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3
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0017254714
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Politics and public health: smallpox in Milwaukee, 1894–1895
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Historically considered, mass vaccination in the U.S. and Europe involved coercion which provoked vehement, sustained and occasionally violent public opposition, but that pattern has given way in the last 50 years to more sophisticated methods of persuasion and less cohesive popular resistance. Regarding opposition to nineteenth-century smallpox vaccination see, for example
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(1976)
Bull. History Med.
, vol.50
, pp. 553
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Leavitt1
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4
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0023948766
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The politics of prevention: anti-vaccinationism and public health in 19th century England
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(1988)
Med. History
, vol.32
, pp. 231
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Porter1
Porter2
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5
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0022170305
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The history of smallpox vaccination in Germany: a first step in medicalization of the general public
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(1985)
J. Contemp. History
, vol.20
, pp. 617
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Huerkamp1
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6
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0020057628
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Identifying the reasons for low immunisation coverage—a case study of Yaounde (Cameroon)
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Among 19 questions which Brown et al. suggest managers should ask about the causes of low acceptance rates in childhood vaccination campaigns, only two focus on the vaccinator-vaccinee interaction: “Does staff's language or culture differ from that of users?” and “Do parents suffer indignities?”
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(1982)
Rev. Epidémiol. Santé Publ.
, vol.30
, pp. 35
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Brown1
Djogdom2
Murphy3
Kesseng4
Heymann5
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13
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84914962502
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Music makes it clear that this degree of chaos was incompatible with long-term SEP methods, and that in a subsequent development the Bangladesh programme began to hire temporary male and female vaccinators in the affected villages rather than launching military-style containment raids. The definition of containment continued to rest on “focally intense ring vaccination,” but the vaccinators were locals, which greatly lessened the coercive aspect.
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14
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84914962501
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The three examples appear [9. p. 46]. Neither the village nor the district is identified. Music did not speak Bengali well
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15
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84914962500
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Music notes that “By vaccinating her first and then providing food afterwards as a personal gesture, I emphasized that there were no exceptions. Later, beggars were to be revealed as a major mode of spread, and we were to establish isolation centres for the care and feeding of these people until they would no longer be infectious” [9. p 49].
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16
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84914962499
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Brilliant, an American, was not a CDC epidemiologist. His unusual path of recruitment into the South Asian WHO-SEP has been narrated in Ram Dass, Arkana-Penguin, New York
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(1991)
Miracle of Love: Stories about Neem Karoli Baba
, pp. 163-169
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18
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84914962498
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July 1992 telephone interview with Dr Brilliant, now associated with the SEVA Foundation, San Francisco. Brilliant pointed out that Mohan Singh spoke Hindi, which Brilliant transcribed himself.
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19
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84914962497
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Singhbhum district in Bihar was a sore spot for the SEP; it was called in spring 1964 “the world's greatest exporter of smallpox” and continued to harry WHO-SEP staff [4, 6].
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21
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84914962496
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Interview with T. Stephen Jones, M.D., Centers for Disease Control, Atlanta, GA, 27 June 1984. Author's collection, Tape 2, side B, Soundesign index 730.
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22
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84914962495
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Emphasis added. The Indian report suggests further that the use of force was always illogical: “The vaccinator who rushed into the village, vaccinating by force, provoked and compounded the animosity and, although he possibly obtained a short-term benefit, he encouraged concealment of any future cases for fear that he might return again” [4, p. 113].
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23
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84914962494
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Joshua Pryor and Ivan Weissman are pseudonyms.
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24
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84914962493
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Other American epidemiologists kept notes in journals, but Pryor's is particularly full and contains very frank observations. His diary (and his field notes) have been furnished to the author on condition of confidentiality. Pryor extended his three-month tour by one month and left India late in 1974.
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25
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84914962492
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For a list of all foreign WHO epidemiologists in India during 1973–1975, see annexes to Ref. [4]. The similar data for Bangladesh will be found in Ref. [5]. The official WHO account of the campaign in South Asia is given in Ref. [6] chapters 15 and 16
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26
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84914962491
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Pryor diary, 9 September, 1974. It seems more than likely that this was the Bihar Health Minister, who is known to have advocated mass vaccination. The Indian Minister of Health and Family Planning, Dr Karan Singh, was a staunch advocate of surveillance/containment methods and on at least one crucial occasion assisted WHO staff in defeating the advocates of mass vaccination
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28
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84914962490
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“Majumdar” is a pseudonym. Part of their friendship was based on shared religious feeling. In his diary entry for 17 September 1974, Pryor records “Dr Majumdar played his usual role of teacher, friend, critic and ally. ... He gave another one of his lesson on Hinduism and discussed the Bhagavad Gita with me. Apparently Dr M. has read the Koran, Bible, Vedas and Bhagavad Gita. He feels that the ultimate truth is the same and that basic underlying principles carry throughout. He believes in a God. He finds the story of Christ charming, but relegates it to a semi-mythological status like that [of] Lord Krishna.”
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29
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84914962489
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The following extracts contain grossly prejudiced statements that belittle the competence of Indian health personnel. Much of what Pryor asserts was written under stress, and the author [PG] reproduces these passages to indicate how Pryor's critical attitudes hardened into markedly unsympathetic prejudices.
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30
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84914962488
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Pryor diary, dated September 22 but probably September 23, 1974.
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31
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84914962487
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As was the case with Pryor's remarks on health personnel in India, much of what Music asserts here about Bangladeshi health personnel in the following passages is strongly prejudiced.
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32
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84914962486
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In the recent World Development Report: Investing in Health (1993) the World Bank notes that “in many ways the Intensified Smallpox Eradication Programme exemplifies the potential of today's medicine” (p. 17) and celebrates its status as a model of what technology can accomplish. This is a familiar position found in numerous articles and documents over the last 15 years.
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33
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0025326809
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Vaccine-preventable disease and immunisation in the developing world
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For likely targets of future disease control and eradication campaigns, see
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(1990)
Pediatr. Clin. North Am.
, vol.37
, pp. 735
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Bart1
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38
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0020220953
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Coercion in a soft state: the family-planning programme of India
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A comparison with the consequences of coercion in the Indian family planning programme during the late 1970s is instructive. See, et seq.
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(1982)
Pacific Affairs
, vol.55
, pp. 373
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Vicziany1
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39
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53349159736
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Coercion in a soft state: the family planning programme of India
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(1983)
Pacific Affairs
, vol.56
, pp. 510
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Bishop1
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40
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0003610398
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The CDC, for example, has repeatedly been buoyed by its effectiveness in organizing vaccine trials and domestic immunization programmes as well as of course its successful leadership role in the global smallpox eradication campaign. See, Chaps 5, 10, 14, 21, University of California Press, Berkeley
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(1992)
Sentinel for Health: A History of the Centers for Disease Control
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Etheridge1
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41
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84914962484
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For example, the World Health Organization has set up a Council for International Organizations of Medical Sciences Group for Development of International Guidelines for Epidemiologic Research and Ethical Review Procedures (1988). The logic of research differs from that of public health measures, but it has to be demonstrated that the ethical dilemmas are not of the same order.
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