Speaker 1: Pushkin Hello listeners, Happy Friday. Before we crack on with
Speaker 1: this episode, I wanted to let you know that Pushkin
Speaker 1: Plus subscribers can now hear an astonishing two part story
Speaker 1: of disaster. A story of enormous egos and enormous mustaches,
Speaker 1: of fraud and financial ruin, of hubris and despair. It's
Speaker 1: a story of new technologies and of death on a
Speaker 1: massive scale, and ultimately a story of understated genius. What's
Speaker 1: this story all about? A war? A revolution? No, something
Speaker 1: even bigger a canal. After you've finished listening to this
Speaker 1: cautionary tale, you might like to check it out for Now,
Speaker 1: on with our episode and a quest to understand how
Speaker 1: the gruesome disease of yellow fever spreads. John Moran enters
Speaker 1: Building number two. It's a simple timber hut with just
Speaker 1: one room measuring fourteen feet by twenty. Dividing the room
Speaker 1: in two is a fine, strong wire mesh with holes
Speaker 1: of a fiftieth and an inch. Moran is wearing a
Speaker 1: night shirt, nothing else. He lies down on the bed
Speaker 1: around him buzz mosquitoes fifteen mosquitoes to be precise. Soon
Speaker 1: one lands on his hand. He doesn't try to squish
Speaker 1: it or flick it off. The mosquito slides its proboscis
Speaker 1: through John Moran's skin and sucks his blood. On the
Speaker 1: other side of the wire net from Moran and the
Speaker 1: mosquitoes sits. Major Walter reed, he could tell you the
Speaker 1: life story of every one of those mosquitoes. They've been
Speaker 1: sucking the blood of people who are sick with yellow fever.
Speaker 1: We're in Cuba, in an improvised U. S Army camp,
Speaker 1: just outside Havana. It's the twenty first of December nineteen hundred.
Speaker 1: Four days later, on Christmas morning, John Moran wakes up
Speaker 1: with chills and a headache. He tries to eat his
Speaker 1: Christmas lunch, but he has no appetite. By the afternoon,
Speaker 1: his temperatures climbed to one hundred and three. Is it
Speaker 1: yellow fever? Moran was twenty four years old. He'd come
Speaker 1: to Cuba with the US Army, but left to get
Speaker 1: a civilian job as a clerk. It pays better, and
Speaker 1: Moran is trying to save money to take a degree
Speaker 1: in medicine. A few weeks earlier, when Major Reid had
Speaker 1: let it be known that he was looking for volunteers
Speaker 1: for his mosquito experiments. Moran's old army friends had made
Speaker 1: sure he knew about it. Reed will pay you, They
Speaker 1: told him several months worth of salary. John Moran knew
Speaker 1: very well how deadly yellow fever can be. It had
Speaker 1: just killed the clerk who.
Speaker 2: Worked next to him.
Speaker 1: He thought about it, then went to introduce himself to
Speaker 1: Major Reed. I want to volunteer, said Moran. And I
Speaker 1: don't want money. I want to do it for science,
Speaker 1: for humanity. Major Reed looked at John Moran.
Speaker 3: I take my head off to you.
Speaker 1: He said. John Moran was bravely taking a risk for
Speaker 1: noble motives. Are we too scared to let people take
Speaker 1: risks like that? Today? I'm Tim Harford and you're listening
Speaker 1: to cautionary tales. What's it like to have yellow fever?
Speaker 1: Here's one victim describing the onset of their symptoms. It
Speaker 1: seemed as if every bone in my body had been crushed.
Speaker 1: My spine felt twisted, and my head swollen, and my
Speaker 1: eyes felt as if they would pop out of my head.
Speaker 1: Even the ends of my fingers felt as though they
Speaker 1: would snap off. If that's as bad as it gets,
Speaker 1: you're one of the lucky ones. In a week or two,
Speaker 1: you'll be okay again, But about fifteen percent of people
Speaker 1: aren't lucky. Their illness develops a second, much more serious phase.
Speaker 1: Your skin turns yellow from jaundice. You're delirious from fever.
Speaker 1: You start to bleed, perhaps from your eyes or your gums,
Speaker 1: or perhaps inside your stomach. So when you vomit, your
Speaker 1: vomit black organs start to fail. There's no treatment. If
Speaker 1: this second phase takes hold, your chance of surviving is
Speaker 1: little more than fifty to fifty. No wonder. Yellow fever
Speaker 1: once caused such terror in America's port cities. Outbreaks didn't
Speaker 1: always spread far, but when they did, they were devastating.
Speaker 1: In seventeen ninety three, yellow fever decimated Philadelphia, killing five
Speaker 1: thousand people, one tenth of the population. In eighteen fifty three,
Speaker 1: it did the same in Your Orleans. Where it came
Speaker 1: from was clear enough ships from the Caribbean in the summer.
Speaker 1: But once it had arrived, how did it spread? Was
Speaker 1: it person to person contact? In Philadelphia, people stopped shaking hands,
Speaker 1: Many shrank with affright at even the offer of a hand,
Speaker 1: observed one writer. At the time, acquaintances and friends avoided
Speaker 1: each other in the streets and only signified their regard
Speaker 1: by a cold nod. Or did yellow fever spread through
Speaker 1: something in the air. In New Orleans, the authorities burned
Speaker 1: barrels of tar and whiskey to try to clear the toxins.
Speaker 1: Or did it spread through contaminated objects. During the Civil War,
Speaker 1: a Confederate doctor plotted an early attempt at bioterrorism. He
Speaker 1: gathered clothes from people who died of yellow fever and
Speaker 1: tried to ship them to cities in the North. He
Speaker 1: even sent a suitcase full to Abraham Lincoln. The assassination
Speaker 1: attempt failed. The doctor was later elected governor of Kentucky.
Speaker 1: By nineteen hundred, the question of how yellow fever spread
Speaker 1: had become urgent for the US Army. The US had
Speaker 1: occupied Cuba, a hot bed of yellow fever. They had
Speaker 1: to figure out what to do to keep the troops
Speaker 1: as safe as possible. They set up a commission, at
Speaker 1: its head, Major Walter Reid. It just investigated how typhoid
Speaker 1: spreads on army bases. He had concluded rightly that preventing
Speaker 1: typhoid was all about sanitation. Build the trenes wash hands.
Speaker 1: But the army had been improving sanitation in Cuba, and
Speaker 1: rates of yellow fever were staying stubbornly high. What worked
Speaker 1: for typhoid didn't work for yellow fever, So what were
Speaker 1: they missing? There were theories and puzzles, like the curious
Speaker 1: case of the court martialed soldier. He was kept in
Speaker 1: a cell on a military race, closely guarded, so they
Speaker 1: knew for sure that he hadn't had contact with anyone
Speaker 1: else who'd been ill. Yet still he caught it and died.
Speaker 1: It was as if the disease had somehow flown in
Speaker 1: through the bars of the cell window. Strange. Major Reid
Speaker 1: chose colleagues to assist him. His old friend James Carroll,
Speaker 1: a brilliant young doctor Jesse Lazier. They'd go to Cuba
Speaker 1: and try to work it out. There was one theory
Speaker 1: that could explain the case of the court martialed soldier.
Speaker 1: For twenty years, a Cuban doctor had been tirelessly championing
Speaker 1: his idea that a certain species of mosquito spread yellow fever.
Speaker 1: It was plausible enough on the face of it. Another
Speaker 1: species of mosquito had just been discovered to transmit malaria,
Speaker 1: why not yellow fever too. The problem was that the
Speaker 1: Cuban doctor had been trying for twenty years to prove
Speaker 1: his theory, with no success. He bred mosquitoes and let
Speaker 1: them feed on yellow fever patients. Then he persuaded nearly
Speaker 1: one hundred people to be bitten by those mosquitoes. If
Speaker 1: that seems like an insane thing to agree to, remember
Speaker 1: that it can't have seemed that much of a risk.
Speaker 1: Yellow fever was common, so were mosquitoes, and hardly anyone
Speaker 1: bought the idea that the two were linked, And with
Speaker 1: every new volunteer, the doctor's theory seemed less and less
Speaker 1: likely to be true. Only a few of those bitten
Speaker 1: got ill, and most of them had symptoms that were
Speaker 1: hard to diagnose with confidence. They might have had a
Speaker 1: mildcare of yellow fever, or it might have been something else.
Speaker 1: It was hard to say. Just one volunteer unmistakably got
Speaker 1: yellow fever soon after the mosquito bite, and who could
Speaker 1: be sure that wasn't a coincidence. He might have got
Speaker 1: it somewhere else. So the evidence wasn't promising, But Major
Speaker 1: Reed and his colleagues wanted to test the theory for themselves.
Speaker 1: They visited the Cuban doctor who gave them some mosquito
Speaker 1: eggs hid bread. The eggs were.
Speaker 4: A jet black color, one end rounded and blunt, while
Speaker 4: the other is slightly pointed, the whole closely resembling a
Speaker 4: cancheedah cigar.
Speaker 1: Put them in water, said the Cuban doctor, and in
Speaker 1: ten to twelve days you'll have mosquitoes. Reed put his
Speaker 1: young colleague Jesse Lazier in charge. That made sense. Laziir
Speaker 1: had worked on malaria. He knew mosquitoes hatched the eggs,
Speaker 1: and kept each mosquito in its own test tube plugged
Speaker 1: with cotton. He'd take them to a hospital with a
Speaker 1: yellow fever ward, sit by the bedside of a patient,
Speaker 1: remove the cotton plug, and put the open end of
Speaker 1: the test tube to the patient's skin. He'd flick the
Speaker 1: test tube to get the mosquito moving. Once the mosquito
Speaker 1: had drunk its fill of the patient's blood, he'd plug
Speaker 1: the test tube again. Could these mosquitoes now infect someone
Speaker 1: with yellow fever? There was only one way to find out.
Speaker 1: Lazir put a test tube on his arm and let
Speaker 1: the mosquito feed on him. An army doctor said he'd
Speaker 1: take a bite two. How risky was it really? The
Speaker 1: Cuban doctor had done this to nearly one hundred people,
Speaker 1: and almost all had been fine. The odds seemed firmly
Speaker 1: in their favor. Days passed, and Lazir and the army
Speaker 1: doctor remained in perfect health. Other soldiers volunteered too, nobody
Speaker 1: got ill. Lazier was fast giving up on the theory.
Speaker 1: He told his colleague on the Commission, James Carroll, and
Speaker 1: now one of his carefully nurtured mosquitoes seemed about to die.
Speaker 1: It had sucked the blood of one yellow fever patient,
Speaker 1: but had since been refusing to feed again. It was
Speaker 1: listless without another blood meal, it wouldn't last for long.
Speaker 1: Carol had never believed in the mosquito theory. Put your
Speaker 1: mosquito on me, he said, I'll see if I can
Speaker 1: feed it to keep it going for you. There were
Speaker 1: two things Jesse Lazier and James Carroll didn't know. They
Speaker 1: didn't know that for a mosquito to pass on yellow fever,
Speaker 1: it needs to have fed on someone in the first
Speaker 1: three days of their infection. Lazier had often fed his
Speaker 1: mosquitoes on patients who had been sick for longer than that.
Speaker 1: Then it takes at least twelve days for the mosquito
Speaker 1: to incubate the virus so it can pass it on
Speaker 1: when it bites someone else. Laziir generally hadn't been waiting
Speaker 1: that long before he put his mosquitoes onto healthy volunteers.
Speaker 1: Lazier passed James Carroll the test tube with the ailing mosquito.
Speaker 1: As it happened, precisely, twelve days had passed since this
Speaker 1: mosquito had fed on a yellow fever patient. According to
Speaker 1: Lazier's notes, a patient who had been on day two
Speaker 1: of his illness, Carol, rolled up his sleeve. Lazier put
Speaker 1: the test tube to Carol's arm. The mosquito didn't move.
Speaker 1: Lazier tapped the test tube to rouse it. Still nothing.
Speaker 1: Lazier shrugged and began to take the test tube away.
Speaker 1: Give it here, said Carol. He held the test tube
Speaker 1: to his arm and waited patiently until at last, the
Speaker 1: sluggish mosquito fluttered onto his arm and slipped its proboscis
Speaker 1: through his skin. Cautionary, tails will be back in a moment.
Speaker 1: Three days after Jesse Lazier's ailing mosquito had fared on
Speaker 1: James Carroll's blood, the mosquito was doing well. So was
Speaker 1: James Carroll. He was enjoying a swim in the warm
Speaker 1: sea off a Cuban beach when I felt as sudden
Speaker 1: chill and a crushing headache. By the next day, Carol
Speaker 1: had been taken to hospital. He was running a fever
Speaker 1: of one hundred and five and trying to say something
Speaker 1: about a mosquito. The nurse couldn't follow it. He must
Speaker 1: be delirious. Jesse Lazier must have felt mortified. He had
Speaker 1: failed time and again to produce a case of yellow fever.
Speaker 1: Had he finally succeeded when he wasn't even trying? Laziir
Speaker 1: sought out James Carroll's notebook. He wanted to see what
Speaker 1: Carol had been doing for the last few days. If
Speaker 1: Carol hadn't left the camp, which was fever free, that
Speaker 1: would point convincingly to the mosquito as the cause of
Speaker 1: the infection. But Carol's notebook said he had been visiting
Speaker 1: hospital wards and autopsy rooms where yellow fever victims were dissected.
Speaker 1: Skeptics would say that he could have got it anywhere. Still,
Speaker 1: at least Lazier now had a lead a mosquito in
Speaker 1: a test tube that might have given yellow fever to
Speaker 1: James Carroll. Could that mosquito give it to someone else?
Speaker 1: Lazier needed another volunteer, and he soon found one in
Speaker 1: the army camp. The young soldier expressed curiosity about his work.
Speaker 3: You're still fallen with mosquitoes.
Speaker 1: Doctor, yes, said Lazier. Then will you take a bite? Sure,
Speaker 1: replied the soldier.
Speaker 3: I ain't scared of them.
Speaker 1: The soldier said he hadn't been off the camp in
Speaker 1: two months. That was perfect. Lazier brought the test tube
Speaker 1: with the mosquito that had bitten James Carroll and put
Speaker 1: it to the soldier's arm. Five days later, the soldier
Speaker 1: began to feel unwell. It's hard to predict how badly
Speaker 1: you'll get yellow fever. We now know there are different strains,
Speaker 1: some deadlier than others, but the younger you are, the
Speaker 1: better your chances. Children would often get it mildly and
Speaker 1: then be immune for life. The soldier was young and
Speaker 1: lucky his case was mild. James Carroll was older, and
Speaker 1: he was having a rougher time, still in his hospital bed,
Speaker 1: writhing in pain and burning up. Nurses giving him ice
Speaker 1: cold enemies to try to bring his fever down. Jesse
Speaker 1: Lazier was desperately worried about James Carroll, but he was
Speaker 1: excited too. I rather think I am on the track
Speaker 1: of the real germ, he wrote back home. But nothing
Speaker 1: must be said as yet, not even a hint. And
Speaker 1: then the story gets murky. The Yellow Fever COMMISSI remember,
Speaker 1: was headed by Major Walter Reid. Where was Major Reid?
Speaker 1: While all this drama was unfolding in Cuba? Reid was
Speaker 1: back in America. He had to finish his big report
Speaker 1: on typhoid and present it to his bosses in Washington,
Speaker 1: d c. He got a telegram describing his old friend
Speaker 1: James Carroll's bite and illness.
Speaker 2: He wrote back, I cannot begin to describe my mental
Speaker 2: distress over this most unfortunate turn of affairs. The next
Speaker 2: piece of news was more positive. Carol at last had
Speaker 2: begun to pull through. His fever was down. There'd been
Speaker 2: none of the dreaded black vomit. He was weak, but
Speaker 2: he'd live. Read fired off a letter.
Speaker 5: My dear Carol Hip Hurrah, God be praised. I can
Speaker 5: never recall such a sense of relief in all my life.
Speaker 5: I shall simply go out and get boiling drunk. God
Speaker 5: bless you, my boy.
Speaker 1: And then another telegram Jesse Lazier had got yellow fever.
Speaker 1: The message was blunt, severe case. What had happened? According
Speaker 1: to Jesse Lazier, this is what had happened. He was
Speaker 1: in a hospital at the bedside of a yellow fever patient,
Speaker 1: holding a test tube to the patient's skin. The mosquito
Speaker 1: in the tube had just started to feed. Then, said Lazier,
Speaker 1: another mosquito that happened to be in the room landed
Speaker 1: on his hand. He didn't want to move because he
Speaker 1: had disturbed the insect in the test tube and have
Speaker 1: to start all over again. And he thought the mosquito
Speaker 1: on his hand was from a different species, one that
Speaker 1: wasn't suspected of spreading the disease, so he let the
Speaker 1: mosquito bite him. Historians think that isn't plausible. Lazia, remember,
Speaker 1: was a mosquito expert. He'd studied malaria. He had been
Speaker 1: spending day after day intently observing his mosquitoes in test tubes.
Speaker 1: He affectionately called them his birds. In their book Yellow Jack,
Speaker 1: the authors John Pierce and James Writer say it simply
Speaker 1: does not make sense that Lazier did not recognize what
Speaker 1: species of mosquito had landed on his own hand. What
Speaker 1: historians think happened is this Jesse Lazier experimented on himself again.
Speaker 1: Today he claimed he had been bitten by accident. September thirteenth,
Speaker 1: nineteen hundred. Lazia's notebook contains a cryptic entry. Up till
Speaker 1: then he had recorded the names of all his volunteers,
Speaker 1: along with the history of the mosquitoes that fed on them.
Speaker 1: This entry simply said, guinea pig number one in the
Speaker 1: mosquito it had fed on a patient in the second
Speaker 1: day of his illness, fourteen days earlier. If Lazier had
Speaker 1: formed a theory about the timelines required to transmit yellow fever,
Speaker 1: this was exactly the mosquito he'd have chosen to put
Speaker 1: that theory to the test. It's possible, of course, that
Speaker 1: Lazier had suddenly decided to feed one of his mosquitoes
Speaker 1: on an actual guinea pig, but as nobody on the
Speaker 1: commission had ever discussed doing experiments on guinea pigs, it
Speaker 1: seems unlikely. We can only presume that guinea pig number
Speaker 1: one was Jesse Lazier. Why it on himself and why
Speaker 1: hide it? We'll never know. Five days after guinea pig
Speaker 1: number one was bitten, Jesse Lazier began to feel unwell.
Speaker 1: He sat down to write a letter to his mother,
Speaker 1: who was taking care of his wife back in America.
Speaker 1: His wife had just given birth to their second child.
Speaker 1: He didn't mention his illness.
Speaker 4: Dear little Houston must be very cute.
Speaker 1: He wrote. Houston was their toddler. The next day, Lazier
Speaker 1: was carried to the hospital. James Carroll had recovered enough
Speaker 1: just about to shuffle over to Lazier's bedside. I shall
Speaker 1: never forget the expression of alarm in his eyes, he said.
Speaker 1: Lazier's illness moved quickly to the deadly second stage. He
Speaker 1: thrashed around so much nurses had to call for soldiers
Speaker 1: to strap his wrists and ankles to the bed. He
Speaker 1: began to convulse and vomit. The vomit was black. Jesse
Speaker 1: Lazier was thirty four years old when yellow fever killed him.
Speaker 1: As Major Walter Reed prepared to return to Cuba, he
Speaker 1: had a problem. It wasn't just that one of his
Speaker 1: team was dead and another would need a long time
Speaker 1: off to recover. Their self. Sacrifice had gone to waste.
Speaker 1: They'd been brave in getting bitten, but they hadn't been scientific,
Speaker 1: as Reid explained in a frustrated letter to the convalescing
Speaker 1: James Carroll.
Speaker 3: If you, my dear doctor, had, prior to your bait,
Speaker 3: remained at the camp for ten days, then we would
Speaker 3: have a clear case. But you didn't. You went just
Speaker 3: where you might have contracted the disease from another sauce.
Speaker 1: And what about Jesse Lazier. According to his own account,
Speaker 1: he had been bitten while at a yellow fever hospital.
Speaker 1: For goodness sake, that knocks his case out, wrote Reed.
Speaker 3: I mean, as a thoroughly scientific experiment.
Speaker 1: There was the young soldier Lazier had infected with the
Speaker 1: same mosquito as Carol. His case was highly suggestive, but
Speaker 1: not conclusive, not yet to remove any doubt. Walter Reed
Speaker 1: was going to have to do more thoroughly scientific experiments,
Speaker 1: and for that he'd need more volunteers. Cautionary tales will return.
Speaker 1: Walter Reed needed a sight to construct a new camp.
Speaker 1: It had to be in a part of Cuba that
Speaker 1: wasn't known for yellow fever. He needed well drained land
Speaker 1: with no stagnant water for mosquitoes to breed. He couldn't
Speaker 1: risk stray mosquitoes buzzing in to mess up his experiments.
Speaker 1: He found a two acre site and brought in brand
Speaker 1: new tents and equipment so nobody could say they might
Speaker 1: have been contaminated. He had the workers quarantined to make
Speaker 1: sure they weren't harboring the disease. He then had them
Speaker 1: tested for fever three times a day. The workers put
Speaker 1: up the tents and two simple wooden buildings in honor
Speaker 1: of their fallen colleague. They called it Camp Laziar. Building
Speaker 1: number one had nothing to do with mosquitoes. Reid wanted
Speaker 1: to disprove once and for all the idea that contaminated
Speaker 1: clothing could spread yellow fever. It was a simple wooden
Speaker 1: shed fourteen feet by twenty with shuttered windows. By now
Speaker 1: it was November, the weather was cooling down. Reed wanted
Speaker 1: a fair test in tropical conditions, so he had a
Speaker 1: stove installed in the room to keep the temperature above
Speaker 1: ninety degrees fahrenheit. Reed got three volunteers to go into
Speaker 1: the dark and sweltering hut with a tightly sealed trunk.
Speaker 1: It had sent from the yellow fever ward at a
Speaker 1: nearby hospital. The trunk contained bed sheets and blankets, all
Speaker 1: soiled with a liberal quantity of black vomit urine and
Speaker 1: fecal matter. The three men cracked open the trunk and
Speaker 1: straightway ran back outside, gasping and wretching, and got their breath,
Speaker 1: stealed their nerves, and went back in. They took the
Speaker 1: fetid sheets and blankets out of the trunk and gave
Speaker 1: them all a good shake. If there were contagious particles
Speaker 1: that ought to spread them around. Then they put the
Speaker 1: sheets on the beds in the hut and slept on
Speaker 1: them for twenty nights.
Speaker 4: We all felt like we were coming down with yellow
Speaker 4: fever every day.
Speaker 1: Said one, but they didn't. It was conclusive proof that
Speaker 1: this long held theory was wrong. The Kentucky Doctor's suitcase
Speaker 1: could never have killed Abraham Lincoln Walter Reed had been
Speaker 1: confident that the volunteers in Building number one were never
Speaker 1: in danger of death, just discomfort. The mosquito experiments for
Speaker 1: a different matter, Reid had studied Jesse Lazier's notebook. He'd
Speaker 1: talked to the young soldier Lazier had infected, and he
Speaker 1: had drawn the correct conclusion. He needed an incubation period
Speaker 1: of at least twelve days. The new knowledge meant Reed's
Speaker 1: experiments at Camp Lazier wouldn't be like Jesse Lazier's earlier,
Speaker 1: more casual attempts, when the volunteers could take comfort in
Speaker 1: odds of one in one hundred. Red knew that his
Speaker 1: volunteers were very likely to get yellow fever. He wanted
Speaker 1: them to know that. So Reid had a form typed
Speaker 1: up spelling out the risks, and every time someone asked
Speaker 1: a volunteer he got them to sign it. Informed consent
Speaker 1: is standard practice. Now Reid was its pioneer. But why
Speaker 1: would anyone sign We heard already the young idealist John
Speaker 1: Moran explain his reasons for science and humanity, and Moran
Speaker 1: didn't want the money, even though he was saving hard
Speaker 1: to go to medical school, and in today's terms, Reed
Speaker 1: was offering many thousands of dollars. Others did want the money,
Speaker 1: and they had another pragmatic reason too. If you moved
Speaker 1: to Cuba from a place without yellow fever, so you
Speaker 1: weren't immune from childhood, you felt sure that you'd get
Speaker 1: it sooner or later, So why not take your chances now,
Speaker 1: knowing you'd have the most attentive medical care. The US
Speaker 1: Army could offer. In March twenty twenty, the enormity of
Speaker 1: the COVID pandemic was starting to dawn on the world.
Speaker 1: Most of us were trying to make sense of the present,
Speaker 1: but three academics were looking to the future. We're going
Speaker 1: to need vaccines, they said, as quickly as possible. Those
Speaker 1: vaccines were already being developed and would need to be tested,
Speaker 1: but the traditional clinical trial might take a long time.
Speaker 1: A big group of volunteers would receive either the new
Speaker 1: vaccines or a placebo and would then go about their
Speaker 1: daily lives. Some of them eventually would get COVID, allowing
Speaker 1: scientists to figure out whether most of these cases were
Speaker 1: in the placebo group, in which case the vaccine would
Speaker 1: have worked. But since most people around the world were
Speaker 1: trying very hard not to spread the virus, just waiting
Speaker 1: for enough of those infections to happen by accident could
Speaker 1: take months. Wouldn't it be quicker to deliberately expose your
Speaker 1: volunteers to COVID. That's called a human challenge trial, and
Speaker 1: they've often been used to develop other vaccines. Josh Morrison
Speaker 1: ran a health nonprofit in New York. He thought ourd
Speaker 1: volunteer to get COVID if it might speed up a
Speaker 1: vaccine that could get life back to normal, would other
Speaker 1: people too? He set up a website called One Day Sooner,
Speaker 1: and words spread. Within weeks, tens of thousands of people
Speaker 1: signed up to say they'd do it if someone asked them.
Speaker 1: Some expressed motives much like John Moran's, They'd do it
Speaker 1: for science, for humanity. Others were pragmatic. Like other yellow
Speaker 1: fever volunteers. They said they thought they'd get COVID anyway,
Speaker 1: and they liked the idea of getting it when doctors
Speaker 1: and nurses would be watching them closely. But many decision
Speaker 1: makers were wary about the idea of challenge trials for COVID.
Speaker 1: They're usually used for diseases. We have a good idea
Speaker 1: of how to treat at the time, we couldn't treat COVID.
Speaker 1: So what said Josh Morrison? This is a global emergency.
Speaker 1: We can't take the risk, said others. What if someone dies?
Speaker 1: The debate rumbled on through the summer of twenty twenty.
Speaker 1: Trials didn't happen for the first set of vaccines. They
Speaker 1: were tested in the usual way. One Day Sooner became
Speaker 1: an advocacy group for Challenge Trial volunteers. Later, they funded
Speaker 1: researchers to ask how many lives might have been saved
Speaker 1: if the first vaccines had come, say, thirty days earlier.
Speaker 1: Sixty three thousand, the researchers estimated in the US and
Speaker 1: UK alone. It's hard to be sure if Challenge trials
Speaker 1: really would have given US vaccines thirty days earlier. But
Speaker 1: this isn't really about COVID. It's about looking ahead to
Speaker 1: the next pandemic and what we might learn one possible lesson.
Speaker 1: Let's be more proactive about lining up challenge trials. Let's
Speaker 1: be more hard headed about the trade offs when we
Speaker 1: ask what if we have a trial and someone dies?
Speaker 1: Let's also ask what if we don't have a trial
Speaker 1: and sixty three thousand people die. We can't eliminate risk,
Speaker 1: but we can take calculated risks in a way that
Speaker 1: advances our knowledge. If we have another global emergency and
Speaker 1: selfless volunteers again raise their hands, let's not allow their
Speaker 1: bravery to go to waste. Jesse Lazier and James Carroll
Speaker 1: wasted their bravery because they gave themselves yellow fever in
Speaker 1: a way that scientifically proved nothing Whialter Reed was determined
Speaker 1: not to waste the courage of his new volunteers, such
Speaker 1: as John Moran. He needed to conduct experiments that nobody
Speaker 1: would be able to nitpick. In Building number two, Red
Speaker 1: wanted to put to rest the idea that led New
Speaker 1: Orleans authorities to burn barrels of whiskey and tar, the
Speaker 1: theory that yellow fever spreads through toxins in the air.
Speaker 1: A fine, strong wire mesh ran down the middle of
Speaker 1: the room. On one side fifteen mosquitoes and John Moran
Speaker 1: on the other side. Not only read, but two more volunteers,
Speaker 1: acting as controls. They slept in their half of the hut,
Speaker 1: breathing the same air as John Moran. On Christmas Day,
Speaker 1: John Moran got yellow fever. The other two never did.
Speaker 1: Moran was young and lucky, His case was mild, and
Speaker 1: he recovered. By early February nineteen oh one, Walter Reed
Speaker 1: was ready to report the results of his thoroughly scientific experiments.
Speaker 1: In a speech to a medical congress in Havana. He
Speaker 1: explained how it proved that yellow fever didn't spread through
Speaker 1: dirty objects, it didn't spread through the air, It spread
Speaker 1: through mosquitoes.
Speaker 2: The hall was Pecked, wrote Reed to his wife, the
Speaker 2: applause long and hardy.
Speaker 1: The authorities in Havana set up mosquito brigades to try
Speaker 1: to rid the city of the mosquitoes that spread yellow fever.
Speaker 1: They went from house to house. Most had no piped water. Instead,
Speaker 1: people collected rainwater in open barrels. Mosquitoes laid their eggs
Speaker 1: on the surface of that water. The mosquito brigades poured
Speaker 1: oil on top. Just a thin film was enough to
Speaker 1: suffocate the larvae. As the mosquitoes disappeared, so did the disease.
Speaker 1: Over the previous ten years, Havana had averaged four hundred
Speaker 1: and sixty two yellow fever deaths a year. In the
Speaker 1: rest of nineteen o one, there were five. James Carroll
Speaker 1: never fully recovered from his fight with yellow fever. His
Speaker 1: heart failed. A few years later. Walter Reed died early too,
Speaker 1: though not from yellow fever a ruptured appendix. His name
Speaker 1: lives on in the Walter Reed National Military Medical Center
Speaker 1: in Bethesda, Maryland. But I was curious what happened to
Speaker 1: John Moran, the poster boy for selflessness with the dream
Speaker 1: of being a doctor. I found an obituary from nineteen fifty.
Speaker 1: Moran had lived to seventy four. He had settled in
Speaker 1: Cuba and built a distinguished career as an oil man.
Speaker 1: What happened to saving for medical school? Soon after his
Speaker 1: bout of yellow fever? The obituary said, Moran took the
Speaker 1: money he'd saved so far and invested it in a
Speaker 1: get rich quick oil scheme. The scheme failed, Moran had
Speaker 1: to give up on his ambition to study. He got
Speaker 1: a job in the oil industry instead, and worked his
Speaker 1: way up. I can't help wondering if he'd have felt
Speaker 1: that need to gamble his savings, if only he'd taken
Speaker 1: the payment from Walter Reed, he'd surely earned it. John
Speaker 1: Moran risked his life for an experiment, then risked his
Speaker 1: savings for his dream career. One risk paid off, one didn't.
Speaker 1: That's the nature of risks. When Jesse Lazier and James
Speaker 1: Carroll took the risk of being bitten by a mosquito,
Speaker 1: we learned far too little because a proper scientific experiment
Speaker 1: wasn't in place, And when the volunteers have one day sooner,
Speaker 1: we're willing to take a similar risk. In the face
Speaker 1: of COVID, we learned far too little yet again because
Speaker 1: a proper scientific experiment just seemed too bold for policymakers
Speaker 1: to approve. But there'll always be people who'll take risks
Speaker 1: as a gift to help others. Shouldn't we be prepared
Speaker 1: to accept that gift. The American Plague by Molly Caldwell
Speaker 1: Crosby is a compelling history of yellow fever, as is
Speaker 1: Yellowjack by John Pierce and James Writer. For a full
Speaker 1: list of our sources, see the show notes at Timharford
Speaker 1: dot com. If you enjoyed this tale, I recommend you
Speaker 1: hop on over to pushkin Plus and check out my
Speaker 1: brand new pair of episodes on the Panama Canal. Yellow Fever.
Speaker 1: Greek's havoc on this mega project just one of many
Speaker 1: obstacles faced by the French and the Americans on their
Speaker 1: mission to dig a waterway across Central America. Cautionary Tales
Speaker 1: is written by me Tim Harford with Andrew Wright. It's
Speaker 1: produced by Alice Fines with support from Marilyn Rust. The
Speaker 1: sound design and original music is the work of Pascal Wise.
Speaker 1: Sarah Nix edited the scripts. It features the voice talents
Speaker 1: of Ben Crowe, Melanie Guttridge, Stella Harford, Jammy Saunders and
Speaker 1: rufus Wright. The show also wouldn't have been possible without
Speaker 1: the work of Jacob Weisberg, Ryan Dilly, Greta Cohne, Eric's handler,
Speaker 1: Carrie Brody, and Christina Sullivan. Cautionary Tales is a production
Speaker 1: of Pushkin Industries. It's recorded at Wardoor Studios in London
Speaker 1: by Tom Berry. If you like the show, please remember
Speaker 1: to share, rate and review, tell your friends and if
Speaker 1: you want to hear the show ad free, sign up
Speaker 1: for Pushkin Plus on the show page in Apple Podcasts
Speaker 1: or at pushkin dot Fm, slash plus