The campaigns to prevent smallpox in the eighteenth and nineteenth centuries are commonly understood as the first attempts of large-scale state-sponsored medical intervention in society as such. Before the discovery of the cowpox vaccine inoculation with variolous matter—known as variolation—was the most widespread preventive against the disease. This practice was well established in parts of Asia and introduced to Europe by Mary Wortley Montagu from Constantinople in 1721. While variolation achieved some popularity—particularly in Britain—Edward Jenner's discovery of the cowpox vaccine in 1796 intensified the efforts to combat smallpox, and vaccination was introduced to large parts of the world within a few years. Although the spread of immunization against smallpox is commonly described as highly successful, the campaigns also represented an early encounter between an elitist state-sponsored medicine and various forms of popular resistance.

During the Second World War, it is argued, “the neuroses of battle” not only deepened an understanding of “psychopathological mechanisms”, but also created opportunities for the practice of psychotherapy, while its perceived efficacy led to a broader acceptance within medicine and society once peace had returned. This recognition is contrasted with the aftermath of the First World War when a network of outpatient clinics, set up by the Ministry of Pensions to treat veterans with shell shock, were closed within a few years in response to financial pressures and doubts about their therapeutic value. In the private sector, psychoanalysis under the leadership of Ernest Jones remained an idiosyncratic activity confined largely to the affluent middle classes of London. According to Gregorio Kohon, “it was strongly opposed by the general public, the Church, the medical and psychiatric establishment, and the press”. The Medico-Psychological Clinic of London, originally set up in 1913, offered psychotherapy on three afternoons a week in premises at 30 Brunswick Square under the direction of Dr James Glover. However, it closed in 1923 after Glover and his brother Edward had both become psychoanalysts. As the First World War drew to a close, Maurice Craig helped to persuade Sir Ernest Cassel to fund a hospital for ‘Functional and Nervous Disorders’ at Penshurst, Kent, to treat neuroses in the civilian population. Although moved to permanent premises near Richmond, it remained small-scale and at the time no attempt was made to establish a network of similar institutions throughout the UK. The Tavistock Clinic, opened in Bloomsbury in 1920, struggled to secure funding throughout the interwar period and its efforts to win official recognition from the University of London were consistently rebutted. Thus, despite the epidemic of shell shock and other so-called war neuroses, psychotherapy remained a marginal activity during the 1920s and 1930s.

“History matters—pass it on” was the slogan of a campaign launched in England in the summer of 2006 to raise public awareness of the huge contribution that history, heritage and the built environment make to our qualify of life. A resumé commented,

It unites the whole heritage sector, led by the National Trust, English Heritage, the Historic Houses Association and the Heritage Lottery Fund, and events will be held over the next six months at hundreds of historic locations across England and Wales. Supporters include David Starkey, Tristram Hunt, Simon Thurley, Stephen Fry, Bill Bryson, Shami Chakrabarti, Tony Benn and Boris Johnson.

In 2014 the World Health Organization (WHO) was widely criticised for failing to anticipate that an outbreak of Ebola in a remote forested region of south-eastern Guinea would trigger a public health emergency of international concern (pheic). In explaining the WHO’s failure, critics have pointed to structural restraints on the United Nations organisation and a leadership ‘vacuum’ in Geneva, among other factors. This paper takes a different approach. Drawing on internal WHO documents and interviews with key actors in the epidemic response, I argue that the WHO’s failure is better understood as a consequence of Ebola’s shifting medical identity and of triage systems for managing emerging infectious disease (EID) risks. Focusing on the discursive and non-discursive practices that produced Ebola as a ‘problem’ for global health security, I argue that by 2014 Ebola was no longer regarded as a paradigmatic EID and potential biothreat so much as a neglected tropical disease. The result was to relegate Ebola to the fringes of biosecurity concerns just at the moment when the virus was crossing international borders in West Africa and triggering large urban outbreaks for the first time. Ebola’s fluctuating medical identity also helps explain the prominence of fear and rumours during the epidemic and social resistance to Ebola control measures. Contrasting the WHO’s delay over declaring a pheic in 2014, with its rapid declaration of pheics in relation to H1N1 swine flu in 2009 and polio in 2014, I conclude that such ‘missed alarms’ may be an inescapable consequence of pandemic preparedness systems that seek to rationalise responses to the emergence of new diseases.

This article describes three periods in Brazil's modern history when governmental action was (or was not) taken against smallpox: first, when smallpox control became a priority in the Brazilian sanitary agenda from the nineteenth century to the beginning of the twentieth century; second, when it was rendered politically invisible during decades when greater attention was given to yellow fever and malaria control; third, when it reappeared at the centre of Brazilian health policy in the 1960s until its eventual eradication in 1973. Smallpox control in the latter two periods is suffused with paradox. For example, evidence suggests that the nearly fifty-year absence or lack of policies and agencies to deal with smallpox actually favoured the mobilization of local, national and international resources once the eradication programme was launched in 1966; these new approaches were accelerated from 1969 until the completion of eradication in 1973. Equally paradoxical, it was during the specific context of the military regime after 1964 that the Brazilian health system developed the capacity to mobilize existing but dispersed resources and flexibly to innovate, incorporate, and adapt new policies. Another important element in this period was institutional learning based on other vertical programmes such as the malaria eradication campaign. Although the Brazilian smallpox eradication programme was constrained by international agencies and by bilateral co-operation with the United States, the period after 1964 offered opportunities for the realization of a new and wide-ranging national health capacity including the creation of a national system of epidemiological surveillance and a national childhood immunization programme. It also saw the empowerment of young physicians who would later come to occupy key positions in Brazilian public health and in international health organizations.