Epidemics and pandemics of infectious disease have been a deep-seated and inescapable part of Australian life for more than 220 years. During this time the lives of millions of Australians have been swept up in such outbreaks and while many were short-lived events and not great demographic crises they nonetheless had tremendous impact. How we reacted to such crises played a critical part in the severity and diffusion of such events. One of the great ironies of Australia’s public health history are the disputes that evolved between the Commonwealth government and the states and territories over what was the best way to handle and deal with epidemic and pandemic outbreaks.
There is little doubt that our global health surveillance and response systems need improvement. Coronavirus caught many countries totally unprepared despite the WHO warnings from the early 21st century that another pandemic was imminent. To a large extent the developed world has tended to overlook infectious disease outbreaks in Asia and Africa believing that they would burn themselves out and offered little risk to the developed world. The Ebola outbreak in West Africa is a case in point where the WHO and many developed countries simply shrugged their shoulders and believed that it offered little or no risk to countries outside Africa. As well, the coronavirus pandemic highlights how little we have learnt from our experience of prior pandemics and epidemics over the last 20 years such as Sars, avian flu, influenza and Mers.
But what have we really learnt from the last 220 years? Our experience with smallpox, bubonic plague, influenza, polio, dengue, HIV/Aids, encephalitis lethargica and a host of childhood infections seems to have added very little to Australia’s defensive strategies. When confronted by a new pandemic all we seem to do is bring forth battles between the Commonwealth and states and territories as to who has the major responsibility for handling such outbreaks and then we simply reach back into our past and embrace long-established quarantine and isolation procedures and await the arrival of a vaccine. Rarely do we give any real consideration to how ordinary people regard risk in their lives or how they respond to infectious disease crises. An important part of our response is compromised by the continuing lack of cooperation between government bodies. There is little doubt that dealing with epidemics and pandemics calls for cooperation between various levels of government – local, state and federal. If nothing else the coronavirus in Australia reveals that such things cannot be taken for granted. Australia’s history of epidemics and pandemics is simply littered with instances of lack of cooperation, of self-interest, ignorance, over-reaction and outright antagonisms. In 1908 the Commonwealth passed the Quarantine Act which gave the Commonwealth the power to oversee all matters of quarantine and border controls during outbreaks of infectious disease but a year later the federal minister assured the states ‘that it was not the Commonwealth’s intention to make use of such powers… with regard to disease arising within a state’.
In 1913 when smallpox broke out in Sydney, Cumpston the new Commonwealth Director of Quarantine, without any reference to the state government, unilaterally declared the area within a radius of 15 miles from Sydney’s GPO a formal quarantine area. Such a move provoked a violent reaction in Sydney.
In November 1918, the Commonwealth alarmed by the rapid spread of influenza around the world and in nearby New Zealand, convened a conference of all state and territory ministers of health and all agreed to a thirteen-point plan aimed at addressing any major influenza outbreak.
All states and territories agreed to immediately notify the Commonwealth once influenza cases occurred and that if the disease spread the Commonwealth would assume full control over quarantine and border surveillance. Yet within weeks of influenza cases appearing in Victoria the state government refused to formally notify the Commonwealth and after a few weeks the disease spread to NSW. South Australia also initially refused to declare influenza cases. Once influenza was formally declared in Victoria, NSW formally closed its land and sea borders with Victoria and thereafter every state and territory went their own way and the formal agreement with the Commonwealth was literally thrown out the window. Victoria threatened reprisals with NSW and all states set up their own border and quarantine camps and developed their own set of treatment and quarantine regulations. Clashes also occurred between the states and Commonwealth over the return of first world war troops, with Queensland not allowing troop ships to dock. Eventually Queensland took the Commonwealth to the High Court to dispute the state’s territorial powers but lost the case. Disputes with the Commonwealth simmered for months with Western Australia threatening to secede from the Commonwealth over the suspension of the intercontinental train link. Tasmania engaged in a bitter dispute over the quarantining of inter-state shipping. Eventually the Commonwealth was forced to withdraw from all activities except where they related to sea traffic. Such rivalry reappeared two years later in 1921 when bubonic plague broke out in Brisbane and it took the Queensland government took three weeks to formally notify the Commonwealth Department of Health and the other states. But it was too late, and plague had spread to Sydney via an interstate ship from Brisbane. In 1937 during the major polio epidemic in Victoria which resulted in more than 2,000 cases, NSW urged the Commonwealth to declare a formal quarantine and lockdown of Victoria but the Commonwealth mindful of failed attempts in the past, simply refused.
In retaliation the NSW government closed its southern border with Victoria to all children aged under 16 who could not produce a health certificate and deployed 100 police officers along the border with more stationed at railway stations, wharves and airports. South Australia was quick to follow suit.
There is a long history of state and territory clashes with the Commonwealth over the control of epidemic and pandemic outbursts of infectious disease. The recent issue of states closing their borders and going their own way because of the coronavirus outbreak is simply a recent example of this.
Faced with such a situation one wonders just how easily Australia might address and respond to outbreaks of infectious disease, now and in the future.
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The author is Emeritus Professor in Population & Health at Macquarie University Faculty of Medicine & Health Sciences.
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