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Wednesday, March 03, 2021

Explained: The history of vaccine opposition in India — the case of smallpox

As the exercise of inoculation against the novel coronavirus infection gains momentum in the country, policymakers are also grappling with significant vaccine hesitancy. This isn’t a new experience — as a look back at the chequered history of the first vaccination efforts in colonial India shows.

Written by Benita Fernando , Edited by Explained Desk | Mumbai |
Updated: February 24, 2021 10:20:15 am
Recent research has shown, British and Indian officials had to grapple with significant public unwillingness to get vaccinated. (Representational Image)

On June 14, 1802, three-year-old Anna Dusthall, born to the female help of a British officer in Bombay, became the first child in India to successfully receive the world’s first vaccine.

From the pus that formed on her skin upon vaccination, five more children were vaccinated against smallpox. Thereafter, enough vaccine material was collected using her lymph, and sent to different parts of the subcontinent.

Dusthall was “remarkably good-tempered”, and the success of the vaccination was partly attributed to “her quietness and patience in suffering the operation”, according to one account.

Smallpox was endemic throughout the Indian subcontinent, turning into an epidemic every five years or so, with a mortality of one in three cases. The success of vaccination was, therefore, a cause for imperial optimism.

Punjab: Panchkula reports 22 new covid cases, 83 receive 2nd vaccine shot Earlier, Vaccine created by the English scientist Edward Jenner was used cowpox to produce immunity against smallpox. (PTI/File)

But the vaccine was not easily accepted in India. As recent research has shown, British and Indian officials had to grapple with significant public unwillingness to get vaccinated, with each section of society having its own reasons to resist.

The first shot: a cross-continental relay

The vaccine, created by the English scientist Edward Jenner, used cowpox to produce immunity against smallpox. (The word “vaccine” comes from the Latin vacca for cow and vaccinia for cowpox).

By 1800, Jenner’s vaccine was delivered “arm-to-arm”, where lymph was taken from vaccine incisions and administered to other subjects. In 1799, Jenner sent threads soaked in lymph vaccine to Vienna; and from Vienna to Baghdad via Constantinople (today’s Istanbul).

A vaccinated child from Baghdad was sent to Bussorah (Basra), and from the child’s arm, successful vaccinations were performed. In May 1802, a batch of lymph was despatched to Bombay, where Dusthall was among the 20-odd children to receive it, but the only successful outcome.

This relay was often lauded in official accounts, but the British administration was yet to fully comprehend the problem of lymph logistics.

Neutralising the influence of ‘tikadars’

In 1805, John Shoolbred, the superintendent general of vaccine inoculation, expressed keenness for Bengal to receive the vaccine. But “the whole tribe of Brahmin inoculators” were determined enemies of the new practice, he noted, and were using their influence to stop parents from presenting their children for vaccination.

The “tikadar” or inoculator/variolator was a product of the region’s existing method of developing immunity against smallpox. Tikadars would manually induce smallpox with preserved dried scabs from previously inoculated subjects. The scabs were first purified in Ganga water, and the subjects were prepared for inoculation through abstention from fish, milk, and ghee.

To blunt the tikadars’ influence, in 1805, pensions were granted to those who were willing to relinquish their practice in and around Calcutta. Some 50 years later, variolation would be equated to practices such as sati and infanticide.

Terrifying vaccinator and painful vaccination

There are many references to weeping mothers, angry fathers, and parents absconding with their children before or after vaccinations in official accounts from 19th century India. Indeed, the vaccinator, who was always Indian, was often a terrifying figure.

For most of the 19th century, vaccination was not the quick jab of today — rather, it was implemented by a variety of sharp instruments. With the arm-to-arm method, children not only had to bear with the painful procedure, but also the extraction of lymph for further vaccinations.

There were concerns over the quality of the lymph, which lost potency in India’s hot weather.

Resistance, including opposition by Gandhi

In 1898, Britain stopped arm-to-arm vaccinations, saying syphilis and hepatitis spread through the practice. Calf lymph was seen as a safer alternative — and also one that would be acceptable to high caste Indians who believed it was ritually polluting to be vaccinated with the lymph of lower caste children. But of course, that was not to be.

In 1913, when he was still in South Africa, Gandhi expressed his strong opposition to vaccination, calling it “sacrilege”: “Vaccination seems to be a savage custom. It is one of the poisonous superstitions of our times the equal of which is not to be found even among so called primitive societies… Vaccination is a filthy remedy. Vaccine from an infected cow is introduced into our bodies; more, even vaccine from an infected human being is used… I personally feel that in taking this vaccine we are guilty of a sacrilege.” (‘General Knowledge About Health – XXIV’, Indian Opinion, June 14, 1913)

Writing in ‘Navjivan’ in 1929, and in a letter to Manilal and Sushila Gandhi that same year, he wondered “how vegetarians can ever take such vaccine”, and described vaccination as “tantamount to partaking of beef”. [Quoted in ‘Fallacy, sacrilege, betrayal and conspiracy: the cultural construction of opposition to immunisation in India’ by Niels Brimnes in ‘The Politics of Vaccination: A Global History’: Holmberg, Blume, Greenough (eds.), 2017]

The opponents influenced by British anti-vaxxers

In the early years of the 20th century, an elite, English-reading section of Indian society was influenced by the opinions expressed in ‘The Vaccination Enquirer’, the mouthpiece of The National Anti-Vaccination League in London.

The anti-vaxxers argued that in Leicester in the United Kingdom, “smallpox has practically vanished, although they have rejected vaccination for nearly twenty years”.

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Push for compulsory vaccination, for the larger good

From the beginning of vaccination efforts, there were ‘policy’ debates between those who believed that a persuasive rather than a coercive method could do the trick, and those who felt there was no option but to ram the vaccine through the public.

Compulsory vaccination acts were passed in several parts of the country from the late 1870s onwards, with imprisonment or fines as penalties for evasion.

The need for understanding fear and creating trust

There has never been a time when opposition to vaccines has not existed — there will always be those who will take any vaccine that is offered, and those who will refuse every vaccine, no matter how much the scientific evidence, said epidemiologist and vaccinologist Dr Chandrakant Lahariya, co-author of a recent book on India’s fight against the Covid-19 pandemic.

Behavioural science is needed along with medical science in this regard, he said. Administrations have to earn the public’s trust in vaccines — and one of the ways of achieving this could be for influential members and leaders to take vaccines to set the precedent.

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