The subject could not seem more obscure, but A Modern Contagion tells an interesting story about unexpected impacts of modernization.
First, it was peace, prosperity, and trade that brought cholera to Iran. Afkhami explains, "Britain's growing colonial presence in India and its wide-reaching navy allowed the ancient disease to break out of its endemic home in the southern Ganges Delta region and assume pandemic proportions." The results were periodic outbreaks with spectacular loss of life.
Second, despite the image of clerical and other traditional elites being resistant to change, as the scientific facts about cholera became clearer in the late nineteenth century, Iranians accepted revisions to long-standing and cherished customs, such as shipping bodies months after death for burial in the Iraqi holy city of Najaf.
Third, the great powers—Britain and Russia but also the Austro-Hungarian empire—used cholera as an issue to advance their interests while presenting their agendas as neutral public health concerns. The early international conferences pressing the Iranians and Ottomans to agree to outside monitoring and interference were held before scientists understood what caused cholera—the leading theory long having been "bad air." European demands were at least as much based on imperial interest as on scientific fact.
Lastly, over the nineteenth century, the Iranian public at all levels radically changed its expectations about what were the responsibilities of the government. By the early twentieth century, all saw the government as having an obligation to provide for public wellbeing, including protecting the citizens from pandemics—something no one would have expected from the shah when the Qajars came to power in 1789. Afkhami notes that when the last cholera outbreak hit Iran in the early 1960s, the imperial government's response was a model of efficiency, with rapid action across a wide range of government agencies containing the disease. So much for the misconception that Mohammed Reza Shah was unconcerned about his subjects.
Afkhami's epilogue makes a convincing analogy between the Qajar experience with cholera and the Islamic Republic's raging opiate crisis with the old-fashioned ills of opium and heroin, rather than the modern synthetic opioids bedeviling America. Afkhami explains how the only effective solution to the opiate crisis—as it was to the cholera problem—would be to tackle the whole range of causes, be it socioeconomic problems or outmoded social attitudes and practices, rather than relying only on draconian penalties.