Governance on the part of the colonial administrators and simply the lack of resources generated important ethical concerns. Gaining historical insight on the political and socio-economic level in public health is important in understanding how influenza policies are developed and how much they change over time.

As observed, it was not possible to review the history of pandemic influenza under different conventional time periods: colonial, post colonial, modern period (those of the 20^th century such as the 1957 and 1968). The choice of the 1918 pandemic is deliberate since according to Potter (2001) many of our current fears and knowledge are embodied in this history, history which may offer important lessons in the formulation of current policies. Potter emphases the relevance of the 1918 pandemic influenza to epidemiologists and medical historians as it serves to underline the past with information that might help in the future (Potter, 2001).

Analyses of the 1918 events are a subject of considerable importance, but without a strong historiographical framework within which to debate and interpret history, not only are questions of validity and credibility raised but they also facilitate a “cry wolf syndrome” as far as current understanding of present day Ghana and Malawi is concerned. The purpose of this chapter was to gain some understanding of how policymakers initiate and develop policies and how the general population responds to the impacts of the disease. To a greater extent, this chapter has flagged up important sociological questions as to why the current debates and literature on pandemic preparedness in Ghana and Malawi undermine the role and relevance of history in developing policy. As mentioned earlier, historical literature and

67 PRO, CO 626, Annual Medical Report on the Health and Sanitary Conditions on the Nyasaland Protectorate for the year ending 1919, Government Printer, Zomba, 1920.

its interpretation regarding pandemic influenza is, at the moment, sufficient across Africa, particularly Ghana and Malawi. There is plenty of scholarly work and substantial contributions of work on influenza, covering social, political, cultural and economic gaps necessary in the general readership of pandemics.

This chapter contributes in several specific ways. Tracking the spread, colonial response and demographic impacts of the 1918 pandemic influenza in Ghana and Malawi, I believe, paints a bigger picture in terms of similarities and contrasts in patterns, numbers and policies. There are many other benefits to studying the historical context of pandemic influenza in present day Ghana and Malawi, not only for its effects on political, economic and social trends, but also for understanding significant and different interpretations that would otherwise remain fragmented and under-theorized. The pandemic influenza policy of any nation should adopt a developmental pattern within its historical narratives which is beyond those influenced by the historical welfare of other countries. In respect to this assumption, the question can be raised as to whether the development of pandemic influenza policies in present Ghana and Malawi are adequately explained within the context of empirical and historical evidence. In addition, what should be the influence of the 1918 experience on contemporary policymaking?

It is possible to draw lessons from the impact of the 1918 experience which has relevance to informing contemporary policy thinking. To take what was done in 1918 and apply that to today is to learn to deal with coping with a pandemic. The 1918 experience, in terms of deaths, had economic and psychosocial impacts on those who survived. Today, death occurring at a large scale is rare and death has generally been taken out of the household.

Authorities or pandemic planners need to talk about death and tough life issues that might arise during a pandemic outbreak as family members are more likely to see their loved ones die in their arms. The relevance of this is to prepare society’s psychological response. One way to learn and apply what death means is to openly start discussing the death issue in terms of how people would be affected if dozens of deaths occurred in a village, including the best coping strategies if death was to occur on a large scale in the future. During the 1918 pandemic influenza, authorities prohibited public gatherings and closed schools. These actions were justified because they made a difference in attempting to manage the pandemic influenza. Today, there is varying evidence that suggests closing schools makes a difference, including the importance of the timing of school closures.

Indeed, there are striking differences between 1918 and the present. Today, we have seen an increase in globalisation and trade that has a direct role in disease transmission; as such working out ways to monitor the disease in a timely fashion during difficult circumstances will be crucial. Today, we have much more developed communication technologies powered by dozens of electronic newspapers, TVs, radios, mobile phones and internet services, although these are limited in present day Ghana and Malawi. Thus the speed at which pandemic influenza outbreak may be reported would be slow, as is noted in Chapter 6.

Nowadays, we have a much more advanced sense of critical infrastructure and interdependency between the structures than our grandparents did. And the political and economic landscape has changed compared to 1918; even so, it is yet to be seen if new opportunities for more hospitals are to amount to the acceptable level of health care. In 1918 medical centres that oversaw the health of Europeans only amounted to basic nursing care.

Just like in 1918, it is important to reflect that after any crisis is over, more should be done to rectify problems identified during the crisis.

In the next chapter, a conceptual theoretical framework is developed based on the historical knowledge of influenza, moral debates and empirical evidence on the role of pandemic influenza. The theoretical framework is introduced before examining its applicability to Ghanaian and Malawian pandemic policies.

CHAPTER 4: THEORETICAL AND CONCEPTUAL BACKGROUND: THE