Australia’s approach to its biosecurity and borders has always been two-pronged – quarantine first, vaccination second. This article asks what this combination looked like in practice by exploring two neglected smallpox vaccination campaigns directed towards Indigenous peoples in the early twentieth century. We argue these were important campaigns because they were the first two pre-emptive, rather than reactionary, vaccination programs directed towards First Nations people. Second, both episodes occurred in Australia’s northern coastline, where the porous maritime geography and proximity to Southeast Asia posed a point of vulnerability for Australian health officials. While smallpox was never endemic, (though epidemic), in Australia, it was endemic at various times and places across Southeast Asia. This shifting spectre of smallpox along the northern coastline was made even more acute for state and federal health officials because of the existing polyethnic relationships, communities, and economies. By vaccinating Indigenous peoples in this smallpox geography, they were envisioned and embedded into a ‘hygienic’ border for the protection of white Australia, entwining the two-prongs as one approach. In this article, we place public health into a recent scholarship that has ‘turned the map upside down’ to re-spatialise Australia’s history and geography to the north and its global connections, while demonstrating how particular coastlines and their connections were drawn into a national imaginary through a health lens.

Henry Rider Haggard, the famed author of adventure romances, wrote the novel Dr. Therne (1898) in response to weakening compulsory smallpox vaccination laws, thus entering one of the most heated debates of the late nineteenth century. With Dr. Therne, Haggard aimed to intervene in the lives of the many working-class anti-vaccinationists who, from the 1850s onwards, mobilised to evade what they perceived as a gross – and targeted – extension of state power at the expense of individual rights. Recovering the novel, which has not yet received scholarly attention from historians of medicine, reveals the way fiction was called upon to change minds during a crucial period of Victorian medicine, one that witnessed a climactic shift in public health intervention. This article will examine the reception of Dr. Therne in various print media – middle-class London papers, medical journals and working-class, anti-vaccinationist publications – to consider some new dynamics of the debate which the disagreement over Haggard’s polemic exposes, including the perceived power of fiction (when properly priced and distributed) to change minds, and the contested role of the evangelical press. Additionally, a discussion of the different iterations of Dr. Therne, and a look at an exceptional anti-vaccinationist response in the form of a competing novel, illustrates that pro- and anti-vaccinationists alike contributed to a moment in late Victorian society when the role of fiction was considered a worthy contender in a debate ostensibly about fact.

This work examines the history of smallpox, a highly infectious and epidemic disease, in Argentina, throughout different governments and public health policies from the nineteenth to the twentieth century. The study focuses on the smallpox vaccine and the social and collective significance of universal immunization. It also analyses the relationship between governments of different political orientations and the international community regarding the production of vaccines and vaccination campaigns from their implementation to the eradication of the disease.

The complex relationship between the history of infectious diseases and social inequalities has recently attracted renewed attention. Smallpox has so far largely escaped this revived scholarly scrutiny, despite its century-long status as one of the deadliest and widespread of all infectious diseases. Literature has demonstrated important differences between rural and urban communities, and between cities, but has so far failed to address intra-urban disparities due to varying living conditions and disease environments. This article examines the last nationwide upsurge of smallpox in the Netherlands through the lens of Amsterdam’s 50 neighborhoods in the period 1870–72. We use a mixed methods approach combining qualitative spatial analysis and OLS regression to investigate which part of the population was affected most by this epidemic in terms of age and sex, geographic distribution across the city, and underlying sociodemographic neighborhood characteristics such as relative wealth, housing density, crude death rate, and birth rate. Our analyses reveal a significant spatial patterning of smallpox mortality that can largely be explained by the existing social environment. Lacking universal vaccination, the smallpox epidemic was not socially neutral, but laid bare some of the deep-seated social and health inequalities across the city.

This article explores the tensions between well-intentioned humanitarianism and coercive colonialism during smallpox outbreaks in eighteenth-century Guatemala, when the state extended inoculation programmes to its predominant, culturally diverse Maya communities. Evidence from anti-epidemic campaigns shows public debates broadly comparable to the current COVID-19 crisis: debates about the measurably higher mortality rates for indigenous people and other marginalized groups; debates about the extent of the state’s responsibility for the health of its peoples; and debates on whether or not coercion and violence should be used to ensure compliance with quarantines and public health campaigns. While inoculations provided medical assistance and material help to Maya communities, and resulted in demonstrably lower mortality rates from smallpox, at the same time they functioned as avenues for the expansion of colonial power to intervene in the daily lives of people in those communities, characterized by colonial actors as necessary for their own good, and for the broader public good.

This article explores a smattering of thematic questions that criss-cross the articles in this special pandemics issue; it signposts some reverberations, overlapping responses, and problematic comparisons currently (mid 2020) being made between past pandemics and the tense experiences (and projections going forward) of COVID-19 across the world. The historical pandemics covered here offer an entry point to a fruitful set of genealogies, chronologies, epidemiologies, trajectories, and imaginaries linked to a host of issues: what makes a pandemic ‘global’? What does a global history perspective bring to the table? How does examining germs and genomes shed light on imperialism as a/the pandemic driver? Where do animals, the environment, and ecology fit in and why are they so often excluded from pandemic histories? What counts as medical humanitarianism when health knowledge, know-how, and cooperation ‘from below’ are sidelined? And what came/comes first: a pandemic or a changed world?

At the end of the nineteenth century, the northern port of Liverpool had become the second largest in the United Kingdom. Fast transatlantic steamers to Boston and other American ports exploited this route, increasing the risk of maritime disease epidemics. The 1901–3 epidemic in Liverpool was the last serious smallpox outbreak in Liverpool and was probably seeded from these maritime contacts, which introduced a milder form of the disease that was more difficult to trace because of its long incubation period and occurrence of undiagnosed cases. The characteristics of these epidemics in Boston and Liverpool are described and compared with outbreaks in New York, Glasgow and London between 1900 and 1903. Public health control strategies, notably medical inspection, quarantine and vaccination, differed between the two countries and in both settings were inconsistently applied, often for commercial reasons or due to public unpopularity. As a result, smaller smallpox epidemics spread out from Liverpool until 1905. This paper analyses factors that contributed to this last serious epidemic using the historical epidemiological data available at that time. Though imperfect, these early public health strategies paved the way for better prevention of imported maritime diseases.

This article explores the introduction of smallpox vaccination into Nepal in 1816 at the request of the Nepalese government; the king, however, was not vaccinated, contracted the disease and died. British hopes that vaccination would be extended throughout the country did not eventuate. The article examines the significance of this early appearance of vaccination in Nepal for both Nepalese and British, and relates it to the longer history of smallpox control and eventual eradication. When the Nepalese requested World Health Organization (WHO) assistance with communicable disease control in the mid-twentieth century little had changed for most Nepalese. We know about the events in 1816 through the letters of the newly imposed British Resident after Nepal’s military defeat in the Anglo-Nepal War (1814–16). By also drawing on other sources and foregrounding Nepal, it becomes possible to build up a more extensive picture of smallpox in Nepal that shows not only boundaries and limits to colonial authority and influence but also how governments may adopt and use technologies on their own terms and for their own purposes. Linking 1816 to the ultimately successful global eradication programme 150 years later reminds us of the need to think longer term as to why policies and programmes may or may not work as planned.