Though Schama is a prolific writer, I hadn’t read any of his books until now. His writing style in the book is narrative and revolves around the emergence of vaccines and the practice of vaccination for three major pandemics in the past centuries. Namely, the global smallpox epidemics in the 18th century and the outbreaks of cholera and the plague at the end of the 19th and the beginning of the 20th century.
Lemonade not the miracle cure for smallpox
Both France and England faced major outbreaks of smallpox in the 1720s and 1730s. Not only children contracted the disease; adults were not spared either. If they did not die from it, they often wore disfiguring scars. The French writer and philosopher Voltaire did not escape the smallpox virus either. He was on the brink of death but ultimately fully recovered. Initially, he attributed his recovery to the excellent care he received and the copious amounts of lemonade he drank during his sick days.
Much was unknown at that time about how the disease originated and how to combat it. Lemonade was certainly not the miracle cure. However, initial reports emerged of residents from the Caucasus and the Ottoman Empire who fought smallpox in a very different way. Fluid was taken from a smallpox blister on a sick child and simultaneously injected into a healthy child. That healthy child quickly showed symptoms but recovered within a few days. Most importantly, they survived without any lasting scars.
The Englishwoman Mary Wortley Montagu witnessed this practice firsthand during her stay in the Ottoman Empire. Back in England, she began promoting the method. The English, however, were initially resistant to the idea. This was despite the fact that a few hundred kilometers further, the Scots were employing virtually the same procedure. It would take considerable effort before vaccination against smallpox in this manner gained widespread acceptance in England and on the continent.
Haffkine: The Man Behind the Cholera and Plague Vaccines
A century later, it was primarily cholera and the plague that emerged in various places in Europe and Asia from time to time. Increased trade between continents facilitated the spread of these diseases. However, while carriers of the diseases, both human and animal, became less confined by borders, the fight against these diseases remained a national matter. Each country affected by cholera or the plague took its own measures. Only after years of lobbying by physician Adrien Proust, the father of writer Marcel, did a cautious beginning emerge for a global approach to pandemics around 1900.
Adrien Proust is one of the figures highlighted in the book. He travelled extensively around the world to witness firsthand the consequences of various outbreaks. However, for the development of vaccines against these diseases, other individuals played more significant roles. Notably, Waldemar Mordechai Wolff Haffkine developed vaccines for both cholera and the plague. Schama elaborates extensively on his vaccination efforts in India and his personal background.
Haffkine was born in 1860 in Odessa and had a Jewish background. In the 1870s and 1880s, frequent pogroms against Jewish inhabitants took place in Russia. As a student, Haffkine joined the Jewish resistance against them. This ultimately made studying and working in Russia impossible for him. Haffkine then left for Europe, and through Geneva, he arrived at the Institut Pasteur in Paris, led by Louis Pasteur.
The Institut Pasteur had opened its doors in 1888 and was developing vaccines, for instance, against smallpox and rabies. In 1892, Haffkine succeeded in developing a vaccine for cholera. He tested it on himself, observing no lasting harmful side effects. But where could he test the vaccine on a larger scale? The opportunity arose in India from 1893 onwards. The British colony was grappling with a significant cholera outbreak. From that year on, Haffkine would frequently travel between India and England for 20 years.
Resistance to Vaccinations
From the outset, there was resistance to vaccination among the English medical services. This was the case for both the cholera vaccine and, a few years later, the plague vaccine. This resistance had various reasons. First and foremost was the person, Haffkine himself. A Russian who had spent some time in prison in his homeland due to the Jewish resistance against the pogroms. A Russian who had also worked in France. At the end of the 19th and the beginning of the 20th century, European countries did not collaborate harmoniously in the field of bacteriology and infection control.
While the French and the Germans emphasized the importance of vaccination, the English adopted a completely different strategy. Both during the plague outbreak in China in the early 1890s and the cholera and plague outbreak in India later that decade, the English mainly focused on hygiene. When the English identified a source of any of these diseases, residents of the affected building or district were promptly evacuated, the houses disinfected or demolished. The English also prioritized hunting rats and other animals identified as the culprits of the diseases. It would take years before the English embraced vaccination against cholera and plague as a cornerstone of their health policy, and even then, with significant reservations.
In addition to dealing with English skepticism towards vaccinations, Haffkine also had to contend with distrust among the Indian population itself. Both Hindus and Muslims made it challenging for vaccinators. For instance, women and girls were not allowed to be vaccinated or examined by a man. The external symptoms of the plague manifest in the armpits and around the genitals, areas off-limits for unfamiliar men.
The Decline of Haffkine
Bit by bit, Haffkine succeeded in vaccinating as many Indians as possible against the plague. To better facilitate his efforts, he was allowed to reside in a former colonial governor’s mansion in Bombay in 1899. There, he established the Plague Research Laboratory. Millions of vaccines were produced there, but in 1902, things went terribly wrong for Haffkine. That autumn, a vaccination in the town of Makowal (in Punjab) went awry. Due to a contaminated vaccine, 19 people died post-vaccination. The English immediately halted the vaccination program, and an investigation into the cause of the contamination began.
The investigative committee concluded that the contamination had occurred in the laboratory, and Haffkine was dismissed from his position as its head. He vehemently claimed his innocence, and after five years, with the assistance of a fellow scientist friend, he finally managed to clear his name. It quickly became apparent that the contamination in Makowal had occurred when the cap of a vaccine bottle fell on the ground and wasn’t adequately cleaned, causing the tetanus virus to mix with the vaccine. However, the English medical authorities were unwilling to reverse their erroneous conclusion for many years.
Once his name was cleared, Haffkine was allowed to return to India, this time to Calcutta. However, he was no longer allowed to be involved in the actual production of vaccines. In 1914, he finally left India for good. Afterward, he spent time in the US and briefly returned to Odessa. He passed away in Swttzerland on October 25, 1930.
Vaccination Then and Now
From the story about Waldemar Haffkine and other pioneers in the field of vaccination, whom I don’t mention further due to the length of this article, it becomes evident that they laid the foundation for the current method of vaccination. While for the smallpox vaccine it was still necessary to extract the ‘vaccine’ directly from the source and inject it immediately into the recipient, the vaccination process for cholera and the plague was much more professional.
The vaccines against cholera and the plague were first developed and tested in a laboratory environment on animals. They could also be stored for some time. This facilitated the administration of the vaccines in remote areas. Moreover, there was no longer a need for human donors. The core principle for the vaccines remained the same, using human or animal cells containing the virus to develop the vaccine against it.
Haffkine also introduced the control group. At every location where he vaccinated, there was also a group of people who did not receive the vaccine. He meticulously studied the differences in outcomes between the vaccinated and the unvaccinated. This has become standard practice today.
And yes, finally, just as at the end of the 19th and beginning of the 20th century, in 2023 there remains significant resistance to vaccination per se. This resistance comes not only from religious beliefs, but also from distrust towards the vaccine itself. The recent coronavirus pandemic has proven this. In the last chapter, Schama delves deeply into the unwarranted criticisms of Dr. Fauci and his COVID-19 policies by, for instance, Republican congress members and (far) right-wing radio hosts.
I believe that this distrust will persist, primarily due to social media. Therefore, it’s beneficial that a book like Foreign Bodies by Simon Schama exists. It demonstrates where we’ve come from and how we can prepare for future pandemics. Schama is also convinced that new pandemics will inevitably occur.
