“The politics of vaccination. A global history” is a multi-faceted study of the connections between vaccination, identity (constructions and politics), political systems and resistance across time and place. The edited volume is based on the proceedings of two conferences in Berlin and Norwich, with an impressive total of twelve contributions from across the social sciences including anthropology, history of medicine, philosophy and local cultural studies. The volume is divided into three parts: Vaccination and national identity; Nationality, vaccine production and the end of sovereign manufacture; and Vaccination, the individual and the society. Each contribution situates the practice of vaccination and immunization as well as the production of vaccines in a different political regime and geographic locale. The authors cover the periods of colonialism and post-colonialism, post-WWII Communism and “ruthless” neo-liberalism, in four of the five continents.
The first chapter, by Paul Greenough, looks at the beginnings of the global campaign to eradicate smallpox, which surprisingly originated in Pakistan. Greenough’s description of physicians and epidemiologists in Cold War Pakistan and their attempts to control the smallpox epidemic serves as an engaging entry into the complex and sometimes painful topic of the politics of vaccinations. The next contribution, by Nils Brimnes, depicts local resistance to immunizations in India from the late colonial period to the early years of Independence. He links this resistance to anti-colonialism and the creation of an Indian national identity: in other words, in contrast to their unifying role elsewhere, immunization campaigns here were seen as a threat to the nation. Chapter 3, by Dora Vargha, examines how Hungary became the model for the global WHO strategy of polio eradication. Providing a wealth of fascinating historical details, the author explores the ways in which the image of the body (in this case the productive, laborious body) coheres with a political ideology underlying public health initiatives. In the fourth and final chapter of Part I, Eun Kyung Choi and Young-Gyung Paik examine the production of modernity through the skillful introduction of Hepatitis B vaccines in a multi-decade study of 20th century Korea. Here it becomes clear that the notion of “backwardness” plays an important role in political decisions, particularly those concerning vaccinations and other public health issues.
The second part of the volume opens with a piece by Ana Maria Carrillo on the health institutions which produced vaccines and national political strategies on immunization in 20th century Mexico. These involved a great deal of toing and froing on matters of safety and efficacy. Chapter 6, by Stuart Blume, discusses the history of the Dutch Institute of Public Health in the Netherlands from the 1960s to the present day. This well-argued piece delves into globalization and the privatization of vaccine production in Europe, providing reflections on the ownership of scientific knowledge beyond the specific place and time covered in the chapter. In Chapter 7, Jaime Benchimol examines the production of yellow fever vaccines in Rio de Janeiro from the mid 19th to the mid 20th century. This chapter stands out for the compelling way it traces etiologies of treatment for diseases such as malaria, dengue, and yellow fever, showing how these came to be understood through modern theories of disease. Finally, in the last chapter of this section, Julia Yongue reviews Japan’s unique approach to global health and immunization policy from the mid 19th century onwards. Here, the notion of modernity played a central role in driving discussions about public health, as the Japanese state put into place explicit policies to “modernize” the country in line with western nations.
The third part of the volume begins with a chapter by Andrea Stöckl and Anna Smajdor on the public controversy surrounding the combined MMR (measles, mumps and rubella) vaccine in the UK. This controversy, which played out in British media some twenty years ago, became a national political issue when it called into question the personal health decisions of then-prime minister Tony Blair. Chapter 10, by Britta Lundgren and Martin Holmberg, discusses influenza immunization in contemporary Sweden. Here, vaccination is seen as an act of solidarity with the state, which was nevertheless shaken by the influenza pandemic in 2009. In the last chapter of this section, Elisha P. Renne examines the obstacles faced by the Nigerian state (including cultural challenges, trust, resistance, difficulties with water and electricity) in its immunization campaigns. Her research also points to the creative ways in which the state faced up to these challenges, for instance by giving gifts as incentives to get vaccinations.
In the afterword, William Muraskin critiques the global humanitarian approach to eradicating disease, which often operates through a willful ignorance of local factors or a downright colonial mindset. Muraskin’s piece is a compelling argument for why public health interventions should take social and cultural factors into account, as these have a direct effect on the success of initiatives and how they are received in different national, regional and/or cultural contexts.
Overall, the volume is a dense, diverse and well-written collection, rich in facts, which covers a significant part of the global history of immunization. The case studies take the reader through scientific error, media manipulation, the inter-cultural transmission of values and concepts, and the quest for modernity through public health. The strength of the volume lies in the diversity of its material, but this is also a weakness at times: for instance, the two competing polio vaccines invented by Sabin and Salk are mentioned in multiple historical and geographic contexts without being brought together in a cohesive analysis. The volume as a whole would have benefited from greater attention to the details that recur in the different histories (like the development of polio vaccines) and how these are connected across time and place.
Readers who are not already specialists in the history of immunization may be distressed to learn that it is also a history of violence and death. The chapters shed light on numerous vaccine tests with “volunteers” such as the 1.5 million people who were unwitting test subjects for vaccines in the USSR, in Brazilian orphanages, or even prisons in ‘democratic’ countries. There were also sacrifices on the part of researchers, like the early and sudden deaths of scientists in the field of yellow fever. These “collateral damages,” as Muraskin puts it in the afterword, contributed to the development of many safer vaccines which are now in common use.
While the volume covers a great deal of historical material, it leaves open a number of questions on immunization today. For instance, how are European states responding to homogeneous EU guidelines for immunization strategies? How does the face of civil resistance change if nearly all global vaccine production is now in the hands of multinational pharmaceutical companies instead of national institutes?
Despite such minor shortcomings, however, this volume is an overdue benchmark in the study of immunization, providing a basis for the analysis of current and historical political struggles and public health strategies on a national, transnational and global level. It is to be hoped that the volume will encourage further inquiry into this ever relevant field.
Holmberg, Christine, Stuart Blume & Paul Greenough (eds.). 2017. The politics of vaccination. A global history. Manchester: Manchester University Press. Link to publisher’s website
Eva Jansen is a medical anthropologist and Fritz Thyssen postdoctoral fellow at the University of Tübingen. Currently, she is working on cancer and complementary medicine in Germany. She is also interested in migration, health policies, and Science and Technology Studies. Eva is the author of “Naturopathy in South India: Clinics between Professionalization and Empowerment”, published by Brill in 2016.