Those who delve into history soon come to the conclusion that the unparalleled time in which we live is not so unparalleled.

Anyone who wants to eat out or go to the movies will soon have to be able to demonstrate with a digital or paper ‘corona pass’ that he or she has been fully vaccinated, has recently been cured of COVID-19 or has very recently tested negative. The new measure has sparked heated discussions in all layers of the population. Just like the corona tests, measures and vaccines did before.

Not so unparalleled

The discussions are inherent in the special time in which we live and the special measures that have come to accompany it. At least: special? If you delve into history, you will soon come to the conclusion that there is little new under the sun in the field of epidemics and how to combat them. Even the corona pass has its own counterpart in history! Researchers write that in the magazine BMJ Global Health. The study deals with two well-preserved immunity passports dating from 1828 and issued in Gibraltar.

Yellow fever

The passports were not used in the fight against a coronavirus, but against yellow fever. That disease struck Gibraltar in 1828 for the fourth time in twenty years. “In 1828 a passport was issued if you had the disease and survived,” said researcher Larry Sawchuk. “The passport allowed you to move freely and actively participate in everything within the community.” In addition to the name of the cured yellow fever patient, the passport also stated his or her age and a statement of immunity confirmed by a doctor. “To our knowledge, it’s the first tangible example of a passport that could tell who was susceptible to a disease and who wasn’t,” said Sawchuck.

The epidemics

The yellow fever pass was introduced in 1828 when Gibraltar was again confronted with yellow fever. The first time the disease manifested itself was in 1804; then about 2,200 people died in Gibraltar in four months. In 1810 the disease struck again. At that time, people were (wrongly) convinced that the disease – which is transmitted to humans by mosquitoes – was contagious and could therefore also spread from person to person. And so it was decided to quarantine all the sick in a camp called ‘Neutral Ground‘ wore. When the disease recurred in 1813, the sick were again isolated in this camp. But in 1828 – when the disease strikes for the fourth time – they opt for additional measures. “By the time the epidemic of 1828 arrived, there was already a bit more knowledge about susceptibility to yellow fever,” said researcher Lianne Tripp. Scientias.nl. It became increasingly clear that people who had already had yellow fever were not affected again during the later epidemics. They were immune. In an attempt to contain a new outbreak, it was therefore decided in 1828 to put people who had not yet had yellow fever in the Neutral Ground to collect. “The idea that yellow fever was contagious may have played a role in this,” Tripp said. “Perhaps the intention was to quarantine those who were still susceptible to yellow fever to prevent these people from coming into contact with the sick. And when people in the camp did get sick, there was also a separate room in which the sick could be isolated.” Eventually, in 1828, some 4,000 people who had not yet had yellow fever arrived in the Neutral Ground justly. And some stayed there for as long as four months. It is also at this time that the yellow fever pass is introduced. People who had been through yellow fever were given such a pass and could go wherever they wanted with it. People who had not been sick before had to do it without a pass and could use the Neutral Ground do not leave.

The yellow fever pass. Image: Gibraltar National Museum/UTSC.

Accidentally successful

Now we know that shielding the people who had not yet had yellow fever made little sense. After all, the disease is not contagious. Yet the choice threw people who had not yet had yellow fever into the Neutral Ground to stay, inadvertently bear fruit. “Collecting the people who weren’t immune protected them,” Tripp said. “Because the Neutral Ground was an area where mosquitoes did not like to visit due to lack of water and windy conditions.”

Agreements

The research by Tripp and colleagues provides a unique insight into an almost 200-year-old epidemic in which – surprisingly enough – measures were taken that are familiar to us in 2021. “It is interesting that despite limited knowledge about the cause and spread of yellow fever, measures were taken that were also taken in the COVID-19 pandemic, such as isolating the sick.” And just like now, all those measures had a price. “The movement of individuals to the Neutral Ground meant, for example, that thousands became unemployed and dependent on the government and charities.”

Lots of arrangements and benevolence

The epidemics that hit Gibraltar at the beginning of the nineteenth century took a toll on the population. But also the civil service. “I think – despite the lack of understanding of how yellow fever was transmitted – we should be impressed by the way health officials were combating the epidemic. Take, for example, the four-month isolation of 4,000 people in a small space. That must have required close cooperation between the health officials and the police and the goodwill of the citizens. These people had to be fed, order maintained and their safety ensured; that must have been a huge joint effort (…) Setting up a special market on the border with Spain was also impressive. All goods offered here were disinfected before crossing the border. From dawn to dusk, hundreds of people gathered at the border to exchange food and other necessities in a neat manner – under the watchful eye of the police.” Nor should we underestimate the implementation of the passport system. “Each pass was made in a print shop and a local GP filled in the personal information by hand.”

Basic principles

According to Tripp, it is very valuable to study how people dealt with diseases in the past. “What we can learn from any pandemic – whether it happened 500 or 200 years ago – is that the measures we take and the basic principles on which epidemic management is based have not changed much over time. We still use measures such as quarantine, isolation of the sick, a cordon sanitaire, wearing masks, keeping distance, travel restrictions and passport systems. Unfortunately, personal experiences gained during epidemics are very poorly passed on in most populations. When it comes to experiences in times of epidemics, there is no collective memory. The average citizen does not know how pandemics have been handled over the past 200 years, which is why it is so important that scientists capture information about current epidemics and pandemics and track down records of past epidemics, otherwise that information will be lost.”

In addition, it is also good to realize that the challenges we now face are not new. Humanity has faced epidemics and pandemics more often. “These so-called ‘unparalleled times’ are not so unparalleled,” Tripp concludes. And just as the people of Gibraltar eventually went back to their ‘old normal’, we too will sooner or later put this pandemic behind us. The crucial role of modern science in this becomes clearer when you realize how little people knew about pathogens nearly 200 years ago in Gibraltar. “We didn’t get a better understanding of pathogens until scientists discovered the cause of diseases in the late 1800s, such as the bacteria that caused cholera and tuberculosis. And our knowledge of diseases and how they spread is still growing, as we see with the coronavirus. Without science, we wouldn’t know what measures to take, let alone obtain effective vaccines.”