Cholera was the first modern pandemic. It has shaped the way we think about the emergence and global interconnectedness of diseases and infections, as well as about countermeasures. A workshop at the OeAW examines the socioecological history of cholera in the Indian Ocean.
The lethality of a cholera disease that remains untreated is between 20 and 70 percent. Cholera is notifiable, the pathogen is a highly motile bacteria that leads to severe diarrhea with massive fluid loss. The seventh cholera pandemic, occurring since 1961, has repeatedly caused outbreaks around the world.
A cholera workshop will be held at the Austrian Academy of Sciences (ÖAW) on 24 May. In an interview, OeAW medical anthropologist Eva-Maria Knoll and Indian medical historian Vivek Neelakantan, who is currently a guest researcher at the Academy, explain the parallels with Covid-19 and how cases of cholera outbreaks are linked to a lack of water supply. These research activities are part of the Appraising Risk project funded by the Social Science and Humanities Research Council of Canada and based at the Indian Ocean World Center at McGill University in Montreal. Climate-related risks in the Indian Ocean past and future are the focus of this project.
Where and when did cholera first appear?
Vivek Neelakantan: Until the discovery of the cholera bacillus by Robert Koch in 1882, the etiology and nosology of cholera were unclear. In India, cholera was personified as a goddess; known as Ola Bibi in Bengal; or as Mari Aai in parts of the West Indies. The people ask for his protection, offer him offerings of food. Then, in 1817, we find the first documented case of cholera in Bengal. The pathogen migrated from there to Bombay, to Asia Minor, Afghanistan, Mauritius, Manila – it spread in different directions. This was the first documented cholera pandemic in history.
Cholera was the first pandemic of the modern era and it shaped how we still think about pandemics today.
Why is cholera so important for pandemic research?
Eva Maria Knoll: The first documented case also represents the emergence of new thinking in science about how diseases arise and how they spread, how infection occurs and how it can be fought. Cholera was the first pandemic of the modern era and it shaped how we still think about pandemics today. One of the main reasons cholera is a fruitful workshop topic is the many dimensions of the disease. Cholera is very persistent, it is endemic, epidemic, but also pandemic. It has been suspected in the human body, but also outside the Ganges basin environment. It is local, linked to poverty and unhealthy living conditions, but it is also global. No one was safe from her. The rich were also affected.
Many cases of cholera go unreported because the disease is stigmatized and reflects poorly on the affected country.
Do you have an example?
button: In 1873 there was a cholera epidemic in Vienna that killed nearly 3,000 people. At that time there was a world exhibition and Vienna wanted to present itself as an innovative city. And then there was this cholera outbreak, many visitors fled the city and canceled their reservations. But there were also positive impulses: the first spring water pipeline in the Viennese mountains was intended to bring drinking water from the Alps to Vienna. Thanks to the efforts of OeAW member Eduard Süss, construction was accelerated. Therefore, the Academy of Sciences is also a perfect location for our workshop.
Is cholera always associated with poverty, does it make it difficult to control?
Neelakantan: Many cases of cholera go unreported because the disease is stigmatized and reflects poorly on the affected country. Several crises are disrupting water supplies and contributing to an increase in cases, such as the climate crisis in Gujarat outbreak in 2022. In Haiti, in 2010, the trigger was a strong earthquake. In 2016, there was a cholera outbreak in Yemen as a result of the civil war.
How many deaths were there in total?
button: The WHO estimates 1.4 million cases annually and 21,000 to 143,000 deaths and has a goal of ending cholera by 2030. With vaccines, electrolytes, antibiotics, clean water, and hygienic and economic standards, cholera can be easily controlled. It’s a question of supply, in fact no one should die from it anymore.
Are there parallels to the Covid-19 pandemic?
Neelakantan: History does not repeat itself, but there are similar disagreements regarding infectious disease quarantines. In colonial times, the Bombay government advocated quarantining incoming ships, but Raj authorities opposed this measure. During the Covid-19 crisis, there was also no consensus between India’s central and state governments on the implementation of lockdowns.
button: Scientist David Arnold has called cholera the primordial pandemic of the modern era. She laid the groundwork for how we in science but also in the public think about pandemics as a global phenomenon that affects everyone. This connection to the global crisis was first clarified by cholera. But also international cooperation to develop a vaccine. In this regard, it is not surprising that there were constant references to cholera during Covid-19.