Letter

Remembering past pandemics to ensure we plan for the future: updated New Zealand survey of memorials to the 1918 influenza pandemic Nick Wilson, Geoffrey Rice, George Thomson, Michael G Baker

ew Zealand has had a problem with insufficient pandemic plan- Methods ning, as indicated by its low score We followed the methods of a previous N 1 5 on a validated Global Health Security New Zealand survey with the same defi- Index in 2019.2 This inadequate planning nition of a pandemic-related memorial. We probably meant that the country needed conducted internet searches for new memo- to have a national lockdown to successful- rials (the last search was on 8 August 2020), ly control COVID-19, in contrast to a very along with field research for all the new well-prepared jurisdiction such as Taiwan memorials we identified. Field visits were (which achieved elimination of COVID-19 conducted between December 2018 and without needing a lockdown).3 This plan- August 2020. ning deficit is even more notable when considering that New Zealand may be the Results second-most-optimal island refuge for A national memorial was identified, humanity in the case of a pandemic that the first such national-level memorial for 4 threatens human extinction. this pandemic created in New Zealand Memorialisation of past pandemic (Table 1). In addition, four new local memo- disasters may serve as a visual public rials were identified: two in , reminder of persisting pandemic threats one in Waimate and one in New Plymouth. and the need to invest in prevention and pandemic planning (as argued previ- Discussion ously).5 With this in mind, we aimed to This survey now brings the total number provide a best current estimate of the of publicly accessible memorials that refer number of physical memorials to the 1918 to the 1918 influenza pandemic in New influenza pandemic in New Zealand. This Zealand to 12, which includes one new pandemic killed an estimated 9,000 New national memorial. Worldwide, it appears Zealanders,6,7 and, at its peak, an estimated very rare to have a national memorial to 440 people died in a single day, equivalent the 1918 influenza pandemic. In addition to to 1,820 deaths in today’s numbers this new one in New Zealand, we only iden- (Figure 1). We also aimed to extend a tified one other national memorial, which previous analysis5 to include the 2018 was in Samoa.11 However, there are a few centennial year to see whether that anni- memorials to specific groups (eg, the Lueg versary had generated additional interest Monument in Switzerland to Bern caval- in memorialising this event. rymen who died in the pandemic).12

NZMJ 15 January 2021, Vol 134 No 1528 ISSN 1175-8716 © NZMA 111 www.nzma.org.nz/journal Letter

The relative lack of memorials to the 1918 announced approval for a large, multi-mil- pandemic contrasts markedly with the high lion-dollar national Erebus memorial to prevalence of war memorials in the New be built in a Parnell park to commemorate Zealand setting. That is, there are now 1.3 the 257 people who were killed when an publicly accessible pandemic memorials per Air New Zealand plane crashed into Mount 1,000 deaths, in contrast to 31 memorials per Erebus in 1979.15 1,000 deaths for World War I and World War Nevertheless, it may be desirable to II combined and 213 memorials per 1,000 move away from the conventional idea 5 deaths for the South African War. Interna- of the physical memorial, as argued for tionally, the lack of memorialisation of past previously in New Zealand, and towards 13 pandemics has also been noted. a research fund as a ‘living memorial’.8 The national war memorial at Pukeahu Such alternatives are also being considered National War Memorial Park in internationally (eg, various digital projects also has qualitative differences compared to relating to the COVID-19 pandemic).13 the national memorial to the 1918 pandemic: In summary, we identified an addi- it completely dwarfs the scale of the national tional five memorials to the 1918 influenza memorial to the 1918 pandemic, which is in pandemic, bringing the total number a corner of this same national war memorial of publicly accessible memorials to 12. site. Similarly, the memorial to the Christ- Nevertheless, New Zealand needs to church earthquake of 2011 that caused 185 further consider how it memorialises past deaths (a photo of which is in another New pandemics—and to make better use of such 14 Zealand disaster memorial study) is vastly memorials to constantly remind the public greater in scale than the national memorial and the government to invest adequately to the 1918 pandemic. Continuing the same in pandemic prevention and pandemic pattern, Auckland Council has recently planning.

Figure 1: Photograph of 440 students at Wellington College symbolically representing the worst day for deaths from the 1918 pandemic in New Zealand (photo by Luke Pilkinton-Ching, University of Otago, Wellington, 2018).8

NZMJ 15 January 2021, Vol 134 No 1528 ISSN 1175-8716 © NZMA 112 www.nzma.org.nz/journal Letter

Table 1: Identified physical memorials to the 1918 influenza pandemic in New Zealand.

Memorial Further details New memorials identified in this updated survey (n=5)

National influenza The memorial was unveiled by the Prime Minister, the Rt Hon , on 6 pandemic memorial at November 2019.9 A specific feature is that, in addition to the memorial being dedicated Pukeahu National War to the victims, the role of others is acknowledged: “The service of the health profes- Memorial Park, Wellington sionals and many volunteers who risked their own lives to care for their communities is gratefully acknowledged.” It also states that “This disaster shaped modern approaches to managing infectious diseases, helping to protect future generations.” The memorial is adjacent to a building that functions as an educational centre, which had additional information on the pandemic (at least at the time of the memorial’s unveiling event).

Memorial to Christchurch The memorial titled Remembering Black November is in the form of an information victims (sited in central board with the image of a grave headstone that refers to the 462 Christchurch resi- Christchurch City) dents who died from the pandemic. The information includes mention of the strong volunteer response in this city, which potentially contributed to the relatively low total mortality rate in Christchurch compared with other New Zealand cities. It was erected by the Christchurch City Council in the centennial year of the pandemic (2018). The information board is located just south-east of the intersection of Hereford Street and Cambridge Terrace.

Memorial to those who This memorial is the only one in the country that refers to deaths in a whole region. It died in the Taranaki region specifically mentions the relatively high mortality burden borne by Māori and includes (sited in New Plymouth text in te reo Māori. It was erected on the 100th anniversary of the pandemic in City) November 2018.10

Memorial to Dr Margaret A giant portrait of this doctor was painted on a grain silo in the town of Waimate in 2018. Cruickshank (Waimate) Near the base of the silo is an associated and publicly accessible information board that discusses her role as a doctor in the 1918 pandemic (which ultimately killed her). This memorial is in addition to the two other memorials to Dr Cruickshank (see Previously identified memorials in Table 1). However, all these memorials are also likely to reflect her contribution as a hard-working local doctor and New Zealand’s first woman general practitioner.

Memorial plaque for those This memorial plaque is attached to a seat by the Avon River, Christchurch (near 24 Ox- who died in Christchurch ford Terrace). It was erected in July 2020 by the Canterbury History Foundation. It is in memory “of the 460 Christchurch victims.” It also notes that “over 9,000 New Zealanders died in this pandemic, including 2,500 Māori.”

Previously identified memorials5

Publicly accessible (i) Granite memorial to the 1,128 citizens of Auckland who died in the pandemic memorials (n=7)5 (Waikumete Cemetery, Glen Eden, Auckland); (ii) headstone on grave raised by public subscriptions for the nurse Jessie Linton (Shortland Historic Cemetery, Thames); (iii) the Featherston Military Camp memorial obelisk and adjacent memorial wall (Featherston Cemetery, Featherston); (iv) marble statue of Dr Margaret Cruickshank with information board (Seddon Square, Waimate, South Canterbury); (v) grave of Dr Margaret Cruick- shank and associated information board (Waimate Old Cemetery, Waimate); (vi) plaque for nurses and a doctor who died and a detailed information board in the Christchurch Nurses’ Memorial Chapel (Christchurch Hospital site, Christchurch); (vii) plaque for nurses who died (Chapel in Dunedin Hospital, Dunedin).

Other memorials This grouping includes pandemic-related memorials with restricted access because they are in private settings, or which do not specifically refer to the pandemic in the text on the memorial. There are another 11 memorials in this category, as detailed in a previous survey.5

NZMJ 15 January 2021, Vol 134 No 1528 ISSN 1175-8716 © NZMA 113 www.nzma.org.nz/journal Letter

Competing interests: Nil. Author information: Nick Wilson: Professor, University of Otago, Wellington. Geoffrey Rice: Emeritus Professor, , Christchurch. George Thomson: Associate Professor, University of Otago, Wellington. Michael G Baker: Professor, University of Otago, Wellington. Corresponding author: Professor Nick Wilson, University of Otago, Mein St, Newtown, Wellington, New Zealand. 64+ (4) 021 2045523 [email protected] URL: www.nzma.org.nz/journal-articles/remembering-past-pandemics-to-ensure-we-plan-for-the- future-updated-new-zealand-survey-of-memorials-to-the-1918-influenza-pandemic

REFERENCES 1. Boyd MJ, Wilson N, Nelson Health Disaster. Christ- New Zealand (24 August C. Validation analysis of church: Canterbury 2019). https://www.rnz. Global Health Security University Press, 2017. co.nz/international/ Index (GHSI) scores 2019. 7. Summers JA, Baker M, pacific-news/397372/ BMJ Glob Health 2020;5. Wilson N. New Zealand’s remember- 2. Boyd M, Baker MG, experience of the 1918- ing-the-lives-lost-in-the-in- Nelson C, Wilson N. 19 influenza pandemic: fluenza-epidemic-in-samoa. The 2019 Global Health a systematic review 12. Whitmarsh A. Swiss Security Index (GHSI) after 100 years. N Z memorials of the First and its implications for Med J 2018;131:54-69. World War. 2015;(5 New Zealand and Pacific 8. University of Otago. Call for November). http://www. regional health security. pandemic research fund switzerland1914-1918. N Z Med J 2020;133:83-92. as “living memorial” to net/blog/swiss-memorials- 3. Summers J, Lin H-H, 1918 flu victims. University of-the-first-world-war. Cheng H-Y, Telfar Barnard of Otago Media Release 13. Shoot B. The rare challenge L, Kvalsvig A, Wilson N, 2018;(14 December). https:// of building a pandemic Baker M. Potential lessons www.otago.ac.nz/news/ memorial. City Monitor from the Taiwan and New news/otago701754.html. 2020;(9 June, updated 19 Zealand health responses 9. Manch T. Influenza October). https://city- to the COVID-19 pandemic. pandemic that killed monitor.ai/community/ Lancet Regional Health 9000 memorialised in the-rare-challenge-of-build- Western Pacific 2020;https:// Wellington. Stuff 2019;(6 ing-a-pandemic-memorial. doi.org/10.1016/j. November). https://i. 14. Wilson N, Jones AC, Rice G, lanwpc.2020.100044. stuff.co.nz/national/ Thomson G. Epidemiology 4. Boyd M, Wilson N. The politics/117209806/ of major disasters in New Prioritization of Island influenza-pandem- Zealand as revealed by Nations as Refuges from ic-that-killed-9000-memo- disaster memorials. N Z Extreme Pandemics. Risk rialised-in-wellington. Med J 2019;132:104-07. Anal 2020;40:227-39. 10. Groenestein C. Forgotten 15. Auckland Council. Local 5. Wilson N, Ferguson C, Rice 1918 flu victims now board gives approval for G, Baker MG, Schrader B, have a memorial in New national Erebus Memorial Clement C, Thomson G. Plymouth cemetery. Stuff in Dove-Myer Robinson Remembering the 1918 2018(10 November). Park. Auckland Council influenza pandemic: https://i.stuff.co.nz/ 2020;(17 November). national survey of memori- national/health/108506823/ https://ourauckland. als and scope for enhancing forgotten-1918-flu-victims- aucklandcouncil.govt. educational value around now-have-a-memorial-in- nz/articles/news/2020/11/ pandemic preparedness. new-plymouth-cemetery. local-board-gives-ap- N Z Med J 2017;130:53-70. 11. Radio New Zealand. proval-for-national-ere- 6. Rice GW. Black Flu Remembering the lives bus-memorial-in-dove- 1918: The Story of New lost in the influenza myer-robinson-park/. Zealand’s Worst Public epidemic in Samoa. Radio

NZMJ 15 January 2021, Vol 134 No 1528 ISSN 1175-8716 © NZMA 114 www.nzma.org.nz/journal