Factors such as climate and geography were important determinants of the types vaccines selected for use and the prevalence of certain infectious diseases in Japan. However, as shown in this chapter, there is strong evidence that preventive vaccination policies that were strongly influenced by foreign health authorities, changing societal expectations, pressure from special interest groups, and new scientific discoveries played as an important, if not a more significant role in the formation of Japan’s approach to immunisation and vaccine production. By delineating the principal features and influences on the development of Japan’s vaccine policies and production using a wide range of illustrations, the writer argues that Japan’s approach differed markedly from the ones adopted by the health authorities in other nations. This distinctiveness stems from Japan’s unique history of disease, policies and institutions, whose centerpiece is the Preventative Vaccination Law (PVL) introduced in 1947 during the Allied occupation (1945-52). This chapter will trace these influences—both past and present—on Japan’s vaccination policies in order to shed light on its unique approach to immunisation and production.
A century ago, state institutes of public health played an important role in the production of sera and vaccines. In The Netherlands and the Scandinavian countries they continued to do so until after World War II. Focusing in particular on The Netherlands, this chapter examines their withdrawal from vaccine production in the past 20 years. In the 1980s the Dutch government was still committed to maintaining the state’s ability to produce the vaccines needed by the national vaccination programme. A series of legal and institutional changes sought to protect the public sector vaccine producer against the threat of privatisation. These changes ultimately proved inadequate. Not only was the Institute’s ability to meet demand for new vaccines being eroded by global developments, but policy makers were increasingly convinced that vaccination practices should be harmonised with those of other European countries. The decision to sell off the Dutch state’s vaccine production facilities, taken in 2009, has to be understood in historical context. It was the outcome of globalisation processes that for two decades had worked simultaneously on both the supply and the demand sides
The cultural construction of opposition to immunisation in India
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.
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.
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.
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 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.
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