British Raj: The Slow Wheels of Bureaucracy
Bristish Raj Red Ensign
Variant flag of the British Raj, used by civilian vessels and during some international events
“Scholars have either reveled in the belief that the ‘scientific’ ideals propounded by the raj’s representatives were gratefully and uniformly absorbed by all Indians, or have sought the comparative safety of the politically correct claim that socially intrusive public health measures were forcibly imposed by British officials on subject populations, whose only response was to resist these initiatives. In both cases, the complexity of Indian agency in the design and deployment of vaccination programs is ignored.” (Bhattacharya et al., 2005, p. 8)
A man holding his nose to avoid breathing in a miasma
17th century drawing a of a man attempting to not breathe in miasma
The British Raj-- the period of South Asian history when the British Empire directly ruled over the Indian subcontinent, including the modern-day countries of Pakistan, India, Bangladesh, and Myanmar-- began in 1858 and lasted until Indian and Pakistani independence in 1947. British concerns about smallpox within their Indian domains predate the establishment of the Raj, with the General Board of Health writing to Parliament in 1857 to express their alarm at the impact of smallpox and the need for increased vaccination. It was not uncommon for such reports to espouse racist explanations for the spread of smallpox, attributing outbreaks to the "uncivilized" and "filthy" lifestyles of the indigenous people. These reports also were heavily influenced by the then-respected but now-discredited miasma theory of disease, which claimed that illness was spread by "bad air" wafting from corpses and other rot, although by the 1860s administrators seemed to understand that smallpox was spread by individuals and not the tropical atmosphere.
The 1860s also saw the establishment of vaccination policies, but these policies would be hobbled by what would become a regular thorn in the side of colonial public health policy: the disconnect between senior officials in the capital of Calcutta (now Kolkata in West Bengal, India) and provincial and local administrators, whose circumstances were poorly understood by their bosses. For instance, in Bengal in the late 1830s, a dispensary system was created in which brick-and-mortar offices provided vaccines for interested locals and lymph for traveling teams of vaccinators venturing into rural areas. However, this system was overhauled in 1853 and 1854: superintendents were appointed to oversee vaccination in newly created districts and perform outreach to city neighborhoods. Additionally, a salaried team of vaccinators under the jurisdiction of the superintendents was formed to replace the traveling vaccinators, who were ineffective at spreading vaccination beyond the cities because they had to charge for their services on account of their lack of government funding. This new system too had flaws, and it was only when vaccinators started collaborating with other organizations (e.g., railroads, tea estates, and labor exchanges) that a workable rural solution emerged. Administrators continued to experiment with urban vaccination authorities in the 1880s and '90s before settling upon a system in which deputy sanitary commissioners supported (rather than controlled) their district's civil surgeons, who in turn were responsible for appointing vaccinators.
Vaccination efforts were also impeded early on by the difficulty of transferring vaccines from Britain to the Raj. Some of the earliest plans for vaccine transmission revolved around using children as human carriers for cowpox lymph, but unsurprisingly parents objected to their kids traveling halfway around the world for a medical mission. Administrators even struggled to locate orphans whose guardians would permit them to make a trip to India. When children did join these vaccination missions, it was hard to maintain arm-to-arm vaccination during the long trip from Europe to Asia, with the chain of transmission often broken en route. Mailing lymph samples to colonial administrators was relatively more reliable, but this method too had its pitfalls. The potency of lymph decreased during travel, and any mailing delays or errors could mean the tropical heat would ruin an entire shipment. After 1850, the medical establishment switched its focus to cultivating and maintaining a domestic vaccine supply. Of course, like their British counterparts, Indian parents objected to their children travelling with doctors from village to village to transfer human lymph, so animal-based lymph became more popular among vaccinators.
Sheetaladevi: The Smallpox Goddess
19th century watercolor of Shitala, a Hindu goddess said to both spread smallpox and protect worshippers from the disease
Beyond these logistical hurdles, British colonial officers also faced opposition from the indigenous population. Variolation was practiced in the subcontinent since the early seventeenth century and appears to have become accepted by the majority of the population by the time vaccination arrived. Not only did the problems importing quality vaccines decrease confidence in this new technique, incidents of leprosy and syphilis being spread through arm-to-arm transmission further increased suspicion, despite efforts by colonial officials to hush up these cases. Top-level administrators grew frustrated with the pace of vaccination and moved towards making the procedure compulsory, but local officials saw such policies as unenforceable and believed the way forward was to vaccinate carefully, deliberately, and knowledgeably. If there were fewer vaccinations that failed to take and fewer unintended side effects, people would come to realize that vaccination was safer and more reliable than variolation.
Officials promoting vacination also had to contend with the ways variolation had been integrated into local culture. Several British commentators observed how in some Hindu communities, variolation was incorporated into religious rituals. Vaccination, in contrast, was uncomfortably secular. In Bengal, Faraizi Muslims suspected vaccination campaigns were actually a British plot to hunt down a messiah prophesized to destroy the Raj. Members of multiple religious communities worried that animal-based vaccine lymph was impure or inhumane, with some Hindu groups requesting to receive vaccine lymph from donkeys rather than sacred cows. These reservations were not universal among all members of religious communities: for instance, lower caste Hindus were more open to vaccination, in part because they were excluded from variolation rituals. Additionally, it is important not to overstate how the Raj's colonial subjects were suspicious of vaccination and had to be goaded by imperial administrators to accept the practice (not unlike Brits back in Europe), as there were many Indians who enthusiastically sought vaccination. By about 1880, as vaccines became more reliably potent and less likely to unintentionally spread disease, popular acceptance of vaccination improved.