There are two reasons why we are incredibly fortunate to have a monograph on the history of mass vaccination in China. First, because Mary Augusta Brazelton's book comes at a time when all the self-assured talk of progress and modernity over the past century has become severely challenged by the brutal reality of antivaccination as a complex and powerful phenomenon that is threatening to derail not just anti-epidemic efforts but entire societies in the developed world and beyond. Second, because the book was written before the Covid-19 pandemic and is thus not contaminated by the “hot take” approach that is currently characterizing an increasing number of works in the history of medicine, whether by choice or through pressure by editors or the marketing teams of various publishers. Brazelton's monograph Mass Vaccination. Citizen's Bodies and State Power in Modern China is thus timely without being opportunistic. What is less fortunate is the manner in which Cornell University Press has chosen to market the book. We read: “Mary Augusta Brazelton examines the PRC's public health campaigns of the 1950s to explain just how China managed to inoculate almost six hundred million people against this and other deadly diseases”. It is odd for a publisher to market a seven-chapter book exclusively on the basis of the merit of its two final chapters. It is moreover unfair to the book and its author who are doing much more, and things far more important, than the publisher's market-oriented summary may suggest.
Mass Vaccination provides the first, thoroughly researched overview of vaccination campaigns in China from the fall of the Qing (1911) to the dawn of the Reform Era (1979), excavating and interrogating the continuities and discontinuities between shifting political and medical/sanitary regimes in the country. This is no mean achievement, as it demands both an in-depth understanding of the history of the country's political and medical systems across the usual historiographical lines of demarcation in academia, and an ability to write from a panoramic perspective without losing touch with microhistorical realities on the ground. Brazelton's book manages this marvellously by means of a well-chosen strategy: writing the history of mass vaccination in China from the vantage point of what is usually considered a backwater area: Yunnan. The strategy is not unfamiliar to ethnohistorians and has also affinities with microhistorical approaches. But, in the case of Brazelton, this is not simply an exercise on how to unsettle an established picture from looking at it askance. For she argues convincingly that Yunnan actually played a key role in the development of vaccination technologies and policies in the country.
Mass Vaccination is delightfully free from the jargon and theoretical straightjackets that burden so many books in the history of medicine today. As a result, the reader will be able to enjoy a rare experience: a robust historical investigation, rather than a forcing of archival evidence into a validation or elaboration of tired theoretical schemes. Biopower makes a shy appearance, but at least we do not have to contend with the usual litany of “nonhuman agency” and “actants” and that have stifled too many good historical investigations. Brazelton's perspective is by contrast refreshingly and luminously ethnographic in that she takes her historical informants seriously and allows their concepts to lead her analysis. And while the analytical framework suggested by the sub-title of the book (Citizen's Bodies and State Power in Modern China) may sound a tad old fashioned, the actual book delivers a nuanced and up-to-date analysis of the history of mass vaccination in China.
Mass Vaccination consists of seven chapters plus an Introduction and Epilogue. After introducing Southwest China and Yunnan in particular as its mise-en-scène (Introduction and Chapter 1), the book is structured in a roughly chronological manner. Chapter 2 begins by providing a concise review of colonial presence in Yunnan in the first decades of the twentieth century and its impact on medicine in the region. The chapter focuses particularly on the development of French vaccination efforts in warlord-held Yunnan and in the midst of epidemic crises. While the analysis of the material discussed would have benefited from a closer engagement with historical and anthropological literature on borderland exchange and hybridity, especially as this concerned late Qing and early Republican China, the chapter provides a lucid image of a complex situation that would provide the matrix upon which the historical processes that are the core subject of the book would develop. Brazelton thus moves (Chapter 3) to discuss how, from imperial hinterland par excellence, the Southwest would transform into a medical capital of China. Resulting, in 1937, from the move of the KMT government to the region in response to the Japanese occupation of East China, this transformation is shown to rely on a series of political and scientific innovations and accommodations. Chapters 3 and 4 develop an in-depth study of wartime mass vaccination, providing what is arguably the finest analysis in the book. Brazelton navigates confidently between a vast number of materials, ranging from military medicine, and US and British scientific aid and cooperation to civic vaccination programmes not only in the Southwest, but also in other important borderlands, like Lanzhou. Yet this is not simply a story of state or medical intervention, for, in spite of the well-known paucity and inaccessibility of primary sources on the subject, in places Mass Vaccination also manages to deliver much-needed and very revealing discussion of popular reception and response to vaccination campaigns. Cases like the cholera epidemic in Yunnan (1942) provide Brazelton with an excellent opportunity to develop a nuanced approach to local responses to vaccination. Aided by ethnographic observations made at the time by the LSE-trained anthropologist Francis Hsu, she shows how the interaction between professional and popular approaches to immunization cannot be captured by panoramic schemes based on a cooperation/resistance dichotomy, but rather require a nuanced excavation of affective, economic and imaginary accommodations and affordances on the ground. The book's next three chapters focus on the post-war years, starting with the 1945–1949 civil war and moving through the foundation of the People's Republic of China, and the years under Mao's rule to the reforms introduced by Deng Xiaoping in the 1980s. In these chapters Brazelton takes seriously the threat posed by infectious diseases to state power, but also the opportunity these presented the new regime as foes against whom the Communist Party could deploy mass mobilization, and around whose defeat it could develop and foster its hegemony. Public health campaigns under Mao have received a lot of critical historical attention in the last decade, and Mass Vaccination comes to contribute to current debates by helpfully positioning itself beyond the “it worked/it did not work” dichotomy, which narrows the scope of many works through residual positivism. Much more interestingly, Brazelton asks what these mass vaccination campaigns actually did, assuming, as is the case under any regime, that prophylaxis is never the sole or most significant impact of such public health interventions. It is thus shown that, while mass vaccination was in the “service of the state” (p. 139), its implementation necessitated new ways of communication and interaction between individuals and the state, which did not always rely merely on coercion or propaganda. Contrary to readings according to which individuals were simply crushed under the power of the party-state, the book stresses that “the success or failure of immunization campaigns in the early PRC hinged on personal, individual choices”, where “small-scale actions not only added concrete figures to the sum of those vaccinated but also gradually reinforced the legitimacy of the state that claimed responsibility for each immunization” (p. 143).
A criticism one may reserve for Mass Vaccination is that its author focuses on the implementation of vaccination but has little to say about the epistemological debates behind it or about the development of and competition between different vaccines and sera. This is strictly speaking true, but an analysis of immunological epistemology and related science wars is also clearly not the topic of this book. What is more important is the book's critique and revision of medical histories of the PRC that have emphasized the impact of revolutionary experience and politics in the development of mass vaccination in China after 1949. Brazelton convincingly argues that this focus neglects the “longer, more complex process of institutionalization, cooperation, and organization” (p. 168) since the beginning of the twentieth century, whose history the book delivers so skillfully.
All great books have significant lacunae, and this is no exception. Brazelton mentions the work of Dr Wu Liande briefly, but falls short on two important points. First, there is no discussion of Wu's efforts to deploy mass vaccination during the 1910–11 Manchurian plague pandemic. Second, and more importantly, the cornerstone epidemiological apparatus known as the North Manchurian Plague Prevention Service (NMPPS), founded and headed by Wu until 1931, when Japan occupied Manchuria, is completely neglected in the monograph. This is particularly important, as in spite of its name, the NMPPS was responsible for research on and response to all diseases in the North-East Provinces with powers extending to other provinces too in cases of emergency. As is readily evident in its published Reports, the NMPPS's work with vaccination was extensive (plague, cholera, scarlet fever, rabies, etc.) and its disease prevention and vaccination program formed if not necessarily a rival, then a second epidemiological pillar next to the National Epidemic Prevention Bureau (est. 1919) which is the focus of much of Brazelton's book. It would have been extremely interesting to read about the interaction and exchange between the two services, and how the experience of vaccination in Manchuria, which was at the time an epidemic hotbed, impacted policies and campaigns across China.
In spite of this omission, Mass Vaccination comfortably establishes itself as the leading and indeed essential monograph on the history of vaccination in modern China; a much-needed contribution to the history of medicine that will undoubtedly become a textbook in our age of vaccine wars, but which by far surpasses the historiographical needs of the moment by delivering a nuanced and systematic history of mass vaccination in the world's most populous and increasingly powerful country.
