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Waiting for the 'Big One': The inevitable pandemic

By Peter Curson - posted Thursday, 4 November 2004


Overcrowded hospitals start turning way sick and desperate people. Many doctors and nurses are ill and there aren’t enough to care for the sick. Public transport breaks down because of a lack of healthy bus, tram and train drivers. Supplies of food and medicines do not reach shops. Schools and places of amusement and worship are closed. People avoid shops, restaurants, sporting events and crowds. Workers are too ill to go to work. Businesses close and send staff home.

Panic, fear and hysteria run rife. Scapegoats are sought, popular cures abound.

It sounds like a major bio-terrorism incident, but in fact it is just what happened in Australia in 1919 during the Spanish flu pandemic. Nationally, more than 12,000 died in a just a few months, and between 30 and 40 per cent of all Australians had flu.

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Globally, more than 20 million died, including more than 6,000 in New Zealand and 600,000 in the US. The 1918-19 flu pandemic was just one of a series of relatively regular flu pandemics that have affected the world over the last 150 years. Pandemics were recorded in 1847, 1850, 1890-91, 1918-19, 1957, 1968 and 1976. All had substantial effects on Australian society.

Most flu experts believe that we are long overdue for another major pandemic and that the question is not if it will happen, but when. If Australia were to experience something like the 1919 flu outbreak then when it was finally over, 7 million Australians would have become ill and perhaps 300,000 would have died.

While this is probably a worst-case scenario, it is not beyond the realms of possibility given the emergence of a particularly virulent flu strain which targeted young and previously healthy adults.

If such an event happened, how would we cope?

The Australian Action Plan for Pandemic Influenza launched by the Department of Health and Ageing a year ago largely falls back on traditional early 20th century responses. Ill people would be advised to stay home and not travel. Public events and places of entertainment would be cancelled or closed. People would be discouraged from congregating in public places or using public transport. Severe cases of flu would be isolated in hospitals, and vaccination, if available, initially restricted to health professionals.

Given the expected high infection rates, most people would be cared for at home and only severe cases admitted to hospital. Essential services would need to be maintained. Antivirals and vaccines would need to be obtained from overseas.

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All this sounds eminently logical, if somewhat reactive. But in the worst-case scenario who would deliver food and medicine and keep our streets safe if shops and chemists were shut, tradesmen and police sick? Who would care for the sick if doctors and nurses were themselves sick? Would state and federal authorities co-operate to control the epidemic or would states go their own way, as has so often happened in the past?

Would the Government have to commandeer private facilities, such as university accommodation, for emergency flu beds, as well as private water supplies, food and medicines? And then who would get vaccinated first, if such a vaccine were available? Do people actually have a “right” to vaccination in such circumstances?

Usually in flu epidemics, those most at risk - the elderly and children - get flu shots. If, however, the virus targeted other age groups, then what would be our priorities? Policy makers might then have to address some very hard questions like should vaccination be given to Australia’s most productive citizens - those in the working age groups, rather than the old and very young? And who should get the hospital bed - the 88 year-old or the 30 year-old father of twins?

Vaccines and antivirals would help contain the pandemic but it seems likely that in the beginning such drugs would be in short supply. The Australian Action Plan suggests that vaccine supplies against a new flu strain would not be available for between three and six months after the pandemic commenced, and that because world demand would be so high, supplies would be limited.

Equally concerning is the lack of interest shown by Big Pharma in developing pandemic flu vaccines and new antiviral drugs. Currently the drugs we have to fight a pandemic are expensive and generally in short supply. Fearing a possible pandemic around the corner some countries are already beginning to stockpile antiviral drugs as well as preparing pandemic plans. Currently Australia has established a stockpile sufficient for about 5 per cent of the population.

Finally, how would we manage the fear, panic and hysteria that would undoubtedly accompany the pandemic? Under such circumstances could we expect the media to act responsibly and not sensationalise and heighten public anxieties? These are not simply academic questions. Although we have no way of knowing when the next pandemic will strike, it really is just a matter of time. Perhaps we will be lucky and it will be a mild plodding virus. Perhaps by then we will have better vaccines and antivirals. We had better hope so.

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About the Author

Peter Curson is Emeritus Professor of Population and Health in the Faculty of Medicine and Health Sciences at Macquarie University.

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