This compendium builds on the works of Brunton, Baldwin, Gradmann and Hess, among others, who linked nineteenth-century public health to the emergence of the nation state. However, it broadens the discussion beyond the nineteenth century and outward from Europe and the United States. Spanning East Pakistan to Africa, and dealing with various viruses, The Politics of Vaccination posits that history of immunization highlights societal and national change over time and that critical analysis of past failings can strengthen current practices.
The work is organized by a three-way thematic division. Part One focuses on connections between vaccination and national identity. Paul Greenough considers the 1958 smallpox and cholera outbreak in East Pakistan, convincingly arguing that citizens’ campaigns solidified a sense of Bangladeshi identity, a significant factor in later separatism and civil war. Dora Vargha also uses polio vaccination campaigns as a lens for considering constructions of communist national identity in Eastern Europe in the 1950s and 1960s, while Eun Kyung Choi and Young-Gyung Paik discuss South Korean hepatitis B prevention in the 1970s and 1980s as part of ‘the nation's future-oriented, developmentalist imaginaries’ (p. 100). While still using vaccination as a frame for discussing national identities, Neils Brimnes focuses on opposition to campaigns. His narrative of BCG in India between 1948 and 1978 posits that vaccination opposition was ‘constructed in relation to ideas about being Indian’ (p. 55). Opponents considered immunization a fallacy, sacrilege, betrayal and neo-colonial conspiracy.
Beginning in East Pakistan and ending in South Korea, this first section demonstrates the truly global approach that this compendium has taken towards vaccination histories. All four accounts convincingly present opposition to and support for vaccination campaigns as intrinsically linked to constructions of national identity. None of these accounts points towards what they can offer in terms of current or future vaccine practices beyond the importance of reflexivity to understand current identity constructs and their relationships with vaccination policies. This is, of course, useful, but considering the proposed aims of the compendium perhaps more could have been done to highlight the aims of contributors in their reflexivity.
Part Two focuses on state vaccine production, its ascendance and later decline. Ana Maria Carrillo and Jaime Benchimol give similar accounts of Brazilian and Mexican vaccine over temporally broad periods as part of the construction of the nation state. Carrillo's is the more interesting of these accounts, with her focus on the peaks and troughs of vaccine production in conjunction with variant social, economic and political conditions. She also highlights the significance of vaccine production as an elite concern tied to national security as much as public welfare, and concludes with an interesting account of national networks after the decline of Mexican vaccine production that demonstrate Mexican science ‘thinking on its own’ (p. 140).
Both Carrillo and Benchimol's accounts touch on Stuart Blume's conclusions in his Netherlands case study that outline the growth in free-market ideologies as justification for corporate amalgamations in vaccine production and patenting of new technologies that led to a decline in state production. Blume's position is both well argued and convincing, perhaps the strongest within the work.
Where Benchimol, Blume and Carillo's accounts demonstrate global trends, Julia Yongue shows Japan as distinct from global communities’ approach to vaccine development and production. She considers German and US influences on institutions’ frameworks in the development of Japan's unique vaccination policies. She notes that though routine vaccinations decreased after the Second World War the country became a world leader in life expectancy. She does not answer why this is but posits that sakoku (closing the country) and kaikoku (reopening) in Japan's recent history led to the development of a risk-averse and self-sufficient institutional framework.
Part Three discusses bottom-up and top-down approaches to vaccination policy. Andrea Stockl and Anna Smajdor write on the much-studied MMR debate in the 1990s in Britain, taking the less common emotional approaches in public health, demonstrated through the personal decisions of political figures, specifically Tony Blair's vaccination choices. The conclusions drawn here are not revolutionary but the approach is interesting.
Britta Lundgren and Martin Holmberg consider A(H1N1) vaccinations in Sweden that led to narcoleptic side effects in 2009. Holmberg was part of the team responsible for coordinating the A(H1N1) response. The side effects marked a turning point in public trust of the Swedish state, which they argue must be critically reflected on. However, the conclusions do not go beyond the assertion that doubt now exists in Swedish public opinion, and must be considered in the future.
Elisha P. Renne tracks the polio vaccination programme in Nigeria. She convincingly argues that state authority could be bolstered by successes; however, with the practicalities of the campaign – low vaccination supplies, lack of clean water and electricity at clinics, and the focus on polio, which was not a major health concern for parents – state authority was instead eroded. She also notes the consistency and inefficacy of British colonial approaches that enforced top-down public health.
Finally, William Muraskin brings these narratives together as he questions the validity of eradication policies and reasserts the position of individual men at the centre of vaccination campaigns. He argues that bottom-up approaches be used in public health, that nations take control of priorities and that global health organizations listen to communities to understand their health needs.
At its strongest it brings forth new insights into identity and nationhood – Blume, Carrillo and Renne particularly stand out; while at its weakest it continues previously made arguments in the field. Stockl and Smajdor do not go much beyond what we have seen before in MMR literature. One aim of the work was to use historical reflections to strengthen current practices; only Muraskin really addresses this topic head-on. However, overall this work is refreshing as a truly global approach to vaccination history.
