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Book Review
| Sanjoy Bhattacharya, Expunging Variola: The Control and Eradication of Smallpox in India, 1947–1977 (New Delhi: Orient Longman, 2006). ISBN 81 250 3018 2. 326 + xv pp + Index.
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| In Expunging Variola: The Control and Eradication of Smallpox in India, 1947–1977, Sanjoy Bhattacharya has written a thorough investigation into the political and technical aspects of a post-war public health programme. His book is an account of the efforts of the Indian government and the World Health Organisation (WHO) to eradicate smallpox on the subcontinent, drawing on official sources that have previously been left unexamined. In analysing in great detail the memoranda, reports and statistics concerning the Indian National Smallpox Eradication Programme (NSEP), Bhattacharya has sought to uncover the ways in which this project was hampered by myriad divisions and conflicts, not only between the Indian government and WHO, but between the many levels of the Indian government and within WHO as well. This attempt to complicate an assumption that monolithic government and international organisations drove the NSEP with unified aims and expectations is the greatest strength of Expunging Variola. In an exhaustive analysis of archival Indian and WHO material Bhattacharya shows how technical and financial problems, policy disagreements, political interests and hostility combined to make the NSEP a lurching and faltering project requiring repeated resuscitation by negotiation and hard work. |
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Financial and technical shortcomings were perennial problems encountered by the project. Shortage of money meant that programmes were restricted by a lack of staff, while the distances involved in covering districts for vaccination work revealed to many observers the ineffectiveness and danger of using liquid instead of freeze-dried vaccines. Poorly trained and inexperienced vaccinators were also seen as a problem, and at the Smallpox Workers Conference in New Delhi in December 1964 some who spoke placed the blame on WHO plans from the late 1950s and the pressure from senior officials to meet vaccination targets. This pressure meant that, in order to reach targets, data would be falsified or multiple vaccinations would often be carried out on whoever was accessible instead of those people most in need. |
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Bhattacharya also shows how significant were the differences in ambitions and expectations of officials at different levels of Indian government, between WHO and the Indian government and between WHO headquarters in Geneva and the Organisation's South-East Asia Regional Office. India continued in the 1950s and most of the 1960s to insist on using outdated liquid vaccines, in large part because it was equipped to make liquid vaccine and India was reluctant to give up the prized self-reliance this provided. India also gained some measure of regional influence because of its ability to provide neighbouring countries with vaccine. For WHO in Geneva, eradication, as opposed to control, was a fundamental part of international public health policy, yet Bhattacharya shows that the regional office felt experience had shown this aim to be misguided. Similarly local government officials in India persistently doubted the very possibility of eradication. These disagreements lead to considerable problems in regard to co-operation. At district level, foreign WHO experts working to reform the programme after 1967 often encountered hostility from public health officials who were critical of the aim of eradication and jealous of their autonomy. |
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Bhattacharya's book is therefore an account that does the important work of closely analysing archival sources in order to better understand the kinds of complicated divisions and power relations that influenced post-war public health programmes like the NSEP and the later Intensified NSEP. Yet there is a sense in which Bhattacharya's work leaves issues unexplored and voices unheard, since an almost exclusive focus on official documents leaves the book a rather narrow technical and administrative account that centres on particular determined officials and workers who faced danger and hostility in their work. In Bhattacharya's desire to tell the story of smallpox in India from early efforts to confirmation of eradication, an issue such as popular resistance is relegated to a subsection of a chapter called 'Torturous Advance,' (p. 230) and addressed in a way that renders it less as an historical phenomenon to be explored, but more as yet another obstacle in the way of eradication. Opposition is left voiceless, a force left chastened after certification of eradication in 1977. |
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Thus Bhattacharya's book is admirable for the way it examines in great detail the myriad technical problems and internal divisions that shaped the programme's course. Yet Bhattacharya's use of sources and the structure of the book mean that it is a narrow account, which in many ways privileges the experience and perspective of officials and leaves broader social, cultural or political aspects of public health in this period muted and unexplored. |
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| ALEXANDER CAMERON-SMITH
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| UNIVERSITY OF SYDNEY |
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