Foreign Bodies: Pandemics, Vaccines, and the Health of Nations

  • By Simon Schama
  • Ecco
  • 480 pp.
  • Reviewed by Jay Hancock
  • September 20, 2023

Anti-science hysteria is nothing new. (Ivermectin, anyone?)

Foreign Bodies: Pandemics, Vaccines, and the Health of Nations

History will see covid-19 vaccines as a scientific triumph won in record time. Vaccines prevented between 14 million and 20 million deaths in 2021. Katalin Karikó and Drew Weissman will receive the Nobel Prize for vaccine-related research on messenger RNA.

Meanwhile, public-health officials have been under attack for recommending vaccines, masks, and isolation. Senator Rand Paul urges resistance against “petty tyrants and bureaucrats,” especially Dr. Anthony Fauci, the United States’ former top infectious-disease official. One in five Americans thinks covid vaccines probably killed more people than covid, a new poll shows.

Here is Simon Schama’s theme: the glory and the cussedness of humans threatened by infectious disease. His Foreign Bodies isn’t about the recent pandemic, but the reader soon realizes that once covid ambushed the world in 2020, Fauci, Paul, and others were fated to reprise roles written long ago and acted many times.

Angelo Gatti, a medical professor practicing in the 1760s, recognized the microbial cause of smallpox, promoted inoculation in Italy and France, and inspired experiments that sound a lot like a modern clinical trial. “An unsung visionary of the Enlightenment,” Schama calls him. Gatti expected speedy acceptance of his methods, writing that he had “always thought that it was enough to let inoculation be justified by its evident success” against “the ravages inflicted by the pox.”

Poor Dr. Gatti. “I was mistaken in all that,” he realized later.

Instead of thanks, he got rejection and “malicious personal abuse,” writes Schama. Attacks came from anti-inoculators, as well as from competitors using techniques inferior to Gatti’s simple, effective poke.

Schama is a British historian known from the BBC and books on the French Revolution and early modern Netherlands. Here, he engagingly investigates science vs. germs — smallpox in the 1700s, cholera and plague in the 1800s. It’s not a full account, however, even for the period covered. Edward Jenner, inventor of the smallpox vaccine, is barely mentioned, and Louis Pasteur is unavoidable but flits in and out. Instead, Schama is interested in lesser-known bug-seekers slighted by history. (Gatti doesn’t even have an English Wikipedia entry.)

One, Adrien Proust, epidemiologist and father of Marcel, published eyewitness plague reports from Bombay and Karachi and argued for a permanent, international health agency. Another, Alexandre Yersin, co-discovered yersinia pestis, the eponymous plague bacillus.

Schama is drawn especially to public-health martyrs vilified, like Fauci, for their expertise. Waldemar Haffkine was a Russian-French bacteriologist who invented vaccines for cholera and plague, tested them on himself, and produced millions of doses for India and Africa in the first factory-scale vaccine production. The British Medical Journal praised his “remarkable self-sacrifice” and “love of humanity.”

Yet Haffkine and his whole project came under suspicion after a small batch of plague vaccine, contaminated with tetanus through a local technician’s carelessness, killed 19 people in 1902. He was banned from his own lab, lost influence, and became “a spent force” at the age of 48. (Born in Odessa, Haffkine is posthumously being named a Ukrainian hero.)

No vaccine works all the time. Covid shots shield against severe illness but fail to limit contagion. Gatti’s reputation suffered when a duchess contracted smallpox three years after he inoculated her. The imperfection of effective treatments is part of the story. So are overreactions — real or perceived — by authorities.

A British military committee ordered inspections, quarantines, and house demolitions after thousands began dying of the plague in Bombay in 1896. Indians rebelled, especially against the mixing of castes in infirmaries and the probing of female groins and armpits for buboes. Jains, respectful of all life, blocked and threatened rat exterminators targeting a deadly vector. Hindus and Muslims, often in conflict, rose together to riot and strike against the lockdowns. (Disease-fueled political fractures ran deep. It was now that Indians discovered “the forces which would ultimately break the Raj — social and religious outrage, and mass strikes and demonstration,” Schama notes.)  

The foreign bodies of the book’s title are deadly microbes but also inoculating agents feared by many patients. They are the outsiders spreading disease but also the elites wielding power in the name of fighting it. The British refused to admit that their ships had anything to do with bringing cholera to Egypt in the 1880s. It had to be the French. Europeans blamed the Ottoman Empire for cholera. The Turks warned against the “European microbe.”

Pro- and anti-vaxxers often sort themselves into political tribes. Accepting smallpox immunization in 18th-century Europe “became a sign that one belonged to the enlightened classes,” Schama explains. Others, meanwhile, rage at the experts ordering them around. One way to retaliate is with unapproved remedies, the ivermectin and hydroxychloroquine of their day: chilled wet sheets against smallpox; cow dung, slit frogs, and totemic pickets to ward off plague.

Schama seems to faintly hope that science and global management will someday prevail. “The need for an alternative, transnational approach to containment, mitigation and protection…has never been more urgent,” he writes in his introduction. Then he spends the next 400 pages showing why this is never going to happen.

Immunologist Paul Offit told NPR a few weeks ago that he once believed the covid vaccine’s success would be obvious to everybody. “I thought people would just rush to get it and 100 percent of this population would be vaccinated and that the anti-vaccine movement would be neutered,” he said. “Wrong.”

It’s the same mistake Angelo Gatti made centuries ago. The pathogens have changed since then. The host organism hasn’t.

Jay Hancock writes about history and economics. His work has appeared in KFF Health News, where he worked for 10 years, the Baltimore Sun, the New York Times, and the Washington Post. His free Substack newsletter is here.

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