Epidemics and pandemics of infectious disease have always played an important part in Australia’s history. Even so, until the advent of Coronavirus many people believed that the threat of death and disease from infectious disease was largely a thing of the past despite the continuing appearance of diseases like Dengue, Ross River Virus, Influenza, a variety of childhood infections and more recently, HIV/AIDS, SARS and Bird Flu.
Berfore the mid- 1950s outbreaks of infectious disease occupied a more central place on Australia’s public health stage. Although a number of outbreaks were for the most part not great demographic and public health events they nonetheless had considerable impact and their effects were wide-ranging. Pandemics, on the other hand, wreaked havoc and took many lives.
The history of epidemics and pandemics in Australia demands our attention for a number of important reasons. In the first place, many epidemics and pandemics had devastating effects and their psycho-social impact was considerable. Most captured public attention and were responsible for outpourings of fear and emotion. In the second place, many became the initiates of public health reform particularly the way they focused attention on insanitary and impoverished living and working conditions as well as how ordinary people responded to such threats. Thirdly they put to the test and challenged the ability of all States and Territories to work with the Commonwealth in the understanding and management of such events. Fourthly, we seem to have learnt very little from our past experience of epidemics and pandemics, particularly how we should respond and react during times of crisis.
From the moment of first European settlement in 1789 Australia was swept up in a recurring cycle of epidemics and pandemics. The stages in this cycle inevitably involved importation of the disease by ship or air from other parts of the world and initial establishment in the central working-class residential and work areas of our towns and cities.
The first manifestation of the old world’s epidemiological reach came within a year after the arrival of the First Fleet. In early 1789 a virulent epidemic resembling Smallpox broke out among the Aboriginal population in the vicinity of Sydney. Within a few months, hundred, possibly thousands of Aboriginals had been swept away by it. Interestingly, with the exception of one coloured seaman, the European community was completely untouched by it. The reasons for this still remain unclear. Possibly it may have been Chickenpox rather than Smallpox something to which most Europeans may have had a high degree of immunity.
The majority of European settlers in the first few decades of the 19th century were convicts and their minders, many from the poorer and crowded slums of England or from gaols where diseases such as typhus, scurvy, dysentery and a variety of infections were common. The overcrowded and unhygienic conditions aboard convict transports helped nurture a wide range of infections.
By the 1820s a seasonal pattern of infectious disease had become well established in Sydney, largely consisting of a variety of skin diseases, dysentery, conjunctivitis, diarrhoea and gastroenteritis. All this was superimposed on a high prevalence of venereal infections, accidents and violence. It was not until the mid-1830s in NSW and later in the other colonies that a raft of childhood infections made their presence felt. Thereafter, most Australian colonies were swept up in pandemics of infectious disease such as the Influenza outbreaks of 1836-37, 1847 and 1850. I
n many ways 1838 represents an important watershed in Australia’s history. In the following decades childhood infections became a regular feature of Australian colonial life. Measles epidemics occurred in 1854, 1860, 1867, 1875, 1880, 1888, 1893-94, 1898, 1902 and 1912. Scarlet fever in 1840-41, 1849-50, 1858-59, 1863-64, 1875-76, 1893 and 1898. Whooping cough in 1833-39, 1845, 1859-60, 1867, 1878, 1889, 1901-02 and 1907 while chickenpox, mumps and diphtheria became almost as frequent.
Some of these outbreaks were devastating, such as the 1867 measles outbreak in Sydney which remains one of the greatest childhood disasters in Australian history. Related to a major outbreak in Britain in 1866 the infection was probably introduced into Sydney by an immigrant ship. The infection ravaged Sydney for almost five months causing 748 deaths including 603 or 80% of all children aged under four years. Few families in Sydney escaped the impact of this epidemic. Sydney’s working-class community bore the real brunt of this outbreak including 30% of the children of all unskilled workers and 31% of the children of small tradesmen.
In September of 1875, a severe epidemic of Scarlet Fever broke across Australia. The epidemic differed from the measles outbreak of 1866 in that it spread over a much wider area, lasted longer and produced a wave of public reaction and concern about sanitation and public health. For more than 40 weeks Scarlet Fever raged causing 575 deaths and possibly 10,000 cases. Three-quarters of those who died were children aged under five.
After 1870 childhood infections were joined by a more threatening group of diseases such as TB, Influenza, Typhoid, Smallpox and Bubonic Plague. The period between 1881 and 1930 saw Australia ravaged by seven major pandemics and numerous epidemics all of which took a considerable toll of human lives. Between 1877 and 1917 there were five outbreaks of Smallpox in Sydney, NSW, Melbourne, Perth and Launceston. Most were small affairs but in terms of human reaction the 1881-82 outbreak in Sydney and the 1903 outbreak in Launceston caused the most disruption and human reaction.
The 1881-82 Smallpox outbreak caused a degree of suffering, human tragedy and response out of all proportion to the numbers of cases and deaths. Smallpox caused a wave of hysteria and panic to sweep across the city the like of which had not been seen before. This was the first pandemic in Australia to inflame popular opinion even though cases and deaths were small. The newspapers were full of stories and advertisements helping to fan the growing panic. The outbreak drew attention to the overcrowded and impoverished living conditions of Sydney’s poor and produced a feverish campaign of cleansing, scavenging, disinfecting and fumigating. Hundreds of people were formally quarantined in their homes, at the Quarantine Station or at the Coast Hospital.
The search for someone to blame took on a frenzy and people turned against their neighbours and the local Chinese community while the local authorities fought over the best way to handle the pandemic and the medical community was divided on what best to do. In many ways, this pandemic was an important watershed in Sydney’s history. Among other things, it helped produce a Board of Health, an Infectious Diseases Act, a Special Hospital and a set of regulations governing Quarantine, Isolation and the Management of Infectious Disease. It ushered in a new phase of Public Health in NSW.
The outbreak of Influenza which hit Australia in 1890-91 was part of a pandemic which affected the world between 1889 and 1891. It was the first time Australia had been swept up in a major pandemic of Influenza and it ushered in a new epidemiological age. In Australia it was the first pandemic with widespread effects and few families escaped its ravages. It also arrived when the medical community still clung to miasmatic theories of disease causation and simply fell back on notification, isolation, quarantine, cleaning and fumigation with people being encouraged to stay home and avoid their neighbours. Businesses, shops and schools suffered heavily. In Sydney, the disease carried off more than 6,000 people and affected at least 290,000 others.
In 1900 Bubonic Plague broke out in Sydney, the first time Plague had appeared in Australia. The pandemic was part of the last great Plague pandemic which swept out of China in the 1890s and whose effects lingered on into the 1930s. In many ways Smallpox and Plague played the role in Australia that Cholera had done in some decades earlier in England drawing attention to living and working conditions of the poor and impoverished in cities like Sydney.
The pandemic caused widespread economic and social dislocation, fear, hysteria and panic. Official policies of Quarantine, isolation and removal, cleansing and scavenging were applied with considerable vigour. All cases and contacts were forcibly removed to the North Head Quarantine Station. More than 1,800 Sydneysiders made this journey, some never to return. Whole neighbourhoods in inner Sydney were formally quarantined with barricades and police guards and teams of cleaners and fumigators worked their way through “infected” homes. Thousands of Sydney people were literally swept up in these undertakings.
At the same time, having recognised the significance of rat populations as harbouring and spreading the disease gangs of official rat catchers toured the city and ordinary people were offered 2/6d for all rats delivered to local furnaces. A new vaccine developed by Haffkine was offered to the public and within weeks thousands of people besieged the Board of Health Offices demanding vaccination. Plague lingered on in Australia until 1922 with the worst of the pandemic occurring between 1900 and 1910. In total more than 600 people were infected with the Plague and 196 died.
Between 1913 and 1917 a milder variant of Smallpox returned and swept through NSW causing more than 2,300 cases and four deaths. Worse was to follow when In 1919 Australia was swept up in the world’s worst Influenza pandemic which caused 15,000 Australian deaths and more than 1.8 million cases. The 1919 Flu pandemic stands as one of the greatest national disasters experienced by Australia. The pandemic was a major demographic and social tragedy affecting the lives of millions. Just under 40% of Sydney’s population caught Flu in 1919 and more than 4,000 died. The most striking thing about the pandemic was that it differed from previous Influenza outbreaks in that it targeted young healthy adults particularly those aged between 25 and 40. In Sydney, 27% of the population were aged between 25 and 40 in 1919 yet people of this age group made up almost 50% of all Flu deaths.
Plague returned briefly in 1921 alongside a pandemic of Encephalitis Lethargica which had spread from Europe and which lingered on into the early 1930s . As Encephalitis Lethargica and Plague demonstrated, not all pandemics were short-lived. In-fact, Australia experienced a number of long– term pandemics some such as Polio which lingered for more than 50 years only to be followed by HIV/AIDS from the early 1980s.
The Polio pandemic was something never before experienced by Australians. For more than 50 years the disease seemingly struck at random targeting both the rich and the poor, urban and rural dwellers. Most of those affected were children and young adults. Probably between 25,000 and 40,000 Australians caught the disease but possibly as many as 110,000 exhibited only minor symptoms and managed to struggle on with their normal life. Others suffered residual paralysis.
Australia suffered some of the most severe outbreaks of Polio in the developed world particularly in the years after 1931. The Tasmanian outbreak in 1937-38 stands as the most severe Polio outbreak in Australia’s history with 1,006 recorded cases and possibly 150 deaths. Within the context of a small isolated State with a total population of not more than 240,000 this represented a devastating total. A large proportion of those affected remained moderately or severely crippled for the rest of their lives. In the same years Victoria also suffered a major Polio outbreak causing 2,096 cases and 109 deaths.
Largely those affected were young children under the age of nine although more than 25% of all cases were aged over 10. Most initially suffered a mild illness accompanied by some vomiting, headaches, neck, back and limb pain and often stiffness in the neck and spine. Even though the Polio virus had been identified early in the 20th century the causes of the disease and its route of transmission remained a mystery for more than 50 years. Given that Australia’s public health specialists had generally come to associate infectious disease with the poor, the disadvantaged those living in deprived and unsanitary conditions.
Polio put all that aside as it seemed to select healthy, well nourished children of middle class families. The way the virus spread also remained a mystery for more than half a century. Polio produced an outpouring of fear throughout Australian communities and people were told to avoid crowds, playgrounds, cinemas, churches, libraries and all sports. Schools were shut, swimming pools drained, people avoided milk, and isolation, avoidance and cleanliness became the order of the day. Between 1948 and 1954 Australia suffered a series of major and frightening outbreaks of the disease.
For most Australians, the battle seemed to be one in 1956 with the advent of Salk and Sabin anti-viral drugs and major vaccination programs were carried out. It seemed a major triumph after 50 years of fear and dread. Yet in recent years in parts of the world a post-Polio syndrome has emerged.
Some major pandemics of infectious disease have largely been forgotten today, perhaps because they killed few people and only incapacitated others for short periods. The Dengue outbreak in 1925-26 is a good example. Dengue has a long lineage in Australia. First reported in Queensland in the 1870s there is a long history of regular outbreaks in Northern Queensland and occasionally Northern NSW.
The 1925-26 outbreak remains the most significant and without doubt was the greatest mosquito-borne epidemic in Australia’s history. For over four months the outbreak caused an extraordinary 560,000 cases and 147 deaths. In many towns in Northern NSW between 70% and 80% of the population caught the disease and schools and businesses struggled to survive and remain open. Ironically Australia has now lived with Dengue outbreaks for more than 145 years and still has not developed a vaccine or eliminated the disease. Perhaps this because the disease never produced many deaths and the majority of those who caught recovered fairly quickly and if an infection does this sort of thing we tend to live with it.
After Polio seemed to be disappearing Australians breathed a sigh of relief many believing that the battle against infectious disease had been won. But in other parts of the world epidemics continued to create havoc. In the 1970s everything changed and Australia entered a new infectious age. The next three decades would witness a seemingly unending parade of “new” infections such as, HIV/AIDS, SARS, Bird Flu Swine Flu and now Coronavirus
The first cases of HIV/AIDS were diagnosed in 1982-83 and it is likely that the infection entered Sydney’s homosexual community from the USA around 1980. By 1984 it is possible that as many as 40% of the homosexual community had become infected. Unlike earlier pandemics, the official reaction and response at both State and Federal level was planned and more successful. Millions was spent on national educational campaigns run by the media. Like Polio, HIV/AIDS was a slow viral disease extending over decades in a slow fashion of diffusion targeting mainly young adult males. Like other pandemics, HIV/AIDS had an important psycho-social component involving human reaction, fear, hysteria and panic. Like many other pandemics to affect Australia, HIV/AIDS was a devastating human tragedy.
After 240 years of living through epidemics and pandemics have we learnt anything and do we better understand the nature of infectious disease, its causative mechanisms, its impacts and the way it spreads among us? In many ways I doubt that we have learnt very much at all. Six critically important areas need to be addressed.
- Firstly, and importantly, we need to appreciate the significance of the biophysical environment in our lives. We need to appreciate that the bio-physical environment is a powerful, ever-changing force and that the microbial world has a dynamism that confirms the significance of evolution in the natural world. Our optimistic assault on the infectious world rests on the assumption that we can simply develop a “magic bullet” or new vaccine. We fail to fully appreciate the complexity of our natural environment and the ability of all bacteria and viruses to adapt, mutate and evolve. An important part of this is our failure to fully appreciate that many infections are nurtured in animal populations and have been so for centuries.
- It seems impossible to develop and implement a coordinated and effective national response when confronted by epidemic outbursts. There is little doubt that dealing with pandemics and epidemics calls for cooperation between all levels of government – local, State and Commonwealth so that a Response and Reaction Plan might be advanced and accepted by all parts of Australia. Unfortunately, our history of confronting infectious disease suggests the opposite. Rarely did the States, Territories and the Commonwealth governments cooperate and accept a coordinated plan to be overseen by the Commonwealth Government. Australia’s history is simply littered with disputes and battles between the States, Territories and Commonwealth governments during times of epidemic and pandemic crisis with States and Territories inevitably going their own way.
- There is without doubt an urgent need to develop a coordinated national surveillance, monitoring and response system to identify, monitor and react to outbreaks of infectious disease throughout Australia. To achieve this, we need to unite our surveillance of animal infections with that of human outbreaks and develop and implement coordinated responses.
- We also need to balance the overall wellbeing and health of all Australians against the individual’s rights and freedoms. There is little doubt that Australia struggles with how a society committed to the supremacy of civil liberties and human rights and sensitive to discrimination in any form can reconcile the conflict between individual rights and the common good, particularly during times of epidemic and pandemic crisis.
- There is also a need to encourage people to act responsibly and seriously consider such things as social distancing and vaccination of themselves and their children.
- We need also to fully understand that as well as an epidemiological side revealed through cases and deaths all pandemics and epidemics impact on how ordinary people regard risk and fear in their lives and how ordinary people’s concept of risk and fear is greatly influenced by the people around them, family, neighbours and local communities.
Finally, the hope of an antiseptic and infection-free Australia that many believed had begun to take place in the 1960s has proved to be illusionary. There seems little doubt that we are on the edge of a new pandemic age.
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