Japan: Taking Public Health Into Your Own Hands
“As in the case of Jenner’s early experiments, parents had to be taught to replace fear with trust. Fear was a given: no one needed to be taught to fear smallpox. Trust had to be won.” (Jannetta, 2007, p. 172)
In August 1849, the first successful vaccination in Japan was performed on Kensaburo Narabayashi, the young son of the founder of a school for Western-style medicine, Soken Narabayashi. Although Dutch merchants had only brought enough inoculum for this single vaccine, the arm-to-arm vaccination technique enabled local doctors to vaccinate others by collecting samples from Kensaburo's cowpox sores. The first stages of the national vaccination process were relatively simple: Dutch Factory physician Otto Mohnike vaccinated the children of Nagasaki over the course of the three weeks after the first successful vaccination. Cautious about the efficacy of any vaccination samples mailed out of balmy Nagasaki in the summer heat, the vaccinators next invited physicians and children from across the island of Kyushu to visit Nagasaki, be vaccinated, and return home to perform arm-to-arm transmission through themselves. This campaign was supported by regional daimyos, such as Nabeshima Naomasa, the Lord of Saga domain, who sent his personal physician and eldest son to Nagasaki to receive and return with the vaccine as soon as he had heard of its arrival.
Bodhisattva Rescuing a Child from the Smallpox Demon
1849 advertisement by pediatrician Kuwata Ryusai
Other lords and elites followed the example of Naomasa, and before the close of 1849, vaccination reached major cities outside Kyushu such as Kyoto, Osaka, and Edo (modern-day Tokyo). Physicians then increasingly turned their attention to convincing the general public of the efficacy and safety of vaccination, knowing that the orders of feudal lords would not be enough to immunize the entire country against smallpox. Pediatrician Kuwata Ryusai, for example, employed reassuring religious imagery (e.g., a boddhisatva trampling a demon with a cow to rescue a child), cited the relieved testimony of early adopters of vaccination, and explained the science of vaccination in simple language to convince hesitant parents to accept vaccination.
During this vaccination campaign, the Japanese central government remained passive and largely ignored this public health advancement, in striking contrast to other countries, where the state was a major player in vaccination. In fact, pro-vaccination daimyos and physicians largely avoided the shogunate. Historians are not entirely certain why this was done. There is one hypothesis that the vaccinators feared repressive action from a regime that officially favored Chinese-style medicine; another hypothesis speculates that the shogunate secretly approved of vaccination but refrained from officially endorsing the procedure until it was absolutely clear vaccination had no negative consequences.
19th century Ainu storehouse
Photo of a storehouse and child in traditional dress in an Ainu village, taken during the 1890s
The vaccination movement was galvanized in 1857 when the two greatest opponents to Western medicine, Taki Motokata and Tsujimoto Shoan, passed away and there was a major smallpox outbreak in the far north lands of Ezo. Although the shogunate commissioned a medical mission to control the outbreak via mass vaccination, the shogunate was yet to fully embrace vaccination. The Ezo campaign would largely affect the inidigenous Ainu people, seen by the shogunate as non-Japanese and therefore "expendable" in case anything went wrong with the vaccination. When the Ezo mission succeeded, ranpo (Dutch-style) physicians petitioned the shogun to open a vaccination clinic in Edo. Their wish was granted, but the government refused to spend a single yen on the project, requiring private donors to support the clinic's construction and operation. In 1860, the shogunate was ready to take a more active hand in the vaccination process and took control of the clinic's management and finances and expanded its operations. In 1861, the clinic evolved into the Institute of Western Medicine and began to teach medical students, not just about vaccination, but other Western innovations like dissection and autopsy.
Mutsuhito, The Meiji Emperor (1873)
1873 photo by Uchida Kuichi of Emperor Meiji, also (uncommonly) known by his personal name, Mutsuhito
In 1868, the shogunate lost political power and the Imperial Court once again became the head of the Japanese state under Emperor Meiji, beginning a period of rapid industrialization and modernization known as the Meiji Era. During this period, state control over vaccination expanded further, as did the practice of vaccination. The government created an orderly, well-regulated system for vaccination that ensured all doctors were certified and all vaccines were safe. State subsidies ensured all smallpox vaccinations were free for patients, and statistics on the age and sex of vaccination recipients were collected and reported to the government. Police became involved in vaccination too, with officers authorized to check citizens' vaccination certificates and sweep neighborhoods for unvaccinated children during smallpox outbreaks. As the country creeped closer to the twentieth century, smallpox cases and deaths gradually declined.