STRATEGY:
Due to Washington’s preoccupation with the First World War, the U.S. government proved unable to create a strategy for combating the epidemic. Instead, federal officials typically devolved almost all liability for organizing the response to state and local governments. The federal agency nominally responsible for managing such emergencies, the U.S. Public Health Service, lacked the resources and authority to do so. The U.S. government did not develop a method to track the disease, nor did it implement effective quarantine and containment procedures. Media censorship during the war precluded press coverage of the epidemic and discouraged Washington from pursuing a public education campaign. In the absence of government assistance, state public health departments which lacked adequate funds and other resources, were quickly overwhelmed by the volume of sick and dying.

INTEGRATED ELEMENTS OF NATIONAL POWERS:
Rather than coordinating a comprehensive response to the pandemic, federal agency priorities remained focused on the production of food, fuel, funding, industry, weapons or soldiers for the war effort. In 1918, the federal government dedicated only 180 public officials and 44 quarantine stations to combat the disease. Some U.S. military officers as well as state and local civilian authorities undertook their own response initiatives, but these were too limited in scope to have much effect.

EVALUATION:
The U.S. government had several opportunities to respond to the outbreak, but failed to take appropriate action. When the disease was first reported to the U.S. Public Health Service, officials neither offered advice nor acted on the information. The disease subsequently infected thousands of men at a U.S. Army training camp, but the Army did not notify the U.S. Public Health Service, nor did it quarantine the post. As the first wave of the flu spread overseas, Washington remained preoccupied with winning the war in Europe rather than developing and implementing an effective response to the crisis.

A second, more lethal, wave of influenza hit the United States in the summer of 1918. Domestic censorship and the limited scientific knowledge that existed about such diseases existed at the time hindered public awareness regarding the disease and impeded local officials from effectively responding to the crisis. The executive and congressional responses to the escalating crisis were always too little and too late.

The third wave of the disease arrived in the United States after the campaign in Europe had ended. Even without the war effort to overshadow domestic concerns, Congress paid little attention to the outbreak. The absence of anyone in charge, the lack of a coordinated strategy, and undeveloped and ineffective interagency decision-making structures prevented organizational learning from improving the U.S. government response.

RESULTS:
The U.S. government’s failure to develop an integrated strategy had a number of negative consequences, both militarily and economically. Soldiers who contracted the flu as trainees were moved from post to post, infecting others and virtually halting combat training. Shipping sick soldiers overseas impeded offensive operations in France. The economy was crippled as businesses and factories operated at a reduced capacity. In raw numbers, the disease killed more people than any other in human history.

CONCLUSION:
During the 1918-1919 pandemic, the U.S. government failed to recognize the importance of employing an effective interagency response to a threat that transcended traditional departmental and federal jurisdictions. Washington never mounted an integrated effort to decrease the number of sick and dying Americans. The federal government lacked strategic vision to conduct national operations and never issued sufficient guidance to states. In the absence of direction, local leaders were left to combat the disease using inadequate staff and resources. The deeply flawed response to the pandemic demonstrates the importance of ensuring shared situational awareness in responding to a crisis, not only for informing top-level decision-makers, but also for distributing knowledge to empower decentralized coordination and execution at the local level.