Diphtheria in the UK

Liam Shaw

Manston is a small village in Kent. The old military base there was repurposed as a ‘migrant processing centre’ in February 2022 to deal with the growing number of people arriving across the Channel. It is intended to hold around 1400 people for a short time – ideally under 24 hours – before they are transferred elsewhere. It is not a residential site.

Suella Braverman first became home secretary on 5 September. Officials have briefed that she repeatedly refused to move people into hotels to alleviate overcrowding. The number detained at Manston spiralled to around four thousand. People have stayed for days, weeks. One doctor who has worked in Manston told the Today programme of inadequate washing facilities in the ‘horrible and crowded conditions’. The chief inspector of borders and immigration said last week that the conditions he had seen on a visit had left him ‘speechless’. According to the Refugee Council, one boy contracted scabies – caused by parasitic mites – after a nineteen-day stay. A video taken by the campaign group SOAS Detainee Support on Sunday, 30 October showed children chanting: ‘We need your help.’

The Home Office has said that ‘a very small number of cases’ of diphtheria have occurred at Manston. Diphtheria – from the Greek for ‘leather hide’ – is a bacterial disease spread by close contact. It can be caused by any of three species in the genus Corynebacteria (so named because they are ‘club-shaped’). The bacteria grow in the victim’s throat, carpeting it with a noxious grey film – the leathery membrane that gives the disease its name – that can suffocate. The pathogenic Corynebacteria also produce a toxin that causes necrosis of cells, which when spread around the body in the blood quickly kills. The immune system fights back, but in young children the defence is often insufficient. For infants under five, the case-fatality rate can be up to 20 per cent. Victorians referred to it as the ‘strangling angel’.

Diphtheria was one of the first infectious diseases to be treatable by modern medicine. In 1890 the Prussian scientist Emil Behring and the Japanese bacteriologist Kitasato Shibasaburō, working together in Berlin, discovered that injecting horses, guinea pigs and goats with a bacterial toxin allowed an ‘antitoxin’ – an antibody manufactured by the animals’ immune systems – to be derived from their serum.

Horses became the animal of choice to produce an antitoxin serum for diphtheria. After injecting a horse with gradually increasing levels of toxin, workers would tap the exterior jugular vein in its neck and bottle the blood. The need for the antitoxin serum was so great that public health departments acquired their own stables to make it. In New York, a seven-year-old bay gelding was bled nine times in a year, producing 22 bottles.

In 1923, it was discovered that heating the toxin with formaldehyde could inactivate it but still stimulate an immune response. This led to immunisation campaigns. In 1940, there were more than 61,000 cases and 3200 deaths in the UK. Routine immunisation began in 1942: fifteen years later, there were only 38 cases and six deaths.

Though diphtheria is much less prevalent worldwide than it used to be, outbreaks still occur among unimmunised populations in crowded and unhygienic conditions. The largest recent outbreak was in 2016-19 among Rohingya refugees in Bangladesh. For unimmunised people the best treatment is still antitoxin from horses. In the UK, such supplies – manufactured by the Butantan Institute in Brazil – are rarely needed. The number of annual cases is rarely more than ten, mostly from chance infection from animals.

Diphtheria has been a notifiable disease since the Infectious Disease (Notification) Act of 1889. The UK Health Security Agency will have been legally informed of the ‘very small’ number of cases at Manston – the media have reported eight cases. Statistics for England and Wales are published weekly: the most recent bulletin, for the week ending 30 October, records one case in Ashford, Kent. In the whole of 2021 only three cases were notified through the system.

In the first nine months of this year there were five isolated cases, scattered across the country. At the end of September (week 39) there were two, in Lincoln and Southampton. In each subsequent week there has been at least one case, taking us up to a run of eight in locations across England. It seems probable that the recent cases are all people who have passed through Manston before being sent elsewhere. Diphtheria has an incubation period of two to five days. Next week’s report will show if the run continues.

The Conservative MP Roger Gale – who has criticised Braverman’s decisions regarding Manston as a ‘car crash’ – described the facility before she took charge as operating ‘absolutely magnificently and very efficiently indeed’. But a report from the Prisons Inspectorate following a surprise visit in July suggests otherwise.

On arrival at Manston, people undergo a medical assessment carried out by two private providers (Medevent and Aeromed). The room used by one provider was ‘poorly equipped’ and ‘poorly ventilated’. The pathway of care between them ‘lacked co-ordination or clinical leadership’, and communication was ‘poor’. Facilities for the management of infectious disease were ‘poor’. Staff were ‘unsure of any guidance, policy or procedure’ that existed for infection: individuals were simply placed in a ‘claustrophobic portacabin with no clear responsibility assigned for managing them’.

An outbreak of diphtheria is only the latest symptom of a broken system. Braverman’s decisions regarding Manston have been disastrous. But the problems pre-date her inadequate leadership. Manston is just one part of the government’s failure to prepare for an ongoing humanitarian crisis: not beyond our borders but inside them. The most sobering moments in the Prisons Inspectorate report are the few, isolated observations of kindness: in the family area, the inspectors ‘saw staff playing with the children, which was good’.


  • 2 November 2022 at 6:48pm
    Simon MacArthur says:
    When I think of Braverman, the only phrase that comes to mind is ‘depraved indifference’. She’s a monster and I struggle to imagine how that mindset was given birth to in the UK I grew up in; we were inclusive, regardless of skin tone.
    She says she loves the country she grew up in but I’m buoyed by the horror with which her stated mindset has been greeted. Are we really this lacking in empathy, in compassion for those less fortunate? She belongs in the same pantheon as Joseph Mengele and Pol Pot - utterly detestable.

    The world over we’re seeing a vicious jag to the far right and Braverman seems to have been seen as a natural lightening rod here; someone, somewhere saw her as susceptible to influence. I think she’s badly miscalculated in thinking that we’re all aligned in te same way she is with Farage, Steve Bannon and Robert Mercer.
    I look forward to her self-inflicted collapse and the exposure of her links with the American proto-fascists. We deserve leaders with compassion now more than ever and it doesn’t exist in any measure with the current crop of Tories.

    • 3 November 2022 at 12:54am
      neddy says: @ Simon MacArthur
      Fair go. Comparing Ms Braverman to Pol Pot and Mengele is extreme in the extreme. Your post is all abuse and no enlightenment. I can't figure out how it passed the LRB's censor. But it obviously did. I doubt anyone subscribes to the LRB to read extreme abuse.

    • 3 November 2022 at 4:36pm
      shewie says: @ neddy
      I subscribe to the LRB and I do not mind reading abuse when it is directed against somebody like Ms Braverman and neither do I mind when a reader makes an impassioned and justifiable comment about Ms Braverman.

    • 3 November 2022 at 11:57pm
      neddy says: @ shewie
      You sound so reasonable. Honourable even. And while I dislike using social cliches, signaling your virtue from the top of the Eiffel Tower. Pol Pot and Mengele tortured and murdered millions. Millions! They did it deliberately and with malice intended. Regardless of Ms Braverman's sins, she does not begin to encroach on their territory. and I suggest you know it. It does not reflect well on the LRB to allow such extreme abuse to be published. It does not enlighten, educate, inform, offer moral alternatives, or even succeed in appealing to ordinary decency. To whom will we compare the next Pol Pot, if Ms Braverman is the standard.

    • 4 November 2022 at 8:58am
      steve kay says: @ neddy
      I imagine that the LRB has moderators, or maybe monitors. Unlike the BBC, the LRB does not have board members imposed from above, Tory party donors, public school boys etc.

    • 5 November 2022 at 2:41am
      neddy says: @ steve kay
      And that's a good thing. No Elon Musk controlling the LRB is as it should be (in my view). Having said that, I much admire Elon, and have one of his cars on order. My only objection to the original post was the unnecessary abuse.

  • 2 November 2022 at 11:29pm
    Derek Pringle says:
    The racist and uncaring attitudes of the British government make me ashamed to be British. Why are some of the worst government offenders themselves from families who have immigrated to the UK? Patel? Kwarteng? Braverman……is it some sort of prerequisite for success in the Tory party of today?

  • 5 November 2022 at 11:11am
    Camus says:
    She dreams of a Telegraph headline announcing the first flight to Ruwanda with a refugee on board, by which Catch 22 comes into operation. Catch 22 says, if you are a genuine refugee, you will be flown to Ruwanda , where you will receive refugee status. Pseudo refugees will be flown to Ruwanda where they will not receive refugee status . Some catch, that Catch 22. Some book, that Catch 22

  • 6 November 2022 at 6:45am
    ben cosin says:
    Slackly, perhaps, I always associated the word diphtheria with classical Greek DIAPHTHEIREIN - ro destroy. Am I the only subject or object of Volksetymologie in this regard? I might also rebuke the reader who complains about the comparison of Braverman with Pol Pot (the year-zero cult of the enraged petit-bourgeoisie is one thing they share) or with Mengele, who at least thought he was engaging in a form of 'genetic science'. Our curtain-twitching defender of the Home Secretary from the .somewhat commonplace, invective of Braverman's critics offers no refutation, not even an attempted rebuttal, of the criticisms, other than their own and apparently others' "hurt feelings" or "taking of offense". Such incipient censorship is all too reminiscent not only of the modish (and often ludicrously vicarious) professional thin-skinnery of the 'woke', but also of the invocation of the feelings of the German people not only by Dr Goebbels by most of the government of the Third Reich.

    • 7 November 2022 at 5:26am
      neddy says: @ ben cosin
      Get yourself under control, mate. You have clearly stopped taking your meds. I didn't defend the Home Secretary; my feelings aren't hurt - I live in Australia - not the UK; I don't twitch my curtains; I ain't thin-skinned and I wouldn't describe myself as "woke". I didn't attempt a refutation of the original abuse of Ms Braverman because none was needed. She hasn't tortured and murdered millions as did Pol Pot. The reference to Mengele, the Angel of Death, makes light of his (Mengele's ) torture of Jewish and non-Aryan persons in the second world war. Mengele selected persons for experimentation or death. He decided who amongst incoming prisoners would be retained as test subjects and who would be sent immediately to the gas chambers. Mengele was partial to Jewish and Roma twins and children in general. You can't seriously be comparing Ms Braverman to either of these hideous individuals.

    • 8 November 2022 at 6:12am
      neddy says: @ neddy
      Come on Ben; hurry up and respond; bloviation is your specialty coupled with arrogance and conceit. Give us some more laughs. We all need it.

Read more