Bernardino Fantini, Professor Emeritus of History of Medicine and Health, University of Geneva

MGM: Cooperation in vaccine development is perhaps the key element for the defeat of SARS-Cov2… but we also know that there is a lot of competition between manufacturers, when in this case there is even a problem in keeping up with the production needed for the whole world, “A totally unsaturated market”. It is what is metaphorically called a Blue Ocean, where there is room for everyone and not a Red Ocean where the competition is massacring and indicates in jargon “a saturated market”. Can you tell us about great collaborations and useless competitions in the centuries of history of medical science and if possible with reference to pandemics and plagues?

BF:  It can first be noted that the first coronavirus pandemic, SARS in 2003, was quickly confined and then halted in a matter of months thanks to the rapid detection of the virus and the application of isolation and tracking measures. But at the same time, it was the first time the Internet was used at the health care level to share clinical, epidemiological, and virological data, with exemplary international collaboration. In the past and until the nineteenth century we cannot talk about scientific collaboration, because each state, each city closed its borders and often obscured the dissemination of medical and epidemiological news, so as not to alarm the population. Foreigners were seen as potential sources of contagion and were therefore excluded. Only the scientific academies continued to exchange publications and discoveries, but each academy organized studies and scientific missions autonomously. International health collaboration began in 1858 with the first international health conference in Paris, a direct result of the first two cholera pandemics. The purpose of these conferences, at a time of developing industrialization and international trade, was to discuss quarantine measures to minimize barriers to trade. However, but hand in hand with these conferences there is a growing awareness that only a true international collaboration can lead to effectiveness in controlling the spread of epidemics, since germs do not know borders. This will later lead to the origin, immediately after the Second World War, of the World Health Organization. Collaboration among physicians develops, albeit slowly, whenever a therapeutic or scientific innovation shows great validity. Thus, the importation of cinchona bark from South America gave rise to a great diffusion of this drug, very effective against “intermittent fevers” (malaria), and in the various universities there was a long discussion on how to use it (for example, the famous diatribe between Bernardino Ramazzini and Francesco Torti on the effectiveness of quinine). Very interesting is the case of vaccination against smallpox, characterized by the need to distribute Jenner’s original vaccine (the only one actually effective, for reasons that have been clarified only a few decades ago). Thus, Jenner’s vaccine travels throughout Europe, arrives in Asia and the USA. Even if two countries are at war (as is the case with France and England), the vaccine is passed through neutral countries, such as Switzerland, to be made available. In the nineteenth century begins the organization of the great international medical congresses, which allow the exchange of knowledge and techniques. After the Pastorian revolution, the spread of new knowledge is rapid, thanks to scientific exchanges. Lister in England introduced antisepsis, even the faraway Japan created a scientific laboratory directed by a student of Robert Koch, who visited it in 1908.

– MGM: Who was funding health in the days of past plagues and pandemics? Was there a micro-system of welfare or charity, or did the rich come out protected compared to the poor? And how was scientific research financed in those days?

BF: It is necessary to distinguish between the treatment of the sick and the practice of healthcare for the whole community. The former were reserved for those who could pay the doctor, even if there were ‘holy doctors’ who also treated the poor. Health care practices have always been the responsibility of civil authorities. According to the theories of the time, contagion was fought with quarantines and cordons sanitaire and with the systematic cleaning of cities, all activities necessarily taken over by the political power, which also had the economic and human means to enforce sanitary measures. Assistance to the sick took place at home for the wealthy and in hospitals, mostly run by religious confraternities, for the poor. From the eighteenth century, for social reasons (the population crisis, the agricultural and industrial revolution) and cultural reasons (the century of Enlightenment, reforms and revolutions), medicine and other health professions broaden their field of action, not being interested only in individual patients, but beginning to feel a responsibility towards society as a whole. Governments create ‘health police’ structures. If classical hygiene aimed at controlling and modifying individual behaviour, modern hygiene becomes public, addresses the community and is necessarily carried out by the community, through public health regulations and legislation. Inequalities in the face of disease and death are a constant in the history of epidemics. Even if germs do not distinguish between rich and poor, powerful and simple citizens, as many chronicles and frescoes tell, in practice the rich could better protect themselves and eventually move away from a city hit by pestilence. Moreover, the rich had the possibility to feed themselves sufficiently, which allowed them to better resist infections. The ‘right to health’, as a fundamental right of every person, without distinction of sex, religion or social position has been recognized only in the second half of the twentieth century. Scientific research in the modern sense, with laboratories and research groups, is a novelty of the nineteenth century and especially of the twentieth century, with the development of so-called ‘big science’. It took place mainly in universities, public and private, and in the laboratories of industries, especially the chemical and pharmaceutical industries. Previously, innovations in the medical field were the result of the craft laboratories of doctors and naturalists or the discovery of natural medicines by explorers, as was the case of quinine for the fight against malaria. In the nineteenth century, ‘scientific medicine’ developed and the principle that all therapeutic measures, starting with drugs, must be based on scientific knowledge and laboratory verification of the efficacy and safety of the treatment was established. 

– MGM: What is new about SARS-Covid19 vaccines compared to those previous?

– BF: Although several vaccines use traditional technologies, with attenuated or killed viral forms, the Pfizer and Moderna vaccines are based on the use of mRNA. Basically, what is introduced with the inoculation is a message, an information, a messenger that tells the ‘cellular machine’ of our body to produce a virus protein, to which the immune system reacts recognizing it as foreign. This is what has greatly accelerated the research of the vaccine and allows its great validity even in case of virus mutations. In fact, it will be enough to change one ‘word’ of the message for the vaccine to cause the production of the mutated protein. This is the first large-scale application of the theoretical and philosophical revolution produced by molecular biology, which defines life as a message that is transmitted through generations, changing with evolution, and that controls the chemical and physical processes necessary for development and vital functions.

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