Louis Pasteur, COVID-19, and the social challenges of epidemics

December, 2022, will see two notable anniversaries: the 200th anniversary of the birth of Louis Pasteur and the third anniversary of China's announcement of the outbreak that would lead to the COVID-19 pandemic. These coinciding events provide an opportunity to reflect on past and current global challenges to bring epidemics under control. Pasteur himself was inextricably connected with a late 19th-century social hygienist movement to promote the health of populations and cities.1Latour B The Pasteurization of France. La Découverte, Paris2001Google Scholar With other noteworthy scientists, including Robert Koch, Agostino Bassi, and Joseph Lister, Pasteur helped to generate a new field of microbiology, developing new knowledge on fermentation, biogenesis, and germ theory. He contributed substantially to the development of tools for infectious disease control in humans and animals, such as vaccines for anthrax, rabies, and poultry cholera. The fields of microbiology and vaccinology, both legacies of Pasteur and his contemporaries, expanded globally during the late 19th and early 20th centuries via the research and initiatives of many individuals and organisations, including Oswaldo Cruz,2Stepan N Beginnings of Brazilian science: Oswaldo Cruz, medical research and policy, 1890–1920. Science History Publications, New York1976Google Scholar whose 150th birthday was also celebrated in 2022. These legacies, along with late 19th and 20th century social opposition to hygienic measures and vaccination around the world,3Holmberg C Blume S Greenough P The politics of vaccination: a global history. Manchester University Press, Manchester2017Crossref Google Scholar have been prominent in the COVID-19 pandemic. Pandemic responses have been hindered by weak public engagement with science and public health, if we understand public engagement to be a multidirectional exchange involving an “interchange of perspectives, opinions, and ideas”4Black GF Cheah PY Chambers M Nyirenda D Public and community engagement in health science research: openings and obstacles for listening and responding in the majority world.Front Public Health. 2022; 101012678Crossref Scopus (0) Google Scholar between authorities, researchers, the public, and other multisectoral interests, the inclusion of the public in pandemic response, and clear scientific and public health communications.4Black GF Cheah PY Chambers M Nyirenda D Public and community engagement in health science research: openings and obstacles for listening and responding in the majority world.Front Public Health. 2022; 101012678Crossref Scopus (0) Google Scholar, 5Osterrieder A Cuman G Pan-Ngum W et al.Economic and social impacts of COVID-19 and public health measures: results from an anonymous online survey in Thailand, Malaysia, the UK, Italy and Slovenia.BMJ Open. 2021; 11e046863Crossref PubMed Scopus (24) Google Scholar The COVID-19 pandemic and responses to it have highlighted unaddressed health and social inequities that have contributed to increased mortality and morbidity in people with chronic illnesses and reduced incomes. Adhering to pandemic control measures, gaining access to COVID-19 vaccines, and enduring the economic and social burdens of these measures have been difficult for some populations, including those in low-income settings and in racially and ethnically minoritised, generational, and gender groups.5Osterrieder A Cuman G Pan-Ngum W et al.Economic and social impacts of COVID-19 and public health measures: results from an anonymous online survey in Thailand, Malaysia, the UK, Italy and Slovenia.BMJ Open. 2021; 11e046863Crossref PubMed Scopus (24) Google Scholar, 6Bambra C Riordan R Ford J Matthews F The COVID-19 pandemic and health inequalities.J Epidemiol Community Health. 2020; 74: 964-968PubMed Google Scholar, 7Whitehead M Taylor-Robinson D Barr B Poverty, health, and COVID-19.BMJ. 2021; 372: n376Crossref PubMed Scopus (56) Google Scholar Redressing these social challenges will require fundamental changes in the old Pasteur-era alliances with political and economic interests that Pasteur himself relied on to support his research and infection control interventions. A substantial integration of social sciences is needed to elucidate reasons for and potential solutions to weak public engagement and health and social inequities. Public engagement to establish priorities for redressing these inequities and preventing their exacerbation in future pandemics is also required.8Napier AD Rethinking vulnerability through COVID-19.Anthropol Today. 2020; 36: 1-2Crossref PubMed Scopus (20) Google Scholar Current public concerns about the quality and effectiveness of vaccines (the second legacy of Pasteur), transparency of data related to vaccine development, support for mass vaccination, and vaccine producer profits are not new.9Majid U Ahmad M Zain S Akande A Ikhlaq F COVID-19 vaccine hesitancy and acceptance: a comprehensive scoping review of global literature.Health Promot Int. 2022; 37daac078Crossref Scopus (2) Google Scholar, 10Adhikari B Yeong Cheah P von Seidlein L Trust is the common denominator for COVID-19 vaccine acceptance: a literature review.Vaccine X. 2022; 12100213Crossref PubMed Scopus (0) Google Scholar In many countries, including France, 19th-century vaccine sceptics, including doctors, scientists, and agriculturalists, questioned the need for vaccination, contending that it constituted an “unnatural”,11Carnino G Louis Pasteur. La science pure au service de l'industrie.Mouv Soc. 2014; 248: 9-26Crossref Scopus (3) Google Scholar even toxic intervention. They criticised Pasteur's links to agricultural and industrial interests.11Carnino G Louis Pasteur. La science pure au service de l'industrie.Mouv Soc. 2014; 248: 9-26Crossref Scopus (3) Google Scholar Distrust of the safety of and need for vaccination increased in the early 20th century in Rio de Janeiro, Brazil, when Oswaldo Cruz faced a so-called vaccine revolt against smallpox eradication efforts as part of an urban sanitation policy.12Lima N Marchand M-H Louis Pasteur and Oswaldo Cruz: innovation and tradition in health. Editora, Rio de Janiero2005Google Scholar The expansion of Rio de Janeiro had displaced the poorest inhabitants of the city to nearby hills, facilitating the construction of favelas. Cruz's policy of compulsory smallpox vaccination and authoritarian hygienic measures further increased popular distrust and opposition to his sanitation plan.12Lima N Marchand M-H Louis Pasteur and Oswaldo Cruz: innovation and tradition in health. Editora, Rio de Janiero2005Google Scholar The effectiveness of vaccines and sanitation interventions were the priority at the time; recognising, understanding, and responding to the consequences of these sanitation policies and measures on the most marginalised in society, including popular opposition, were not. Pasteur responded to criticisms of vaccines and other hygienic measures by arguing that the science could speak for itself; he claimed to be “disinterested” in industrial and political interests, instead motivated by “a real love of science”.11Carnino G Louis Pasteur. La science pure au service de l'industrie.Mouv Soc. 2014; 248: 9-26Crossref Scopus (3) Google Scholar However, Pasteur's actions throughout his career contradicted this rhetoric. From studies of fermentation and pébrine (ie, silkworm disease) to investigations of rabies and vaccination, Pasteur and his colleagues largely depended on the patronage of political authorities and agricultural interests to fund research activities, and actively engaged with state authorities, industry, clinicians, veterinarians, and farmers to support research and vaccine production.13Cassier M Producing, controlling, and stabilizing Pasteur's anthrax vaccine: creating a new industry and a health market.Sci Context. 2008; 21: 253-278Crossref PubMed Scopus (9) Google Scholar Historical studies of science show that science as Pasteur, his colleagues, and his followers practised it was never isolated from the social, political, and economic contexts in which it took place.1Latour B The Pasteurization of France. La Découverte, Paris2001Google Scholar, 11Carnino G Louis Pasteur. La science pure au service de l'industrie.Mouv Soc. 2014; 248: 9-26Crossref Scopus (3) Google Scholar The scientific and public health institutes created in the late 19th and 20th centuries were important sites of public engagement in science. However, they simultaneously relied on and reproduced elite power and sociopolitical inequalities, particularly in colonial and postcolonial contexts.14Geissler PW Lachenal G Manton J Tousignant N Traces of the future: an archaeology of medical science in Africa. University of Chicago Press, Chicago2016Google Scholar In the current COVID-19 pandemic, both public engagement in science and public health and pandemic-exacerbated social and health inequalities are crucial and intertwined weaknesses. One indicator of weak public engagement is the so-called COVID-19 infodemic—an excess circulation of disinformation and misinformation about the COVID-19 pandemic, including its origins, treatments, and control measures.9Majid U Ahmad M Zain S Akande A Ikhlaq F COVID-19 vaccine hesitancy and acceptance: a comprehensive scoping review of global literature.Health Promot Int. 2022; 37daac078Crossref Scopus (2) Google Scholar, 10Adhikari B Yeong Cheah P von Seidlein L Trust is the common denominator for COVID-19 vaccine acceptance: a literature review.Vaccine X. 2022; 12100213Crossref PubMed Scopus (0) Google Scholar, 15Jaiswal J LoSchiavo C Perlman DC Disinformation, misinformation and inequality-driven mistrust in the time of COVID-19: lessons unlearned from AIDS denialism.AIDS Behav. 2020; 24: 2776-2780Crossref PubMed Scopus (94) Google Scholar Weak public engagement has been partly supported by intense social mistrust of political and health authorities and scientists, but also by little public inclusion in the pandemic responses.5Osterrieder A Cuman G Pan-Ngum W et al.Economic and social impacts of COVID-19 and public health measures: results from an anonymous online survey in Thailand, Malaysia, the UK, Italy and Slovenia.BMJ Open. 2021; 11e046863Crossref PubMed Scopus (24) Google Scholar, 9Majid U Ahmad M Zain S Akande A Ikhlaq F COVID-19 vaccine hesitancy and acceptance: a comprehensive scoping review of global literature.Health Promot Int. 2022; 37daac078Crossref Scopus (2) Google Scholar, 10Adhikari B Yeong Cheah P von Seidlein L Trust is the common denominator for COVID-19 vaccine acceptance: a literature review.Vaccine X. 2022; 12100213Crossref PubMed Scopus (0) Google Scholar, 16Sabahelzain MM Hartigan-Go K Larson HJ The politics of COVID-19 vaccine confidence.Curr Opin Immunol. 2021; 71: 92-96Crossref PubMed Scopus (21) Google Scholar Investigations from social scientists between 2020 and 2022 have shown that social mistrust and distrust are “inequality-driven”;15Jaiswal J LoSchiavo C Perlman DC Disinformation, misinformation and inequality-driven mistrust in the time of COVID-19: lessons unlearned from AIDS denialism.AIDS Behav. 2020; 24: 2776-2780Crossref PubMed Scopus (94) Google Scholar social groups and communities experiencing historical exclusions and structural inequities may be more likely to embrace this misinformation and disinformation.15Jaiswal J LoSchiavo C Perlman DC Disinformation, misinformation and inequality-driven mistrust in the time of COVID-19: lessons unlearned from AIDS denialism.AIDS Behav. 2020; 24: 2776-2780Crossref PubMed Scopus (94) Google Scholar, 17Bajos N Spire A Silberzan L The social specificities of hostility toward vaccination against COVID-19 in France.PLoS One. 2022; 17e0262192Crossref Scopus (10) Google Scholar, 18Leach M MacGregor H Akello G et al.Vaccine anxieties, vaccine preparedness: perspectives from Africa in a COVID-19 era.Soc Sci Med. 2022; 298114826Crossref PubMed Scopus (6) Google Scholar Therefore, weak public engagement in science and public health and serious health inequities are intertwined, and Pasteur's model of public health, supported by alliances of science, state, and economic interests, cannot respond to these social challenges. Social sciences research shows that social and health inequities among the most socioeconomically disadvantaged have been compounded by control measures,5Osterrieder A Cuman G Pan-Ngum W et al.Economic and social impacts of COVID-19 and public health measures: results from an anonymous online survey in Thailand, Malaysia, the UK, Italy and Slovenia.BMJ Open. 2021; 11e046863Crossref PubMed Scopus (24) Google Scholar, 19Alexander SA Shareck M Widening the gap? Unintended consequences of health promotion measures for young people during COVID-19 lockdown.Health Promot Int. 2021; 36: 1783-1794Crossref PubMed Scopus (5) Google Scholar similar to the dislocations precipitated by Cruz's social hygiene measures in the early 20th century. In the COVID-19 pandemic, some social groups, including informal workers, undocumented migrants, people older than 65 years, low-income populations, and people living in collective housing, substandard housing, or informal settlements, have found it difficult to adhere to Pasteurian hygienic measures (eg, physical distancing, mask wearing, and aeration of living and working environments) when other, more important concerns (eg, food, childcare, and income) exist and when suitable housing, clean water, sewage systems, and health care are not accessible.20Matta GC Rego S Souto EP Segata J The social impacts of COVID-19 in Brazil: vulnerable populations and responses to the pandemic. Fiocruz, Rio de Janiero2021Google Scholar Consequences of control measures have included income loss, increased domestic violence, interrupted education, social isolation, and mental illness.19Alexander SA Shareck M Widening the gap? Unintended consequences of health promotion measures for young people during COVID-19 lockdown.Health Promot Int. 2021; 36: 1783-1794Crossref PubMed Scopus (5) Google Scholar, 21Silberzan L Martin C Bajos N Social isolation among older adults in the time of COVID-19: a gender perspective.Front Public Health. 2022; 10840940Google Scholar The management of pandemics is never only about disease surveillance, diagnostics, vaccines, and treatments. Pasteur's legacies of microbiology and disease prevention through hygienic measures and vaccination have remained crucial during the COVID-19 pandemic. However, beyond such efforts, pandemic management and preparedness should also be about recognising and addressing the global, regional, and local inequities that have prevented all populations from securing health and wellbeing. An initial advance would entail strengthened scientific and public health dialogue and consultation with local populations to account for their experiences and priorities. The social sciences have a crucial role in identifying hidden vulnerabilities and the power relations that produce and entrench them; evaluating the social consequences of epidemic control measures; and co-developing specific multisectoral initiatives that redress the long-term consequences of the COVID-19 pandemic and its interventions and prepare for future outbreaks with officials, formal and informal leaders and organisations, and the public.22Osborne J Paget J Giles-Vernick T et al.Community engagement and vulnerability in infectious diseases: a systematic review and qualitative analysis of the literature.Soc Sci Med. 2021; 284114246Crossref PubMed Scopus (6) Google Scholar, 23Leach M MacGregor H Ripoll S Scoones I Wilkinson A Rethinking disease preparedness: incertitude and the politics of knowledge.Crit Public Health. 2022; 32: 82-96Crossref Scopus (13) Google Scholar Such actions entail a reworking of pandemic preparedness, response, and recovery as consultative, open-ended, and equitable processes. We declare no competing interests. Pasteur's legacy in 21st century medicineThe Lancet bids 2022 adieu with a commemoration of Louis Pasteur. Born in France on Dec 27, 1822, Pasteur was a young polymath when he embarked on a path of discovery with profound societal relevance. By the age of 40 years, he was a national hero and an international authority on microbiology, vaccines, and immunology. His germ theory of disease laid the foundation for hygiene and sanitation within public and global health. He developed the first vaccine against human rabies in 1885. Along with other great scientists of his time, Pasteur shaped scientific reasoning and communication for the better, creating a legacy that catalysed progress in human health that has been sustained for the past 150 years. Full-Text PDF Research focus: Pasteur Institute of DakarFrom yellow fever to COVID-19, the Pasteur Institute of Dakar has been leading African health research and response. Talha Burki reports. Full-Text PDF Louis Pasteur's public engagementConcern with public engagement by scientists and doctors is nothing new, but one of its consummate early practitioners was born 200 years ago. Louis Pasteur (1822–95) was not a natural communicator with ordinary people from the wider community. Shy and reserved, he was happiest when he was working in the laboratory, but he was deeply committed to the value of science in human affairs and used his own research to further that message. He was also intensely and successfully ambitious, both for himself and his family, and for the scientific ideas he espoused. Full-Text PDF Science knows no country: fulfilling Louis Pasteur's legacy2022 marks the bicentenary of Louis Pasteur's birth. Pasteur's discoveries helped lay the foundation of modern public health, microbiology, and medicine. His legacy echoes in the many streets, schools, and hospitals that bear his name, and in the widespread use of pasteurised food worldwide. After his pioneering work on veterinary vaccines, Pasteur developed the rabies vaccine for humans in 1885, the success of which led to the foundation of a dedicated institute in Paris, France.1 The Institut Pasteur was registered in 1887 as a private foundation of public utility, and its statutes state that the institute's dual purposes were “the treatment of rabies according to the method developed by M. Full-Text PDF Building on Pasteur's legacy: producing vaccines in AfricaLouis Pasteur's legacy of translating scientific knowledge on vaccines to create a healthier world resonates with his comment that “Science knows no country because knowledge belongs to humanity, and is the torch which illuminates the world. Science is the highest personification of the nation because that nation will remain the first which carries the furthest the works of thought and intelligence.”1 However, during the COVID-19 pandemic vaccine knowledge has not belonged to humanity, leading to global vaccine inequity2 and attempts to obstruct Africa, the world's poorest continent, from manufacturing mRNA vaccines for those most in need. Full-Text PDF A call to accelerate an end to human rabies deathsEvery year, an estimated 59 000 vaccine-preventable deaths occur globally due to rabies.1 These deaths occur despite more than 100 years of existence of effective vaccines against rabies in humans and dogs, which serve as the main source of infection for humans.2,3 Full-Text PDF Innovation for infection prevention and control—revisiting Pasteur's visionLouis Pasteur has long been heralded as one of the fathers of microbiology and immunology. Less known is Pasteur's vision on infection prevention and control (IPC) that drove current infection control, public health, and much of modern medicine and surgery. In this Review, we revisited Pasteur's pioneering works to assess progress and challenges in the process and technological innovation of IPC. We focused on Pasteur's far-sighted conceptualisation of the hospital as a reservoir of microorganisms and amplifier of transmission, aseptic technique in surgery, public health education, interdisciplinary working, and the protection of health services and patients. Full-Text PDF