“Humans are a marvel of ingenuity, yet we seem to exist in this great pond of primitive terror and paranoia”: Simon Schama on pandemics and vaccines

This, suddenly, felt very much like the right subject for a book. My wife is a biologist, so I asked her: “Is this ridiculous? Will I perish with a terminal case of imposter syndrome?” But she encouraged me. I think something happens when you’re a really old geezer, too: you either want to escape completely into a hobby – Byzantine coinage in the 11th century, perhaps – or, if you’re like me, you only want to do history with an immediate link to what’s happening right now.

The first section of your book focuses on the fight against smallpox. How disruptive was that disease at its peak in Europe?

It was extraordinarily contagious and apocalyptically terrifying. It ran amok in crowded urban environments, killing as many as one in three people who contracted it. Plague had been even more frightening in the late Middle Ages and 17th century, but had somewhat retreated by the early 18th century, so people had been lulled into a false sense of security. Within 100 years, fortunately, there was a great breakthrough against smallpox with the first mass inoculation campaign.

Plague had been even more frightening in the late Middle Ages and 17th century, but had somewhat retreated by the early 18th century, so people had been lulled into a false sense of security

It seemed such a counterintuitive thing to do: put inside your body the very thing responsible for so many deaths. This benevolent self-poisoning was an astonishing psychological barrier, and it’s still amazing to me that people have eventually come to accept it in such large numbers.

What were the key factors in persuading people that inoculation was a good thing?

It helped – in Britain, in particular – that the royal family was converted. Lady Mary Wortley Montagu, the wife of the British ambassador to Constantinople, had survived a terrifying attack of smallpox herself, and had also heard stories of women escaping death from the disease. Her curiosity led her to believe that the process of inoculation – taking pus from a smallpox victim and pre-emptively injecting it into yourself – would save you.

She was a born publicist with lots of important social and literary connections and, when she came back to Britain in 1718, she converted Caroline of Ansbach, the Princess of Wales, to her cause. Smallpox was a real worry among the royal dynasties of the time, because it was mowing down princes and empresses around Europe. Then, because the royal family was doing it, the press started reporting what was happening.

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There was, of course, committed opposition – particularly from clerics, some of whom preached that inoculation was interfering with God’s judgment. But by the 1720s, the cause had been taken up by various doctors and had become more than a mere fashion. One of the figures in my book is Thomas Nettleton, a doctor in Halifax who inoculated as many people as he could in the area. Crucially, such individuals sent their results to the Royal Society, which collected the data – that struck me as very modern.

Your book profiles a series of remarkable individuals such as Mary Wortley Montagu. But are there wider cultural forces at play, too?

The 18th century was a very interesting moment in the relationship between science and religion. I think the extent to which the period was non-religious is sometimes overstated, because the rise of evangelical faith was a very important aspect of the century.

However, it’s true to say that facing pandemic after pandemic had weakened people’s willingness to be passive in the face of ‘divine judgment’. There was a growing belief that science and human ingenuity might be able to do what God seemed indifferent to or incapable of doing. So this was a real sea-change moment.

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You also explore the 19th-century spread of cholera. What was its impact?

Cholera was pretty unknown in Europe until the early 19th century so, again, people were unprepared for this horrifying disease. If you caught it, you quickly died a very unpleasant death, losing all of your bodily fluids. One of the paradoxes that runs through my book is the fact that the key aspects of progress that brought power and wealth and happiness to people in Europe and the west – new forms of transport and extensive travel networks – also created the ideal conditions for pathogens to spread and flourish.

After London doctor John Snow determined that a water pump dispensing faecally contaminated water in Broad Street (now Broadwick Street, Soho) was the epicentre of a major cholera outbreak in London – and therefore that cholera was a water-borne disease – it seemed that cleaning up water sources would solve the problem.

In fact, people in trains or horse-drawn carriages might invisibly soil the upholstery, putting the next person to use the carriage at risk of catching cholera. So the conditions that brought economic prosperity and interconnectedness and commercial progress were also increasing the likelihood of spreading terrifying infectious diseases. It was only when the cholera bacillus was discovered in the 19th century that scientists realised how disastrously and speedily the bacillus itself could travel.

One particularly intriguing character in your book is Adrien Proust. How important was his work?

Adrien Proust – father of renowned author Marcel – was a doctor who became a key figure at the International Sanitary Conferences. He promoted the idea that it wouldn’t be possible to get to grips with cholera without imposing a lockdown or serious quarantine on particularly vulnerable areas. He believed that some kind of international public health organisation was needed – an idea that sowed the seeds of what later became the World Health Organization.

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So he had a far-sighted and benevolent side, but was also classically imperialist and defensive: his primary concern was to prevent cholera coming to western Europe, so he called for a cordon sanitaire against its spread from Asia.

One of his specific concerns was about the Hajj – the pilgrimage to Mecca. That’s not because it was a Muslim or Asian thing – it wasn’t simple prejudice – but because the Hajj involved hundreds of thousands of people lodging together in tight quarters on small boats with no sanitary provisions, which was a paradise for microbial reproduction.

There were two huge problems with taking this tack. One was that the British empire was, in the middle of the 19th century, beginning to make a huge amount of money from its Indian enterprise. So the British didn’t want to stop traffic coming through the Suez Canal, and were the last to accept the science about cholera transmission and germ theory. They maintained that it wasn’t a contagious disease, so could be resolved by local disinfection with no need to interrupt the empire’s international trade routes.

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The other problem was that the Indian uprising of the late 1850s had a very strong religious element, so the British were, quite rightly, nervous about interrupting the pilgrimage to Mecca, which might light a tinderbox of insurrection that could bring down British imperial presence not just in India but across the region. So the science had to pass a test of political acceptability – as it still does.

How much is that relationship between science and politics a recurring theme?

One would love to think that science could be accepted as non-ideological, as disinterested in politics, even when it leads to inconveniences such as lockdowns, the shutting down of trade routes and so on. But that’s not the case, even today.

You can see the attitude forming in those 19th-century dialogues, in which science was somehow held to be – hence the title of my book, Foreign Bodies – an alien thing: that it belonged to international organisations of elite scientists who might have suspicious motives. At the sad core of my book is this extraordinary paradox: we celebrate and marvel at the extraordinariness of human ingenuity and the speed at which science can achieve practical results, while the most irrational and feverishly prejudiced biases and suspicions about that ingenuity endure.

We celebrate and marvel at the extraordinariness of human ingenuity and the speed at which science can achieve practical results, while the most irrational and feverishly prejudiced biases and suspicions about that ingenuity endure

So what enlightened minds of the 18th century thought would happen – that, one day, knowledge itself would be responsible for eliminating sickness and ignorance and poverty – never came about. There seems to be something hardwired into our shared cultures, from one end of the world to the other, that wants to resist that development – to see science as some sort of plot.

Another pivotal figure in your book is Waldemar Haffkine. Can you briefly introduce him and his work?

Waldemar Haffkine was an extraordinary figure: a Jew from Odessa who, in the second half of the 19th century, was running guns in an attempt to protect the Jewish community from pogroms. Odessa was one of those rare places in the Russian empire in which Jewish people were not trapped in a kind of Fiddler on the Roof world, and could enjoy a secular education.

So Haffkine became a student at the new university in Odessa, where he was tutored by another extraordinary figure: the avant-garde microbiology professor Ilya Mechnikov. In 1889, Haffkine joined Mechnikov at the recently founded Pasteur Institute in Paris. There he was given the task of developing a vaccine against cholera. And, after a great struggle, he succeeded.

Cholera, at that point, was finally receding somewhat from Europe. So Haffkine decided that the only way he would be able to demonstrate the acceptability of a vaccine to the public was with a series of controlled experiments. He would recruit a cohort of subjects, half of whom would get inoculated and half of whom wouldn’t. At that time, the British ambassador in Paris was the Marquess of Dufferin, who’d been viceroy of India; he was also extraordinarily interested in the possibility of inoculation against cholera, so gave Haffkine the opportunity to work there.

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When Haffkine reached India, he discovered that the medical service there did not want to know. They assumed that simply disinfecting contaminated water would combat the problem, and weren’t interested in learning about microbiology or germ theory, in understanding the deep science of how these organisms live and multiply, or in how disease can be contained. So Haffkine had very little support and even fewer funds.

Despite such reticence from the local medical community, Haffkine set to work inoculating not just Europeans in India but also the poorest of the poor. He began with people in Calcutta’s slums, then trained Indian doctors in inoculation, explaining why and how to do it. This is an extraordinary untold chapter in imperial history, when a gun-running Ukrainian-Russian Jew from a laboratory in Paris was working in India.

When Haffkine reached India, he discovered that the medical service there did not want to know. They weren’t interested in learning about microbiology or germ theory

Haffkine became famous in Britain, where people such as Joseph Lister lauded him as a hero. In 1899, he began work in Bombay (now Mumbai) heading up the first mass production line of vaccines, against plague. The disease had returned in a major way, killing approximately 12 million people between the mid-1890s and early 1920s, mostly in India and China. Haffkine’s lab sent out tens of thousands of doses each day across India, saving huge numbers of people.

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He was constantly dogged by suspicion and hostility in India, though, because this was the era of the Great Game [when the British and Russian empires vied for dominance in Asia]. Because of his Russian origins, he was often viewed as eccentric or suspicious, and even at one point thought of as being a spy. And then, in 1902, a tragic catastrophe occurred.

In the tiny village of Mulkowal in Punjab, 19 people died of tetanus poisoning caused by one contaminated batch of plague vaccine. It was discovered much later that the contamination actually happened not at the Bombay production facility but in the village. A rubber stopper had been dropped on the ground – inoculations in rural districts often took place in fields, in the open air – but, rather than being passed through heat sterilisation, as Haffkine had insisted, it was simply swished around in a carbolic solution.

Blame was directed at Haffkine, who was suspended and then fired in disgrace. The viceroy of India, Lord Curzon, was beside himself with rage: he held Haffkine responsible for what he viewed as a disaster that had undermined the credibility of the British empire. This was a period, after all, in which the empire wanted to be seen as tough and strict and paternalistic but also interested in the physical welfare of its Indian subjects.

Curzon went so far as to declare that Haffkine should be tried and hanged for his actions. There was, of course, a strong whiff of antisemitism surrounding this, although it wasn’t explicit. Haffkine tried to plead his case – giving lectures in Paris, writing to the great and the good – to no avail.

Then another extraordinary figure, Ronald Ross – who had discovered that Anopheles mosquitoes transmitted the malaria parasite – launched a campaign that resulted in vindication for Haffkine, though not until 1907. Too late: his career and life had been ruined.

How does that story reflect the wider issues of power and society at the time?

It happened in an era of great pomp and circumstance – Elgar composing music, Kipling writing stories – but also at a moment when imperial authorities in India were beginning to feel the ground shift beneath their feet in ways that made them uneasy.

They were concerned that the government, both in India and in the colonial office in London, should be seen to be doing things for the good of Indians themselves. And they were correspondingly eager to scapegoat someone or something – the someone being Haffkine, the something being the new science of microbiology – that had, as they saw it, rashly discarded the cult of disinfection.

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Cholera was constantly on their minds, but when plague came along – a disease that has nothing to do with contaminated water but everything to do with microorganisms living in fleas that bite and infect humans – a completely different mindset was needed to figure out what it was and how to deal with it. The authorities continued their policy of disinfection, however, tracking down any body suspected of showing symptoms and inspecting people as they stepped off trains.

They tore down houses, burned furniture and clothing, and separated families – often impoverished families – taking children from parents and husbands from wives. Haffkine pointed out that none of this was doing any good. When you destroy a house, the rats simply leave – and the fleas leave on the rats, carrying with them the microorganisms, spreading plague rather than getting rid of it. The authorities, of course, did not want to listen, and Haffkine was regarded as committing a heresy against the accepted method for containing infectious disease.

How would you like your book to change our view of our own pandemic moment and our relationship with the wider world?

This book is a passionate statement on behalf of science. I referred earlier to the paradox in which we’re trapped: on the one hand, humans are a marvel of ingenuity and astonishing resourcefulness. Yet at the same time, we seem to exist in this great pond of primitive terror and paranoia and superstition.

So I would love it if this book could act as an antidote to some of the mistrust and suspicion that surrounds science, and to the sense that scientists are involved in some kind of scheme that only benefits themselves. If this history moves the dial even a tiny bit through the stories it tells, then that will make an old geezer marginally happier.

This article was first published in the July 2023 issue of BBC History Magazine