16 September 2005
Although dealing with serious problems is a government minister's job, I have never had quite such a shock as the Chief Medical Officer's bird flu brief in February last year. This warned of the far-from-hypothetical risk of a new disease that could readily result in 13,000 deaths, 58,000 hospitalisations and 2.6 million people seeking medical attention in the first three months of a killer flu outbreak. The Government has taken this threat just as seriously as it would a threat to national security and has implemented a series of precautionary measures that mean Australia is better prepared than almost any other country in the world to deal with a new flu pandemic.
Although always overshadowed by World War One, the 1918-19 Spanish Flu pandemic actually killed about three times more people. For Australians, 12,000 flu-related deaths in homes and hospitals during 1919 have not had anything like the historical resonance of the 61,000 deaths among the soldiers of the First AIF. Effective quarantine measures, which were much easier in the days of seas travel, meant that Spanish Flu struck much later here than in America where there were 650,000 deaths in a then population of 105 million. Still, since that time, health authorities have maintained constant vigilance against the flu pandemics to which the world is intermittently subject.
The outbreak of Asian Flu in the late 1950s and Hong Kong Flu in the late 60s are each estimated to have killed about one million people round the world, including about 500 in Australia. According to the World Health Organisation, the world is now overdue for another severe flu pandemic. The WHO is particularly worried that the bird flu now devastating poultry stocks in Asia (and which has killed 26 people since last December) could mutate into a human flu virus still deadly to people and very easy to catch. Earlier this year, the WHO's regional director warned that the world was now "in the gravest possible danger of a pandemic". The Australian Government's assessment, derived from a range of expert views, is that the odds of a severe flu pandemic occurring in any year have now shortened from about 100 to one to about 10 to one.
We don't know if or when a pandemic might occur. We don't know how severe it might be. We do know, however, that a Spanish Flu-type pandemic would be a public health challenge to exceed the worst environmental disaster and to dwarf almost any conceivable terrorist atrocity. An Australian assessment suggests that "many countries could experience mass panic, especially if the disease (as in 1918) took its toll on the fit and the healthy…And some health professionals, fearing for their own lives might, as during the SARS crisis, refuse to treat the ill. At a deeper level, human values and motivations could be strongly affected".
For problems which are possible but not certain, the challenge is to provide information without spreading alarm and to take prudent precautions in proportion to the potential threat. The danger, especially in a risk-averse society with a "find-someone-to-blame" media and political culture, is doing too little or too much: too little, from fear of creating a talk-back driven firestorm of controversy; too much, from fear of being exposed to political oblivion should the government ever seem "asleep at the wheel". The competing temptations are "it won't happen here" complacency, "there's nothing we can do" fatalism, or "no precaution is too great" alarmism.
So far, the Australian Government has spent about $160 million on domestic precautions against a possible flu pandemic. On a per capita basis, Australia has the world's largest per capita stockpile of anti-viral drugs after Finland (although this is still only enough to protect a million essential service workers for about six weeks). The Government is stockpiling 50 million vaccination syringes and 40 million surgical masks and preparing facilities for six quarantine stations capable of holding 500 people. The WHO-collaborating flu laboratory in Melbourne is being up-graded. Most importantly, the Government has commissioned CSL to produce a candidate pandemic bird flu vaccine. Trials of this vaccine will begin shortly and, if successful, it could be ready for possible mass production by the end of the year.
Since late 2003, federal and state health officials, epidemiologists and clinicians have been regularly meeting as the National Influenza Pandemic Action Committee. In May, the Government publicly released the Committee's draft plan for responding to a flu pandemic. Each state and territory has designated hospitals on a cascading basis to deal with potential flu cases as well as plans for mobile medical teams and home quarantine. The Committee will advise the Chief Medical Officer about who should receive anti-viral drugs. This is likely to include key decision-makers as well as health staff, police and essential service workers - but because it's not recommended that people take anti-virals continuously for more than six weeks, those on the list will almost certainly end up taking their chances like everyone else should pandemic flu take hold before a vaccine becomes available.
The Health Incident Room in Canberra is constantly monitoring potential flu outbreaks around the world. As soon as Australian health officials are confident a pandemic is imminent, flights from any affected countries may be suspended (apart from evacuating Australian citizens) and strict border controls will be implemented, including thermal screening of incoming passengers. Once pandemic flu was widely present in Australia, depending on its severity, the Government would have to decide (as in 1919) whether to discourage or ban large gatherings and close schools. Any such measures would have serious economic consequences but they could slow the spread of disease in the absence of an effective vaccine.
A severe flu outbreak would test our national character as well as our public health system. Under great pressure not everything works out as planned. Still, our "have a go" culture means that we can usually improvise to meet the unexpected or the daunting. This should be some consolation to those tempted to dwell on the fear and confusion which would inevitably accompany any deadly scourge.
Page currency, Latest update: 16 September, 2005
