Open Access (free)

The uneasy politics of epidemic aid

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

Open Access (free)

The politics of vaccination

A global history

Edited by: Christine Holmberg, Stuart Blume and Paul Greenough

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.

Open Access (free)

Paul Greenough, Stuart Blume and Christine Holmberg