In January 2021, United Nations Secretary-General Antonio Guterres argued that “‘vaccinationalism’ is self-defeating and will delay a global recovery”. He said: “vaccines are reaching high-income countries quickly, while the world’s poorest have none at all. Some countries are pursuing side deals, even procuring beyond need.”
Vaccinationalism has its roots in the way imperial medicine grew in the 19th century around the Asian, African and other colonies of European nations.
When tropical medicine was introduced in India in the 19th century, it was primarily focused on ensuring the safety of the British stationed in the subcontinent, in the midst of cholera, malaria and other diseases. As historians David Arnold, Dipesh Chakrabarty and others have shown, it enabled the creation of cordon sanitaires and the regulation of local individuals and collectives. While it did serve the colonial subject race, it was mainly a regulatory mechanism. In Arnold’s words in Colonizing the Body
“Western medicine in India was always … caught between the thrust of metropolitan science on the one hand and the gravitational pull of India’s perceived needs, constraints, and potentialities on the other…”
In the case of sexually transmitted diseases, as Kenneth Ballhatchet, Ashwini Tambe and other commentators have shown, in order to protect British soldiers from Indian prostitutes who were suspected of passing on these diseases, massive hygiene and medical surveillance campaigns, including the Contagious Diseases Act, creation of lal bazars and other measures were instituted. Yet again, we see the linkage between disease, medical research and processes and national/racial – here, British – identity. Regulating prostitution to save the British, says Ballhatchet, “made sinning safe.”
There was an economic angle to imperial medicine and its preventive measures as well. Historian Partho Datta shows how the segregation of the whites and the natives was accompanied by a segregation of “the abandoned and destitute on the one hand and the sick but potentially productive and useful labourers on the other.” To take another example, this time of malaria, Nandini Bhattacharya has shown how the plantation economy “inhibited any large-scale investment in anti-malarial sanitation” in the hills.
There were other aspects to imperial medical pursuits too. Research laboratories began to be established across India from the late 19th century. This led, of course, to debates on the ethics of animals in research – debates that reflected the prevalent ethos in England, caught between a scientism and a romantic view of animals. Through such laboratories, the history of science scholar, Pratik Chakrabarti, has argued, “Indian animals became subjects and resources of the British Empire.”
So medicine, especially imperial, did always have national overtones and racial undercurrents. For instance, the British government was extremely worried that drunken and mad British soldiers in the Indian streets were a blot on the Empire. Colonial psychiatry evolved so as to ensure this did not happen. “The justification of British rule as a ‘noble cause’ and … the preservation of the prestige of the ruling race”, required the “institutionalisation and repatriation of the European mentally ill,” writes Waltraud Ernst in Mad Tales from the Raj: Colonial Psychiatry in South Asia, 1800-58.
From another context, the British doctors dealing with indigenous medical practitioners were caught between a dismissive attitude towards native systems of medicine and having to utilise them for medical interventions during epidemics.
That said, it must not be imagined that the local populations took to vaccination willingly. Resistance to these campaigns has been recorded throughout history, from England to colonial Bombay (where Waldemar Haffkine, after whom the institute is named, encountered local anger at his plans to vaccinate them). The historians Niels Brimnes and Michael Bennett have documented extensively India’s resistance to such campaigns throughout the 19th and early 20th century. While the British saw vaccination as an “act of imperial beneficence” (Bennett’s words), the colonised subjects found the procedure intrusive and religiously offensive, leading to resistance.
Waldemar Haffkine was a Ukrainian who later became a French citizen, and came to India as a bacteriologist, having tested vaccines for cholera and the plague: he tested the vaccines on himself
Tropical medicine and the development of vaccine politics produced vaccine heroes, of course. During epidemics, the British medical establishment experienced scientific and social rivalries, even as it dealt with massive events such as the plague of 1896-1914. The interaction between the plague administrators and the colonised people was far from easy, as Brimnes has argued in the case of smallpox. In the case of diseases like cholera, the imperial perspective often took the stance that it was man-made, and attributed it to Indians’ living conditions, the mass gatherings and festivals and hygiene practices, as historian of medicine, Mark Harrison, notes in a 2019 essay in Modern Asian Studies.
Then there is the role of missionaries. In the case of dreaded diseases like leprosy, as Sanjiv Kakar notes, prevailing prejudices prevented medical intervention. It was the Christian missionaries in India who enabled the employment of western medicine, even as the disease and the diseased native populations became subject to police and medical control (see Jane Buckingham’s Leprosy in Colonial South India).
The Epidemic Diseases Act of 1897 was created to tackle bubonic plague in colonial Bombay
Driven by ‘National Interest’
There are several ways in which we can think of vaccinationalisms.
First, the research, production and marketing of vaccines by the nation’s institutes and pharma companies as driven by ‘national interest’ and embedded in the rhetoric of the same. The race to produce vaccines and the race to be the ‘first’ , firmly locate the biomedical and the pharmacological within the rubric of national identity. When the then President of the United States sought to acquire monopolistic purchase rights over the imminent Covid vaccine, he was merely repeating an instance of vaccinationalism.
Second, when a state proceeds to vaccinate an entire citizenry, it sets out to determine the immunity of entire populations, and has brought a biomedical process within the ambit of national ‘work’ and identity. It furthers this process by also linking vaccination to the sense of civic duty of citizens: good citizens get vaccinated. The hierarchisation of the ‘deserving’ populations in terms of age, comorbidities and others, the anxieties over unregulated pricing by pharma companies and hospitals are also constitutive of the debate around ‘national interest’.
A third related point is: the right to health and the claims made by citizens upon the state/government to ensure immunisation, protection and treatment. The state is mandated, in this view, to provide appropriate and timely vaccines and treatment, and is accountable for the same.
Then, the emphasis on public health clearly shifts the focus away from individual autonomy to collective responsibility and rights. That is, vaccination is a public good, and individual views differing from this can (must) be ignored if we as a nation think of the public good as foundational. The discipline of public bioethics and the work of James Childress in particular makes this crucial point. Should individual autonomy – not wearing masks, for example, for any reason, even religious – be given precedence over the larger good? Quarantine and epidemiological laws in history have always foregrounded the larger good.
A slightly tangential point also needs to be made. What do philanthropic organisations and charity work have to do with vaccinationalism? Very often the NGOs and philanthropic organisations are backed and regulated by their transnational offices and donors. This means, the question of national sovereignty over the public health of its publics is mired in larger issues of transnational interventions and the implied assumption that the state is not capable of producing (enough) vaccines for its people.
It is this area that provides vaccinationalism its dual-edged nature.
According to a new British Medical Journal report, the US has secured 800 million doses of at least six vaccines in development, and the UK purchased 340 million shots: approximately five doses for each citizen
“Covid-19 cannot be beaten one country at a time,” declared Guterres as he called for sharing of information about current research and emphasised the need for collaboration and cooperation. This call for global cooperation to ‘battle’ (one cannot, it would seem, escape the martial metaphor, as Susan Sontag pointed out in her Illness as Metaphor) Covid 19 implicitly signalled the need for a global moral code in ignoring national and self-interest in tackling this virus, which did not respect national, racial and ethnic borders.
In their The Politics of Vaccination: A Global History (2017), Christine Holmberg, Stuart Blume and Paul Greenough note the role of organisations like the International Red Cross, the World Health Organization, among others, in shaping global eradication and immunisation campaigns such as the polio and hepatitis initiatives. The rise of a global health paradigm has been a key feature, the volume shows, of the 20th century.
William Muraskin’s ‘Afterword’ notes the tension between vaccinatonalism and ‘vaccinternationalisation’ (to coin a term) when he writes:
“global health power-brokers can, and regularly do, take advantage of this belief to subvert the priorities of developing world governments, national medical professional associations, local communities and millions of families. Too often, countries’ autonomy and authentic independence are the collateral damage of top-down global health.”
Thus, immunisation campaigns are situated at the intersection of national identity and global interests.
As the pandemic rages, vaccinationalisms surge and calls for a larger outlook emerge, what we do recognise is that vaccines or not, we are linked in a chain of mutual vulnerability.
(The author is Professor, Department of English, University of Hyderabad)
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