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Among the many research interests that I share with “The Reluctant Internationalists” is the understanding of internationalism as a varied and multifaceted phenomenon. This is one of the many ways in which my research on the history of international responses to the needs of prisoners of war and refugees in the 1920s connects with the interesting discussions that I have had over the past three months at Birkbeck College.
Coming from the history of Western liberal internationalism and, in particular, the history of the international organisations such as the League of Nations, I enjoyed learning about the history of other internationalist projects, such communism, socialism, or Catholic internationalism. Despite the singularity of each historical process, there are communalities in the creation and development of structures as well as in the centrality of expert knowledge in international networks.
Mapping the geography of internationalism is also a productive way to think at the refugee question after the end of the First World War. Something that has spurred from the discussions is to think of internationalism in terms of “center” and “peripheries.” For instance, in the case of refugees, there are the places where decisions are made, such as national cabinets and the headquarters of international organisations, while these same places are also the hub of initiatives developed in other spaces, such as the local, national, regional, and transnational. The local – such as a refugee camp – is no less international than the decision-making process at the headquarters of international organisations. Implementing projects locally or distributing technology is highly international.
It has been also essential for my own research to think how to recover the experiences of prisoners of war and refugees themselves. Internationalism is not only a history of institutions but it is also embedded in people’s lives. Migrants and refugees choose or are forced to go international. For others such as relief workers, health professionals, or international civil servants, internationalism is often a professional choice.
There are many perspectives, geographies, scales, and methodologies to look at the history of internationalism in the 20th century. By recognizing the malleability and plurality of internationalism, there is the potential to write more interesting stories, connect different historiographies, and, as such, complete and challenge the history of the 20th century.
In 1930, Bernard Long of the British Esperanto Association published a compact booklet titled, Esperanto: Its Aims and Claims. A Discussion of the Language Problem and its Solution. Humankind, Long argued, was not fated to remain helpless prisoner to “the confusion of tongues” that had for so long stood obstinately in the way of international understanding and cooperation. Just like bridges built to cross rivers, or like tunnels carved through treacherous mountains, language could be designed in such a way as to facilitate not merely human interaction, but also international cooperation of the type that the world’s proud optimists, worrying statesmen, and enterprising businessmen so desperately craved. Esperanto, Long insisted, was just such a language. Designed not to replace the world’s national languages, but instead to transcend them, Esperanto presented itself as “an easy, expressive, neutral form of speech for international use.” Esperanto’s appeal spoke to “the practical and idealistic alike,” Long argued, and Esperantists eagerly invited “all thinking people” to join the growing and avowedly global Esperantist movement. Esperantists welcomed “all progressive men and women whose vision extends beyond their national frontiers, and who feel, or desire to feel, that they are also citizens of the world.”
Long’s celebratory booklet was but one of countless broadsheets, pamphlets, journals, and books that had been published worldwide to extol and to popularize Esperanto since the international auxiliary language’s debut in 1887. In that year, a Polish Jew of the Russian empire, L.L. Zamenhof, published the first Esperanto primer – the product of this precocious polyglot’s years of painstaking efforts to create an effective, logical, and felicitous international auxiliary language. In the avowed name of hope, Zamenhof unveiled his creation as the easily assimilable answer to the linguistic, ethnic, and ideological fractures that divided not only tsarist Russia, but also humankind. In so doing, Zamenhof launched what rather quickly developed into a global movement and, ultimately, global movements, to deploy Esperanto as the key to lived internationalism, variously conceived.
The understudied history of Esperanto, and of the diverse array of adherents and political entrepreneurs whom Esperanto inspired in the late nineteenth and twentieth centuries, is where my research interests coincide with those of the Reluctant Internationalists project. In June 2015, I joined the Reluctant Internationalists Project Team in London for a month of scholarly collaboration and conversation. My month as a Visiting Fellow at Birkbeck College also enabled me to conduct essential primary source research at the British Library and Cambridge University Library for my current book-length research project, tentatively titled Speaking Transnationally: Esperanto, Citizen Diplomacy, and Internationalism in Russia, 1887-1939.
Speaking Transnationally places Russian and Soviet history in global perspective. It is a study of how tsarist Russian subjects and Soviet citizens communicated transnationally via Esperanto in pursuit of a variety of ideological aims. My project highlights Esperanto as a cultural tool with which “ordinary” citizens pursued global efforts to variously promote “international brotherhood” and mutual understanding. I focus on the underappreciated story of how Esperantists from Russia and the USSR met, face-to-face, with fellow Esperantists from abroad. It explores how Esperantists shared ideas, commodities, as well as the sheer joy of communicating via an international auxiliary language. It is also a patently modern story of Esperantists forging affective bonds and ideological solidarity by means of the postal service, telegraph, radio, and rail. My project illuminates the unique transnational encounters that Esperanto made possible by focusing on how Esperantists in late imperial Russia and the early Soviet Union imagined and asserted themselves as members of global communities with global concerns.
Although “reluctant” may not be the first adjective logically applied to the Esperantists whom I study, their visions and experiences of lived internationalism as Esperantists do raise questions that sync well with those of my colleagues of The Reluctant Internationalists project. In particular, my research not only looks into the ambitions of my historical subjects to collaborate with fellow Esperantists (and others) on an international basis, but also focuses on their practical ability to communicate via their chosen international auxiliary language, or via any other language for that matter. Historians who study internationalism cannot escape the literal question of (mis-)communication. Agents of internationalism – reluctant or otherwise – themselves inescapably confront the challenges and the opportunities that language presents to them in pursuit of their global endeavors. At a fundamental level, language is crucial to the lived experience of internationalism (or any attempt thereof). Arguably, the success or failure of an internationalist project hinges on its participants’ ability to effectively communicate amongst themselves and with others.
With this in mind, I also worked with the Reluctant Internationalists Project Team during my residence at Birkbeck College to begin planning for a “Languages of Internationalism Conference” to be held in May 2017. The conference will bring together scholars whose work examines how language has enabled and/or frustrated human efforts to communicate and collaborate on an international basis. A formal call for papers will be announced in due time, but I join the Reluctant Internationalists Project Team in looking forward to what is bound to be a stimulating “Languages of Internationalism Conference.”
My incentive for proposing a joint network meeting between the research network “Health and Social Welfare in Eastern and Southeastern Europe in the Long 20th Century” coordinated at Regensburg University and Birkbeck’s “Reluctant Internationalist” project was to bring together two diverse groups of young and international scholars that are dealing in their research with questions of public health, social welfare, humanitarianism and internationalism. The researchers of both networks investigate practices and discourses of public health and social welfare, focusing on historical continuities, discontinuities and processes of transnational transfers. The geographical focus stretches from Eastern and Southeastern Europe to Western Europe and beyond, and embraces research on Bosnia-Herzegovina, Soviet Russia, Armenia, Spain, Germany, the GDR, Serbia, Belarus, Hungary, Poland, Kosovo, Russia to Czechoslovakia, Romania and Greece. While the main interest of the Reluctant Internationalists lies in public health in Europe as an arena of internationalism, the Health and Welfare network centers its attention on the local enactment of health and welfare in the – often overlooked region of – Central, Eastern and Southeastern Europe from the end of the nineteenth century until recent times.
Yet, both networks have a lot in common. Both research networks do ‘extra’-ordinary research in the way that they test the boundaries of the widespread and conventional understanding of the history of medicine. While the history of public health and social welfare is often just perceived as a negligible and marginal part in modern history, we aim to challenge this perspective in three main ways. First, we propose to approach public health and social welfare as a centerpiece in historical processes of state-and nation building as well as an arena of international cooperation. When looking at global health crises such as Ebola, we see the dramatic impact on entire populations and the need for common global responses. Second, by geographically expanding our research also to the eastern and southeastern peripheries of Europe we hope to counterbalance the ongoing trend to focus exclusively on Western Europe when talking about Europe. A main aim is to understand the history of health and welfare in Eastern Europe as a core component of an integrative all-European history of public health and welfare. Third, we want to enrich the still widespread top-down approach to the history of internationalism, humanitarianism and health by means of agent-centered research. This approach moves away from the exclusive focus on the institutional history of health and welfare that focuses largely on medical elites and international organizations. Our projects equally value and closely examine local responses of health and welfare recipients, such as patients, the elderly, the disabled, children, the poor, veterans, minority groups or nurses. By pursuing research in these three ‘extra-ordinary’ ways, we are hoping to contribute to the field of an inclusive and social history of health and welfare. I believe that the encounter between both networks has created possibilities for future cooperation, as the members of both networks share not only common research interests but also an alternative understanding of the history of health and welfare.
Guest Postby Visiting Fellow Jessica Pearson-Patel
On May 9th, 2015, after months of fighting the outbreak, the World Health Organization (WHO) declared Liberia to be Ebola-free.[1] While this success demonstrates that both local public health services and international organizations did something right, the experience of the past year—along with the ongoing epidemic in Sierra Leone and Guinea—also demonstrate a number of important things they did wrong. A slow global response compounded a crisis sparked by poorly developed public health infrastructure—a legacy of European colonial rule in Africa—and a limited local understanding of the ins and outs of how the disease is transmitted. To date, the outbreak has resulted in over 11,000 deaths, and, even if fully eradicated, will have social and economic consequences for years to come.[2] The Ebola epidemic in West Africa reminds us that the role politics inevitably plays in shaping public health often has catastrophic consequences for the affected populations, something that historians of public health know all too well. In the case of Ebola, the political concerns that stopped the WHO from responding quickly and effectively to the outbreak resulted in thousands of deaths, often-inhumane quarantine measures, and, in certain cities, even widespread riots.
Criticism of the WHO’s inaction has focused on the decision to hold off on declaring the epidemic a Public Health Emergency of International Concern (PHEIC), a declaration that comes with legally binding recommendations for the 194 member countries and can help to facilitate a coordinated global response. In internal emails and memos from June 2014, senior officials in the WHO cited fears of disrupting African economies, interfering with the pilgrimage of African Muslims to Mecca, and the pressure that such a declaration would have on the already-overextended WHO emergency response services, who were in the midst of dealing with a resurgence of polio and the spread of Middle East Respiratory Syndrome (MERS).[3] (The resurgence of polio was declared a global health emergency in late spring, while MERS was not given this designation.) Dr. Michael Osterholm, a disease expert at the University of Minnesota, likened the decision to not declare the outbreak an international health emergency to “saying you don’t want to call the fire department because you’re afraid the trucks will create a disturbance in the neighborhood.”[4]
Several news sources registered shock at this apparently deliberate decision to delay the process of enacting emergency measures. After all, both the 1946 constitution of the WHO and its current mission statement suggest a staunch commitment to put the physical, social, and psychological needs of its global constituents first. Indeed, one of the founding principles, according to the constitution, was that “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”[5] But as Dr. Thomas R. Frieden, the director of the Center for Disease Control, recently stated: “Too many times the technical is overruled by the political in W.H.O.”[6]
While contemporary media sources expressed surprise at the way politics shaped the Ebola response, for historians of global public health this story is a familiar one. In this particular context we can easily trace the entanglement of political imperatives and public health responses back to the earliest days of the World Health Organization’s involvement on the Africa continent. When the WHO was founded in 1946, it also created six regional offices to respond to varying health needs on the ground in different places. Of the six regional offices (Europe, the Americas, Western Pacific, Eastern Mediterranean, Southeast Asia, and Africa), the creation of the WHO Africa Office was the most rife with political drama and backroom diplomatic maneuverings. In colonial Africa, imperial powers feared that opening the door to the WHO would be akin to inviting international criticism of colonialism. Doctors and government officials worried that international health workers might use their work in Africa as a chance to spy on the inner-workings of their African empires. One French official wrote that a WHO Africa office would become a meeting ground for various kinds of “troublemakers: African, political, and medical.” He worried that by allowing the WHO to operate in Africa, they would be allowing outsiders a chance to create “a political climate unfavorable to French rule.”[7] Instead of thinking first about how to stop the spread of epidemic disease, these doctors and bureaucrats were thinking first about how to stop the spread of decolonization.
Despite their best diplomatic efforts, the French, British, and Belgians ultimately failed to keep the WHO out of Africa and a regional office was established in Brazzaville (French Congo) in the late 1940s. The decision to build the headquarters in Brazzaville was based on the idea that one should “keep one’s friends close and one’s enemies closer.” Colonial doctors thought that by setting up the office in the capital of French Equatorial Africa they would be able to more closely regulate the office’s programs. The first few years of the Africa office’s existence were not spent setting up the kinds of public health programs we have come to associate with the WHO. Instead, these years were plagued by bickering between WHO officials and colonial doctors about things like the creation of a public relations position, a role that the French administration claimed would allow the WHO to spread anti-colonial propaganda. It was not until the late 1950s, as European colonial rule in Africa was winding down, that the WHO was able to launch large-scale disease eradication campaigns in sub-Saharan Africa.
Both the current Ebola epidemic and this longer history of public health cooperation in Africa remind us that international health organizations like the WHO are often driven by broader local, regional, and international political contexts. As we consider the lessons that we can draw from the WHO’s failure to effectively respond to the current public health crisis brought on by the Ebola virus—and as the WHO considers reforms that will shape the way it responds to future public health emergencies—we should also consider the longer history of the way that politics have constrained the organization’s ability to execute its crucial mission.[8]
[1] WHO Statement: “The Ebola Outbreak in Liberia is Over,” 9 May 2015, http://www.who.int/mediacentre/news/statements/2015/liberia-ends-ebola/en/
[2] For current case counts, see the Center for Disease Control, 2014 Ebola Outbreak in West Africa – Case Counts, http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html
[3] “Bungling Ebola Documents,” The Associated Press, http://interactives.ap.org/specials/interactives/_documents/who-ebola/
[4] “Emails: UN Health Agency Resisted Declaring Ebola an Emergency,” The New York Times, 20 March 2015, http://www.nytimes.com/aponline/2015/03/20/world/ap-un-who-bungling-ebola.html
[5] WHO constitution, 1946. http://whqlibdoc.who.int/hist/official_records/constitution.pdf
[6] Sheri Fink, “W.H.O. Members Endorse Resolution to Improve Response to Health Emergencies,” New York Times, 25 January 2015.
[7] Archives de l’Institut de Médecine Tropicale du Service de Santé des Armées 238, Note pour Monsieur le Directeur des Affaires Politiques – 3ème Bureau, no. 6843, DSS/4, 4 Juil 1951, 1-2.
[8] For an outline of proposed WHO reforms in the wake of the Ebola outbreak, see “WHO reform: overview of reform implementation,” World Health Organization Executive Board, 136th Session, 19 December 2014, http://apps.who.int/gb/ebwha/pdf_files/EB136/B136_7-en.pdf?ua=1
Dora Vargha and David Bryan have written an article on the recent appearance of diphteria in Spain. The re-emergence of this infectious disease, which had not been recorded in the country in the last 28 years, has instigated heated debates regarding the impact and legitimacy of the anti-vaccination movement, and Vargha and Bryan have addressed this topical issue in the context of the general history of vaccination as well as of Spain’s troubled legacy of authoritarianism and public health. The article has been published in English on the UK website The Conversation, and in Spanish in El País.
The return of diphtheria in Spain after nearly three decades highlights the challenges posed by infectious diseases that had been mostly eliminated from Europe.
Falling vaccination rates, complex population movements, and the disappearance of international health practices perceived as redundant, all contribute to the emergence and spread of infectious diseases that were thought forgotten. At the same time, such public health crises throw light on the delicate relationship between state and citizens, and competing concepts of responsibility for health.
A six-year-old boy from the Catalan town of Olot was admitted to hospital suffering from diphtheria last week. This was the first case of the disease recorded in Spain for 28 years. The boy, who is in a critical but stable condition in a Barcelona hospital, had not been vaccinated due to his parents’ concerns about the safety of the vaccine. They now say they feel tricked by the anti-vaccination groups which had originally stoked their fears.
Diphtheria, now a rare disease in Europe, is a serious, potentially fatal disease caused by bacteria that can cause heart failure, pneumonia and paralysis of the muscles used for swallowing. Up until the 1920s it was one of the leading cause for death in children, sometimes referred to as “strangling angel”, because the bacteria can create a pseudo-membrane in the airways, causing death by choking.
It was widespread in Spain during the first half of the 20th century, particularly following the physical and economic devastation caused by the Spanish Civil War. Over 27,000 cases of diphtheria were recorded in 1940 alone. Improving infant health was officially a priority for the new Franco regime, and cases did reduce significantly in the post-war era. However, Spain’s impoverished and fragmented public health system failed to make the rapid progress towards eradication achieved by its western European neighbours, with almost 250 new cases a year still reported in the late 1960s. A comprehensive vaccination programme was finally implemented in 1966 and until last week, there had been no diphtheria cases recorded since 1987
As diphtheria had been eliminated in Spain for the last three decades, stocks of the anti-toxin needed to treat the disease are no longer available in the country. This anti-toxin, listed as an “essential medicine” by the World Health Organisation, is increasingly unavailable due to the disease’s rarity and because, as a blood-derived product, its production is highly regulated.
For instance, in the US there are no licensed anti-toxin products available in the whole country, and in case of diphtheria an unlicensed Brazilian product is used by the CDC under investigational new drug status, which basically provides an exemption from federal regulation. In Europe, some public health experts have called for the establishment of a central EU stockpile that all countries can access in times of emergency.
This time, Spanish health authorities were forced to look abroad for supplies, which were personally flown in from Moscow by the Russian ambassador to Madrid. The difficulties in locating and supplying the relevant anti-toxins highlight how quickly international structures can break down once a disease has been eliminated in a particular country and has disappeared from the authorities’ radar.
The recourse to diplomatic channels and the ad hoc supply of medication echoes the chaotic situation more usually associated with times of war and international emergency. A look into the Spanish government archives reveals that during the World War II, for example, Spain’s small West-African colony in what is now Equatorial Guinea faced a dangerous outbreak of Yellow Fever. Facing the collapse of its economy and wartime disruption to international supply, the Spanish government struggled to secure basic medication and to distribute the relevant vaccines both at home and in its overseas colonies.
Help eventually arrived from the local British Consul who agreed to fly to Lagos and bring back supplies of the vaccine in thermos flasks. While these kind of ad hoc solutions may have been a necessary during a time of international conflict, they seem profoundly out of place in today’s apparently more orderly international system.
It was no coincidence that the anti-toxins were available in Russia. Diphtheria cases had begun to fall in the Soviet Union following the introduction of universal childhood immunisation in 1958. By the mid-1970s they had plummeted to an all-time low, approximately the same level as the US. However, changing immunisation schedules contributed to a rise in diphtheria in the 1980s, partly because of reduced levels of public support stoked by a strong anti-vaccination movement that channelled distrust in the state during the period of perestroika. With the collapse of the Soviet Union and much of its public health services, especially in the newly independent states, a severe epidemic broke out in 1993.
Shortages in vaccine supply, economic hardship and mass population movements all contributed to the outbreak and the difficulties authorities faced in controlling it. Eventually diphtheria in Russia and the former Soviet states was brought under control through international cooperation between governments, NGOs and UN agencies. Since then, the former Soviet republics and Russia have remained the only area of Europe where diphtheria is still a public health concern. Although no longer in epidemic proportions, the lingering presence of the disease led Russian authorities to keep stocks of diphtheria anti-toxin readily available.
Long-forgotten diseases that make a comeback also bring to light problematic relationships between citizens and the state. Recent American anti-vaccination movements highlight conflicting ideas of individual and public health, while Spain’s authoritarian legacy has coloured the vaccination debate in the country. This week Luis Garciano, economic spokesman for Spain’s new centrist party Ciudadanos (Citizens), said that unvaccinated children should be withdrawn from school and their parents fined and stripped of benefits.
Garciano’s comments have been denounced as “neofascist”, and anti-vaccination campaigners have frequently drawn parallels between the idea of obligatory vaccination and Spain’s fascist past. For them, the right to reject vaccination is a freedom that should be protected in the era of democracy.
The return of diphtheria to Spain mirrors the measles, TB and other infectious diseases in Europe and the US. When diseases disappear due to high vaccination coverage, the national and international public health infrastructures needed to deal with them often also whither away.
When distrust in public health organisations and practices or the break-down of relationship between state and citizens give way to faltering vaccination rates (whether through anti-vaccination movements or through lack of access to vaccines), forgotten diseases can make a quick comeback. The case of diphtheria reminds us of the very real stakes at hand when infectious diseases re-emerge and throw light on the personal, national and international consequences of declaring the end of a disease.
Jessica Reinisch’s The Perils of Peace has just been published as an Open Access monograph. You can download the full pdf from the OUP catalogue, here: http://ukcatalogue.oup.com/product/9780199660797.do
In The Perils of Peace Jessica Reinisch considers how the four occupiers – Britain, France, the Soviet Union, and the United States – attempted to keep their own troops and the ex-enemy population alive. While the war was still being fought, German public health was a secondary consideration for them: an unaffordable and undeserved luxury. But once fighting ceased and the occupation began, it rapidly turned into an urgent priority. Public health was then recognized as an indispensable component of creating order, keeping the population governable, and facilitating the reconstruction of German society.
But they faced a number of problems in the process. Which Germans could be trusted to work with the occupiers and how were they to be identified? Who could be tolerated because of a lack of alternatives? How, if at all, could former Nazis be reformed and reintegrated into German society? What was the purpose of the occupation in the first place?
This is the first carefully researched comparison of the four occupation zones which looks at the occupation through the prism of public health, an essential service fundamentally shaped by political and economic criteria, and which in turn was to determine the success or failure of the occupation.
On March 12 and 13, the University of Lausanne hosted a thought-provoking and intellectually rich conference on the ‘Globalization of medicine and public health: economic and social perspectives (1850-2000).’ Convened by Sanjoy Bhattacharya (University of York, UK), Thomas David (University of Lausanne, Switzerland), Pierre-Yves Donzé (Kyoto University, Japan), Davide Rodogno (Graduate Institute of International and Development Studies, Geneva, Switzerland), this inter-disciplinary meeting aimed to explore the roots, development and consequences of the intensive globalizing trends in medicine and public health since the mid-nineteenth century. As Davide Rodogno and David Thomas said in their opening remarks, the conference sought to provide a critical analysis of the emerging historiography of global health and narratives of globalization, primarily by connecting the history of public health with other approaches such as business and economic history, history of medicine, international history etc. Moreover, the conference aimed to move away from linear and simplistic narratives of international cooperation and harmony, and to study international health organizations as spaces of interrogation, contestation, opposition and imposition of ideas.
The first panel addressed a score of these themes and opened up a number of key questions in the historiography of global public health. Anne-Emanuelle Birn (University of Toronto, Canada) discussed complex ties between philanthropic organizations and global health agencies through the prism of the fraught relationship between two of the most important actors in this field – the Rockefeller Foundation and the WHO. In her analysis of the ups and downs in their cooperation between the 1940s and 1980s, Birn examined the RF’s (often indirect) role in defining the WHO’s approaches and priorities, its participation in the WHO’s personnel, and emphasized the key moments as well as tensions, conflicts and dilemmas in the relations between the two institutions. Her paper explored how these developments affected global health initiatives in the second half of the twentieth century, and how they shaped the current role of philanthropy in the field of global health. Erez Manela (Harvard University, USA) discussed the WHO’s campaign for the global eradication of smallpox in the 1960s and 1970s. Focusing primarily on the US perspective, Manela examined the circumstances of this signal event in the history of global health in the second half of the twentieth century, and asked how this programme managed to achieve its goal of eradication on a global scale in the midst of international conflict, when so many similar initiatives had failed. Manela placed the smallpox eradication programme in the context of the US-Soviet Cold War rivalry and the growing role of the global South in international politics following the de-colonization. A transnational network of experts succeeded in co-opting governmental power and the backing of inter-governmental agencies for the project of small pox eradication at the very moment when the US sought to improve its vulnerable international status, while the programme of international development gained increasing importance for the US government as a tool for containing the spread of Communism in the newly independent countries in Asia and Africa. Nitsan Chorev (Brown University, USA) presented her research on the emergence in the 1970s and 1980s of remarkable local pharmaceutical sectors in East Africa, and explored the structure and development of local pharmaceutical production in Kenya, Uganda and Tanzania in a comparative perspective. According to Chorev, the development of local pharmaceutical manufacturing was seen as an important industrial goal in these countries, as they hoped to free themselves from their dependence on multinational companies and to secure access to necessary medicines. Chorev emphasized three interrelated factors that contributed to significantly different levels of success of local pharmaceutical industries in the three countries: state policies, transnational ties and foreign aid in support of state policies, and capable local entrepreneurs with cross-national ties (the key role was here played by ethnic minorities, for instance Indian Kenyans with their educational ties to the UK and India and work experience multinational pharmaceutical companies). The discussion following the panel was rich and vigorous, and it explored the difference and similarities between the concepts of global and international, but also emphasized the missing link in all three presentations – the Soviet perspective.
The second panel sought to focus on “non-Western visions” in the history of global health. Marcos Cueto (Casa Oswaldo Cruz, Brazil) shed light on the establishment and role of the WHO’s African Regional Office (AFRO) in the 1950s and 1960s, and placed the history of this important regional health agency in the context of the Cold War rivalries and the ongoing struggle for independence in sub-Saharan Africa. While initially this office was led by European experts in tropical medicine, its activities and personnel soon reflected the changing political and social realities in Africa, and this led to the increasing number of African personnel and African member-states. AFRO produced important studies on malaria, yellow fever and onchocercasis, and contributed to the revival of tropical medicine as a discipline, but Cueto’s presentation offered a critical analysis of the complex political role and achievements of this regional agency. On the one hand, the existence and activities of AFRO may have indirectly helped the independence processes in the 1960s, but it also re-produced the dependency of the south of Africa on Western, colonial models, and encouraged problematic discourses in which the newly independent countries of sub-Saharan Africa were constructed as the most underdeveloped and anarchic region in the world in need of a new form of humanitarianism, while AFRO was constituted as an island of (Western-style) modernity and progress. Monica Saavedra (University of York, UK) presented her research on the involvement of Portuguese India in the WHO’s South-East Asia Regional Office, in the final years of the Portuguese colonial rule. Saavedra showed that the WHO and SEARO were not merely forums for scientific and technical exchange and cooperation in the area of health, but also an international political stage where Portugal struggled to lay claim to Portuguese India and to legitimate its rule. This ambiguous relationship with SEARO resulted in political interests overshadowing the health needs of the population, so that official sources were dominated by political manouvres and agendas. The SEARO archive reveals a selective way of dealing with the international health affairs, and illustrates Porugal’s efforts to keep a flimsy balance between international approval and self-interest.
The third panel dealt in some detail with the history of pharmaceutical practices, initiatives and marketing in a global perspective. Jeremy Greene (Johns Hopkins University, USA) presented his research on critical discourses regarding the uneven distribution of access to life-saving pharmaceuticals in different parts of the world between the 1960s and 1980s. Greene explored the key discussions of the role that access to medicines played in international political and health development, and looked at positions of a number of stakeholders – doctors, policymakers, lawyers, manufacturers – in this global mapping of therapeutic inequalities. Julia Salle Younge (Hosei University, Japan) traced the emergence of a global vaccine industry model. According to Yongue, combination vaccines have become the global standard of vaccination in all developed nations — save one. Her presentation then traced the process that led to the formation of a global model for the vaccine industry while comparing two distinctively different cases, the French vaccine industry, which played a central role in the acceptance and propagation of combination vaccines and the Japanese vaccine industry, whose government, until only recently, has promoted the ‘de-combining’ of vaccines as the best means of preventing adverse reactions. The final speaker of the panel, Johanna Conterio Geisler (Birkbeck, UK), provided the sorely missing Soviet perspective and countered the historiographical narratives of the Soviet Union as increasingly isolated and isolationist in the interwar years. Her research explored the development of Soviet pharmaceutical industry in the global context of the 1920s and 1930s, and looked at how Soviet medical and health experts engaged with Western networks and approaches. They actively sought external influences and Western – US – models in order to spur the development of pharmaceutically crucial agricultural products and raw materials in the Soviet peripheries, and aimed to prevent the Soviet dependence on international pharmaceutical monopolies. While Soviet borders were closing down, outside influences continued flowing in.
In the fourth panel, focusing on actors and networks, David Thomas and Davide Rodogno discussed their ongoing project on the history and genealogy of public health fellowships in the twentieth century. They sought to connect the post-WW2 WHO international fellowships programme to its predecessors – the Rockefeller Foundation and UNRRA fellowships. Their research explored continuities and ruptures in this history, and focused on the concepts of human capital and development which informed and shaped the structure and goals of the different health fellowship programmes across the twentieth century. Clifford Rosenberg (CUNY, USA) analyzed the RF International Health Board’s attempt to establish a field programme in French Algeria in the 1920s, following the successful anti-TB programme it funded and ran in France during WWI. Rosenberg’s research explored this failed attempt in a political and colonial perspective, and placed the RF’s initiative in the context of the emerging international institutions and French and Algerian colonial patronage networks. Paul Weindling (Oxford Brookes, UK) presented his research on the RF’s social medicine healthcare experiments in the twentieth century. His paper focused on the RF-funded schemes in Natal, South Africa, in the 1950s. Weindling traced the RF’s efforts to establish a Department of family practice at Durban, the University of Natal, in a new medical faculty for non-white students, and its attempts to obtain guarantees that the non-white graduates would get government posts. While the Durban scheme ultimately failed in the context of the South African apartheid, Weindling argued for its great significance for understanding the history of the RF’s involvement in social medicine healthcare experiments, and he related the Natal health centre to other earlier attempts of the RF to combine primary healthcare with rural development and cultural and social factors.
The subsequent panel dealt with a variety of historical approaches to analyzing ‘Diffusions and models’ in global healthcare. Thomas Zimmer’s paper addressed the history of the Malaria Eradication Programme in the 1950s and 1960s, and specifically explored the role of the World Health Organization in the development and implementation of this initiative. Zimmer (Freiburg University, Germany) argued that, although the WHO financial and material contributions to the MEP were significantly lower than those of the main donor countries (such as the US), the WHO played a fundamental role in coordinating and codifying the Programme by establishing pilot projects which served as future models, lent legitimacy to the very idea of eradication, served as an intermediary between donor and developing countries, and was pivotal in evaluating ongoing projects. The paper concluded that the global malaria eradication was ultimately a WHO project, although the WHO could not have possibly launched or run it by itself and was at mercy of the ebbs and flows of international politics. Pierre-Yves Donze discussed the theme of diffusion and globalization of health models from a slightly different perspective – that of economic entrepreneurs and the history of industrial business. At the centre of Donze’s story was the German electro-medical equipment maker Siemens-Reiniger-Werke and its attempts to re-enter non-European (Latin American, as well as Asian and African markets) in the aftermath of WWII through the project of hospital construction. Instead of merely exporting goods, SRW organized and directed an informal association called Deutsche Hospitalia, which gathered around thirty German manufacturers. They were all involved in constructing and fully equipping the final product – the German hospital, which was then offered to the local governments. Donze analysed the initiative in the context of globalizing trends in medicine, and discussed how SRW contributed to these trends. Yi-Tang Lin (University of Lausanne, Switzerland) critically analysed the nature and production of WHO health statistics in different regions and areas, questioning the value of statistics as neutral markers of local health programmes and placing them in proper socio-political contexts. Lin concluded that the WHO’s strategy of standardization was not making a unique standard, but giving different instructions to countries with different public health administration capacities, and using statistics as a tool for legitimizing health programmes in different countries. Moreover, the WHO forged a network of knowledge transfer by providing fellowships for national health statisticians, inaugurating short-term training centres, and employing a statistician or economist for every regional office.
The final panel of the conference was titled ‘The world as a laboratory.’ Agata Ignaciuk (University of Granada, Spain) presented a comparative study of the leading European and US pharmaceutical companies’ strategies and practices for marketing the contraceptive pill in Francoist Spain and socialist Poland in the 1960s and 1970s. Although the two markets were radically different from the West European and American ones, as well as form each other, Ignaciuk was able to identify striking similarities. In the Spanish case, although sale and advertising of contraception had been banned until 1978 and the pill was marketed as a therapeutic drug, the pharmaceutical strategy was not fundamentally different from that practiced in Western Europe or the US, and focused on normalizing the idea of family planning among physicians and the broader public. According to Ignaciuk, this helped legitimize the idea of contraception in Spain, and aided its social and medical acceptance well before 1978. On the other hand, although the Western pharmaceutical companies were significantly less successful in the context of Poland’s nationalized industry and state markets, their marketing strategies and persistent attempts to approach Polish institutions throughout the 1960s and 1970s prepared the market for a massive expansion in the 1990s. Dora Vargha (Birkbeck College, UK) discussed the development and coordination of polio live vaccine trials in the late 1950s and early 1960s in as many as fifteen different countries on four continents. Vargha’s presentation revised the common historiographical understanding of the globalization of pharmaceutical research, and demonstrated that the 1950s and 1960s were in fact the crucial decades for the internationalization of drug testing, while polio vaccine trials were among the first truly global phenomena in twentieth-century medicine. Her paper shed light on the nature, assumptions and mechanics of international cooperation between health institutions, governments and individual researchers in organizing polio vaccine trials and evaluating their results. Sarah Hartley (University of York, UK) focused on the international, regional and colonial politics of nutrition in British Colonial Fiji over the two decades after WWII in order to assess how the relationships between various health agencies – UN, WHO and FAO bodies, as well as regional and colonial administrations and offices – affected the design and delivery of nutrition programmes, and the development of international health. Hartley showed how the South Pacific Commission (a Western dominated multi-governmental agency), the South Pacific Health Service (the British and New Zealand colonial health service), and the regional offices of WHO and FAO sought to shape health policy in accordance with their individual ideological and security needs in the South Pacific region. The resulting networks of political and professional allegiance created a patchwork of practice in the field of nutrition across the South Pacific.
In the final analysis, this conference offered a rich and sophisticated account of the complex political and economic circumstances in which twentieth-century international health projects and initiatives emerged and developed – the vagaries of the Cold War constituted the core theme of most presentations. Many papers successfully explored the convoluted relations between pharmaceutical businesses and health organizations; others sought to evaluate the role of experts, their intellectual trajectories and meeting places, as well as their attempts to co-opt political governments for various unorthodox international health endeavours in the context of extreme political rivalries. The conference also emphasized the multiple effects of colonialism and de-colonization on the development of international medicine and health, and several participants attempted to move away from exclusively Anglo-American and Francophone accounts of health globalization. At the same time, while the conference aimed to engage the discussion of scales of historical analysis and to shed light on how international public health programmes were implemented at the local level, it did not devote enough attention to exploring the wealth of social and cultural consequences of such globalizing forces in different parts of the world. Most papers addressed institutional histories or discussed the role and discourses of individual experts, researchers or health administrators, and offered almost exclusively top-down accounts. Many of these narratives would have likely been significantly different – or at least enhanced – if told from the perspective of cultural and social history, history from below and medical anthropology: how did such important international medical and health projects, plans and initiatives transform the social micro-universe of those on the receiving end? did these health programmes induce any significant cultural shifts in how people – patients, physicians, lawmakers – in different parts of the globe thought of and defined illness, death, medicine, political ideology or nation and internationalism? how did the globalization of healthcare and medicine change everyday lives and human interactions? Some of these themes were occasionally touched upon in the course of the conference, but they certainly remain important potential topics for future meetings.
Dora Vargha has been selected to be a 2015–2016 Research Fellow at the Consortium for History of Science, Technology and Medicine, for her project “Road to Eradication: Global Polio Vaccine Testing in the Cold War.” During her stay, she will be visiting the collections at American Philosophical Society, the University of Pennsylvania and Yale University.
By Philippa Hetherington
Reposted from Cosmopolites: The Blog of the Laureate Research Program in International History at University of Sydney.
Early last month, Laureate postdoctoral fellow Philippa Hetherington took part in an intellectually rich conference on the comparative and connective history of the Black Sea region at Birkbeck, University of London. The workshop was convened by Johanna Conterio, a postdoctoral research fellow in the Department of History, Classics and Archaeology at Birkbeck, and part of the Wellcome Trust-funded project “The Reluctant Internationalists: A History of Public Health and International Organisations, Movements and Experts in Twentieth Century Europe, led by Dr Jessica Reinisch. The February event, ‘Landscapes of Health: the Black Sea in the Socialist World,’ brought together historians working on both the Soviet Union and Eastern Bloc, and explored the idea of the Black Sea region as a particularly important node in the geography of socialism. Coinciding with the sixtieth anniversary of the Yalta Conference (4-11 February 1945), the conference highlighted the unique position of the Black Sea in international history, as well as in the economic, social and cultural history of tourism, health, and migration in the region. Mirroring the international focus of the conference, speakers came to Birkbeck from across the world, including Russia, Australia and Switzerland as well as Texas, California and Illinois.
The opening panel explored the singular trajectory of the Black Sea in the Cold War. Samuel Hirst (European University, St Petersburg), spoke about the shared antipathy of both Soviet and Turkish policy-makers towards Western economic dominance in the 1920s. As Hirst explained, for a brief moment in the interwar period, anti-Westernism and economic cooperation bound the Soviet and Turkish states into an unlikely trans-Black Sea alliance. In her examination of the transnational politics of Soviet deaf activism, Claire Shaw (Bristol) turned from Turkey to France, exploring the sites of miscommunication and misunderstanding between French and Soviet understandings of welfare and support for deaf communities. Finally, Stephen Bittner (Sonoma State), discussed the visit of international wine experts to the Soviet Union in the 1960s and 1970s, on the invitation of the Soviet wine industry. As Bittner outlined, definitions of ‘taste’ and ‘quality’ vis-à-vis wine proved fundamentally untranslatable, as wine occupied a different social role for the Soviets and their guests. All three papers emphasised the contingent nature of cross-cultural cultural and economic ties between the Soviets and their neighbours, and highlighted the importance of attention to the ruptures, as well as the points of connection, produced by trans-national ties.
The second panel discussed population mobility on the Black Sea, through the prisms of both short-term travel (for tourism) and long-term departure (emigration and defection). Diane Koenker (University of Illinois at Urbana-Champaign) explored the particular place of Black Sea tourism in the internationalization of Soviet culinary tastes. Any visitor to the former Soviet Union will notice the ubiquity of Georgian cuisine across the region: Koenker uncovered the longer history of this love affair with shashlyk, which she explained was complicated by fears of Caucasian ‘danger’ alongside a desire for ‘Eastern exoticism.’ Mary Neuberger (University of Texas, Austin) gave the first paper of the day focusing on Bulgaria, tracing the highs and lows of the country’s Black Sea resort industry since 1949, and particularly the initially highly successful Balkanturist state tourism agency. Erik Scott (Kansas) explored the politics of the Turkish-Georgian border in the post-war Soviet Union, highlighting the importance of studying immobility alongside mobility in the migratory dynamics of the region. He then discussed a notorious example of a defection from Georgia, on a plane traveling from Tblisi to Trabzon, and the long lasting effects of this event on the imagination of the space between Turkey and Georgia. Finally, Philippa Hetherington (Sydney) spoke about the importance of the Black Sea as a ‘laboratory of mobility’ in the interwar period, and in particular the special place occupied by displaced Russians crossing the sea in the refugee regime instigated by the Nansen Office at the League of Nations.
The final panel of the first day focused on a topic particularly close to the heart of the Reluctant Internationalists project: the Black Sea as a site of experimentation in health resorts after 1945. Juliana Maxim (San Diego) discussed the architecture of early Romanian socialist resorts from the perspective of art history, arguing that the bright new seaside resorts of the late 1950s operated as vehicles of cultural engineering, turning a ‘backward’ region into a hub of socialist modernity. Johanna Conterio (Birkbeck) emphasised the Black Sea as a site of aesthetic exchange, through which the Soviet authorities learned a new architectural language of ‘mass healthcare resort’ from their Bulgarian and Romanian neighbours. As she pointed out, examples such as this are an important corrective to a historical narrative that assumes the Soviet Union always imposed its political and aesthetic preferences on the rest of the Eastern Bloc. In the third paper, William Nickell (Chicago) examined the instrumental use of Sochi as the ‘model resort’ within Russia and the Soviet Union since the 1930s, and its role as a palimpsest serving as a paradigm of both socialist and capitalist development. Arguably, it was more viable in the former incarnation than in the more recent latter, and Nickell ended by speculating that new development plans in the city would be undermined by their decidedly un-democratic nature.
Day two of the conference opened with a rich panel on mapping, both literal and imaginary. Kelly O’Neill (Harvard) discussed a remarkably diverse set of maps inspired by the archeological exploration of the Russian/Ukrainian Black Sea Coast since the eighteenth century. As she argued, maps of the Black Sea, and visualizations of its archeological riches, could convey highly disparate ideological messages, from presenting the coast as a sum of its ports, to highlighting the great distances between the origin point of archeological treasures and their homes in museums. Susan Grant (University College, Dublin) explored the production, and sometimes unraveling, of Sochi as the ideal ‘place of rest’ through the perspective of the ‘middle’ health care workers, the nurses and feldshers who tended to patient needs for health through ‘cultured rest’ from the 1930s to the 1970s. Finally, Ruxandra Petrinca (McGill) introduced conference participants to 2 Mai and Vama Veche, two Romanian socialist-era resorts that she argued were ‘oases of individual freedom’ for the middle-class holiday-makers in the 1960s and 1970s. Thus, participants learned about the various ways in which the Black Sea Coast was imagined as site of historical authenticity, idealized space of health, and even rare arena for political freedom, in the context of socialism(s).
Rounding off the conference, three distinguished discussants summed up the weekend’s proceedings and pointed to directions for future research. Diane Koenker (Illinois, Urbana Champaign) highlighted the need to pay more attention to both gender and class in our analyses of the region, and to question whether we are writing specifically connective histories of the different national spaces around the Black Sea, or more comparative ones. Elidor Mehilli (Hunter College) reminded participants that the Black Sea historically was not only a space of mobility and freedom, but also a space of Communist careerism, political posturing and the socialisation of Communist elites. Further, he raised the question of whether the socialist model of interconnectedness across this space was distinctive. Valeska Huber (German Historical Institute, London), meanwhile, called speakers’ attention to the need to think about the space of the sea itself, and not merely the coastline, and thus to engage with maritime historians who have discussed the social and cultural role of water. She also reiterated the need to historicize not only the dynamics of movement across the region, but also of immobility – moments of acceleration and deceleration in population and cultural exchange, as well as points of flow and spaces of blockage.
Ultimately, this conference sought both to place the Black Sea region in the burgeoning scholarship on global and transnational history, and also to problematize both comparative and connective perspectives on the region. Participants agreed that thinking more broadly in terms of the region as an ‘inter’ or ‘trans’-national space, albeit one ideologically divided at specific moments along nationalist lines, was enriching for scholars of the Soviet Union, Bulgaria, Romania and Turkey. However, many participants also felt that it was important to remember how national boundaries were also reified at various points in the twentieth century, and processes such as cultural, economic and population exchange could sometimes serve to concretize imagined notions of essential difference, rather than break them down. Podcasts of the discussions at the conference are available here; readers are also encouraged to look out for the proceedings of the conference, which are to be published in a forthcoming issue of the Slavonic and East European Review.
This week you can find The Reluctant Internationalists in Lausanne, Switzerland at the “Globalization of medicine and public health: economic and social perspectives (1850-2000)” conference organized by Sanjoy Bhattacharya (University of York), Thomas David (University of Lausanne, EPFL), Pierre-Yves Donzé (Kyoto University), and Davide Rodogno (Graduate Institute of International and Development Studies).
At this exciting event Jessica Reinisch will be chairing the panel “Global Public Health After The Second World War: Non-Western Visions”, Johanna Conterio will be presenting a paper titled “The Global Botanical Roots of the Soviet Pharmaceutical Industry: The Case of Quinine” and Dora Vargha will be talking about “The Globalization of Vaccine Trials: Networks and Rivalries in Live Poliovirus Vaccine Development”.
For more information about the conference and the detailed program, see the official website.
In our second Newsletter (see the first one here), we will include a noticeboard for announcements about events, publications, new projects or initiatives relating to the history of internationalism. If you have any news you would like to include, please email it to reluctant.internationalists@gmail.com by Friday, 13 March.
We are pleased to announce our 2015 Visiting Fellows. This summer we will host three visiting fellows:
Jessica Pearson-Patel is a historian of France, the French empire, international organisations, public health and development. During her residence at Birkbeck, Jessica will work on a book manuscript, The Colonial Politics of Global Public Health: France and the United Nations in Postwar Africa. She will conduct more research on the Commission for Technical Cooperation in Africa South of the Sahara, a joint Franco-British organisation active in developing public health in the French and British African colonies after the Second World War.
Brigid O’Keeffe is a specialist in late imperial Russian and Soviet history, with interests in internationalism, ethnicity, citizenship and everyday Soviet life. Brigid is the author of New Soviet Gypsies: Nationality, Performance and Selfhood in the Early Soviet Union (University of Toronto Press, 2013). She is currently working on a new book, Speaking Transnationally: Esperanto, Citizen Diplomacy and Internationalism in Russia, 1887-1939.
Friederike Kind-Kovacs is a historian of childhood, central, eastern and southern Europe, and the author of Written Here, Published There: How Underground Literature Crossed the Iron Curtain (Central European University Press, 2014). During her fellowship she will be conducting research for her second book, The Embattled Child: Child Welfare in Interwar Hungary between International Philanthropy and National Propaganda, 1918-1944, in which she explores the effects of the First World War and the dissolution of the Austro-Hungarian Empire on children in central Europe, with a special focus on Hungary.
The Reluctant Internationalists project is also delighted to host Francesca Piana’s extended stay at Birkbeck from May 2015 to November 2016. Francesca is a postdoctoral fellow of the Swiss National Science Foundation, and currently working on two projects: a book manuscript on the history of international initiatives for prisoners of war and refugees after the First World War, and a project entitled Women and Humanitarian Work: Three Parallel Lives, ca.1880s-1950.
You can read more about them on our website under ‘people’.
We look forward to welcoming the fellows to London, and to spending a productive summer of discussions and collaborations with them. Our new round of visiting fellowship applications will open in the autumn.
Johanna Conterio will be giving a talk on Monday, 23 February, 2015 at 6pm in the Modern Russian History Seminar at UCL School of Slavonic and East European Studies. No RSVP necessary — please stop by if you are in Bloomsbury and have a free hour!
Academic life, as I have learned, makes you painfully aware of the many different regimes of immunization across the globe. Moving between fellowships and jobs, our first son got his vaccines in four different countries – that means four distinct healthcare systems, vaccination schedules, payment structures and vaccination records in three different languages. I think it is safe to say that he has become a reluctant internationalist in his own way. As for us, parents, we pretty much did what we usually do in our working life. We spent hours after each vaccination appointment to analyze the microcosm of public health systems: the doctor-patient encounter. We have been fascinated by the carefully crafted pro-vaccination speech prepared by our American paediatrician, the kind, but firm approach of the German doctors, the inescapable abundance of posters and leaflets on vaccination in the British surgery, and the lack of any kind of publicity and a matter-of-fact discourse in the district paediatrician office in Hungary.
This personal experience has also made me particularly interested in the way childhood immunisation is conceptualised and the points when it is contested or even seems to break down, such as the current ‘anti-vaxx’ controversy prompted by the Disneyland measles outbreak. As I am currently finishing a chapter on debates surrounding the Salk vaccine in Eastern Europe in the 1950s, I started thinking about how communist public health officials would have made sense of debates like this.
An excellent analysis by Jennifer Reich, published in Gender& Society has brought up an important point that would surely have sparked the interest of the communist vaccinators. In this study Reich is speaking to a debate that, in broad brushstrokes, posits crazy and irresponsible people (mainly women) against rational and responsible parents, physicians and public health experts. Reich is arguing that the ‘anti-vaxxers’ are far from being ‘crazy’: in fact, they base their decision on time-consuming research and their choice reflects their social and economic privilege. Not only is this analysis important in understanding current American anti-vaccination movements and their consequences, it also makes clear that behind this potential public health crisis is the primary role of the patient-consumer and an interpretation of personalised medicine. According to Reich’s study, mothers who decided not to vaccinate their children were unconvinced by arguments that they should be participating in public health and expressed that their responsibility was to their own children, not others’. This is along the lines of what popular satirical outlets, such as The Onion have picked up on.
Responsibility for health was exactly the thing in the crux of Cold War attitudes towards public health. Eastern European party dignitaries and public health officials were always happy to boast that countries like Czechoslovakia and Hungary triumphed over polio years before the West and about a decade before the United States did. Their Western colleagues acknowledged the feat, and explained this with totalitarian state organisation – effective epidemic management tends to be authoritarian. The Eastern Europeans had a different explanation, however: the socialist model of organising public health, where prevention is seen as key to the health of the population, healthcare is available to all, vaccines are free, and the paternal state takes responsibility over children’s health. They pointed to the ‘backwardness’ of America for sacrificing the health of children to selfish and market-driven agendas.
With the end of the Cold War, we could dismiss this as a moderately interesting episode in history, but, as most things in the Cold War, such sentiments, experiences and ideologies have long-term effects. Traces of the Iron Curtain linger in vaccination coverage: measles, for instance, tends to appear in Western Europe much more than in the East. In 2011 of all measles cases in Europe, over 83% was reported from Western Europe, while Central and Eastern Europe accounted for less than 14% of them. According to data from 2013 by the WHO, in Poland, Slovakia, the Czech Republic, and Hungary the vaccine coverage for measles has been 98-99%, while in the US it is 91%, UK (after a dip to 81% in 2004) rising to 95%, France 89%.
Vaccine coverage of course is a marker of superiority only in Cold War rhetoric. It does not reveal much about the quality of healthcare, access to it, or the overall health of a population. Coverage rates can also quickly change due to political unrest and/or economic problems, like in Ukraine, where vaccination has hit critically low rates in the past decade. However, when comparing politically and economically stable countries in the Global North, this difference between East and West does reveal Cold War legacies and attitudes towards the responsibilities of citizens. In much of Eastern Europe, the state expects physicians and parents to comply with vaccination policies without much debate or contestation, and parents expect the state to provide free vaccine and to guarantee its safety. The ‘social’ in medicine is very much still present and high vaccination rates are still a point of pride for Eastern European governments.
Vaccine resistance is also not a new phenomenon. Since there had been vaccines, there has been resistance to it – revealing a wide variety of reasons, usually connected with a much larger issues regarding power relations, distrust, religious integrity, etc. In some societies, like Britain, vaccine resistance has a long history, since the introduction of Jenner’s vaccine.But resistance to vaccines is not even something particularly Western, even if we limit our view to the Global North, although it is slightly more difficult to spot on the Eastern side of the Iron Curtain in the Cold War era. Archival sources give a glimpse of resistance to the Salk vaccine in Hungary, which had to do mostly with opinions that the state was not fulfilling its public health provider role adequately, either by following the ‘wrong’ method of injection, or supplying vaccine lacking in quality and quantity.
There are, of course, new aspects of today’s vaccine resistance in the Global North. Parents have easy access to information online and can establish ties with each other over social media. These ties and the flow of information does not stop at borders, making vaccine resisters at once national agents – in that they respond to a particularly local set of problems of state, public health and culture – and internationalists who participate in shared networks across the globe. Over 25 years after the fall of the Berlin wall, the wind of change might finally reach public health organisation and vaccination in Eastern Europe. In Hungary, where vaccination is compulsory and free, the voice of vaccine critics seems to be growing steadily, drawing mostly on social media, supported by arguments based on translations from English language materials. With a healthcare system that perpetually seems to be on the verge of breakdown – another Cold War legacy -, questions of responsibility for health keep bubbling up to the surface. But for now, the legacy of a previous century is imprinted on my child’s body, who has moved with ease back and forth between East and West, unknowingly becoming a vaccine cosmopolitan.