The International Politics of Vaccine Testing in Interwar Algiers

Abstract

The ancient core of Algiers, with its narrow, winding streets, the Kasbah is built into the hillside facing the Mediterranean. Poor and overcrowded, it was the segregated colonial city's one predominantly Muslim neighborhood: 75–80 percent of its residents were Muslims (Arabs and Kabyles) in the early twentieth century. Rates of tuberculosis and other respiratory diseases soared along with population densities, as the dispossessed from the surrounding agricultural hinterland arrived with their families. Between the world wars, the Pasteur Institute began a massive human experiment there involving the administration of a new tuberculosis vaccine to children. The ancient core of Algiers, with its narrow, winding streets, the Kasbah is built into the hillside facing the Mediterranean. Poor and overcrowded, it was the segregated colonial city's one predominantly Muslim neighborhood: 75–80 percent of its residents were Muslims (Arabs and Kabyles) in the early twentieth century. Rates of tuberculosis and other respiratory diseases soared along with population densities, as the dispossessed from the surrounding agricultural hinterland arrived with their families. Between the world wars, the Pasteur Institute began a massive human experiment there involving the administration of a new tuberculosis vaccine to children. In 1928, Albert Calmette, one of the most powerful scientists in the world, found himself in a bind. Heir apparent to Émile Roux at the Pasteur Institute and a leading contender for a Nobel Prize, Calmette was convinced that he had found a successful vaccine for tuberculosis, the Holy Grail of medical research. Since Louis Pasteur and Robert Koch, vaccines have held out the promise of preventing the world's deadliest diseases, none a greater killer than TB. Years of careful laboratory work and animal testing suggested that Calmette had succeeded where his rivals had failed. His initial human trials at a Paris maternity clinic confirmed his laboratory work, or so he thought.1 But a bitter international dispute called his findings and the efficacy of his vaccine, known as BCG, into question.2 A commission of expert statisticians convened by the newly formed Health Organization of the League of Nations—men Calmette considered his professional inferiors—repudiated his reading of the evidence. More effectively than any international advisory panel had been able to do before, the assembled experts in Geneva called for a set of best practices for establishing the worth of medical interventions.3 They insisted on a randomized clinical trial with a control group, laying out in detail many of the criteria that have since been adopted by scientists and regulatory agencies around the world.4 The problem, for Calmette, was both political and practical. There were precious few places he could carry out such a study. He knew immediately that French family doctors and their powerful unions would block his efforts on the mainland. No other European country seemed any more hospitable, and he feared the likelihood of damaging publicity, especially after a laboratory error in Germany in 1930 killed dozens of infants and infected many others.5 So he turned to French colonial populations: he worked first with African soldiers on the mainland, and when that failed to produce meaningful results, he moved his efforts overseas.6 But the colonial territories he tried did not have adequate civil recordkeeping. He could vaccinate huge numbers of children, but he could not monitor them long enough to convince critics that his vaccine had given them protection. The only place experiencing rampant tuberculosis that also offered civil records he could use, without facing resistance from patients or their doctors, was neither colonial, in formal terms, nor part of the French mainland: Algeria. Invaded in 1830 and annexed four years later, the former Ottoman territory became part of France in 1848. When civil authorities took over from the military in 1870, the minister of the interior in Paris rather than the minister of colonies appointed its governor-general, who shared power with European settlers.7 That quasi-colonial status, combining massive social and political inequality with a functioning administrative state, set Algeria apart and made it an ideal site for vaccine testing.2 The main building of the Algiers branch of the Pasteur Institute in 1934. © Pasteur Institute. The main building of the Algiers branch of the Pasteur Institute in 1934. © Pasteur Institute. Calmette called on colleagues at the Algiers branch of the Pasteur Institute in his bid to satisfy League statisticians.8 Scientists used birth records held by the Government General to create a random sample and sent teams of nurses to the second arrondissement, the Kasbah, the poorest, most overcrowded neighborhood in the city. Those nurses delivered oral doses of BCG and observed a control group (without giving a placebo), returning periodically to provide boosters to the vaccinated and to monitor both groups' health. They tested and tracked some 40,000 subjects over the of a from 1930 to The Algiers BCG trial was the of its out in the world the and trials of the as the a to testing in to carry out his experiment in a formal such as or the of an to that been over the to the of the and of Since and in the the of colonies as of been in the on In colonial from and by and them new of social from the to and French one of had called to the the to and in on the of had the of to that political and made in the of a colonial to have long that colonies were that could at have that in built by not a power by the of More international and have the of as administrative both to European and to an international European as were not at for most of their They to colonial subjects as and on rather than to their especially on have so as to the French as a to an of European and quasi-colonial territories such as Algeria into a a of colonial with and and that the of and were not only but in as A of have and in a of But the most of to on a of a in and that a that efforts to European of have their without their is a or that only in for a European to the of In the of human a of colonial, and international a dispute a dispute the In to the League of Calmette took of that out from Paris and colonies and quasi-colonial such as Algeria with the was the of in of and power that to the Kasbah as a the Pasteur work on in French and and Robert on in and work on in was more Algiers trial to A took of by In it was to the trial of the in in the to the of the made the testing of in most experiment on a rather of it was to the The Algiers BCG trial at the of it an early of an international the on and at the it an in the of clinical trials more in the of of The BCG trial also many of the and of human in that have as in the of European scientists in Algiers were than in the an of in the not to where powerful They did not as and his colleagues did in the experiment in the In made to in In the the Algiers BCG trial a European African and in The human experiment was by experts and that had to do with in the as it to The Algiers BCG so many from the of out on the European Calmette and his a began to BCG at the Pasteur Institute laboratory in in They that that a of tuberculosis tested and a resistance to They the part of the years and animal testing to a and it for in In after and their of when in massive doses into the most laboratory that Calmette and had the for animal Calmette and his colleagues of the a in especially for vaccines to vaccines on human subjects and political other patients to in to an The children, the of in to a There was in the early twentieth that vaccines could diseases is the power of to from the Pasteur That was by of the resistance that had vaccine the only one by the French In Calmette had to and the that his new vaccine was and he had to convince General were powerful in France and of their They would not have a without that it convinced of its to provide it to their doctors the that any could their clinical The of their to was The of the French the by at the of and been as a of power for and agencies in new of to medical and a powerful for the of patients at the of the Calmette to his work and to from over into the The first human with BCG took place in a Paris maternity in Calmette that the of the had for to his new vaccine and offered to to vaccinate Calmette were to TB. that a had he was by the from animal to human subjects and have for some himself from of human years of an oral to and resistance it was known to Calmette and his that the vaccine was by and of the and them to its was more In to that BCG would have to that vaccinated than children. French doctors were not to there were Calmette tried to the by a to around the he an of That he that out of in France would their first one of their had a of his of vaccinated at he found a of with Calmette his Louis In he his work to the of and it was immediately by the medical He was with from French for of BCG, he sent them of in for the he used the to his findings from the In he the and on a that BCG offered a and to the leading of in for Calmette as for laboratory work took of place in establishing the worth of a medical Calmette only a few of his of BCG to more than one to his laboratory he statisticians to his he as an only to for the on human and to to his laboratory with that in the laboratory that had long a as to a out of Calmette his results, a of his work on The first and the one he found most from a at the Pasteur and a of the French of In insisted that the of found an animal did not that BCG was that most subjects the vaccine, he suggested that a vaccine a for an of especially with He was the by Calmette, who suggested that as a the to in A of and statisticians from a more damaging They took at that percent of infants to with would a A careful of in a of found an of percent the first and a of The their findings by them with other had The of the that Calmette from percent to than to did the who the vaccine to who did the most from of a in the new of did Calmette to from their long enough for the vaccine to as were and in the first of could for the was and that it the by was to with the sample that Calmette had worked were His was Calmette to the and in his of that been so that in his or in the of the he In a the Calmette of so with for his new vaccine that he had the of scientists would have of In from a new international the League of Health that and the of the Pasteur Institute had to over the French the international the new The Health Organization on a the or power to its But that an it the at of of and the to the of for its the it to the of international had been to to himself from his he from the to his and the in to he to international for and to have his Health Organization as an international for The BCG and his colleagues with an ideal in the of 1928, the Health a group of leading experts to part in a on the of the new convinced to the it in an to the power of the new of medical the League to he was a vaccine from its critics and to his of and of the Health and its in medical as as the Institute was Calmette to the League to the to his efforts to the had to his and the experts from and in the of a in medical the panel to to the of that would to the In to Calmette, held the at in The expert by of a of the the an of for The years of without to BCG, the to that who on BCG, on an or in or human that it is at the doses by Calmette and his that efforts to tuberculosis with BCG have failed and that the of its to a by to the in the of for the were the international experts on the commission to the for the on their The experts were on the of Calmette, out in had he to nor could he for his He the of vaccinated with a of In the of many of the he to could have from the were to that the vaccinated in France was than the for the was to the of the a of set out for were and to the of The most is to the of in and control by infants in in the to in the The to for clinical an in statisticians and medical in to the most of medical the most of had been by one of the of statisticians to have had over the of clinical trials statisticians in the to after was the trials of the and to the of of his at the in the and that he and had and in and the in the the to found of statisticians and the one the the was only after the was to the experiment The by the League statisticians in for Calmette and to over with the of professional the League the experts considered to best but practices were not out to Calmette that a would and administrative not to resistance from French family In to a from Calmette, an to the new the League do to on children, the or in a do to doctors in the other from a would to the to vaccinate in one since the in the other would the of the Calmette turned first to the French In he had so to BCG When he began of the vaccine to doctors in he took the of the French years the Pasteur Institute and medical tested African who doctors were to have been to the out the for in to and the Calmette out random trials with control in to of such as sent many to the of testing the new vaccine on soldiers was that Calmette resistance from civil had especially African to as subjects for the of the the the trials soldiers were by the for a to made the vaccine made any The of the vaccine that soldiers did not the best were and is in both and testing would to place to produce meaningful Calmette to the a former and of the medical for colonial he had the He had a in of the Pasteur Institute in in as he had in in and in the Algiers Institute in He had at other new and in with a of and and the from vaccine the Pasteur Institute in Paris on to a of and at The Pasteur were with the in scientists in the colonies at such a to to from by new diseases or was not a but it was he had with the of he in and Algiers, had their work to to since the The Pasteur Institute in vaccinated huge numbers of children. to an the some doses a in the nurses vaccinated some and by the were more than as Calmette himself in the of his with the of as a on its administrative the French doctors had of the Calmette the of and the of and the that patients and any to the of a vaccine, or any other The of Algeria was with the of an administrative than more colonial Algeria had a functioning of and especially their predominantly European the most civil administration and in the the French mainland. a of an the French on Algeria. in the French authorities had to create and to a had the and of more than as it the civil in Algeria had been administrative records for years by the BCG became The of Algiers also of tuberculosis The began to French colonial and medical authorities the of the twentieth century. A of the French of his colleagues in is to in the in the French have records on that is is in the first years of the some soldiers and but that the of the was not in Algeria but from France it that have at in so many other that were and after the for tuberculosis in only in the century. were not to in France and in the colonies was in French Algeria as of and not more for European than for Muslim In records to the records for Algiers, by the of the city's at the the for than percent of for in the in the the Muslim was more than that over percent in the of Muslims of for one European in a have been than the in Algeria as a the in to medical it that a greater of European patients in when and the in and Muslims was than that for European in Algiers were the as in Paris at the the Muslim was greater than and to the the of the city's that who in the Kasbah his in of in his medical by to them and an to the been in the percent of Muslims who had to France and tested The to to it the to European or not their the the Muslims of Algiers one of the of the twentieth by population in Algeria as a the by the were by in the Muslims in Algiers were four to more than to of The at Muslims tuberculosis were to in at the of the and in of both the and the and and were greater than the by the the of and the who of in the in When the experts at the League of for random of subjects in with rampant tuberculosis who could over a of Algeria was the only place in the French where it was to such The Pasteur Institute vaccines and laboratory as did Pasteur scientists worked with the medical in doctors and in Those Calmette to the colonial where greater had failed. The of in the out the of the in for his The of the Health in and his to Algeria the in Algeria and an made a who in his in is a and of but he Government to for not on when the new of of and from with the He could the of the French in Calmette took a vaccine the in in and on the French by turned it into a random trial with a control group that into the the and out by the after the or the in the Algiers BCG trial was by a it took of by the French in was to or the was a to to critics and The Pasteur Institute in Algiers had a to produce BCG in around the Calmette his at the of the first few the branch of the Pasteur Institute to doctors and who and began their efforts at and in In the of the of and the of at the League of the in had worked with Calmette before, and to the initial that Calmette in to his laboratory the called in the in the initial to the the Algiers their of with could on the Kasbah, with a population of more than The that on a neighborhood the of of the there the had to to a or a in the the years of the were in the second The vaccinated more than of their over to that of the as a that BCG the by percent for the first of In the Algiers moved to a randomized trial with a control the Pasteur their The vaccine would by to in their medical with at at and years of would a laboratory The would more than 40,000 more than vaccinated and as a over the of a The of the a on the of in the of in the the first trial was out in in the to patients on In the twentieth the world wars, the to trials of for in in and the had used a In the the a to to a sample of patients in the The Algiers BCG trial was the trial that was in a and its was the most the trials after The Algiers Pasteur Institute worked in the Kasbah, of the in a that Calmette had not been able to do with African soldiers in and to the the of is not only from tuberculosis but from and The in with the of BCG, would the is not to the of but to the trials involving African in one in the control group There was of the by in the A of most from the French the first there were only but by there were in teams of or appointed the nurses the and of by Muslim the at their The of Algeria had the Pasteur Institute to Muslim was so that a random sample could The nurses the in a and numbers were vaccinated with numbers were observed as a The nurses the and the oral vaccine the to doses with in They and observed the control group on the without giving a In both and the nurses patients to for any the the and when a is in their for the to and The Muslim to the to of Pasteur had to to the that there was there to that the Muslim in the Kasbah their The French did not any of in their on Muslim was any in the Muslims had a long with French to the in Algiers in the had been in the out that Muslims their were than of French and other the that the of Muslim any and as the most successful by the French to their to the to for it is that the population did not for their children. But there the the of and especially after 1870, the of to is a and its is In in a with tuberculosis a to especially children. not to vaccinate them The vaccine that been by the French Calmette and is in is a for and of French have been and more vaccinated not trials that to from the of French as vaccinate do the to them from the were and the of the Pasteur teams to subjects over that there was at a of not to Pasteur the scientists their the the of the and its the of from who the teams from the and their to have to the new that the trial was by a with

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