The forgotten pandemic: lessons from the 1968 Hong Kong flu
More than half a century has passed since the 1968-70 Hong Kong flu, yet its toll still reverberates in public health debates about vaccination, vaccine supply, and pandemic preparedness. Often described as the “forgotten pandemic” because it occurred alongside seismic world events, the Hong Kong flu was driven by the H3N2 influenza strain and infected millions worldwide. In Australia, about 10,000 people died from influenza across two brutal winters, a figure that underscores the disease’s reach even before modern vaccines and rapid testing.
A personal lens on a public crisis
Dr John Gerrard, a former chief health officer in Queensland, carries a personal memory of the era. He was six years old when his eldest brother Stephen died in the winter of 1968. Stephen’s death, like thousands of others, marked a family’s heartbreak and a nation’s sobering reminder that influenza can be fatal even to the seemingly healthy. Gerrard’s professional work at the Gold Coast University Hospital has since been shaped by that memory, reinforcing the imperative to prevent flu through vaccination and vigilant public health planning.
What the numbers reveal about Hong Kong flu and COVID-19
Retrospective analyses of Australia’s two Hong Kong flu seasons show an excess mortality burden approaching that of COVID-19 in 2020–2023, with a measured 87.3 versus 91.4 deaths per 100,000 population. Yet the age distribution differed: roughly 30% of Hong Kong influenza deaths occurred in Australians under 65, compared with about 11% of COVID-19 deaths in those under 70. The contrasts highlight how different pathogens can strike different age groups, and how public health measures must adapt accordingly.
Implications for younger populations
While COVID-19 captured global attention for its striking effects on various age groups, the Hong Kong flu demonstrated that influenza can also take a substantial toll among younger adults. This reality reinforces the argument that vaccines and early treatment matter not just for the elderly but for people across the age spectrum who may be at higher risk due to comorbidities or exposure.
Public sentiment, vaccine supply, and policy parallels
Public concern over vaccine supply is not new. In 1968, Australia possessed the capacity to mass-produce influenza vaccines at the Commonwealth Serum Laboratories (CSL). Yet the era’s biggest controversy involved CSL sending 1.3 million Hong Kong influenza vaccine doses to Britain to assist a fellow nation during its winter surge. Gerrard notes this “flu furore” reflected a broader sensitivity to vaccine availability—an issue that also arose during COVID-19 and informed the COVID-19 Response Inquiry’s findings on vaccine distribution and public trust.
Vaccine supply as a life-saving priority
The lesson is clear: without timely vaccines, mortality rises. Gerrard points to COVID-19 outcomes in Australia, noting that if 90% of the population had not been vaccinated before the peak of the pandemic, death rates would likely have been higher than during the Hong Kong flu. The message remains relevant as health systems plan stockpiles, distribution networks, and communication strategies to counter vaccine hesitancy and ensure access during future crises.
Lessons learned and the path forward
From the result of the Hong Kong flu to the modern COVID era, the core lessons are joined at the hip: invest in vaccine production and distribution, build robust surveillance systems, and communicate transparently about risk and protection. Dr Gerrard’s experience—treating flu patients, witnessing the consequences of delayed vaccination, and advocating for strong immunization programs—serves as a reminder that the costs of inaction are measured not only in numbers but in human lives and families affected for generations.
Conclusion: a continuing public health charge
As the season for influenza returns each year, the debate about vaccines, supply chains, and preparedness persists. The Hong Kong flu’s “forgotten” label fades when we consider how its legacy informs today’s preparedness and how vaccination can reduce mortality—just as it did during COVID-19. The experiences of Dr Gerrard and many others underscore a simple, enduring truth: proactive prevention saves lives, and learning from the past strengthens our resolve for the future.
