An unknown disease… highly contagious… its cause unknown… its victims shunned… the number of cases and deaths rising. A description of the AIDS epidemic but one that also fits virtually every major epidemic that Australia has experienced over the last 200 years. Every virulent outbreak of infectious disease to hit Australia carried with it not one but two epidemics – firstly, the physical manifestation of the disease itself in cases and deaths, and secondly, the way we reacted and responded: denial at first, followed by apprehension, fear, hysteria and panic, and always showing little confidence in the government’s ability to protect us. Regrettably the psycho-social dimensions of epidemic encounters are often ignored by those responsible for planning our official response. And finally, we were usually confronted by an onrush of commercial and media exploitation.
Ever since SARS we have been repeatedly told that another pandemic is coming. It might be flu or perhaps some exotic infection nurtured in animals in Asia or Africa, but whatever it is, it is coming. Health experts and the media have been saying this for more than 10 years, therefore it must be true. And then in 2009 we had swine flu and our worst fears were realised. But what has changed? Pandemic has become the buzz word of the 21st century. Since 1940 more than 400 emerging infectious diseases have been identified. More than 60 per cent were zoonotic or animal in origin. New infections like SARS, avian flu, swine flu, Ebola and Zika have come to plague us while older infections like dengue, Lyme disease, malaria and yellow fever as well as a raft of childhood infections, continue to take their toll.
We have never been particularly empathetic when faced with epidemics or pandemics. Fear of contagion and ignorance of the origin and mode of spread have often lead to a search for scapegoats or someone to blame, and friendly behaviour and ‘mateship’ have gone out the window. During the plague epidemic in Sydney in 1900, for example, the police were deluged with letters reporting that a neighbour or workmate had not been seen for a couple of days or had been heard coughing and that perhaps they were harbouring the plague. Sadly, many of these people were forcibly removed to the Quarantine Station and detained for lengthy periods even though they were free of the disease. In times of epidemic crisis, rationality and friendship are replaced by emotion and fear of possible contagion, and people fall back on their own resources and place family and relatives first. During the very severe polio epidemic of 1937-38 in Tasmania, nurses and hospital workers were strongly advised not to tell their neighbours and friends what they did for fear of repercussions. Australia also has a long history of blaming the Chinese for the introduction and spread of diseases like smallpox and plague. During the smallpox epidemic of 1881-82, for example, the Chinese in Sydney were subjected to extraordinary prejudice and violence. All ships from Chinese ports were quarantined, people throughout Sydney boycotted Chinese goods and services, refused to allow the Chinese to board trams, ejected them from shops and spat at them in the street. The state government also introduced a bill into parliament to restrict Chinese immigration. The number of cases and deaths in an epidemic has little impact on the human reaction and fear it can cause, the lengths people will go to avoid it and the way governments and medical authorities react. SARS demonstrated all this as did polio between 1903 and 1956. In Australia approximately 40,000 people, mainly children, caught polio. It is now well known that polio enters the body through the mouth and is transmitted almost entirely by contact with an infected person. Yet throughout the 1940s and early 1950s there was no knowledge as to what caused the disease and how it spread. People were advised to avoid crowds, playgrounds, cinemas and libraries. Children’s sporting events were cancelled, swimming pools closed and people urged to boil their drinking water.
Many now believe that we are entering a new era of infectious disease and that future generations will face a dangerous array of epidemics and pandemics. It is a sobering thought and one that requires us to reassess how we respond to such events. There is little doubt that we need early detection of disease outbreaks no matter where they occur and critically we need to respond much better, both at the international and national level. Ebola is a case in point. The WHO was notoriously slow to react and respond, perhaps weighed down by its ponderous bureaucratic organisation. We could also be excused for thinking that Western developed countries tended to ignore the Ebola outbreak possibly believing or hoping that the epidemic would simply burn itself out in West Africa. Finally, during a pandemic could we expect all levels of government and business to cooperate in trying to contain it? In Australia current official policy is that the Commonwealth would take full responsibility for managing the outbreak and put into place specific quarantine and border controls, and that all levels of government would work cooperatively. Yet our history suggests otherwise. In 1918, for example, the Commonwealth and all the states and territories convened a conference to address the flu pandemic threat. All agreed on a 13 point plan whereby the Commonwealth would be notified immediately flu cases appeared anywhere in Australia and would then assume total authority for all interstate transport, border security and formal quarantine. What actually happened? Well in 1919 when the first flu cases appeared in Melbourne, the Victorian Government delayed informing the Commonwealth for some weeks for fear of what quarantine might do to local business, by which time the disease had spread to NSW. SA also initially refused to notify cases. Once flu was officially declared in Victoria, NSW closed its land and sea borders and instituted its own quarantine procedures. It was every state for itself and the Commonwealth agreement of 1918 went out the window. Australia’s pandemic experience is replete with such examples. And now the bad news. The swine flu pandemic will not be the last pandemic we face. Many believe that future generations will have to face a dangerous array of infectious disease threats. It is a sobering thought.
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