When Marcantonio Zezza left Venice in 1611, a piece of paper in his pocket may have been one of his most prized possessions.
The small print, handwritten with his name and important data and signed by an official, certified that he had left the city "with God's grace" "freed from all contagious evils".
It is quite possible that without such a document he would have been denied access at the travel destination or even the mere transit - out of sheer fear that he might have death in his luggage.
Because what the note, measuring only 16 by 11 centimeters, attested to Mr. Zezza, would be formulated today as follows: This man is free from the plague.
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Certificate of freedom from the plague of 1611: Have a good trip, Signor Zezza
Photo:
Wellcome Collection
In Covid times, this is reminiscent of the current »3G«: vaccinated, recovered or tested.
There have not yet been any vaccinations, but those who have recovered - and men like Zezza, who may have been the "tested" of their time, free of symptoms.
And traveling without such a certificate might have been associated with similar, but probably worse, problems than in 2021.
The Italian city-states of Milan and Venice had already begun in 1347 to devise effective measures to curb the rampant "black death" by breaking the chain of contacts.
This stood in open contrast to the teaching of the church, which did not interpret epidemics as contagious diseases, but declared them to be God's punishment - for whatever.
Plague ordinances from the middle of the 16th century therefore always named the most important and first measure against the disease to be kneeling prayer several times a day and zealous penance.
Miasm and plague seeds: the idea of the "pathogen"
But Milan and Venice proved that one could also actively influence the containment of the epidemic, which regularly killed up to a third of the population of affected cities and districts. "The isolation of the sick, the quarantine for people suspected of being ill, the cleaning (Purga) of suspicious goods, the absolute ban on passage (Bando) for merchants from infected places, all these facilities were essentially developed in northern Italy during the 15th century," wrote the doctor and medical historian Vera Waldis in an essay.
As early as 1546 Girolamo Fracastoro, a doctor, poet, philosopher and polymath from Verona, came up with a scientific thesis for the first time as to how the spread of such diseases could be explained physically: In addition to poems about syphilis, he also wrote a treatise on the "plague seeds" could spread the disease without direct contact with the sick.
At that time, the church and establishment only recognized the “miasma”, the breath of plague from the air or the ground, as a possible cause.
However, Fracastoro gave medical practitioners and the city's epidemiological commissioners a more concrete idea of how and what action could be taken to curb the spread of the disease: isolating the sick, restricting traffic, preventing public life in an affected region by »lockdown«, burning corpses and more everything that came into contact with them.
We now know that this fight against the epidemic would last for centuries and could not prevent countless deaths.
We don't know how much worse it could have been.
Because the approach was right - and we have known that for several centuries.
Free from sickness, free to travel
From the 18th century onwards, recovery and health certificates, which were supposed to guarantee travelers freedom of travel even in times of epidemic diseases, spread throughout Europe. The earliest reports of vaccinations against smallpox also date from the early 18th century: Ground blood scabs with live viruses were blown into an open wound. If the vaccinated survived, he was immune afterwards - and since 90 percent of the patients succeeded, more and more dared to do so, because smallpox killed up to 50 percent of those infected in the normal way.
It was the English country doctor Edward Jenner who developed the method on which the principle of vaccinations is still based: from 1796 onwards he instead infected his patients with cowpox pathogens. The cows killed, but only caused side effects in humans - and gave the immune system the life-saving signal to defend itself against anything that somehow reminded of the pathogens that were sprayed. It worked, and so a new type of official certificate was issued a few years later: the vaccination certificate.
As in Venice in 1611, it began regionally, often at the instigation of individual doctors or authorities. When Johann Wetzler published his "Instruction of the rural people on the protection sheets" in 1802, he did so in the form of an advisory brochure for parents suffering from suffering: "How often are you not, dear parents, betrayed by the sheets in your hopes and joys in your children?" The young doctor Joseph Servatius D'Outrepont explored the concept in the following year for the book under the same title - and landed a bestseller with three editions in the first year.
The fear was great, because the flakes or smallpox killed children by the thousands.
How much better was it to infect the little ones with "protective leaves" and thus protect them from worse in the medium term?
The vaccination spread correspondingly quickly.
In the 1820s, authorities in what is now Germany have long been issuing their »vaccination certificates« on official forms - this is how the nationally valid »vaccination pass« was invented.
Pandemics strike globally
That the one and a half year old Anna Christine Harmsen had "vaccinated in the year 1831 and regularly survived the real protection sheets" on August 25th, was attested to her on an official form by a licensed medical officer. Formally, the document was valid for Schleswig-Holstein, but it should at least have been accepted in the rest of the German-speaking area as well. For smallpox, the first deadly disease against which one could vaccinate, vaccination was standard for young and old alike by the middle of the 19th century at the latest.
However, the world was still waiting for an international standardization of health-securing measures. While the smallpox in Europe was visibly losing its strength due to vaccination campaigns, cholera raged in more and more places - a consequence of urbanization in the wake of the industrial revolution. Disastrous hygienic conditions were the norm in the working-class neighborhoods, and the fact that it was there that the worst diseases spread the fastest contributed to an understanding of the causes and ways of spreading.
They were now increasingly transcontinental.
In 1826 there was an outbreak of cholera in India, and by 1837 the disease spread via China to Japan, across the vast expanses of Russia, through Central Europe, and from Great Britain to North America.
This first pandemic, perceived as global, killed at least hundreds of thousands, if not millions, of people - there are not even reliable estimates of the number of victims.
Russia alone put the number of its victims at at least 1.1 million.
This shocked the world, and almost everywhere there were authorities and ministries whose mission was to preserve the health of entire nations.
Faster response to new threats
In the middle of the 19th century the time had come: at the same time as the first World Industrial Exhibition in London, at which an economy that recognized itself as globalized, the delegates of the First International Medical Conference against the globalization of the disease met in Paris in 1851.
Their goal: an international coordination of quarantine and other containment measures in order to make "the spread of contagious and exotic diseases" more difficult.
The French government recognized the need as early as 1834.
Above all, she identified the acceleration of travel by rail as the greatest pandemic risk.
Twelve countries accepted the first invitation and each sent a diplomat and a doctor.
The first conference ended with a joint catalog of measures that comprised 137 articles.
The medical conferences proved to be effective, although initially no formal international organization emerged from them.
Up until 1938, a growing number of countries conferred 14 times and reacted to new threats with new measures - for example, a cholera epidemic in 1866, and in 1933 the renewed acceleration of global travel by passenger aviation.
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Vaccination certificate today: internationally regulated
Photo: Schöning / ullstein bild
This conference also led to the introduction of the first globally valid, uniformly designed vaccination pass, which was expanded in 1944 by a health agreement on sea voyages.
The World Health Organization (WHO), which was founded in 1948 and is the successor to the international medical conferences, then took over the ID.
That is still the case today. In 1611, the Venetian plague charter, Signor Marcantonio Zezza, guaranteed free travel in northern Italy and what is now Switzerland - that was a lot in times when you usually had to walk from A to B. However, our current vaccination certificate, which should enable us to continue traveling worldwide in times of Covid-19, is no longer a document of a small regional state, not issued by the Federal Republic of Germany or the EU, but one of the WHO. At least when it comes to illness and health, we are citizens of the world today.