The Endeavors for Universal Vaccinationand Their Impact: Focusing on Smallpox Epidemic in Shanghai, 1938-39
Authors:   The Korean Association for the Social History of Medicine, Jo Jeong-Eun 
Published: May 2023

In this paper, we investigated what kind of efforts were made to expand vaccination amid a smallpox epidemic in Shanghai in 1938-39, as well as the significance of such efforts.
In Shanghai, various strategies were employed to achieve universal vaccination. When it was first introduced, theories of Chinese medicine were borrowed to help people’s understanding, and various media outlets were used to promote the effect and safety of vaccination. Health institutions in the foreign concession and the Chinese elites helped to expand free vaccination. At the time, vaccination was not mandatory, and people voluntarily visited a clinic for innoculation. Between 1932 and 1937, the number of fatality from smallpox fluctuated and did not reach a threatening level due to the vaccination effort.
However, upon the outbreak of the Sino-Japanese War, the number of smallpox patients and the subsequent death toll surged. Some of the refugees who fled to the foreign concession to avoid the war had smallpox, and the disease spread from there. The Japanese military force that occupied Shanghai began mandatory vaccination in a bid to protect the health of Japanese people and soldiers as well as the safety of Japan.
Setting aside justifications for war and pillage of the colony, the Japanese occupation helped to expand universal vaccination to an extent. Statistical data indicate that the number of vaccination applied by Japan’s health institutions is significant, and the military institution enabled forced vaccination. Various institutions including the Japanese military force, health institutions, hospitals, clinics, charity organizations in the foreign concession joined hands for the shared goal of fighting against smallpox. Due to the nature of an epidemic that does not distinguish between friends and foes or across races, an odd cooperative relationship was formed in Shanghai.
The significance of an increase in vaccination can be observed in that its infrastructure and method were replicated to fight cholera. Specifically, the two approaches―active and forced innoculation by the authorities and free innoculation in the form of traditional charity work―were first made to increase vaccination and then fully applied to expanding cholera inoculation. Vaccination also paved the way for universalization of inoculation. At the time, the Chinese people were not familiar with the method of cholera inoculation, and its effect was dubious. They suspected that the Japanese injected poison and shunned cholera inoculation. When a rule was implemented that banned people without a certificate of cholera inoculation from traveling to other regions, people forged certificates. In comparison, over a century had passed since vaccination was introduced in China, and people knew its effect well. For this reason, the public probably did not strongly oppose forced vaccination by the Japanese.
However, this is merely in comparison with cholera inoculation, and the goal of universal vaccination was not attained. Smallpox continued to break out after 1939, and many people remained reluctant to receive vaccination. For peaceful ruling, the People’s Republic of China had to endeavor for vaccination from the beginning of its foundation as did the authority of the foreign concession and the Japanese military force. Reasons for a failed attempt to achieve universal vaccination despite tenacious efforts need to be investigated from various angles including political, social and cultural aspects.