In 1860 a Jewish boy named Waldemar Haffkine is born in Odesa, in the shadow of the fiery pogroms that would only intensify as late-imperial Russia slid towards revolution. He is brilliant, a standout young scientist, but he is also pulled towards radical politics and the armed Jewish self-defence gang that protects his neighbourhood. In 1881, caught with a pistol in the aftermath of a street fight, he is arrested. The patronage of the future Nobel Prize-winning physiologist Élie Metchnikoff keeps him – only just – on the right side of the law, but he is prevented from advancing beyond a doctorate: no Jews may become university professors.
He lands in Paris in 1889, and finds another patron in the germ theorist Louis Pasteur. At the newly founded Pasteur Institute, Haffkine develops the first widely used vaccine against cholera. He is daring: before testing his vaccines on volunteers he takes the preparations himself. Aware that the frontiers of disease are at the frontiers of empire, he travels to British India in 1893 with his precious cases of serum. He chafes against the pompous and cruel colonial administrations, but is comfortable working out of their reach in the provinces, vaccinating tens of thousands of people and whipping up his medicines on the road and in crowded train cars.
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Summoned to Bombay to deal with an outbreak of plague in 1896, he creates the world’s first effective plague vaccine in just three months. But then comes his downfall. Amid the millions successfully vaccinated, 19 people in the remote village of Mulkowal in Punjab die of tetanus, possibly from a contaminated batch of serum. The colonial Indian medical service, suspicious of vaccination, foreigners and Jews, pins the blame on Haffkine and uses the pretence to halt his work. He loses control of the vaccination campaign and it rots away while the plague rolls on. Shattered, he never resumes his work at scale. A giant of early public health, Haffkine is now nearly forgotten.
Simon Schama loves a good character. His histories often unfold at ground level, closely following the lives of a few protagonists who reveal the grander sweep of an era. He is especially fond of the perspective of free-thinking, often slightly ahead-of-their-time liberals and pragmatists: he spent much of his epic history of the French Revolution, Citizens, locked into the perspective of the statesman Talleyrand. His new book, Foreign Bodies, focuses largely on Haffkine. His story, Schama suggests, is relevant to our own post-pandemic world, where “something about inoculators, vaccinators, epidemiologists” – to say nothing of foreigners – “gets under the skin of public tribunes for whom nothing, certainly not epidemiology, is politics-free”.
Covid has left Schama unsettled. Man is pushing recklessly against the bounds of nature – we are hopelessly interconnected with it and each other, but unwilling to admit it. Those who are different from us are under suspicion. But foreign bodies, ideas and practices aren’t always a vector for disease and discord. Schama suggests that it is only by recognising our deep and varied connections – that “there are no foreigners, only familiars” – that we might find a way through.
The book opens by tracking a foreign idea moving from east to west. The key to halting smallpox in 18th-century Britain was inoculation or “variolation”: scratching a glob of smallpox pus from a disease survivor into a healthy person to prime their immune system. Variolation was common in the Ottoman empire, and often practised in religious settings. (It was also present in the Welsh countryside, possibly an even more foreign domain for the English elite of the time.) Lady Mary Wortley Montagu observed its effectiveness in Constantinople in 1717, and brought it back to British high society.
But ideas – especially foreign ones – don’t simply survive and thrive on their own merits. High Tory politicians and medical reactionaries opposed variolation. The Hanover royals were supportive – Princess Caroline of Ansbach had the procedure successfully tested first on prisoners, then orphans, then her own children – as were progressive doctors, scientists and the press. Crucially, the bustling machinery of early capitalist Britain was ready, and medical entrepreneurs like Robert Sutton brought inoculation to the masses – for a fee. But, since the procedure itself was cheap, they made their profits freighting it with pre- and post-op treatments – such as bleeding, purging and emetics – that were often outright harmful. It was through this patchwork of interests: cultural, scientific and commercial, that variolation gained acceptance in Britain, and saved many lives. The means of its spread and adoption were imperfect, but ultimately effective.
The corresponding journey that Schama follows from west to east is even less smooth. The concept of foreign bodies attaches itself everywhere: Haffkine was an outsider to the British in India, the British were an occupying force, and the people of India were often treated as outside agents in their own land. Haffkine was an epidemiological idealist, ostensibly out to save the most lives possible. But he must also have been aware of the poisoned gift of colonial medicine. His sometime benefactor Joseph Lister believed in the value of his scientific work, but also that it “convinced the people of India that the government and Europeans were trying to do their best for them”.
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The central drama of Haffkine’s story is the way in which “institutional barbarism”, in the words of his supporter Ronald Ross, stymied his hope of bringing mass vaccination to India. The Indian Medical Service, crammed with yesterday’s men, clinging to miasmatic theories of disease and “militarised” sanitation regimes that involved ransacking houses and cordoning off neighbourhoods, proved resistant. Haffkine found supporters – Indian Jews, Parsis, local doctors, foreign scientific grandees – but his coalitions were fragile, as was his health.
In 1902, at the peak of his influence, he had what is perhaps “the world’s first large-scale vaccine production line” in Bombay, pumping out 10,000 doses a day. Millions were vaccinated, with a plan to inoculate six million more. But the work was halted after the deaths in Mulkowal. Like his contemporary Alfred Dreyfus, Haffkine had his champions. In Britain his science was eventually vindicated – an assistant’s error was found to have contaminated the deadly batch of vaccine – and his name cleared. Despite this, he was never allowed to restart his vaccine operation.
Schama’s now-familiar approach, with its over-the-shoulder perspective and deluge of local detail, gives a pleasing verisimilitude to his stories of jostling individuals, ideas and institutions. The camera stays tight, and he rarely comments on events with much perspective from the future. He builds up large narratives using a fragmentary approach. It worked to tell the story of the French Revolution, it – somehow – worked to cover the 3,000-year history of the Jews, and it mainly works here.
Foreign Bodies is more didactic than some of Schama’s previous work, and more beholden to its central metaphor. There are jumps in perspective that abandon the main narrative to explore other cases of “foreign bodies”. We return to 19th-century Britain many times and a new generation of microbiologists, but never learn that the scientific and cultural consensus around variolation hardened into orthodoxy, and stalled the adoption of Edward Jenner’s far superior method of vaccination. Or that the organised working-class movement that would do so much to puncture the airlock of elite rule also incubated the first modern anti-vax campaign.
Though he has written a book in which nearly all the principal characters are doctors or scientists, Schama is not a historian of science. Even traditional histories struggle with the unpredictable way that theories emerge into the intellectual mainstream. Schama’s approach deftly weaves in the development of medical statistics, early clinical trials and germ theory itself. But some threads, treated with care at first, are left a bit ragged as the book goes on. The development of the nascent field of immunology is picked up in the mid 19th century, but stalls with Metchnikoff’s somewhat idiosyncratic 1880s take on it (he was a bitter opponent of the scientists who discovered what we now understand to be antibodies). Titanic shifts there, and in vaccinology itself, would have been keenly felt by Schama’s characters. But once the narrative enters India, the sometimes over-managed presentation of the scientifically sainted Haffkine versus his retrograde detractors crowds out subtler details.
In the end though, it is Haffkine’s political fall that provides the book’s strongest passages. The colonial administration – a bureaucratic machine for misery, terrified of resistance – was willing to mobilise against what it saw as a foreign threat, even with millions of lives, and its own legitimacy, in the balance. We see the reactionary drive towards both self- and collective harm repeat on the scale of the nation, institution and individual, in Haffkine’s world as well as our own. History suggests there are other paths, imperfect and difficult though they might be, if we could only recognise them.
Foreign Bodies: Pandemics, Vaccines and the Health of Nations
Simon Schama
Simon & Schuster, 480pp, £30
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This article appears in the 07 Jun 2023 issue of the New Statesman, The Reeves Doctrine