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The cultural construction of opposition to immunisation in India
Niels Brimnes

While the history of immunisation in India is mainly about some of the world’s most extensive programmes, this article focusses on four instances of well-articulated opposition to immunisation from elite sections of Indian society. Analysing an anti-vaccination pamphlet from 1921, Gandhi’s writings on immunisation and medicine, protests against BCG vaccination in the first decades after independence, and Debabar Banerji’s vociferous criticism of immunisations programmes since the 1970s, it explores how the opposition was culturally constructed and linked to imaginations of the Indian nation. The article finds that a recurrent theme is the notion that immunisation is – due to distinctive features of Indian society and culture – particularly problematic in India, rather than strengthening the national body, immunisation threatens to destroy it.

in The politics of vaccination
Open Access (free)
Paul Greenough, Stuart Blume and Christine Holmberg
in The politics of vaccination
Vaccine scares, statesmanship and the media
Andrea Stöckl and Anna Smajdor

This chapter discusses the MMR vaccination controversy in the UK following the publication of a paper in Lancet which linked the MMR triple jab to childhood autism. We discuss the response of the British media to the paper’s claims, and its subsequent retraction, and the way that the actions of the then Prime Minister contributed to the debates. We analysed media reports from that time and draw on policy papers on science communication in order to show how a combination of events before and after the publication of Wakefield’s paper influenced public debates on science, trust and personal responsibility for health protection, and thus also had an impact on public health policy making. We follow a historical thread on actions of public figures on health policy issues and situate the debate in the context of British science policy in general to better understand vaccine controversies and debates in the British context.

in The politics of vaccination
Britta Lundgren and Martin Holmberg

During 2010 an increasing incidence of narcolepsy in children and adolescents was reported in Sweden and Finland, associated with the pandemic vaccine Pandemrix. Vaccination has since the 1940s been seen as a magic bullet to protect from flu. During past influenza pandemics in Sweden, the vaccine was, however, either absent or in short supply. Since the pandemic 2009-10 – caused by the Influenza A(H1N1) virus – production increased and mass vaccination campaigns were launched in many countries. Sweden was the most successful, with over sixty per cent coverage in what became the largest public health intervention in Swedish history.

Facing the A(H1N1) pandemic, Swedish mass vaccination efforts were preceded by consensual decision-making relying on historically successful vaccination campaigns. Paradoxically, both the efficiency of the response as well as the approach to consensual decision-making may have harmed instead of strengthened public trust.

The aim is to discuss pandemic influenza as an old and a contemporary problem and place it within the framework of national and international flu vaccination practices, pandemic preparedness, and nation building. This work is built on research on flu pandemics, on public documents and on interviews with parents of children suffering vaccination-induced narcolepsy and with officials working on pandemic preparedness.

in The politics of vaccination
Elisha P. Renne

Vaccination campaigns rely on the political authority of the state to carry out public health programs for the benefit of its citizens. In sub-Saharan Africa where vaccination programs were introduced by health officials during colonial rule, subsequent postcolonial programs, such as interventions which focus on a single disease and are supported mainly by western international NGOs, may be viewed with suspicion by some. Rather than strengthening state control of its citizens, vaccination campaigns such as the Global Polio Eradication Initiative as implemented in northern Nigeria, may undermine state authority and control. With its initial focus on polio vaccination rather than on childhood diseases which parents considered more life-threatening, the initiative highlighted the federal government’s failure to provide basic primary health care. That the GPEI was funded by western international NGOs also led some Muslim parents, religious leaders, and medical professionals to question the safety of the oral polio vaccine and to refuse vaccination for their children. However, in 2013 their actions have been tempered by programs providing monetary awards to state governments and foodstuffs to cooperating mothers and in September 2015, WHO announced the interruption of wild poliovirus in Nigeria.

in The politics of vaccination
A global history

In this book scholars from across the globe investigate changes in ‘society’ and ‘nation’ over time through the lens of immunisation. Such an analysis unmasks the idea of vaccination as a simple health technology and makes visible the social and political complexities in which vaccination programmes are embedded. The collection of essays gives a comparative overview of immunisation at different times in widely different parts of the world and under different types of political regime. Core themes in the chapters include immunisation as an element of state formation; citizens’ articulation of seeing (or not seeing) their needs incorporated into public health practice; allegations that development aid is inappropriately steering third-world health policies; and an ideological shift that treats vaccines as marketable and profitable commodities rather than as essential tools of public health. Throughout, the authors explore relationships among vaccination, vaccine-making, and the discourses and debates on citizenship and nationhood that have accompanied mass vaccination campaigns. The thoughtful investigations of vaccination in relation to state power, concepts of national identify (and sense of solidarity) and individual citizens’ sense of obligation to self and others are completed by an afterword by eminent historian of vaccination William Muraskin. Reflecting on the well-funded global initiatives which do not correspond to the needs of poor countries, Muraskin asserts that an elite fraternity of self-selected global health leaders has undermined the United Nations system of collective health policy determination by launching global disease eradication and immunisation programmes over the last twenty years.

in The politics of vaccination
The CDC’s mission to Cold War East Pakistan, 1958
Paul Greenough

Global smallpox eradication was achieved only after decades of unsuccessful experiments in smallpox-endemic countries. A case in point occurred in 1958 when a severe epidemic imposed heavy mortality on East Pakistan. In response a Bengali regional-nationalist ‘Citizens Provincial Epidemic Control Committee’ pushed aside the provincial health department and launched an eradication campaign based on student volunteers using foreign-donated vaccine. In a period of ten weeks thousands of volunteers vaccinated thirty million Bengalis, albeit relying on shortcuts in sterile technique and neglect of patient record-keeping. The US government, in support of its Cold War ally, Pakistan, provided half of the vaccine supplies. The US also sent a team of Communicable Disease Center epidemiologists to assist public health officials. The team, led by Alexander D. Langmuir, proposed ‘active surveillance’ methods but was constrained by T. Aidan Cockburn, the Chief Public Health Adviser, who favored the Bengalis’ volunteer approach. A struggle developed between politicised volunteerism and epidemiological professionalism, and the CDC experts failed to prevail. The two sides' published reports thus made contradictory recommendations to the global campaign, but subsequent experience has shown that both mass participation and active surveillance are critical ingredients for successful disease control and eradication programmes

in The politics of vaccination
Polio in Eastern Europe
Dora Vargha

Through the case of Czechoslovakia and Hungary, this chapter explores the role of Eastern European states in polio prevention and vaccine development in the Cold War. Based on published sources and archival research, the chapter demonstrates that polio facilitated cooperation between the antagonistic sides to prevent a disease that equally affected East and West. Moreover, it argues that Eastern Europe was seen – both by Eastern European states and the West - as different when it came to polio prevention, since the communist states were considered to be particularly well suited to test and successfully implement vaccines.

in The politics of vaccination
Ana María Carrillo

This chapter deals with the development and production of vaccines in Mexico from the last third of the nineteenth century to 1989, when the erosion of this sector began. Along with discussing Mexican’s physicians’ reception of discoveries in microbiology and immunology, it points out the existence of a network of relationships between Mexican institutions and others around the world. The chapter shows that vaccine development and production did not follow a constant ascendant path, but that it also suffered declines and regressions. It describes the field’s achievements and limitations, and reveals its relationships with the political, economic, and social conditions of the country in different historical moments. Finally, it evaluates the importance of attaining national self-sufficiency in vaccine development and production for the building of the state in pre- and post-revolutionary Mexico, and seeks to provide some answers to the questions of how and why the erosion of this strategic field occurred.

in The politics of vaccination