The Spanish flu pandemic of 1918–19 killed 228,000 people in the UK alone. The lack of a universal health service readily able to mobilize nationally, squalid living conditions for many and the diverted attentions of a public and government already plagued by war, created the perfect storm for this emergent flu to flourish. Although war and the infancy of virology are important factors differentiating the experience and response to the pandemic of 1918–19 with the Covid-19 pandemic a hundred years later, there are parallels. The ease with which the Spanish flu spread among the poorer or more crowded segments of society was, for example, replicated in the more recent pandemic. Covid-19 exacerbated existing inequalities in society, throwing into sharp relief the plight of those living and working in relative disadvantage, precarity and poverty. It also shone a light on the depth of the challenges facing our health and social care system. The history of the Spanish flu of 1918–19 may have been very different were a comprehensive, universal healthcare system already in place. The revolutionary social security system Beveridge inspired has been transformative to the health and wellbeing of the population. But the system developed has not kept pace with the wider transformation of society. Neither Beveridge who imagined it, nor Bevan who implemented it, anticipated an aged and ageing population that is ethnically diverse and that remains persistently unequal. Considering care during the Covid-19 pandemic illuminates the transformations that are now imperative.

CARE IN THE TIME OF COVID-19

Although not without problems, the Covid-19 vaccine rollout is perhaps the best illustration of how and why a universal healthcare system can be of instrumental importance in responding to a global health crisis. Under such a system, the vast majority of the population are registered with a single health entity, although this may be administered differently in different geographies. As soon as the vaccine was available, it was relatively straightforward to begin inviting people to receive the vaccination according to a predetermined schedule of priority. In fact, the NHS is practised at this, having championed mass routine vaccination programmes since its inception and through delivery of the annual flu vaccination. The foundations offered by practised vaccine rollouts were undeniably an advantage.

The UK was the first country in the world to grant approval for a Covid-19 vaccine for emergency use in December 2020.