Scandinavian entry points to social medicine and postcolonial health: Karl Evang and Halfdan Mahler in India.

Our contributions examine the Norwegian Karl Evang's (1901-1981) and the Dane Halfdan Mahler's (1923-2016) participation in international health co-operation facilitated by the World Health Organization (WHO) in India in the 1950s. While Evang's was a hectic, but relatively short visit as part of a WHO visiting team of medical scientists in 1953, Mahler's spanned the entire decade on assignments as WHO medical officer to tuberculosis control projects. Mahler's name should be familiar to researchers of international health as the Director-General of the WHO 1973-88, and for his promotion of primary health care through the 1978 Alma-Ata Declaration. Evang, Norway's Director of Health 1938-72, was also a key figure in international health in the mid-twentieth century as one of the original instigators of the WHO, and a participant in much of its early work.A core theme is the place of social medicine, both in Evang's and Mahler's work, and within the WHO and its navigation of complex postcolonial settings in the 1950s. Investigating cross-regional encounters and circulations of social medicine ideas between Evang and Mahler and their Indian interlocutors as well as international WHO staff members, we ask what the role of social medicine was in international health in the early post-war period. Researchers have found that social medicine had its heyday during the 1930s and 1940s, and that a technology-focused, vertical approach became dominant soon after the war. In contrast, we suggest that continued circulation of social medical ideas points towards a more complicated picture.

Negotiating social medicine in a postcolonial context: Halfdan Mahler in India 1951-61.

This article investigates how World Health Organisation (WHO) Director-General Halfdan Mahler's views on health care were formed by his experience in India between 1951 and 1961. Mahler spent a large part of the 1950s in India assigned as WHO medical officer to tuberculosis control projects. It argues that Mahler took inspiration from the official endorsement of the doctrine of social medicine that prevailed in India; even if it was challenged by an increasing preference for vertical, techno-centric campaigns. It shows how, from the outset, Mahler was remarkably hostile towards the highly skilled, clinically oriented doctors, but embraced prevalent ideas of community participation. It suggests that Mahler - although he remained silent on the issue - was impressed by the importance and resilience of indigenous traditions of medicine, despite hostility from leading political figures. In this way, the article attempts to establish links to Mahler's advocacy of primary health care in the 1970s. A broad approach to health, scepticism toward clinically oriented doctors, preference for simple technologies and community participation, as well as an accommodating attitude towards indigenous practitioners, were all features of primary health care, which correlate well with views developed by Mahler as he negotiated social medicine in India between 1951 and 1961.

Another vaccine, another story: BCG vaccination against tuberculosis in India, 1948 to 1960.

Through an examination of mass BCG vaccination against tuberculosis in India between 1948 and 1960 this article draws attention to the diversity of the history of vaccination. The features of vaccination campaigns often differed from those of the celebrated campaign to eradicate smallpox. Due to differences between smallpox and tuberculosis as well as between the vaccines developed against them, an analysis of BCG mass vaccination against tuberculosis seems particularly well suited for this purpose. Three points of difference are identified. First, in non-Western contexts BCG vaccination procedures were modified to a greater extent than vaccination against smallpox. Second, tuberculosis lacked the drama and urgency of smallpox and BCG vaccination campaigns suffered more from recruitment problems than did the more "heroic" smallpox eradication campaign. Third, the BCG vaccine was contested in medical circles and was much better suited than the vaccine against smallpox as a vehicle for the articulation of concerns about post-colonial modernization.

Another vaccine, another story: BCG vaccination against tuberculosis in India, 1948 to 1960 / Outra vacina, outra história: a vacinação de BCG contra tuberculose na Índia, 1948 a 1960

Através da observação da vacinação em massa de BCG contra a tuberculose na Índia durante os anos de 1948 a 1960, este artigo chama a atenção para a diversidade da história da vacinação. As características das campanhas de vacinação geralmente diferem daquelas celebradas nas campanhas para erradicação da varíola. Devido às diferenças entre a varíola e a turberculose, assim como entre as vacinas desenvolvidas para combater essas doenças, uma análise da vacinação em massa de BCG contra a turberculose parece especialmente bem situada para essa proposta. Três pontos de diferença foram identificados. O primeiro é que em contextos não ocidentais os procedimentos da vacinação de BCG foram modificados em uma extensão maior do que a vacinação contra a varíola. Em segundo lugar, a tuberculose não tinha o drama e a urgência da varíola, e as campanhas de vacinação de BCG sofreram mais com problemas de recrutamento do que a mais "heroica" campanha de erradicação da varíola. E por último, a vacina de BCG foi contestada em círculos médicos e foi muito mais bem adaptada do que a vacina contra varíola como um veículo para articulação de preocupações sobre a modernização pós-colonial.

Through an examination of mass BCG vaccination against tuberculosis in India between 1948 and 1960 this article draws attention to the diversity of the history of vaccination. The features of vaccination campaigns often differed from those of the celebrated campaign to eradicate smallpox. Due to differences between smallpox and tuberculosis as well as between the vaccines developed against them, an analysis of BCG mass vaccination against tuberculosis seems particularly well suited for this purpose. Three points of difference are identified. First, in non-Western contexts BCG vaccination procedures were modified to a greater extent than vaccination against smallpox. Second, tuberculosis lacked the drama and urgency of smallpox and BCG vaccination campaigns suffered more from recruitment problems than did the more "heroic" smallpox eradication campaign. Third, the BCG vaccine was contested in medical circles and was much better suited than the vaccine against smallpox as a vehicle for the articulation of concerns about post-colonial modernization.

Introduction: simultaneously global and local: reassessing smallpox vaccination and its spread, 1789-1900.

SUMMARY: The last two decades have seen a reawakening of scholarly interest in the history of smallpox prevention. Accounts of vaccination and others efforts at controlling smallpox have moved away from heroic narratives toward more nuanced and contextualized understandings. It is now accepted that several viruses traveled under the vaccine label from the outset, and it has been demonstrated that a variety of techniques were used to perform vaccination operations. The character of nineteenth century sea voyages that took the vaccine to distant territories has also been re-examined; sometimes the spread of the vaccine was caused by private networks and ad hoc decisions, while at other times it was the result of enterprises with close resemblances to contemporary centralized vaccination campaigns. Looking beyond Europe and North America we encounter a variety of state attitudes toward vaccination, ranging from concentrated efforts to spread the technique to efforts more uncertain and diluted. Although the reluctance to accept vaccination has been amply documented, recent studies emphasize this should not be attributed to simplistic dichotomies of modernity versus tradition or science versus culture; instead, instances of resistance are best studied as specific contextualized interactions. Indeed, factors like favorable geography, strong bureaucratic structures, and the absence of variolation seem to have helped the relatively smooth transfer of vaccination technologies. Perhaps most important, recent research encourages us to continue to study smallpox vaccination as a phenomenon that was simultaneously global and local.

BCG vaccination and WHO's global strategy for tuberculosis control 1948-1983.

Mass vaccination with BCG against tuberculosis has been one of the major health interventions of WHO since the Second World War. This article traces the history of the controversial BCG vaccine from its adoption by WHO in 1948 up to 1983. In 1948, there was no clear scientific evidence to support the vaccine, and its adoption by WHO seems to have been urged by the existence of the UNICEF funded 'International Tuberculosis Campaign' and a fear of a threatening global epidemic. Moreover, BCG fitted well with the post Second World War perception of public health interventions. The vaccine was not systematically reviewed by WHO until 1959, and this review appears to have been biased in favour of the vaccine. In 1979 the results from the South Indian Chingleput trial, which showed no protective effect of BCG against pulmonary tuberculosis in adults, prompted WHO to change the arguments for recommending the vaccine. Since 1983 BCG has been recommended with specific reference to its protective effect against severe forms of childhood tuberculosis. The story of the BCG vaccine and WHO is a story of medical uncertainty, institutional inertia, strategic obduracy, and not least, hope.

Vikings against tuberculosis: the International Tuberculosis Campaign in India, 1948-1951.

Between 1947 and 1951 the Scandinavian-led International Tuberculosis Campaign tested more than 37 million children and adolescents for tuberculosis, and vaccinated more than 16 million with BCG vaccine. The campaign was an early example of an international health program, and it was generally seen as the largest medical campaign to date. It was born, however, as a Danish effort to create goodwill in war-ravaged Europe, and was extended outside Europe only because UNICEF in 1948 unexpectedly donated US $2 million specifically for BCG vaccination in areas outside Europe. As the campaign transformed from postwar relief to an international health program it was forced to make adaptations to different demographic, social, and cultural contexts. This created a tension between a scientific ideal of uniformity, on the one hand, and pragmatic flexibility on the other. Looking at the campaign in India, which was the most important non-European country in the campaign, this article analyzes three issues in more detail: the development of a simplified vaccination technique; the employment of lay-vaccinators; and whether the campaign in India was conceived as a short-term demonstration or a more extensive mass-vaccination effort.