4 Nov 2018

The next pandemic - are we ready?

From Insight, 8:10 am on 4 November 2018

November was the peak month of the 1918 pandemic that killed 9000 New Zealanders. One hundred years on, will we be able to deal with the next one?

No caption

Photo: The Press Collection Alexander Turnull Library - Ref 11-008542-G

The memories captured from the days and weeks the pandemic took hold in 1918 are tragic.

Decades later, in a 1967 interview, a Wellington shop assistant recalled how a little boy came in one morning with the paper, as she went into work at a pharmacy.

"He told me the children next door were crying. I asked him why and sent him off to find out."

The answer the boy came back with was chilling.

"The mother and father looked awfully funny, the mother was black and the father was turning black and there was a baby in the cot and there was a little toddler running round and there was no-one to do anything for them."

Karori Cemetery, Wellington - One of many graves on those who died of the flu in 1918

Karori Cemetery, Wellington - One of many graves on those who died of the flu in 1918 Photo: RNZ/Philippa Tolley

Nationwide, it is thought 135 children lost both parents. While the virus itself was bad, it was the pneumonia, a secondary infection, which proved to be the real killer. The skin of some people who develop pneumonia darkened due to burst blood vessels.

People were dropping on the streets, hospitals, doctors and pharmacists were over-run. Lawyers were hurriedly brought into wards to draw-up wills before people died.

Insight is on Apple Podcasts: subscribe and give us a review - Or head to Spotify or wherever you get your podcasts.

H1N1 Flu virus commonly known as Swine Flu

H1N1 Flu virus commonly known as Swine Flu Photo: SUPPLIED

In lieu of undertakers funeral carriages, trucks were used to transport coffins to local cemeteries as the number of deaths rose rapidly. At the Waikumete Cemetery in Auckland, hundreds of victims were buried in one mass grave.

On the 19 November there were 63 burials at Wellington's Karori Cemetery in one day.

In total 9000 New Zealanders lost their lives to the virus.

Even though medical science has made huge leaps forward, Professor Michael Baker, who specialises in public health at Otago University in Wellington, believes the threat remains high.

"There are literally tens of thousands of microbes in the animal world that have the potential to infect us...even pathogens we think are now eradicated like small pox could be re-introduced.

No caption

Otago University Public Health professor Michael Baker Photo: RNZ/Philippa Tolley

"There's no guarantee it's contained in the two sites we know about. It's maybe elsewhere or it could be re-created."

Despite being eradicated, the small pox virus is still held in two locations for research. It is officially stored and handled under WHO supervision at the Centers for Disease Control in Atlanta in the United States and at the State Research Center of Virology and Biotechnology in Koltsovo, Russia.

Virus samples are checked at the  WHO National Influenza Centre at Wallaceville

Virus samples are checked at the WHO National Flu is Photo: RNZ Insight/Philippa Tolley

Any release of the small pox virus would be absolutely devastating, according to Professor Baker, as the world's populations has very little natural immunity, supplies of vaccine are quite small and it would take some time to build up stocks.

"In that time it could kill hundreds of millions of people potentially."

The most likely cause of the next pandemic is thought to be a new strain of flu.

In Wallaceville, north of Wellington, you have to be expected and buzz-in at the gate before you're allowed to visit the World Health Organisation's National Influenza Centre. It is part of the WHO worldwide network keeping tabs on strains that are already circulating and any possible new ones.

Its director, Dr Sue Huang, speaks of the virus almost as if it is an animal siting in front of us, one she describes as "very cunning."

Dr Sue Huang at the World Health Organisation's National Influenza Centre in Wellington

Dr Sue Huang at the World Health Organisation's National Influenza Centre in Wellington Photo: RNZ/Philippa Tolley

"They have this ability to jump into humans. The animal virus and the human virus can mingle together and...they are actually able to transmit into a population that has no immunity."

This is what creates a new pandemic strain, the mixing together of animal and human flu that has been seen with bird flu and swine flu. Seasonal flu comes from the virus' ability to mutate frequently to "outsmart" antibodies, but does not have the animal-human interchange of a pandemic strain.

"This is really the biggest worry because it cause a pandemic...no other virus is able to do," Dr Huang said.

The response to a pandemic is planned for and co-ordinated through an Emergency Management team based at the Ministry of Health.

Director Charles Blanch explained there are national pandemic reserve supplies including anitvirals, masks and syringes to deliver vaccinations once they are developed. Pharmac requires medical wholesalers to hold higher than minimum stocks of drugs in the country, so Mr Blanch says New Zealand does have a reasonable level of resilience.

Boxes of flu vaccination in fridge

Flu vaccination supplies Photo: RNZ Insight / Philippa Tolley

But not everyone is happy with the way the response system is set up.

Otago University Public Health professor Michael Baker is worried about the public health infrastructure is broken into smaller parts and talks about an erosion, especially in staff and fragmentations of services.

"If the future was predictable that may work, but the things I'm talking about are highly unpredictable and when they come, they'll come in a way no-one expects in many cases and you need to assemble an almost military style operation to manage that."

But Mr Blanch is satisfied the system is robust. Through contracts, collaboration and co-ordination, he is confident of the high quality surveillance and response system being provided.   

Emergency Management team director, Charlie Blanch believes New Zealand is ready to face down the next pandemic

Emergency Management team director, Charlie Blanch believes New Zealand is ready to face down the next pandemic Photo: RNZ/Philippa Tolley

"We are always looking at how other countries and states organise themselves and continually review systems," he said.

Prof Baker would like this country to mark the 100 year anniversary of the great pandemic by setting up a specialised public health agency, similar to those established in England and Wales in recent years.

Archive audio for this programme is courtesy of Nga Taonga Sound and Vision

Follow Insight on Twitter