'No concept of how awful it was': the forgotten world of pre-vaccine childhood in Australia

It is 1940 and a five year-old boy lies in an air-conditioned tent. He struggles to breathe and has hallucinations that his leaden soldiers, who are marching around the room and terrorizing him with their bayonets, are alive.
He has diphtheria. This is also known as The Strangling Angel. Although there is a vaccine available, not all children have been vaccinated. The bacterial infection causes a membrane to form at the back of your throat that cuts off air supply.

The mother of the little boy, who is sat in desperate vigil near the oxygen tent, had seen diphtheria kill other children.

In the end, it will not take her son. He will be able to breathe again after the membrane fails to completely close his airway. He will attend the funerals for his classmates who have died from polio and diphtheria. In time, he will run with his friend, who was born blind due to rubella. To help his friend reach the finish line, he will rattle a rock in a can.

Children he has known for their health will die during his schooling.

Tom Keneally, five years old, said that he would like to have anti-vaxxers taken back in time shortly before he contracted diphtheria. Photograph by Supplied

He will survive, if he is lucky. At 85 years old, he is still living. He is my father. His name is Tom Keneally.

Keneally stated that one of the brothers, the Christian Brothers of St Patricks College Sydneys Strathfield, would occasionally come into the classroom and inform us of a death. We would pray a decade of Rosary for them and the brother would tell us that God only takes the best children. I would be glad I wasn't one of them.

As children, it didn't seem like a constant threat because we were living our lives. However, for our parents, I believe that was always the case.

Australian children receive hepatitis B vaccinations shortly after their birth. They are vaccinated against a variety of diseases, including diphtheria and tetanus (whooping cough), meningococcal and pneumococcal diseases, and measles (chickenpox).

Certain vaccines may also help prevent certain cancers later on in life. Professor Raina MacIntyre of the Kirby Institute's Biosecurity Research Program and professor of global biosecurity, University of NSW, points out that the hepatitis B vaccine protects against liver carcinoma, while the human papillomavirus vaccine protects against penile and cervical cancer.

McIntyre states that people don't remember the gains they have made.

Infectious disease was the leading cause for death among children in the 19th century. There would be 10 children, and five deaths. She says that we lived with high infant mortality rates.

In addition to two world wars and numerous other diseases, the first half century saw an outbreak of bubonic plague, a Spanish flu pandemic, and several other epidemics.

Childhood was made precarious by the lethal diseases that plague the population, such as the crippling polio and the choked diphtheria.

In intensive care, child in oxygen tent. 1950-1959 Photograph: Australian Photographic Agency/State Library of NSW

In 1911, one in thirty children died of gastroenteritis in the United States. According to the Australian Institute of Health and Welfare, more than 300 people died from infectious diseases in every 100,000 people in 1907. In 2019, this number was around 10.

Modern parents have relegated disease names such as polio, smallpox, and diphtheria to obscure words that are of no practical use. Experts warn that these terrible diseases are no longer fatal for Australian children. However, there is a danger of complacency.

David Isaacs, a clinical professor in paediatric infectious disease at the University of Sydney and author of Defeating The Ministers of Death: The Compelling History of Vaccination, says that the public's awareness of the ravages of Polio and the fact that many people knew someone who had lost a child to it were powerful motivators. It is something that many younger people don't realize how terrible it was.

Tom Keneally's diphtheria infected was not his last hospitalization as a child. He was recovering from pneumonia in 1944, near a boy with polio who was being kept alive in an iron lung. He was studying for his Leaving Certificate, which is the precursor to the HSC.

Keneally said that he had a bracket over his head where textbooks could be slid in. His mother was always there to turn pages and change books. That's how he learned.

An iron lung is used to keep a child alive at the Children's Hospital in May 1938. Photograph by Olson/State Library of NSW

He learned that the boy had died after a power outage rendered his iron lung inoperable.

Dr Peter Hobbins is a medical historian at Australia's National Maritime Museum. He says that polio still kills children in the 1950s.

It was part of Australian life. Many people don't realize how prevalent many diseases were until recently. He says that there is less awareness of the effects of these diseases and people don't appreciate the fear of sending their children to school, or having them return home.

We are fortunate not to be seeing any new cases of Polio, but there are still people who are suffering from the effects of the disease and feel neglected.

There were some successes, however, such as the elimination of smallpox. Isaacs claims that it killed approximately one third of all babies born in London in the 18th and early nineteenth centuries. It was eradicated by 1980 after a campaign started by the World Health Organization in 1967.

In the 1800s, Australia received its first smallpox vaccine. It did not do any good for the Eora nation. The colonists introduced smallpox in 1789. It decimated the Aboriginal population in Sydney, killing as many as 70%.

Although smallpox no longer poses a threat to the public, MacIntyre warns us that other diseases we may have forgotten about can quickly return if vaccine rates drop.

She cites the example of the Soviet Union's fall. There were many good vaccine programs. However, when the Soviet Union collapsed, many of them stopped being run.

The number of cases of diphtheria, previously almost unheard-of due to vaccination, soared to 140,000 and the disease claimed the lives of 4,000 children and young people.

MacIntyre states that if we stopped giving diphtheria vaccines here, we would also see the same.

Despite their lifesaving properties, vaccines are often met with suspicion. Hobbins believes that a 1928 tragedy had an impact on diphtheria vaccinations, but it could also have increased vaccine safety.

The Bundaberg Tragedy or the Serum Tragedy was named after it. He claims that a batch of diphtheria vaccine contaminated by Staphylococcus Aureus was administered in high doses to 20 children. Twelve of them died.

Diptheria vaccination, 25 March 1940. Photo: State Library of NSW

Although an outbreak of diphtheria could kill 12 children per 20 children, it set the stage for vaccinations back many years. One consequence of this tragedy was an increase in quality testing and manufacturing standards that drastically decreased the chance of vaccines becoming contaminated.

Although vaccine mandates can be used to counter vaccine hesitancy and sometimes even work in the opposite direction, they can backfire. Isaacs, "Defeating the Ministry of Death" describes the 80,000 strong protests that took place in Leicester, UK, in late 19th-century response to a smallpox vaccine requirement.

Because vaccine hesitancy does not concern intelligence, I believe in negotiation and respecting others' intelligence. He says that a lot of vaccine hesitancy is based in fear and misunderstanding, and that we don't want to alienate anyone.

If you have a good relationship with someone, you may be able to bring them around. This is why I believe in the power of GPs to spread those messages.

He says that the Australians support childhood immunizations.

Thomas Keneally is an Australian playwright, novelist, and essayist. Photograph by Murdo MacLeod/The Guardian

About 95% of children receive routine childhood immunizations. This is enough to provide herd immunity so there's no epidemic spread of measles.

MacIntyre is in agreement.

Australia has high vaccination rates. She says that the anti-vaxxers rate is around 2%.

It's not vaccine hesitancy that is the problem, but vaccine confusion [with Covid-19 vaccinations]. We can achieve high rates of vaccination [against Covid-19] here in Australia, I believe.

Tom Keneally is aware of what he can do to change the perspective of anti-vaxxers who are committed.

I would like to go back in time and take anti-vaxxers with me to my childhood. Every street would have a story that could change their minds.