The forgotten pandemic and what it still teaches us
The term forgotten pandemic refers to the Hong Kong influenza outbreak of 1968–70—a crisis that arrived during a year of upheaval and transformation across the globe. For Dr John Gerrard, a clinician and former Queensland health leader, the memory is personal: he was six when his eldest brother Stephen died during the Hong Kong flu wave, part of a broader pattern of respiratory pandemics that have punctuated Australia’s history since the 1918 Spanish flu. At least 10,000 Australians died in that era of influenza, a stark reminder that even decades later, the consequences of a pandemic can echo through generations.
Hong Kong flu in Australia: a stark toll and a lasting imprint
The Hong Kong influenza pandemic, rooted in a novel H3N2 strain, unfolded across much of the wealthy world and produced a landscape of illness that often affected comparatively younger adults. In Australia, excess mortality from that season approached figures that now invite comparisons with the COVID-19 era. An analysis cited in the Medical Journal of Australia shows that the excess death rate during two Hong Kong flu seasons was similar to that of COVID-19 from 2020 to 2023 when measured per 100,000 people. Yet the age pattern differed: around 30 per cent of Hong Kong flu deaths occurred in people under 65, compared with roughly 11 per cent of COVID-19 deaths among Australians under 70. The parallels and differences are instructive for today’s public health planning.
Two pandemics, two public narratives about vaccines
Vaccine supply and public concern
Public dialogue around vaccines has repeatedly shaped responses to pandemics. In Australia during the Hong Kong flu, the public’s concern over vaccine supply dominated the discourse. A key moment involved the Commonwealth Serum Laboratories exporting about 1.3 million Hong Kong flu vaccine doses to Britain to support its winter surge—an act that drew both incredulity and consternation at home. The episode underscored a perennial tension in pandemic management: the need to secure sufficient vaccine doses while maintaining public trust in domestic stockpiles and supply chains.
What the Hong Kong flu can still teach about COVID-19
Dr Gerrard notes that both pandemics originated with global shifts and have shared epidemiological threads, including initial outbreaks on ships and a media environment sensitive to vaccine availability. Retrospective assessments of mortality show that while COVID-19 had a different age distribution, the underlying lesson remains clear: robust and timely vaccination and a reliable vaccine supply are foundational to reducing mortality. He points to the idea that if vaccination coverage had been lower during COVID-19, death tolls could have been far higher. The comparison is not about equating the pathogens but about recognizing how preparedness, vaccine access, and public health measures shape outcomes.
Antibiotics, vaccines and the evolving toolkit of public health
Even as the Hong Kong flu raged, doctors faced the therapeutic limits of the era. Antibiotics, now a standard tool against secondary bacterial infections, were not available during the Spanish flu. By the time Hong Kong flu struck, antibiotics were on the table but vaccination remained one of the most effective defenses against primary influenza disease. Modern responses, in contrast, rely on a combination of vaccines, antivirals, surveillance, and coordinated public communication—tools that have evolved alongside our understanding of how influenza viruses mutate and spread. Dr Gerrard emphasizes vaccination as a constant in reducing deaths from influenza, a message that resonates even as we confront the current season’s risks.
Lessons for today and tomorrow
For this generation of health professionals and policymakers, the Hong Kong flu’s legacy lies in preparedness, vigilant surveillance, and the politics of vaccine distribution. The personal perspective of Dr Gerrard—who has spent decades treating flu victims and advocating for higher vaccination uptake—frames a broader public health imperative: protect the vulnerable, address supply bottlenecks, and communicate clearly about the benefits of vaccination. He notes that in his work with flu patients, many regret not being vaccinated after experiencing severe illness, a reminder that vaccination decisions can be a matter of life and death in the emergency room corridors and hospital wards alike.
Conclusion: turning memory into preparedness
History does not repeat itself in exact form, but it often rhymes. The Hong Kong flu is a painful but instructive chapter that warns against complacency in the face of a familiar threat. In Australia and beyond, the comparison with COVID-19 reinforces a simple truth: strong vaccine programs, transparent public health messaging, and reliable vaccine supply are indispensable to saving lives when the next respiratory threat arrives. The memory of a brother lost to the forgotten pandemic becomes a call to action for today’s clinicians, scientists, and citizens alike.
