1918 — The Year the Nobel Prize Stopped

What You Will Learn in This Article

You will understand why the deadliest pandemic in modern history, which struck as World War I was ending, became the starting point for the entire 20th-century system of infectious disease control, and why today’s public health principles were learned from the failures of that year.

More Deaths Than the War

Let's start with the numbers.

• Total Deaths in World War I (4 years): Approximately 20 million (soldiers and civilians)
• Total Deaths from the Spanish Flu (2 years): 50 million (lower estimate: 20 million, higher estimate: 100 million)

More people died from a flu-like illness than died in the war. However, there was no Nobel Prize awarded in that year for this disease, nor for many years afterward. It took 15 years to determine that the cause of the disease was not bacteria, but a virus, and 80 years to identify the virus as influenza A H1N1.

The absence of the Nobel Prize in 1918 reflects the fact that humanity spent that year without knowing what it was dying from.

The Era: The Overlap of the End of the War and a Pandemic

The timeline of 1918 is brutally symbolic.

• Early March: First cases reported at Camp Funston, a U.S. Army training camp in Kansas.
• Spring: Arrival in Europe via American soldiers deployed to the Western Front.
• Summer: Second wave of the pandemic. Spread throughout Europe.
• Autumn: Third wave of the pandemic. The highest mortality rate.
• November 11: Armistice signed, ending World War I.
• Celebrations of the Armistice: Explosive spread of the infection.

The war ended, and people gathered in squares, where the virus spread explosively. From today’s perspective, this is a perfect example of failure in social distancing. However, the concept itself did not exist at the time.

Even the name “Spanish Flu” is a misnomer. It did not originate in Spain, but because Spain was not a belligerent in the war and did not have press censorship, the Spanish press freely reported on the disease, while other countries suppressed information to avoid damaging wartime morale. This is a classic example of information distortion and remains in today’s public health textbooks.

Another characteristic of this period was the expansion of women’s suffrage. In 1918, Britain granted voting rights to women over the age of 30, and in the following years, the United States, Germany, Austria, and the Soviet Union followed suit. This was a result of women entering the workforce, hospitals, and government in large numbers as the war disrupted the social structure. This change gradually began to influence the barriers to entry for women in science.

When viewed in the context of Korean history, 1918 was the year the Spanish Flu arrived in Korea. It is estimated that about 140,000 people died in Korea. The colonial government called the disease the “Mu-o Year Flu” and responded passively. The impact of this pandemic on the social tensions that led to the March 1st Movement in the following year is being reevaluated by contemporary historians.

Nevertheless, Science Did Not Stop

The Dawn of Virology

In the face of the 1918 pandemic, bacteriology first encountered its limitations. Attempts to isolate the pathogen according to Koch’s postulates failed. While various bacteria were found in the lungs of deceased patients, it was impossible to determine which one was the actual cause. This was because the actual cause was not bacteria.

During this period, some scientists began to suspect that the disease was caused by a “filter-passing agent” — something small enough to pass through a bacterial filter. This is the origin of the concept of viruses. This concept, which was already foreshadowed in 1898 by Beijerinck’s research on tobacco mosaic disease, began to emerge as a mainstream concept in clinical medicine in light of the 1918 pandemic.

The first visualization of a virus under an electron microscope occurred in 1931, and the influenza virus itself was first isolated in 1933. It was in 2005 that the 1918 strain was identified as influenza A H1N1 through genetic analysis. This 87-year delay has significant implications. We often have to endure diseases without even having the tools to respond to them.

The Establishment of Epidemiology

The 1918 pandemic provided a crucial stimulus to the field of epidemiology. Until then, research on infectious diseases focused primarily on identifying the causative bacteria. When bacteriology failed in the face of the pandemic, the focus shifted to statistical and mathematical models of how the infection spreads through the population.

Key concepts began to be established during this period:

• Abnormality of the Age-Specific Mortality Curve: The 1918 pandemic had an unusually high mortality rate among young adults (20-40 years old). This unusual pattern led to the concept that the immune response itself could worsen the disease (the precursor to cytokine storm).
• Wave Theory: The observation that the pandemic came in multiple waves, each with different characteristics.
• Effectiveness of Isolation and Quarantine Measures: Empirical data on how port and border controls slowed down the epidemic curve.

In terms of a CS analogy, this is similar to a mathematical understanding of the pattern of failure propagation in a distributed system. Modeling how quickly and under what conditions a failure of one node spreads to neighboring nodes — this is the root of today’s SIR models, contact tracing, and the concept of the reproduction number (R₀).

The Beginning of Large-Scale Data Collection

The 1918 pandemic impressed upon governments the need for infectious disease surveillance systems. Standardized codes for causes of death, regional mortality reporting systems, and international information sharing. These systems, which were previously sporadic, became national infrastructure after this pandemic. The League of Nations’ Health Organization was established in 1923, which became the WHO in 1948.

The Connection

The 1918 pandemic is connected to the following Nobel Prizes:

• 1954 Nobel Prize in Physiology or Medicine: Enders, Weller, and Robbins: Development of a method for culturing poliovirus. Without their methodology, culturing viruses in response to pandemics would still be impossible today.
• Developers of COVID-19 Vaccines in 2020 and Beyond: The lessons learned from the 1918 pandemic are embedded in the history of mRNA vaccine development.
• The Entire Modern Pandemic Preparedness Infrastructure: WHO pandemic surveillance, national CDC organizations, and international joint vaccine development frameworks.

In terms of a CS analogy, 1918 was like an unexpected background process exploding during the final stage of a large deployment. In software, we often discover unexpected bottlenecks or resource leaks shortly after a major release. We are forced to watch the site crash, without even having the tools to analyze it. Humanity in 1918 was in exactly that state.

The dark side of this analogy: Software downtime results in a loss of user experience, but the downtime in 1918 resulted in the loss of 50 million lives. The modern pandemic preparedness infrastructure — the infrastructure we struggled to use during the COVID-19 pandemic — has been built over 100 years from the failures of 1918.

What the Three Years Left Behind

From 1915 to 1918, the Nobel Prize in Physiology or Medicine was suspended for four consecutive years. These four years were a period of downtime in terms of the Nobel Prize, but in terms of medical history, they were four years in which the fundamental infrastructure of 20th-century medicine was built.

• 1915: Trench medicine, response to chemical warfare, stored blood
• 1916: Triage, shock management, concept of PTSD
• 1917: Birth of the American and Soviet medical systems, international standardization
• 1918: Dawn of virology, establishment of epidemiology, prototype of pandemic surveillance

Without this infrastructure, there would not have been the explosion of Nobel Prizes in the following half-century. Downtime and progress are not opposites — this is the most important lesson that the four years of World War I left us.

Summary: The 1918 Pandemic and the Restructuring of Infectious Disease Science: The failure of bacteriology led to the need for virology, the statistical characteristics of the pandemic led to the mathematical formalization of epidemiology, and the cost of international information distortion led to the creation of international infectious disease surveillance infrastructure.

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