Flu pandemic that killed thousands of New Zealanders could happen again

Thursday, 11 October 2018

The medicine depot in Cathedral Square where the Government standard influenza medicine was supplied.

A flu that killed thousands of New Zealanders in 1918 could repeat in the future, experts say, but they're in disagreement over how to deal with it.

'In many ways the world of 2018 is more conducive to a 1918-like pandemic than 1918,' says Amesh Adalja, senior scholar at the John Hopkins centre for Health Security.

Global travel times have fallen, which a virus can exploit, he says, and population increases and cramped cities could also encourage a virus to spread 'like wildfire' in the right context.

He claims pharmaceutical companies have a lack of interest in infectious disease research, and few are engaged in the hunt for new vaccines or treatments.

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University of Otago Professor Michael Baker believes that in the face of a 'devastating' pandemic New Zealand's border should be closed.

The Spanish Flu pandemic of 1918 is estimated to have killed as many as 60 million people worldwide. In just over one month it claimed the lives of 9000 New Zealanders.

Head of Auckland University's Superbugs Lab, Dr Siouxsie Wiles, says people have simply been lucky in terms of the severity and spread of swine and avian flu, and the Zika virus.

She's concerned there is complacency about the threat of a pandemic, even recklessness.

Wiles says factors increasing the likelihood of a pandemic include greater risk of cross-species contamination, as people encroach further into the habitats of wild animals.

Her greatest fear is around rampant antibiotic use. She says their use in medicine, food and agriculture, plus the ability of viruses to mutate, is weakening their effectiveness to a point where 'we're very close to having nothing left'.

Wiles says flu sufferers are typically killed by conditions like pneumonia, which she believes may soon be untreatable.

SARS, Zika, swine and avian flu haven't developed into deadly pandemics because according to Professor Kanta Subbarao, director of the World Health Organisation's centre for reference and research on influenza, a number of unique factors came together in 1918, including huge population displacement caused by war.

'It wasn't all just the virus,' she says.

In the three flu pandemics since 1918- in 1967, 1968 and 2009 - the number of deaths has decreased.

'That gives me hope.'

Typically a deadly pandemic needs two ingredients; a new virus strain for which no vaccine exists, made airborne.

Adalja says pandemics do not respect borders and living in an island nation should not allow a false sense of security to hamper planning for a pandemic.

He says travel times are decreasing past the incubation periods for conditions like influenza, meaning someone could depart for New Zealand from anywhere in the world and only become sick on, or after, arrival.

World Health Organisation influence expert Professor Kanta Subbarao says an influenza pandemic would overwhelm health services 'easily.'

Professor Michael Baker, from the University of Otago Department of Public Health, says NZ borders should be closed in the event of a pandemic that is 'absolutely devastating and unstoppable'.

'We could see the same or worse, there's no question about that,' he says.

Baker co-authored a paper examining the pros and cons of a total border closure, using data from past influenza pandemics and modelled on two scenarios, one for a death toll of 12,973, the second for 129,730 deaths.

The estimated net benefit of successfully closing the border against the first scenario was $7.86 billion, climbing to $144 billion for the second.

He argued an estimated $144 billion benefit from a societal perspective in one scenario should sharpen the minds of policy makers, especially with regard to spending what, they argue, would be a relatively trivial amount on analysing intervention options.

Adalja disagrees, arguing restricting movement of people - and medical supplies - to the site of an outbreak could worsen the situation.

'In most cases, border closures are not driven by the actual scientific principles of infectious disease management but by political considerations and a need to 'do something.''

Health Minister Dr David Clark said the official Ministry of Health position is not to close the border, because the ease of transmission meant it was 'highly likely' a pandemic would arrive undetected.

Clark says Ministry officials are set to meet with Wilson to discuss their suggestions and report back, something he said may prompt further work and formal discussions at Cabinet level.

Dr Heather Battles, University of Auckland Anthropology School of Social Sciences lecturer and researcher into infectious disease and epidemics, says one of the major lessons of previous pandemics has been the importance of cooperation, support and assistance.

'Good communication, both among health officials and with the public, and support for those affected and their families, would be key.'