1918 Influenza Outcomes among Institutionalized Norwegian Populations: Implications for Disability-Inclusive Pandemic Preparedness

People with disabilities are often at increased risk during infectious disease pandemics, due to complex biological and social factors. Synergistic biological interactions can lead to severe complications or reduced vaccine efficacy, while people with disabilities also tend to have lower access to health care, higher rates of poverty, might be institutionalized, and are frequently excluded from preparedness planning and crisis responses. Further, there are limited data from historical epidemics to inform public health efforts that address disability concerns. We provide novel evidence for disability-related disparities in influenza outcomes using data from Norwegian psychiatric hospitals and schools for children with disabilities during the 1918 influenza pandemic. Both students and patients suffered higher mortality compared to staff members. Recognition of differential risk factors for people with disabilities is essential for the development of equitable and effective pandemic preparedness policies.