“History doesn’t repeat itself but it often rhymes”

– Mark Twain

There’s a lesson to draw from the annals of another infectious disease as the coronavirus death toll mounts, lockdowns are lifted and the world awaits a vaccine.

For centuries, tuberculosis (“TB”) has been the world’s most infectious disease but it was not until 1882 that the German scientist Robert Koch identified the pathogen as Mycobacterium tuberculosis. Once Koch found the cause, he set out to discover a cure.  At the time, millions of people with TB clamoured for results. Koch’s goal was simple – find a way to kill M. tuberculosis without killing the patient. After eight long years, he thought he found the answer. He initially tested the cure on infected guinea pigs with positive results. Instead of testing his results in animals over and over again, Koch decided to move forward and try this experiment on humans. He wasn’t certain how the human body would react so even though he didn’t have TB, he decided to inject himself first.  He had an immediate and severe reaction to the injection but after several days these side effects went away so Koch viewed it as a positive sign that his formula, tuberculin, was fighting bacteria in his system.

He decided that he was ready to begin experimentation on individuals with the disease. The TB patients he inoculated reacted much like he did but there was some initial positive news – patients with tuberculosis of the skin saw the spots begin to shrink and eventually disappear. Koch assumed that something similar would happen to patients with TB of the lungs.  The bad news was the severe side effects could last for weeks on end.

Normally, Koch would have taken time to examine the mixed results more carefully until he knew for certain whether his formula worked or not.  The pressure to deliver a cure meant that he announced his findings perhaps earlier than under normal circumstances. Although Koch tried to be cautious, he was so revered during that era that his words were immediately interpreted to mean he’d found the holy grail cure.

The initial positive results spurred ever greater production and use of the formula around the world. Trouble began almost immediately when doctors began using tuberculin to treat their patients. Within weeks, newspaper headlines featured stories of patients dying suddenly as a result of the treatment. In a three month study of patients given the vaccine, about 1% were actually cured, most saw no improvements and 4% actually died. Eventually people realized tuberculin didn’t cure most forms of tuberculosis, just tuberculosis of the skin, and refused treatment. Worse yet, there was even a bit of a scandal – newspapers revealed that Koch was to receive money from the German government’s worldwide sales of the formula.

So eight years after the discovery of the bacteria there still wasn’t a cure, just bitter disappointment. Two French scientists – Albert Calmette and Camille Guerin – began work on a cure for TB in 1906. Finally, after fifteen years of research, they tested their formula on a human in 1921 – nearly 40 years after the original discovery of the cause of tuberculosis.  Sadly, the results were mixed and doctors couldn’t say with certainty how effective it was in protecting against TB, and still can’t today.

It was only in 1943, sixty years after the pathogen was identified by Robert Koch, that a farmer in the US noticed that his chickens were having trouble breathing.  He worried that something in the dirt where they fed might be causing the illness and took one of the sick birds over to the local agricultural school at Rutgers University.

The lab was run by Selman Waksman who had been studying soil samples for years. The farmer’s chickens intrigued Waksman so his assistants rubbed a cotton swab inside the bird’s throat for analysis. Waksman’s lab discovered that the sample from the chicken’s throat contained a new form of ground mould which was named Streptomyces griseus. The antibiotic drug made from it came to be  known as streptomycin.  The scientists tested to see if this new compound would kill bacteria. Not only did it kill a wide variety of harmful bacteria in test animals, it also seemed relatively harmless to animals injected with it.  And when tested on TB samples, the testing revealed something remarkable. Streptomycin inhibited the growth of the Mycobacterium tuberculosis. The story could have ended there but a separate scientist visiting their lab tested the antibiotic on guinea pigs infected with TB. The guinea pigs improved and within weeks there was absolutely no trace of TB left in the bodies. So not only was streptomycin a good inoculant but also a cure for the disease that ravaged the world for centuries.

In the end, it took the international medical community over 60 years to deliver an efficacious drug to treat tuberculosis notwithstanding the urgency for a cure nor the death and despair caused by the disease. Along the way there were several false starts due to the pressure on researchers to develop a result before all testing was complete. Granted, medicine has advanced tremendously since the 1880s and 1900s but the lesson is clear – expecting a universal vaccine for COVID-19 to be developed in a short period of time as in months or one year, while possible is not probable, and comes with the consequent risks around safety and efficacy.  We should always be hopeful and optimistic but plan for the more likely scenario of requiring several years for a solution. Perhaps we should heed the advice of John F Kennedy and learn to get comfortable with the uncomfortable.

“As every past generation has had to disenthrall itself from an inheritance of truisms and stereotypes, so in our own time we must move on from the reassuring repetition of stale phrases to a new, difficult, but essential confrontation with reality. For the great enemy of truth is very often not the lie – deliberate, contrived and dishonest – but the myth – persistent, persuasive and unrealistic. Too often we hold fast to the clichés of our forebears. We subject all facts to a prefabricated set of interpretations. We enjoy the comfort of opinion without the discomfort of thought.”

– John F Kennedy, 35^th President of the United States

In my next update, I’ll speak to the Spanish Influenza of 1918 and similar lessons we can draw from that pandemic and the many false starts in correctly identifying the pathogen and delivering either the wrong vaccine or an ineffective vaccine.