‘No concept of how awful it was’: the forgotten world of pre-vaccine childhood in Australia | Vaccines and immunisation
It is 1940 and a five-year-old boy is in an oxygen tent. He gasps and hallucinates that his lead toy soldiers are still alive and march across the room, sampling him with their bayonets.
He has diphtheria, a disease also known as the strangulation gel. There is a vaccine, but not every child is vaccinated. The bacterial infection creates a membrane over the back of the throat, cutting off the air supply.
The little boy’s mother, who sits a desperate watch next to the oxygen tent, has seen diphtheria take other children.
It won’t take her son in the end. The membrane will not completely close his airway and he will emerge from the oxygen tent. He will attend the funerals of classmates who die of diphtheria and polio. In time, he will run with his friend, a fine athlete who was born blind after his mother contracted rubella during pregnancy. He will rattle a rock in a can to lead his friend to the finish.
During his school days, children he knows will die of a disease.
“I want to take antivaxxers back in time,” says Tom Keneally, here five years, shortly before he got diphtheria. Photo: Included
He will, by luck, survive. He is still alive today, at the age of 85. He is my father and his name is Tom Keneally.
“One of the brothers (the Christian brothers from St Patrick’s College in Strathfield in Sydney) would come into the classroom from time to time and tell us someone had died,” Keneally said. “We’d pray a decade of the rosary for them, and the brother would say God takes the best kids, and I’d be relieved I wasn’t one of those kids.
“It didn’t feel like an ever-present threat as kids because we just lived our lives, although I think for our parents it was always there, that possibility.”
Shortly after birth, Australian children are vaccinated against hepatitis B. Between six weeks and 18 months of age, they receive vaccines against a range of diseases, including diphtheria, tetanus, pertussis (whooping cough), pneumococcal disease, meningococcal disease, measles, mumps, rubella, polio, Haemophilus influenzae type b (Hib), rotavirus and varicella (chickenpox).
Some vaccines may also protect against certain cancers later in life. As Prof Raina MacIntyre, head of the Biosecurity Research Program at the Kirby Institute and professor of global biosecurity at the University of NSW, points out, the hepatitis B vaccine protects against liver cancer, while the human papillomavirus vaccine protects against cervical and penile cancers.
“People don’t remember the profit we made,” McIntyre says.
“In the 19th century, infectious disease was the leading cause of death among children. People would have 10 children and lose maybe five. We lived with high infant mortality rates,” she says.
In addition to two world wars, in the first half of the 20th century, Australians had to contend with a Spanish flu pandemic and an outbreak of the bubonic plague, along with numerous diseases.
The deadly diseases that routinely afflict the population — such as suffocating diphtheria, crippling polio, debilitating tetanus — made childhood precarious.
Child in an oxygen tent in the intensive care unit. 1950-1959. Photo: Australian Photographic Agency/State Library of NSW
One in 30 children died in 1911 from gastroenteritis, diphtheria, scarlet fever, whooping cough and measles. In 1907, infectious diseases killed more than 300 people in 100,000, according to data from the Australian Institute of Health and Welfare. By 2019, that number had dropped to about 10.
For modern parents, disease names like polio and smallpox and diphtheria have been relegated by vaccination to mysterious words with no practical relevance. But while these cruel diseases no longer kill Australian children, experts say there is a risk of them falling into complacency.
“The visibility of the ravages of polio and the fact that most people knew that someone who had a child was dead were really powerful motivators. People were desperate for vaccines,” said David Isaacs, clinical professor of pediatric infectious diseases. the University of Sydney, and author of Defeating the Ministers of Death – The Compelling History of Vaccination. “A lot of younger people now have no idea how awful it was.”
Tom Keneally’s diphtheria infection would not be his last hospital stay. In 1944 he was recovering from pneumonia with a boy with an iron lung who was suffering from polio. The boy studied for the Leaving Certificate, the predecessor of the HSC.
“He had a bracket over his head to put textbooks in, and I remember him studying Hamlet,” says Keneally. “His mother was always there, turning pages and swapping books, and that’s how he studied.”
A child lies in an iron lung at the Children’s Hospital May 20, 1938. Photo: Olson/State Library of NSW
Some time later, he learned that the boy had died when a power outage rendered his iron lung useless.
dr. Peter Hobbins, a medical historian at the Australian National Maritime Museum, says polio continued to kill children into the 1950s.
“It was the reality of life in Australia. Many people do not realize how many diseases were rampant until recently. There is a reduced visibility of the consequences of these diseases, people do not appreciate the fear that parents felt about sending a child to school and possibly not coming back into the family,” he says.
“Fortunately, we are not seeing any new cases of polio, but there are still people living with the effects of the disease and feeling forgotten.”
Not that there were no triumphs, especially the eradication of smallpox, which according to Isaacs killed up to one in three babies in 18th- and early 19th-century London. A World Health Organization campaign that began in 1967 saw it wiped out in 1980.
The first smallpox vaccinations in Australia were given in the early 1800s. That was not good for the people of the Eora nation. In 1789, a disease believed to be smallpox was introduced by the settlers. It tore through Sydney’s Aboriginal population, killing up to 70%.
While smallpox is no longer a threat, MacIntyre warns that diseases we’ve all but forgotten could easily return if vaccination rates drop.
“An example is the fall of the Soviet Union,” she says. “There were good vaccination programs, and when the Soviet Union fell, many were stopped.”
As a result, the number of cases of diphtheria, almost unheard of due to vaccination, reached 140,000 and the disease killed 4,000 children and young adults.
“If we stopped vaccinating against diphtheria here, we would see the same thing,” MacIntyre says.
Despite their life-saving properties, vaccines are often greeted with suspicion. Hobbins says a tragedy in 1928 had an impact on diphtheria vaccination rates, but it may ultimately have increased the vaccine’s safety as well.
“It became known as the Bundaberg tragedy or the serum tragedy. A batch of diphtheria vaccine contaminated with Staphylococcus aureus was injected at high doses into 20 children, and 12 died,” he says.
Vaccination against diphtheria, March 25, 1940. Photo: NSW State Library
“A diphtheria outbreak could potentially kill 12 in 20 children, but that event set the vaccination rate back several years. But one consequence of the tragedy has been a rise in manufacturing and quality testing standards, drastically reducing the risk of vaccines becoming contaminated.”
While vaccine mandates are sometimes raised as a counterbalance to vaccine hesitancy, they can backfire. In Defeating the Ministers of Death, Isaacs writes of 80,000-strong protests in the British city of Leicester in the late 1800s in response to a mandate for a smallpox vaccine.
“I really believe in negotiating and respecting people’s intelligence because hesitation about vaccines is not about intelligence. A lot of hesitation is based on fear and misunderstanding, and we don’t want to alienate people,” he says.
“Then you can sometimes bring people around if you’ve developed a close relationship, which is why I’m a firm believer that you should use GPs to get those messages out.”
Still, Australians are big proponents of childhood immunization, he says.
Thomas Keneally, Australian novelist, playwright and essayist. Photo: Murdo MacLeod/The Guardian
“Our use of routine childhood vaccinations is about 95%. That’s enough to give you herd immunity, so there’s no endemic spread of measles at all.”
“Australia has had high vaccination rates. Anti-vaxxers are about 2%, which isn’t that much,” she says.
“It’s not so much vaccine hesitation as vaccine confusion” [with Covid-19 vaccines]. I believe we can achieve good vaccination rates [against Covid-19] in Australia.”
As for committed anti-vaxxers, Tom Keneally knows what he’d like to do to change their perspective.
“I would like to take anti-vaxxers back in time to my childhood. There would be a story on every street that could make them change their mind.”