[Building confidence in biological products]

During the last decades of the 19th century, discoveries in microbiology paved the way for health programmes as an integral part of social modernisation. Public opinion about the consequences for governmental involvement differed, but in Denmark the state's openness to modern medicine encouraged the establishment of Statens Serum Institut (SSI) in 1902, initially for the production of anti-diphtheritic serum. Under its director, Thorvald Madsen (1870-1957), the SSI soon acquired a reputation for the high quality of its products and its cutting edge research. After qualifying in medicine in 1893, Madsen worked both at the Pasteur Institute and with Paul Ehrlich in Frankfurt. During World War I, he served with the Red Cross, caring for German, Austrian and Russian prisoners of war. He had an extensive and expanding network of international contacts, and he was eminently qualified to assume the elected office of President of the League of Nations' Health Committee. The Committee served as the 'parliamentary body' of the League of Nations Health Organisation (LNHO), and Madsen's hand can be seen in much of the work undertaken by the LNHO. The drive to achieve uniform standards for biological products related directly to his own as well as the SSI's interests and expertise. Undoubtedly, standardization of biological products had an immense importance for their distribution, scientifically, commercially and therapeutically. Madsen was president of the LNHO's Commission on Biological Standardisation from 1924, and during the interwar years, the SSI was heavily involved in establishing standards for biological products such as tuberculin and tetanus antitoxin. Madsen's interests extended to application of prevention technologies, and he utilised the opportunities in Denmark to further their use, notably in the case of tuberculosis. The introduction of the BCG vaccine promised a solution to the TB problem, but the Lübeck disaster generated a widespread reaction against the vaccine. Sponsorship from the Rockefeller Foundation led to close investigation of TB incidence in Denmark, and eventually to the offer of vaccination of tuberculin-negative Danes. The programme provided a foundation for later UNICEF and WHO eradication policies. The paper throws light on how local cultures and experience, and personal dedication, shaped the policies developed by the interwar international movement.