Nfld. & Labrador·Apocalypse Then

The century-long debate over vaccine passports

More than a century ago, two countries had two very different responses to the introduction of vaccine passports, writes conrtibutor Ainsley Hawthorn.

More than a century ago, two countries had two very different responses

Vaccination efforts and public health policies during the 1896-1897 plague outbreak in India were managed by the British colonial administration. (Courtesy of the Wellcome Collection)

This column is an instalment in our series Apocalypse Then, in which cultural historian Ainsley Hawthorn examines the issues of COVID-19 through the lens of the past.

As vaccination numbers rise worldwide, institutions from federal governments to the Calgary Stampede are beginning to ask for proof of COVID vaccination as a requirement for entry. Critics have raised concerns about the ethics of pinning a person's freedom of movement to their private medical status.

More than a century ago, two countries had two very different responses to the introduction of vaccine passports. One of the first places to require proof of immunization from travellers was India. Beginning in 1896, the region was struck fiercely by the third plague pandemic, which had been building up steam since 1855.

At the time, the Indian subcontinent was under British colonial rule, the Raj. Faced with a growing outbreak, the colonial government reached out to Waldemar Haffkine, a Ukrainian scientist on the cutting edge of vaccine research.

Haffkine was in India immunizing locals against cholera using a vaccine he had developed. The Raj government asked him if he could reproduce the methods used to make his cholera vaccine to create an inoculation against plague.

Amazingly, by treating plague bacteria with heat to reduce their virulence, as he had done with cholera bacteria, Haffkine was able to produce a plague vaccine in just a few months, and he verified its safety by testing it on himself. It was only the world's fifth vaccine.

Once word got out that an effective method for plague prevention was available, demand for Haffkine's new vaccine soared. More than 11,000 people in plague-affected areas were inoculated in the next three months alone. In a region with a population over 200 million, though, 11,000 vaccinations were nowhere near enough to make a dent in the spread of the disease. Mortality rates in urban areas climbed so high that city dwellers began to decamp for the countryside in droves.

We often think of flea-infested rats as the primary vectors for plague, but it can be transmitted from person to person, too. There was a high risk that urban evacuees would unwittingly carry the plague with them into India's hinterland.

Mandatory vaccine checks and physical examinations, like this one at Bandra Railway Station, exacerbated tensions between the local Indian population and colonial authorities. (Public Domain)

The Raj instituted a requirement that all travellers must carry proof of immunization, not just to cross India's borders but even to move about within India itself.

The colonial government had already been taking draconian measures to control the outbreak, deploying the military to detain people, evict them from their homes and demolish buildings where plague rats were believed to be nesting.

The vaccine passport mandate was the last straw.

Indians saw the strict public health policies as severe government overreach that infringed on their personal rights and social customs, like religious pilgrimages. Riots broke out, attracting crowds of up to 10,000 people, and strikes and shop closures ground the colonial economy to a halt.

Authorities had no choice but to change their approach. The military was withdrawn, and vaccine passport requirements ceased to be enforced.

Around the same time Indians were rebelling against the policies of their colonial government, checking a traveller's vaccination status was becoming widely accepted in another country: the United States.

Americans were keen to halt the spread of smallpox, and border officials in the late 19th century checked incoming travellers for evidence of immunity to the disease. Three forms of proof were accepted: a pockmarked face showing someone to be a smallpox survivor, an immunization certificate, or a vaccination scar.

Schoolchildren in Tacoma, Washington, show off their new vaccinations, 1922. (Courtesy of the Washington State Historical Society)

Unlike other vaccines, smallpox inoculations weren't injected but rather administered through a scratch on the skin. Afterward, the scraped area would blister and scab over, leaving a distinct scar that was treated as confirmation of vaccine status.

Businesses, social clubs and public schools soon began checking for vaccination scars as well. Companies where staff worked in close quarters, like factories, mines and lumber camps, made immunization a condition of employment. Schools required students to be vaccinated before they could attend.

Vaccine checks became so common that people who were opposed to vaccination resorted to forging scars. Some sculpted fakes out of plaster; others took the more extreme step of burning their upper arms with nitric acid to resemble the characteristic mark of the smallpox vaccine.

Several types of vaccinations leave distinctive scars. This photo of three vaccination marks on a woman’s arm was taken in the Netherlands in 1970. (Courtesy of the Nationaal Archief NL)

Despite the popularity of the anti-vaccination movement in the United States today, though, most Americans seem to have been in favour of making proof of vaccination status mandatory for participation in public life.

In 1901, a physician from Chicago wrote, "Vaccination should be the seal on the passport of entrance to the public schools, to the voters' booth, to the box of the juryman, and to every position of duty, privilege, profit or honor in the gift of either the State or the Nation."

Although smallpox has since been eradicated and plague can now be treated with antibiotics, some of these measures have survived. To this day, a few Canadian provinces and most American states expect children to be vaccinated before they can enrol in school.

In many parts of the United States, vaccinations were required before children could attend public school. (Courtesy of the Library of Congress)

And one vaccine passport is currently in use for international travel. The yellow card, which proves that a person has been vaccinated against yellow fever, is required for entry into some countries in South America and Africa.

There has never been a consensus on whether the public health benefits of vaccine passports outweigh their infringement on individual rights, but, over the next year, many jurisdictions will find themselves wrestling with the same dilemma that faced India and the United States over 100 years ago.

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