The 1918-19 flu pandemic in Australia

The following article from A History of the Pharmacy Board of New South Wales by Dr Gregory Haines, published by the Pharmacy Board of New South Wales and the Australian Pharmaceutical Publishing Company (1997), is reproduced with the kind permission of Dr Haines and the Pharmacy Board of New South Wales.  

Before the emergency of the Great War had passed, a new crisis which would fully engage pharmacists had already begun to show itself. The winter of 1918 saw a sudden increase in the incidence of influenza in New South Wales. This was the prelude to the 1919 influenza pandemic which was to claim 6387 lives in the state. The death rate was about to frighten and generate enormous alarm: for each 100,000 people in the population, 319 were going to die.

Just over half of all Australian deaths due to the 1919 influenza pandemic were recorded in New South Wales. The state government took initial steps in 1918 to try to prevent the spread of the anticipated outbreak of the disease. Health authorities had been aware of the influenza outbreaks in Europe and Britain from July 1918. At that stage, what became known as Spanish Influenza was not exhibiting unusual virulence, though its spread was anticipated.

The government made the wearing of masks compulsory in shops, hotels, churches, theatres and on public transport in the populous parts of the state. Those who had become infected were to be isolated and quarantine rules were tightened. Price control on treatments for influenza was enforced and one Sydney pharmacist was severely fined in October 1918 when he was found to have overcharged. In December 1918, representatives of the Pharmaceutical Society and the medical association met and formulated a stock mixture and a solid inhalation for use should the disease spread into Sydney from North Head Quarantine Station.

Early in 1919 the government strengthened its public health measures. It insisted on the use of masks. Libraries, reading rooms, theatres, music halls, auction rooms and billiard rooms and indoor or outdoor church services within the County of Cumberland were prohibited. Space regulations limited the number of people able to gather in shops, hotels, tea rooms and restaurants. Shops were forbidden to hold crowd-attracting bargain or clearance sales. Travel on long-distance trains was restricted and quarantine regulations were further tightened. Troops returning from the war were quarantined at North Head and the Sydney Cricket Ground.

The epidemic peaked in the winter of 1919 and abated by the February of the following year. While it lasted, the influenza pandemic increased work and risk for those engaged in pharmacy. It also prevented or limited the activities of pharmacy organisations, either by preventing their meetings or by robbing erstwhile participants of energy. The Australasian Pharmaceutical Conference, which had not met since 1913, thanks to the war, did not gather until 1921, due to the pandemic.

"We assume that in a pandemic, the only vaccine available to Americans is going to be a vaccine made in America," says Bruce Gellin, director of the National Vaccine Program office in the Department of Health and Human Services. "A goal of our pandemic vaccine program is largely to ensure we have sufficient domestic capacity to meet this country's need."

This is crucial because it is widely, and reasonably, believed that every country will nationalize the vaccine within its borders should a pandemic happen. The US government can have all the paid contracts it deems necessary, but we will not be taking delivery of those orders post start of a PanFlu if the vaccine resides in some other country, even one of staunchest allies, and neither France nor Germany qualify on the staunch front.

Sanofi's existing plant, which is set to close down for renovations when the new plant goes online, churns out up to 50 million doses a year. The new one, which the company says will be ready in late 2008 or early 2009 after licensing by the Food and Drug Administration, will produce 100 million doses of vaccine for annual flu seasons.

So, in a bit over a year from now at the soonest, and more likely a year and half from now we will have the annual capacity to manufacture enough PanFlu vaccine for 50 million US citizens and residents. At the start of a moderate to severe influenza pandemic there will be somewhere upwards of 300 million folk all wanting their 2 vaccine doses.

posted by Medclinician