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Cornell University Press

States of Immunity

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This month, children are returning to school across the country. Over the flurry of new schedules, textbooks, and school supplies hangs an important, newly controversial question: that of compliance with state laws for school attendance, and specifically mandatory vaccination policies. New York, for instance, has just implemented a new law prohibiting exemptions from vaccination on religious grounds. Twenty-six thousand schoolchildren who previously avoided immunization with MMR (measles-mumps-rubella) and other vaccines now face a choice: get vaccinated, or face expulsion.

Twenty-six thousand schoolchildren who previously avoided immunization with MMR (measles-mumps-rubella) and other vaccines now face a choice: get vaccinated, or face expulsion.

Resistance to vaccination on the grounds of religion, political beliefs, or other reasons is not a new phenomenon, of course. In the United States, a robust tradition of anti-vaccination movements has persisted despite legal injunctions like the 1905 Jacobson v. Massachusetts Supreme Court ruling, which asserted the rights of states to implement mandatory vaccination against smallpox. It reflects a tension between the public good and private freedoms that has long characterized the history of public health. Yet the United States does not necessarily provide the only or best case with which to understand relationships between individual and state authority over health. There are other ways to think about this dynamic, ways that don’t constrain the conversation so narrowly to questions of legislation and protest movements. One historical case in particular sheds light on a wide range of strategies using state power to implement immunization policies: that of China.

One historical case in particular sheds light on a wide range of strategies using state power to implement immunization policies: that of China.

Next month Cornell University Press will publish Mass Vaccination, my history of mass immunization in modern China. Drawing on novel archival materials from Europe, China, and the United States, the book uses immunization as a focal point through which to analyze relationships between public health, governance, and citizenship in China throughout the twentieth century. I tell the story of the people, materials, and systems that comprised mass immunization in China, and how they first came together before the Communist Revolution of 1949, in the Second Sino-Japanese War, when China’s Nationalist government fled Japanese occupation and moved to the country’s western hinterlands.

Drawing on novel archival materials from Europe, China, and the United States, the book uses immunization as a focal point through which to analyze relationships between public health, governance, and citizenship in China throughout the twentieth century.

The book describes how researchers and physicians in China’s wartime southwest sought to establish mass vaccination programs that immunized as many people as possible in urban and rural areas against a variety of diseases; how these key figures remained in China after the war and assumed prominent positions in the health administration of the new Communist People’s Republic; and the expansion of mass immunization programs to genuinely national scales after 1949.

The Chinese Communist Party built on wartime foundations to create vaccination programs that not only eradicated smallpox and controlled many infectious diseases within the country, but also contributed to the consolidation of state power and authority. Resistance to immunization did not necessarily take the form of overt confrontation or strident protestation, but rather could be constituted in evasion and excuse-making; the enforcement of mandates for vaccination did not only rely on legislation or court decisions, but rather manifested in a diverse range of local interactions—ranging from persuasion to coercion—between representatives of the state and the people they sought to immunize.

The Chinese Communist Party built on wartime foundations to create vaccination programs that not only eradicated smallpox and controlled many infectious diseases within the country, but also contributed to the consolidation of state power and authority.

Questions of how to implement mass immunization policies are especially pressing in the twenty-first century, not only because of the resurgence of anti-vaccinationism in the United States but also because of the new dangers of global health crises. One reason cited for the New York policy is the ease of worldwide transmission of diseases like measles. The advent of commercial aviation, high-speed rail, and other technologies of transport has made infectious disease control a key area of concern around the world. The history of China’s remarkably successful program of mass immunization is therefore not only a valuable addition to comparative studies of public health—these systems have also had profound consequences for global health.


Mary Augusta Brazelton teaches in the Department of History and Philosophy of Science at the University of Cambridge. Her research focuses on the history of science, technology, and medicine in modern China and its place in global histories of science.

Featured image courtesy of the National Library of Medicine. 

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