While Canada struggles with lagging COVID-19 vaccination rates, few people remember that Ontario once led the development of the first modern vaccine against what historians say was one of the biggest health challenges of the early 20th century: diphtheria. But the horror of diphtheria and the work of John G. FitzGerald, the doctor behind the large-scale production of a vaccine for it, have largely been forgotten.
Like COVID-19, diphtheria was a highly infectious disease that attacked the respiratory system. It was also the biggest contributor to childhood mortality until the mid 1920s, according to Catherine Carstairs, a history professor at the University of Guelph who specializes in public-health history. “It was horrific for parents because this diphtheric membrane would form in the throat, and the child would essentially strangle to death,” she says. “It was a horrific way for a child to die.”
The only treatment was an antitoxin that had to be imported from the United States. But its price was beyond the reach of most families. A 1915 Maclean’s magazine article told of a family that had two children with diphtheria but only enough money to treat one: “The parents decided which child should have the anti-toxin — the other died.”
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FitzGerald didn’t want parents to have to make such choices. He knew how to make the antitoxin and believed that he could put it within reach of every Canadian family. He had studied unique approaches to public health around the world, including through stints at the Pasteur Institute, in Brussels, and the New York City Department of Public Health. So he pitched the idea of making an antitoxin, at cost, to the University of Toronto. But, impatient to get started, he decided to forge ahead on his own without waiting for a decision.
In 1913, he built a modest wood-frame stable and laboratory behind a colleague’s house, near Bloor and Bathurst Streets, in Toronto. With four horses rescued from a glue factory and $3,000 from his wife’s inheritance, he set to work. He injected the horses with tiny-but-deadly doses of diphtheria germ, extracting their immunized blood and processing it into antitoxin.
He knew it was risky — a slip of the needle could be fatal, because the amount injected into the horses was enough to kill a human being. But grandson James FitzGerald, author of What Disturbs Our Blood: A Son's Quest to Redeem the Past, suggests that the risk involved might have helped his grandfather’s cause: “He was smart enough to see that if he could develop an antitoxin for diphtheria, and show the elites that he could do that in a barn,” then he could get the university to support his vision.
FitzGerald’s gamble paid off. The antitoxin was successful, and, on May 1, 1914, U of T formally established the Antitoxin Laboratory at the University of Toronto (it was renamed the Connaught Antitoxin Laboratories in 1917, after the Duke of Connaught, Canada's governor general from 1911 to 1916). According to Christopher Rutty, a professor at U of T’s Dalla Lana School of Public Health and a medical historian, the organization represented “a bold commitment to public health” that evolved into the cornerstone of Canada's public-health infrastructure in the 20th century.
The diphtheria antitoxin — which helped treat the disease but not prevent it — was only a prelude to FitzGerald’s full vision, which included a self-funding public-health research, manufacturing, and teaching institution within the university. This vision, James says, was based on his grandfather’s obsession with disease prevention, an obsession that had come from working in his father’s pharmacy in the late 1890s. Born in 1882, FitzGerald grew up in Drayton, north of Kitchener; his mother, who had experienced long-term chronic illness, died at 51. “Here he was, watching his father making these pills by hand, and they aren't helping,” says James. “And so he gets this idea that prevention and education is how you eradicate disease.”
On a 1924 European research trip, FitzGerald discovered that the Pasteur Institute’s
Gustav Ramon had just figured out how to treat the diphtheria toxin so that it created immunity in humans. He immediately cabled back to Toronto and told his colleague Peter Moloney to drop everything and start making it. The Connaught lab was “ideally suited to take Ramon’s discovery to the next step in a way that Ramon was not,” says Rutty. “Although Ramon was well-established in the Pasteur Institute, he was more based in the laboratory, and at the time the public-health system in France was less integrated.” Connaught Antitoxin Laboratories, on the other hand, was already well-established in the Canadian public-health system, distributing bio-health products, such as insulin, nationally. And, Rutty adds, FitzGerald “was at the peak of his Canadian and international public-health networking powers.”
The Connaught lab was quickly able to scale up manufacturing and launch a Toronto field trial involving 36,000 children. The trial, completed in 1929, “sealed the deal” in terms of conclusively showing that the vaccine worked, Rutty says: “It was the first modern vaccine, and Connaught and Canada were ahead of everybody on this.” What was the secret to Connaught’s success? “Its seamless integration of scientific research and vaccine manufacturing, a model that could be of great value for facing future infectious diseases,” says Rutty.
U of T sold Connaught Medical Research Laboratories, as it had come to be known, to the Canadian Development Corporation in 1972. Canadian ownership ended in 1989, when the government approved a sale to French-owned Institut Mérieux. Several mergers later, it became Sanofi Pasteur Canada and had head offices in Lyon, France, producing existing vaccines for Canadian and global markets. FitzGerald’s vision had been realized, but he died by suicide in 1940.
James says that one of Canada’s greatest public-health stories has been forgotten not only because the vaccines were so successful that people have forgotten about the horrors of such diseases as diphtheria, but also because of the stigma of his grandfather’s suicide: “It’s a double amnesia."