The ‘Spanish flu’ pandemic emerged at the end of the First World War, killing more than 50 million people worldwide.
Despite a swift quarantine response in October 1918, cases of Spanish flu began to appear in Australia in early 1919. About 40 per cent of the population fell ill and around 15,000 died as the virus spread through Australia.
Sydney Morning Herald, 28 January 1919:
Australia must now face the fact that the scourge which has taken so heavy a toll from the rest of the world has invaded her own frontiers.
What is influenza?
Influenza, or ‘the flu’, is a highly contagious respiratory illness caused by the influenza virus.
In 15th-century Italy, an upper respiratory infection was considered to be ‘influenced’ by the stars, thereby giving the disease its name.
There are three types of the virus: Influenza A, B and C, with Influenza A causing the most severe infections.
The virus mutates rapidly and constantly, meaning the human population cannot build up an enduring immunity. The flu is estimated to cause up to 3500 deaths in Australia each year.
History of influenza in Australia
Influenza was first noted in Australia in 1820 and reported in the Sydney Almanack of 1834.
While influenza epidemics commonly occur each winter, there have been a number of pandemics (epidemics of worldwide proportion) in Australia’s history. These include a series of pandemics in the 1890s, 1957, 1968 and 2009. The most devastating pandemic took place in 1918–19.
Preparing for the Spanish flu pandemic
The 1918–19 influenza pandemic is often called the ‘Spanish flu’, not because it originated in Spain, but due to it first being widely reported there.
This pandemic started in 1918, the last year of the First World War, and passed through soldiers in Western Europe in successively more virulent waves.
Unusually, the Spanish flu affected healthy young adults much more than its usual targets: children, the elderly or those with weakened immune systems. In Australia, the virus became known as ‘pneumonic influenza’.
The virus spread rapidly around the world as soldiers returned from active service at the end of the war. Because of its remoteness from Europe, Australia had months to make necessary preparations.
The first line of defence was to try to prevent the virus reaching the Australian mainland.
The Australian Quarantine Service monitored the spread of the pandemic and implemented maritime quarantine on 17 October 1918 after learning of outbreaks in New Zealand and South Africa.
The first infected ship to enter Australian waters was the Mataram, from Singapore, which arrived in Darwin on 18 October 1918. Over the next six months the service intercepted 323 vessels, 174 of which carried the infection. Of the 81,510 people who were checked, 1102 were infected.
The federal government’s second line of defence was to establish a consistent response in handling and containing any pneumonic influenza outbreaks that might occur in Australia.
It held a national influenza planning conference in Melbourne on 26–27 November 1918, at which state health ministers, the directors-general of their health departments and British Medical Association representatives met with Commonwealth personnel.
The conference agreed to the federal government taking responsibility for proclaiming which states were infected along with organising maritime and land quarantine. The states would arrange emergency hospitals, vaccination depots, ambulance services, medical staff and public awareness measures.
Development of influenza vaccine
Commonwealth Serum Laboratories was established during the First World War to alleviate Australia’s dependence on imported vaccines. In 1918 it developed its first, experimental vaccine in anticipation of pneumonic influenza reaching mainland Australia.
Researchers did not know what caused influenza, but produced a vaccine that addressed the more serious secondary bacterial infections that were likely to cause death. Between 15 October 1918 and 15 March 1919, CSL produced three million free doses for Australian troops and civilians. It later evaluated the vaccines to be partially effective in preventing death in inoculated individuals.
Spanish flu in Australia
Maritime quarantine contained the spread of the virus until its virulence lessened, and restricted its eventual introduction into Australia to a single entry point.
The first case of pneumonic influenza appeared in Melbourne, on 9 or 10 January 1919. Early cases were so mild, however, that there was initially confusion about whether the virus was the Spanish flu, or simply a continuation of the seasonal flu virus from the previous winter.
This uncertainty delayed the confirmation of an outbreak from Victorian health authorities, which allowed the infection to spread to New South Wales and South Australia by the end of January 1919. New South Wales was the first state to officially proclaim an outbreak of pneumonic influenza on 27 January 1919, with Victoria following suit the next day.
Tensions in the new Federation surfaced as the other states viewed Victoria’s delay in confirming the outbreak as a breach of the November agreement made with the Commonwealth. Soon each state made their own arrangements for handling and containing outbreaks, including organising their own border controls. The Commonwealth temporarily withdrew from the November agreement on 11 February 1919.
The experience of pneumonic influenza varied from place to place. The city of Sydney implemented strict measures in an attempt to limit the spread of the disease. This included closing schools and places of entertainment and mandating the use of masks.
Such measures didn’t prevent the spread of the disease, but did manage to slow its movement. Even so, Sydney experienced three waves of outbreaks, with many deaths and many more infections.
In Perth, the combination of the city’s relative isolation and effective state border quarantine control ensured that pneumonic influenza didn’t appear there until June 1919.
Perth experienced a spike in infections after crowds gathered to celebrate Peace Day on 19 July 1919.
Spanish flu death rates
By the end of 1919, the influenza pandemic was over.
Across the globe, the pandemic had had a devastating effect on a population only just beginning to recover from years of war. Many more people died from the influenza pandemic (50–100 million) than had died during the First World War (18 million). The Spanish flu is considered second only to the ‘Black Death’ plague pandemic in overall mortality rates.
In Australia, while the estimated death toll of 15,000 people was still high, it was less than a quarter of the country’s 62,000 death toll from the First World War. Australia’s death rate of 2.7 per 1000 of population was one of the lowest recorded of any country during the pandemic.
Nevertheless, up to 40 per cent of the population were infected, and some Aboriginal communities recorded a mortality rate of 50 per cent.
R Arrowsmith, A Danger Greater Than War: NSW and the 1918–19 Influenza Pandemic, Australian Homeland Security Research Centre, Canberra, 2007
B Blackwell, Western Isolation: The Perth Experience of the 1918–1919 Influenza Pandemic, Australian Homeland Security Research Centre, Canberra, 2007