Jesse B Bump, a lecturer on global health policy at the Harvard TH Chan Public School of Health, has researched the evolution of ideas and institutions that improve societal performance in health. He shares his personal views on the pervasive influence of colonialism on global health with Sharmila Ganesan Ram:
No, they are not. All institutions and individuals in global health owe an incalculable debt to the people of South Asia. South Asians are more closely connected to the development of knowledge about vaccination campaigns than any other group, in my view. So much of what we know about how to do these campaigns was learnt in South Asia, from South Asian people and their communities, and yet this debt goes cruelly unacknowledged. The history runs from the dawn of modern vaccines around 1800 during the occupation by the East India Company, through the colonial period, and the independence era.
The global community has benefitted from knowledge that was generated that way. Similarly, in the 1960s and 1970s, Indian communities organised in support of smallpox eradication. There were many international partners involved, as well as national and private sector contributions, but the crucial role of community leaders and ordinary people is not widely known in global health. The learning that happened during smallpox eradication was used to launch Unicef’s Expanded Program on Immunisation, which helped create the backbone of many national vaccination systems, and later led to Gavi, the Vaccine Alliance.
How has colonialism coloured our view and knowledge of the history of vaccination and Western medicine?
Colonialism never really ended and its basic premise of extractive inequality persists today. It is everywhere you look, visible in the way rich nations treat less developed ones, and firmly engrained in the ways elites relate to marginalised groups in both the metropoles – the old colonising countries – and the former colonies. For example, see how painfully slow vaccine production and distribution have been in much of the world. Rich countries have hoarded supplies for themselves while people elsewhere die in record numbers. Within many countries, elites are well-protected while others are at grave risk.
Global health itself has its origins in colonialism and imperialism. Its original concerns were European interests in tropical areas – their own survival and security, principally, and then managing the ecological, social, and cultural disruption caused or demanded by their business interests. That was the source of metropolitan interest in the health of colonised people and places. The medical missionary tradition became part of it. No single statement could capture the motives of all the people involved, but most of the aims were linked to the creation of economic, military, and cultural inequalities. Now you have academic institutions, philanthro-capitalists, large NGOs, international organisations, religious networks – basically all the same players as in the colonial period and all struggling with the persistent inequalities of that time. Some want positive change; many don’t. The pandemic reveals these patterns vividly, but they are historic and enduring. At the international level, colonial attitudes explain why intellectual property rights (IPRs) are used to withhold life-saving technologies.
Bill Gates initially was against waiving patent protection on Covid vaccines.
Gates is absolutely wrong and he should be held accountable for it. He and his foundation convinced Oxford to abandon plans for free licences for its vaccine, and to instead pursue an exclusive deal with AstraZeneca that blocked broader worldwide scale-up of production. His outsize influence in funding global health, plus his well-known extremist views on intellectual property, seem to be having a chilling effect on this whole discussion.
What is variolation and how did it relate to vaccination?
Variolation was a historic inoculation process practised in India, China, the Ottoman Empire, Liberia, and possibly some other places. The likely origin was probably India or China. It refers to collecting scrapings or pustules from smallpox victims and then introducing that infective material into someone else, typically via a small cut or by snorting a powdered preparation to produce a mild case of disease that would provoke immunity. In developing the first modern vaccine, English physician Edward Jenner built on this idea, which he had learnt about via an ambassador in Istanbul. It is very likely the Ottomans had learnt about it through trade and migration from Bengal. Jenner’s way was much variolation-safer because he was using cowpox virus rather than smallpox, but the underlying idea was likely from Bengal.
Are efforts to decolonise global health yielding results?
The centres of power, accountability, and decision-making are still in the old colonial capitals, and outside expert knowledge is valued and rewarded far more than that of communities. We still prioritise biomedical ideas of disease over development solutions, and we still embrace fundamentally unfair trade relationships. But a lot of people have noticed and are speaking up in protest. Students are the main leaders in this respect. I am hopeful for the decolonisation agenda because of their leadership.
Views expressed above are the author’s own.
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