Chapter 9 charts the fortunes of vaccination in the Russian empire. Emulating Catherine the Great’s patronage of inoculation, Dowager Empress Maria sponsored its introduction and establishment in the Foundling Houses in Moscow and St Petersburg in 1801. Early in 1802, Tsar Alexander commended the practice and supported a plan for a vaccine expedition through the empire, using children under vaccination to deliver vaccine from one district to the next. Projecting an image of paternalism and philanthropy, the expedition required local notables and medical men to assist in extending and embedding the practice. The Russian embassy to China in 1805–6 included a vaccination arm that helped to consolidate and further extend the practice in Siberia. By a variety of means, including promotional prints (lubki) addressed to the peasantry, pressure from the nobility and direct coercion in 1811, large numbers of vaccinations were achieved. The French invasion of Russia only briefly halted the progress of the practice. After the defeat of Napoleon, Tsar Alexander visited London, congratulating Jenner in person.