Smallpox in India, 1900-1977
According to one estimate, there were 250,000 cases of and 64,000 deaths resulting from smallpox in India in 1951. This, as in most years, represented over half the smallpox cases in the whole world. The eradication of the dreaded disease was, therefore, not only a triumph for the Indian, but also the international, medical fraternity, At the height of the project, more than 150,000 health workers from over 30 countries involved themselves in the eradication programme. Such a massive campaign, not unnaturally, faced multifarious challenges and difficulties, and ruffled many influential feathers. These, as well as the marked social and political effects of forced vaccination drives, tend to be ignored in an otherwise well-documented eradication programme.By Sanjoy Bhattacharya
On 23 April 1977, an International Smallpox Assessment Commission declared India to be completely rid of the dreaded scourge. This triumph, rightly portrayed by many as being Herculean in character, was a culmination of almost three decades of official initiatives and striking international co-operation during a period of heightened 'cold war' animosities. However, the process was not a smooth one. Indeed, some of the troubles that punctuated the efforts of the diverse governmental and international medical workers were serious enough to cause facets of the campaign to seem, albeit in hindsight, strikingly disjointed. In fact, seen in this light, the eradication project can be said to be made up of a series of independent initiatives, some of which came to an inglorious end. Nonetheless, it is impossible to question the cumulative value, and ultimate significance, of a multifaceted smallpox eradication programme in the South Asian context.A recent grant by the Wellcome Trust to Sheffield Hallam University has allowed the initiation of a major endeavour to analyse and re-assess the history, as well as the political and social aspects, of official attempts to prevent the spread of smallpox in India between 1900 and 1977. An examination of the medical initiatives launched in the colonial period - especially during crises like the Bengal Famine of 1943 and the Second World War - provide a useful backdrop to the Smallpox Eradication Programme launched by the independent Indian government approximately a decade after the British withdrawal from South Asia. As in other aspects of governance, colonial medical and health records very often supplied Indian administrators insights into the organization and the possible impact and the efficacy of initiatives to counter epidemics. In notable, but rarer, instances, the administrative repositories of the Raj left indelible imprints in the organization of specific governmental projects. Therefore, a detailed study of the nature and the debates surrounding colonial health measures dealing with smallpox outbreaks remains significant, not merely because they provide us with insights into colonial mindsets, but also as this allows contemporary researchers to locate post-Independence health measures more effectively.
The current project also hopes to re-assess the developments between 1958, when the Indian Ministry of Health appointed a 'Central Expert Committee' to suggest means for the eradication of smallpox, and 1977. In doing so, the researchers hope to move away from the valuable -- but rather triumphalist -- description of the campaign provided by the published reports released by the World Health Organisation. Whereas the extremely important role played by theWHO -- and other organizations like the Centre of Disease Control and U.S. Aid -- in the eradication programme is never ignored or belittled, greater sensitivity is shown towards the social and political costs of the campaign not only in the urban centres, but also the rural expanses of India. The concepts of 'State power', 'intimidation', and 'coercion' are examined, sometimes re-defined and utilized to understand the far-reaching, and often culturally invasive, effects of the eradication programme on a linguistically and culturally heterogeneous society.
An attempt will also be made to identify the various practical difficulties encountered by the health workers attached to the eradication programme and the measures utilized to overcome them. A good example of this was the defective reporting apparatus, through which dependable feedback about the effectiveness of the programme came in irregularly for most of the campaign. The problem was tackled by involving ever-greater numbers of bureaucrats, and also soliciting civilian assistance in the discovery, reporting, and limiting of smallpox cases through the provision of very generous cash awards. Another interesting tactic was to encourage school children to report on smallpox cases within their community!
Ayurveda
In addition, local -- and 'traditional' -- medical attitudes towards smallpox, and its eradication, will also be examined. This will not only allow us to investigate the clash of disparate medical beliefs, but also the not infrequent interaction between knowledge systems like ayurveda and Western allopathic practices. In unravelling this aspect of the eradication programme, a wide range of vernacular sources will be put to use. Local records --written in indigenous languages and dialects -- and an ambitious programme of interviews with officials, as well as civilians, will also be used to elucidate the class, caste, and gender based provision of health benefits in independent India. It is in this context that the complex inter-relationship between national, regional, and local political practices, and a centrally organized health campaign become very obvious. Indian politics, particularly in the rural areas, have always had a very marked parochial flavour. The reactions towards the eradication programme were thus extremely, sometimes maddeningly, diverse: it provided some politicians with the excuse to complain about requisite health measures in their localities; it caused others to complain against forcible vaccinations. In other cases, confrontations violent or otherwise occurred between village leaders and spokespeople and health workers. An investigation into these facets of the eradication programme will form an integral part of the current project, and a concerted effort will be made to uncover examples of the anti-vaccination propaganda produced in the localities. Such an expansive focus, it his hoped, will allow for a more comprehensive and nuanced history of one of greatest medical triumphs of the twentieth century to be written.
:Dr Sanjoy Bhattacharya (scl@mrc-lmb.cam.ac.uk), a Wellcome Post-Doctoral Fellow, stationed at the Department of History, School of Cultural Studies, Sheffield Hallam University.