Investigating the History of a Disease

Though the introduction of antibiotics and public health campaigns in many countries in the mid-twentieth century greatly reduced its occurrence, tuberculosis (TB) remains one of the most common and deadly diseases in the contemporary world.  According to the World Health Organization (WHO), nearly two million people still die of TB each year. 

Christian McMillen, assistant professor of history at the University of Virginia, is interested in understanding more about how TB became widespread among certain groups of people historically and how it was combated.  McMillen points out that TB was becoming the primary killer of American Indians before rigorous scientific research into the causes of the disease began in the U.S. 

“Beginning in the 1930s, TB reached epidemic proportions among Indians and really became impossible to ignore,” says McMillen.  Clinical trials took place in the U.S. involving Indian subjects, in an effort to test the efficacy of the Bacille Calmette Guerin (BCG) vaccine.  BCG eventually became, and remains today, the primary vaccine for the disease. 

Through comprehensive epidemiological research, ultimately a link between TB and poverty was demonstrated, which contributed to an important significant shift in thinking about the disease.  The research helped to spur an aggressive, international vaccination campaign for TB prevention.  “This was the first global vaccination campaign,” comments McMillen. 

McMillen’s research has broadened in focus to look at how local people, worldwide, have responded to the international, public health campaign to prevent TB, from 1948-1965.  In order to ascertain this, McMillen is asking questions about how local populations responded to the vaccination campaigns.  Different populations exhibited varying degrees of resistance, for different reasons.  McMillen notes that the response of American Indians was not as oppositional as the response of Indians in Madras, who launched a major resistance campaign against the TB vaccination program in the 1950s.

Much of McMillen’s TB research on American Indians was completed by utilizing the National Archives.  McMillen has also visited the headquarters of the United Nations Children’s Fund (UNICEF) for data and has plans to travel to the WHO in December.  His research will involve examining a substantial range of materials, ranging from on-the-ground accounts by field agents to administrative documents.

The Center for Global Health at U.Va., through funding from the National Institutes of Health’s Fogarty International Center, is supporting some of McMillen’s research.  The Framework Program in Global Health is a new initiative through the Center that has awarded grants to six faculty members across Grounds this year.  The purpose of the grants is to expand the offering of multidisciplinary global health classes at U.Va.  This funding will allow McMillen to develop “A History of American Indian Health and Disease in a Global Context, 1900-2000” this year.  He will teach the course at U.Va. in the next three subsequent years. 

McMillen also teaches courses such as “The Politics and Culture of Indian Law” and “The History of the American West.”  His forthcoming book from Yale University Press, Making Indian Law, is an extension of his dissertation research at Yale.  The book examines the origins of Indian activism in the 20th century in relation to the claiming of indigenous land.