A health passport issued by the City of Milan’s Public Health Office (Sanità) in the early eighteenth century. Archivio di Stato di Alessandria, Comune, III, 2181. Photo by the author.
Australia has finally begun a mass vaccination campaign against Covid-19. It’s been a moment many have been looking forward to, but it’s also an occasion to reflect back on the important yet limited role this type of immunization plays in the pursuit of public health.
When it comes to safeguarding communities’ wellbeing, vaccines (as distinct from inoculations, which date to fifteenth-century China at the latest) are a recent, expensive and modest part of the process. Since their introduction in the nineteenth century, they have certainly helped to improve birth rates and reduce mortality and morbidity rates, and as such enabled populations around the globe to grow. But vaccines have a narrow scope, and the high costs of developing new ones render them vulnerable to funding shortages in both the public and private sectors. Most human societies, most of the time, fight infectious diseases and numerous other hazards by relying on simple methods of avoidance and harm-reduction, such as filtering water, zoning, waste disposal and using protective gear.
The current pandemic is no exception: apart from testing, administering the Coronavirus vaccine is the first major instance in which governments and healthcare providers will be making use of a complex biomedical product. For more than a year, while data was being gathered and analysed, and vaccines synthesized and trialled, the country relied on prophylactic methods that date back hundreds, if not thousands of years: physical distancing, travel bans, hard perimeters, curfews, quarantine, mask-wearing and hand washing. And once vaccination begins in earnest, the requirement to present a clean bill of health will likewise date back at least to the introduction of health passports in sixteenth-century Europe.
To be sure, none of the measures we’ve been practicing are water-tight, and each came at a price, economically, emotionally, physically and politically. Nor were they equally burdensome or beneficial to everyone. Far from it. But collectively, non-biomedical or “low-tech” prevention alongside the cultivation of civic solidarity saved numerous lives every day and at the fraction of the cost of curing the sick and developing and distributing vaccines, to say nothing of the inestimable agony of premature death.
The success of simple preventative measures, even in wealthy welfare states like Australia, should not be taken for granted. Without resources to keep un- or less employed people from losing their homes or spiralling into debt; without medical infrastructures that are both excellent and accessible; and without informed leadership and a strong sense of mutual responsibility, any of these robust methods would be insufficient. The rich, democratic global north has furnished us with too many examples of how shortcomings in one field literally nullified advantages in others.
But when such cohesion exists, examining our diverse hygienic pasts is essential for at least two reasons. First, as the past year has demonstrated, excluding prophylactic methods because they were developed before or outside the context of modern, Euro-American biomedicine can actually be detrimental to saving lives. In Covid’s early days, a New York Times op-ed, among other observers, described some Asian governments’ recourse to quarantine and travel bans as ‘medieval’. It was not meant as an endorsement. Twelve months later, such ‘barbaric’ measures, having saved millions of lives around the world, are part of a ‘holistic strategy’, striking a reassuringly modern sound.
Knowing more about communities’ hygienic pasts is practical in a second sense. Experiences of health and disease are culturally specific, and people’s shared memories of health-related and other forms of trauma are an important part of what shape their approaches to curing and preventing illnesses. Governments and organizations seeking to impact diverse constituencies benefit from being able to tap into their pasts and understand communities on their own terms. A lockdown, for instance, is a difficult experience for most people, but there are those for whom it conjures particularly negative memories, such as living under an oppressive regime, war or an ethnically-biased intervention. That is not a reason to avoid implementing such measures, but communicating about it to different audiences in appropriate ways is crucial, and often best led by local organizations and governments.
To offer a second and final example: billions of people around the world have different ideas about disease transmission and resilience dating back millennia, and do not draw a clear line between physical and moral wellbeing. Addressing their concerns during a global pandemic in purely biomedical terms risks lowering their motivation to comply with preventative measures. At worst it can be entirely counter-productive and lead to dismissing the gravity of a situation at least as seen by others, shirking civic duties and inaccurate- or under-reporting of symptoms. Once again, understanding communities’ deeper hygienic pasts makes it easier to communicate across cultural divides and to the benefit of society at large.
Looking forward, vaccines are not a panacea for covid-19, not to mention its emerging variants and mutations. And if globalization is the normalcy many people continue to crave, the likelihood of fast-spreading viruses will remain high. Historians are not in the business of predicting the future, but they are on firm ground to point out that the dream of eradicating all infectious diseases was and remains just that. Until it’s realized, we will continue to rely for much of our health on an arsenal that is tried and true, but which works best when its efficacy is acknowledged and appropriately explained.
[Originally appeared in the Monash Lens 0n 3 March 2021 as “COVID-19: Age-old preventive measures still needed even after coronavirus vaccination rollout.”]