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The Arts and Medicine
August 5, 2022

Just the Plague: Reflections on State Control of Infectious Outbreaks

Author Affiliations
  • 1Institute of Continuing Medical Education of Ioannina, Ioannina, Greece
JAMA. 2022;328(9):810-811. doi:10.1001/jama.2022.0354

In 1939 prominent Soviet microbiologist Abram Lvovich Berlin was working on a plague vaccine as deputy director of the Workers’ and Peasants’ Red Army Biotechnology Institute, then located in Vlasikha, on the outskirts of Moscow.1,2 He immunized laboratory animals with a candidate live-attenuated plague vaccine and challenged them with Yersinia pestis (then called Pasteurella pestis) aerosol, and he was infected in the process. He was called to Moscow to present interim results of his vaccine development efforts to superiors; shared a train compartment with numerous fellow travelers; came into close contact with National Hotel receptionists, its barber, and other visitors and residents; then was evaluated by a physician for emerging cough and malaise before presenting his research results to high-ranking officials. He was hospitalized; the diagnosis of pneumonic plague was made by an astute physician on duty (Dr Simon Gorelik),3 and a massive tracing and quarantine expedition was undertaken. Among the extensive network of potentially exposed contacts, only Berlin, his hotel barber, and Gorelik were known to have become sick and died (see Additional Information below).

This is the true story behind Ludmila Ulitskaya’s Just the Plague, published by Granta Books in 2021. Ulitskaya is a major literary figure in contemporary Russia, her name often mentioned as a potential Nobel laureate for Literature. The child of a biochemist, she studied genetics as an undergraduate and worked for a short time at the Vavilov Institute of General Genetics before being sidelined for political activity. She wrote Just the Plague in the late 1980s as a screenplay for an application to a filmmaking course after hearing the story of the almost-outbreak from a friend, Natalya Rapaport, whose father, a pathologist, performed autopsies on the 3 victims (Rapaport wrote her account of the events in 2020; see Additional Information below). Ulitskaya, considering the story an expensive film to make and being inexperienced in how to “shop it around,” shelved it, but the topicality of the subject with the coronavirus pandemic led to renewed interest and its recent publication.

Just the Plague, a novel by Ludmila Ulitskaya.

Cover image provided courtesy of Granta Publications, 2021.

Ulitskaya accurately describes the clinical course of pneumonic plague and its potential for spread,4,5 enriching the story of the outbreak with details of Soviet-era social and political life revealed though a host of characters and multiple points of view, from the “staunch Party loyalist” in an apartment “marked by the Communist ethos of austerity” to the “Very High Personage, second only to the Big Boss (Stalin),” a reference to Lavrentiy Beria, the exceptionally brutal chief of Stalin’s secret police, the NKVD (Naródnyy Komissariát Vnútrennikh Del, or the People’s Commissariat for Internal Affairs, one of several precursor agencies to the KGB).

The intent is to show in human terms the effect of the Soviet political apparatus on management of the outbreak, which occurred in the immediate wake of the Great Purge of 1936-1938, when hundreds of thousands of people including prominent scientists were persecuted or executed as traitors to the state in Stalin’s attempt to eliminate perceived enemies and consolidate power. The NKVD had already developed a vast surveillance network, and it was relatively easy to trace and forcibly isolate contacts. In addition, the state had near-complete control over the flow of information. The public was never told of the potential for a serious plague outbreak, and contacts who were forcibly quarantined were never told why. It is that context that gives the story its punchline, and title: in a society and a time when a door knock and arrest meant exile or execution, all were relieved to discover on release from quarantine that it was “just the plague.”

The political commentary hints at why the story could not be published in the late Soviet era, and why it is newly relevant today. Ulitskaya has Rudolf Maier, the character based on Abram Berlin, travel to Moscow in a train compartment with a young follower of Soviet biologist Trofim Lysenko, who sought to replace scientific truths with more ideologically correct fantasies. They broach the topic of “proper breeding” and science. “I’m afraid my object of study obeys different laws,” Maier says. “How are they different?” the young man asks; “We all live according to one law, Marxist-Leninist law.” “Naturally,” Maier agrees, “only my microbes don’t know that,” a reminder most liberal societies forgot they needed, that the laws of infectious epidemiology ignore political ideologies.

The book’s Afterword includes the transcript of a contemporary conversation with Ulitskaya making further connections between the story and current events. Ulitskaya acknowledges the threat that totalitarian states may use the pandemic to justify repressive measures but also recognizes that the instruments of control can be used to advance the public’s health and common good. She comments on the situation in Russia: “For the first time the Kremlin has allowed the Russian regional governors to find their own independent solutions…and to carry them out,” adding, “This is not openness; it reflects the helplessness of authorities.” And she draws parallels between the Soviet plague outbreak of 1939 and now. That was a plague within a plague, she says. Thousands of people were “unable to sleep, trembling with apprehension they might be arrested at any time.” At that very moment, she says, “Yersinia pestis emerged, an infection that originated in some laboratory. Does this sound familiar?”

Ulitskaya’s story adds to a majestic body of work that explores the Russian experience and the Soviet legacy (read also The Big Green Tent and Jacob’s Ladder), in this instance penetrating the norms of state and society when both are stressed by a potentially explosive infectious disease outbreak.

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Article Information

Corresponding Author: Georgios Pappas, MD, Institute of Continuing Medical Education of Ioannina, H. Trikoupi 10, 45333 Ioannina, Greece (gpele@otenet.gr).

Published Online: August 5, 2022. doi:10.1001/jama.2022.0354

Conflict of Interest Disclosures: Dr Pappas reported receiving personal fees from Hellenic Society of Medical Oncology (HeSMO) for advice on pandemic strategies for oncology patients and grants from Captain Vassilis & Carmen Constantacopoulos Foundation for developing a guide for safe university attendance during the pandemic with the University of Peloponnese, all outside the submitted work.

Additional Information: There are differences in some details of the 1939 outbreak presented in the historical literature. Most reliable sources agree that the vaccine research institute Abram Berlin worked at was based near Moscow,1,2 and that the outbreak led to subsequent relocation of the institute to a more distant, secure site (initially to Kaliningrad and subsequently to Saratov, the source stated elsewhere).3 It was in Saratov that the institute began to be called the Mikrob Institute, often used in narratives of the incident. Ulitskaya’s friend Natalya Rapoport, whose father performed autopsies on the plague victims, has faulted Ulitskaya for failing to acknowledge her as a coauthor or her narration of the episode in her recently released “Medicine and Stalin”.3 Ulitskaya acknowledges Rapoport as the source of the story but not as a coauthor of the screenplay.

Domaradskij  IV, Orent  W.  Biowarrior: Inside the Soviet/Russian Biological War Machine. Prometheus Books; 2003.
Leitenberg  M, Zilinskas  RA, Kuhn  JH.  The Soviet Biological Weapons Program: A History. Harvard University Press; 2012. doi:10.4159/harvard.9780674065260
Rapoport  N.  Stalin and Medicine. Untold Stories. World Scientific Publishing Co; 2020. doi:10.1142/11504
Kool  JL.  Risk of person-to-person transmission of pneumonic plague.   Clin Infect Dis. 2005;40(8):1166-1172. doi:10.1086/428617PubMedGoogle ScholarCrossref
Inglesby  TV, Dennis  DT, Henderson  DA,  et al; Working Group on Civilian Biodefense.  Plague as a biological weapon: medical and public health management.   JAMA. 2000;283(17):2281-2290. doi:10.1001/jama.283.17.2281PubMedGoogle ScholarCrossref
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    1 Comment for this article
    Actual History of the Screenplay
    Natasha Rapoport, Ph.D., D.Sc. | University of Utah
    My name was mentioned twice in the above text and I feel the need to offer some clarifications. In 1987 I wrote a novella “This is Just the Plague", later renamed "Eight Days of Quarantine," telling the fictional story of five families involved in the real events of the pneumonic plague outbreak in Moscow in December 1939. I read about these events in an underground manuscript written in the mid-1970s by my father, pathologist Yakov Rapoport, who conducted the autopsy on Simon Gorelick, the doctor who treated Berlin.

    Intending to turn my novella into a screenplay, on the advice of
    a writer friend I collaborated with Lyudmila Ulitskaya, who was attending a screenwriting workshop at the time. We were close to finishing the script when I had to interrupt our work for a two-month business trip. When I returned home, I found out that the script was in the hands of film director Andrei Razumovsky and that Ulitskaya was listed as the sole author. It was a surprise and I wrote letters to the chairman of the Union of Cinematographers, and to Razumovsky. The script did not go into production, and I considered the incident to be over.

    In 2020 Ulitskaya published our script of 1987 as the book reviewed here, ‘Just The Plague,’ without my name. She has since mentioned my name as a source of information, but has not acknowledged my role as co-author.

    More detailed information is available here.