Ian Ring AO
When confronted with a pandemic, one had better hope for a combination of sound scientific medical advice, and a government that will hear that advice – and act on it!
Australia has been fortunate this time around with COVID-19, very fortunate indeed with an extremely able medical team headed by the Chief Health officer, Dr Brendan Murphy and a Prime Minister, Scott Morrison, who, temporarily at least put aside the political cudgels, and led a national unity response, largely based on the medical and scientific advice. So, while much of the rest of the world dilly dallied and flirted with populist approaches, and paid the price with countless cases, overloaded health facilities and far too many deaths, Australia appears to have put a lid on COVID-19, so far at least, with just over 7,000 cases and around 100 deaths – in contrast to deaths in the tens of thousands and caseloads in the hundreds of thousands in many other countries. Getting it right comes with huge benefits to the population, though sadly, with associated social and economic costs, but these pale in comparison with the huge costs from messing it up.
The response to COVID-19 has some parallels with the work of an unsung hero of public health, Dr Cecil Cook, in confronting the polio pandemic, first as Commissioner of Public Health in Western Australia, and later, in his role at the National Health and Medical and Research Council (NHMRC), in the development of the national poliomyelitis vaccination campaign. In both capacities his approach was everything you could hope for – but don’t always see.
Australia’s eastern states had experienced alarming increases in the number of cases of poliomyelitis between 1944 and 1946. But then, as now, Western Australia was somewhat protected by the desert and had only a handful of cases in 1946-47. And then it took off in 1948 with 5 cases in March and 14 in April – indicating the start of an epidemic which Cook had feared – an epidemic, which at that time, had no identified cause.
While we are still learning about the finer points of transmission of COVID-19, at that stage little was known about the method of transmission of poliomyelitis. Nonetheless Cook used the West Australian newspaper “to inform the public, to allay their fears and advise of hygiene practices”. The Acting Premier and State Ministers met to wrestle with the questionof whether to close schools – the same question which for some time divided State governments during the height of the COVID-19 epidemic. Cook preferred schools to remain open, the same advice as the national medical team gave now (though individual State Chief Health Officers saw it differently). Cook took a pasting from the Sunday Times but events proved him right as cases increased during school holidays. Cook and his team held their ground.
Cook’s advice to the public, then, for poliomyelitis, was remarkably similar to the advice offered today for COVID-19: if there is infantile paralysis (polio) in the neighbourhood, children should not go to the pictures, places of sport, meetings, parties or places of public assembly; play in the fresh air but don’t over do it; no swimming in public pools; eat a balanced diet and get plenty of sleep; defer ear, nose and throat operations; prevent food contamination by flies; always wash hands before eating. He also reassured the public that most cases were either mild or fully recovered and that early recognition of the disease and hospital attention improved the chance of a favourable outcome.
This advice, given over 70 years ago for a disease whose cause and method of transmission were then largely unknown, bears an uncanny resemblance to the advice given today for COVID-19 – allowing for minor differences because of the different nature of the
two conditions. Then as now, the restrictive measures proposed excited public controversy, but Cook did not alter his advice and the number of cases in 1949 were 80% less than in 1948 – a triumph of public health given the circumstances.
The world is waiting now on the promise and the prospect of a safe and effective vaccine for COVID-19. By 1950, Australia had 2,200 polio cases and the NHMRC formed its Epidemiology Committee whose remit included poliomyelitis, for which, at that stage there was no vaccine. In 1952 NHMRC created a Poliomyelitis Committee with Cook as its Convenor, and State Poliomyelitis Officers as members. Members considered the use of respirators, rehabilitation and meeting the psychological needs of patients. They considered interstate quarantine to be impractical (which remains the national advice for COVID-19) and recommended schools should stay open and noted a higher risk of infection after operations for tonsillitis.
In 1953 Cook reported on a vaccine being mass produced in the USA – the Salk Vaccine. In 1955 the Poliomyelitis Committee met at the Commonwealth Serum Laboratory (CSL) in the context of reports of deaths from faulty vaccines in the USA and reports of problems with quality control in other US vaccine manufacturers. Administration of a mass vaccination campaign with a new vaccine is a highly complex matter involving Commonwealth and State authorities, the supply, storage and distribution of the vaccine, determination of the optimal dose, and surveillance for effectiveness and safety. Suffice it to say that, should a vaccine for COVID-19 become available, Australia could well look to Cook’s role with the Salk Vaccine as a textbook model to follow, and profit from his experience as laid out in Barry Leithhead’s carefully researched and very readable book, A Vision for Australia’s Health.
Of course, Cook’s work with poliomyelitis is simply a small part in a stellar public health career which spanned pioneering public health work in the Northern territory, Western Australia and in military service, in fields which included, amongst others, leprosy, Aboriginal health, tobacco smoking and lung cancer, reducing infant mortality and still births, food additives and standards, and reforms for the control of malaria and scrub typhus in the military.
He combined intelligence, persistence in the face of opposition, training (in medicine, public health and tropical medicine, and anthropology) and the incorporation of a scientific approach into health and medical administration. He was a visionary who ‘saw problems on a national scale’ and in the context of both past history and of the future horizon. He was a giant of public health in Australia and Barry Leithhead’s account of his life does him justice.
Dr Ring was head of the School of Public Health and Tropical Medicine at JCU, Foundation Director of the Australian Primary Health Care Research Institute at ANU and Principal Medical Epidemiologist, Qld Health.
He has contributed a lifetime of work on public health aspects of cardiovascular disease, cancer epidemiology and Australian Aboriginal and Torres Strait Islander health, which has greatly contributed to knowledge as well as informing policy for both government and non-governmental organisations at national and international levels. He has done this work through James Cook and other Universities, state and federal governments, and through various professional organisations for more than 40 years.