Since the late 19th century, a healthy population has been considered a central component of a nation's economic, social and political well-being. Successful public health initiatives are a tool to legitimize governance, as control of disease consolidates state power and is a symbol of a country's political validity. Compliance with health policies signals support of the state. Linked to individual rights, vaccination status exemplifies state control over bodies and populations and can determine one's freedom of movement within and across borders. Mary Augusta Brazelton shows that as an aspect of public health, immunization was foundational for governance in China under various regimes across the 20th century, from French and British colonizers, through the warlord and Republican periods, and ultimately in the People's Republic of China. Building on the burgeoning work on history of medicine and health in 20th-century China, Brazelton uses Yunnan as a case study to examine vaccination, drawing from medical publications, reports from various health organizations, and first-hand accounts gleaned from archives and libraries in China, France, Taiwan, Switzerland, the US and the UK.
Brazelton shows that immunization was and remains fundamentally important. Like biomedical childbirth, immunization was one of the first introductions to a Western medical paradigm, and, like childbirth, biomedical methods were indigenized to suit traditional medical beliefs and utilize native products. The effectiveness of vaccines created trust in the biomedical paradigm and in the state that sponsored it. Vaccination further contributed to related political movements, for example, the 1952 Patriotic Hygiene Campaign's mass vaccination project, which gave ordinary civilians a way to participate in the war effort. Personal health, which had signified duty to one's family, became a marker of support for one's country and shifted allegiance from family to the nation. Vaccination also contributed to China's image internationally as an important aspect of medical diplomacy since the 1960s. Ultimately, and perhaps most importantly, immunization dramatically reduced mortality rates and increased life expectancy, contributing to China's major epidemiologic shift mid-20th-century from having a burden of infectious disease to one of chronic disease. Although Brazelton does not address this shift, it has created significant problems in China's health system, which was created to address infectious disease and has not kept up with epidemiologic changes.
This book is divided into seven chapters. Chapter one, “Journey to the Southwest,” relates the wartime relocation of manpower and materiel to Kunming, Yunnan. In many histories of China, wartime is often overlooked as a bridge between Republican China and the People's Republic. Instead, Brazelton highlights the importance of this period in creating a foundation for public health systems and immunization legitimacy. Although her work focuses on Yunnan as a case study, she provides a global background of microbiology and bacteriology and its development in China, convincingly arguing that mass immunization campaigns during wartime were the basis for post-socialist control over bodies in China, as the GMD and the CCP extended and normalized these controls.
Chapters two through four show how warlords, philanthropic organizations and colonial regimes in the first decades of the 20th century contributed to medical infrastructure, transportation networks, and vaccination research and administration hubs in Kunming and across China to establish influence and legitimacy. Furthermore, war in China “reshaped global processes of scientific circulation and translation” in immunology and bacteriology as “medicine became more significant to military operations” (p. 56). In chapter five, Brazelton examines how the Nationalist government promoted the BCG vaccine against tuberculosis to save China's labour force as the economy crashed during the civil war.
Chapters six and seven address vaccination work in the early PRC, which was built upon the supplies, infrastructure and facilities left behind by the Nationalists. Vaccination campaigns “signaled a national commitment of the new regime to epidemic prevention” thanks to “new systems of recordkeeping, surveillance, and accountability” (p. 123). The medical system that began in the 1920s was expanded and institutionalized. In this process, China became a model for global health and provider of medical aid to nonaligned states during the Cold War, helped largely by China's immunization programme and emphasis on primary health care. Here Brazelton highlights the tremendous importance of immunization as an element of geopolitics and international relations.
A shortcoming of this book is that its jacket description claims to be about the early People's Republic, when in fact less than one-third takes place after 1949. More detail on immunization programmes in the People's Republic is warranted, for example, a contextualization of China's barefoot doctor programme, primary care, and smallpox eradication in a global framework; as well as an elaboration of how vaccination fit in to other national health campaigns like family planning. Nonetheless, scholars and students of modern Chinese history and especially 20th-century history of medicine will find this book essential as a platform for exploring the interconnectedness of global health systems and the importance of public health to governance and diplomacy.
