Winning and losing in centuries-long struggle for vaccine recognition

Foreign Bodies: Pandemics, Vaccines and the Health of Nations
Simon Schama
Simon & Schuster

Simon Schama is best known as a chronicler of art and European history, so it is perhaps surprising to find him immersing himself in the subjects of pandemics and immunology and their resulting fallout. But the Covid-19 pandemic and lockdown did strange things to all of us. Schama admits that at the beginning of the pandemic he was working on a completely different book, but events changed his mind.

However, most of Foreign Bodies does not deal directly with Covid. The main canvas is the 18th century and 19th century struggle to combat smallpox (in Britain), cholera (in France and Asia) and plague (in India) by developing immunisation that would stop these diseases which had ravaged populations throughout history.

Vaccination of different kinds had been practised in parts of the world, often remote parts, for a very long time before the mainstream medical profession took an interest. Of course, then as now, once immunisation became available, the anti-vaccination brigade became vocal and often dangerous.

Schama looks at the lives of heroes and heroines of the cause of immunology including Lady Mary Wortley Montague, Adrien Proust, who was the father of the more famous Marcel, and, above all, Waldemar Haffkine from Odessa. Slowly discoveries were made about how bacteria and viruses operate and, therefore, how to combat them and how to use the body’s own immune responses, but it was slow and dangerous work.

Inevitably it was also political. A good deal of Schama’s energy is taken up with this aspect of his subject. There was huge international rivalry. The Brits distrusted and resented the Pasteur Institute in Paris because it was French. Haffkine, the Jew from Odessa who did extraordinary work in treating cholera and plague, was distrusted and disliked by the British Raj in India because he was perceived to be an outsider, a potential Russian spy and, above all, “one of them” — a Jew.

In 1903 two million people died of plague in India, a figure that would rise exponentially before antibiotic treatment began to be used in the late 1920s. The British authorities in the Raj believed in the draconian measure of destroying people’s homes and possessions in the name of improving sanitation even though Haffkine and others realised, and said, it was ineffective, and that vaccination was the way to go. But a tragedy when a batch of vaccine was contaminated by tetanus at a vaccination site brought an abrupt and humiliating end to his career. It was deemed to be his fault, though eventually the authorities had to climb down and admit they were wrong. But the damage was done.

In 2022 and 2023, outbreaks of cholera occurred in parts of the world, including South Africa and Mozambique. Vaccines were in short supply globally and Schama raises the need for an international response to such events, but it is still bedevilled by politics and rivalries. Not even Covid has managed to change this in a truly meaningful way.

The final part of Schama’s book deals with Covid and the lunatic fringe in the US who have called for Anthony Fauci, the face of the American immunisation campaign, to be publicly killed. For them, vaccination seems to be an affront to civil liberties, and rather than be injected, they would like to take a veterinary drug that has been proven ineffective,  except for its original veterinary purpose. They are as dangerous as their forerunners were centuries ago.

The book makes a strong plea for universal rather than nationalistic endeavour to control our environment and the challenges it throws at us. Schama’s research is considerable, and Foreign Bodies is a solid read, but it is never less than fascinating, and sobering.