In the midst of the COVID pandemic, many today put their hopes in a vaccine. It’s a vain hope.
Our capacity to control the world of viruses is very limited. Microbes are the most common forms of life on our planet, with “5 x 1030 bacteria” and ten times as many viruses, divided into about 100 million different types. There are more viruses than every other form of life put together. They’re found in “every niche occupied by living things, including the most inhospitable places,” from the bottom of Earth’s seas to polar ice caps. Water teems with viruses, and viruses are the most common life form in the ocean, perhaps “10 billion viruses per one liter of sea water.” If ocean viruses were laid side-by-side, they would “span 10 million light years” (Crawford, Viruses, 18).
Even if we could get rid of them, we wouldn’t want to, because many are essential to life on earth. Many, though, are potentially harmful, but we don’t know which ones they are. Even if we could stamp out SARS-CoV-2, billions of other potentially harmful viruses wait to take its place.
Vaccines and similar remedies didn’t curb other infectious diseases in the first place. The incidence, severity, and fatality of whooping cough, measles, smallpox, and other diseases were already declining before antibiotics or vaccines. As Ivan Illich noted,
Tuberculosis . . . reached a peak over two generations. In New York in 1812, the death rate was estimated to be higher than 700 per 10,000; by 1882, when Koch first isolated and cultured the bacillus, it had already declined to 370 per 10,000. The rate was down to 180 when the first sanatorium was opened in 1910, even though “consumption” still held second place in the mortality tables, After World War II, but before antibiotics became routine, it had slipped into eleventh place with a rate of 48. Cholera, dysentery, and typhoid similarly peaked and dwindled outside the physician's control. By the time their etiology was understood and their therapy had become specific, these diseases had lost much of their virulence and hence their social importance. The combined death rate from scarlet fever, diphtheria, whooping cough, and measles among children up to fifteen shows that nearly 90 percent of the total decline in mortality between 1860 and 1965 had occurred before the introduction of antibiotics and widespread immunization.
Illich admits there are success stories: “Immunization has almost wiped out paralytic poliomyelitis, a disease of developed countries, and vaccines have certainly contributed to the decline of whooping cough and measles, thus seeming to confirm the popular belief in "medical progress." But other factors have been crucial in the reduction of many other infectious diseases.
Rene Dubos (Mirage of Health) writes that the “spectacular improvements in the sanitary and nutritional state of the Western world. . . . cannot be credited to the type of laboratory science with which we are familiar today.” Nineteenth-century advocates for public health were social reformers who “believed that, since disease always accompanied the want, dirt, pollution, and ugliness so common in the industrial world, health could be restored simply by bringing back to the multitudes pure air, pure water, pure food, and pleasant surroundings – the qualities of life in direct contact with nature” (20-1).
Laboratory medical science came in as the “eleventh hour laborer” in the campaign against the disease, when many diseases were already declining both in incidence and lethality (21). Dubos admits that “modern medical science has helped to clean up the mess created by urban and industrial civilization,” but “the job had been carried far toward completion by the humanitarians and social reformers of the nineteenth century” (23).
Far from being guided by the latest science, these reformers operated on the “romantic doctrine that nature is holy and healthful” (23). During the 1830s in England, the physician Southwood Smith worked with the engineer Edwin Chadwick to form the “Health of Towns Association.” It aimed to “substitute health for disease, cleanliness for filth, order for disorder . . . prevention for palliation . . . enlightened self-interest for ignorant selfishness and bring home to the poorest . . . in purity and abundance, the simple blessings which ignorance and negligence have long combined to limit or to spoil: Air, Water, Light” (147-8).
The Association advocated for education, sought to improve “the attractiveness of habitations and surrounding areas,” pushed for maintaining wide lanes in large cities for the public to enjoy. Florence Nightingale operated on similar premises, putting her faith in “the healing power of pure air.” “There are no specific diseases,” she said, “there are specific disease conditions” (148).
Germany’s leading health reformer, Max von Pettenkofer, was actually hostile to the germ theory. He “regarded hygiene as an all-embracing philosophy of life, implying that not only an abundant supply of clean water and air but also trees and flowers would contribute to the well-being of men by satisfying their aesthetic longing.” In Munich, he persuaded the city leaders to bring clean water from the mountains into the city and to dilute sewage. It worked. In 1880, typhus was killing 72 per million in Munich; after these reforms, the number was down to 14 per million (148-9).
The nineteenth-century “sanitary movement,” which called for better waste disposal, improved nutrition and hygiene, and changes in living conditions and proximity of humans and animals arrested the spread of disease and, especially by bringing down infant mortality, extended life expectancy. Laboratory medicine was a welcome addition, but a latecomer.
We’re used to flu season, but we are fooling ourselves if we think flu is mild. Influenza has killed more people through the centuries than any other disease, and we haven’t figured out how to stop it. We should be measured in our hope for a COVID-19 vaccine. We will have to learn to live with this virus, as we have learned to live with many others.