Expunging Variola: The Control and Eradication of Smallpox in India, 1947–1977 (review)

Expunging Variola is a meticulously researched, dispassionate account of the coordinated (and not-so-coordinated) worldwide effort to eradicate smallpox from late twentieth-century India, one of the disease’s last major strongholds. Bhattacharya focuses on the complex relationships that emerged between, on the one hand, such international and metanational organizations as the U.S. Centers for Disease Control and the World Health Organization and, on the other, elements of the new Indian state’s sprawling national and state-level bureaucracies. The relationships were often contentious. Bhattacharya again and again points out that the battle against smallpox was not waged and won by a monolithic global public-health administration, or even by monolithic entities within a more cacophonous worldwide health network. Instead, policies and practices were contested, refigured, rejected, or sometimes deployed by local governments, politicians, and medical officials. Arguments even extended to vaccination practices and types of vaccine (wet versus dry, for instance).

In the context of the hysteria about bird flu that dominated head-lines at the time of this book’s release, Expunging Variola’s dry cascades of detail effectively lay out the extraordinary amount of planning, preparation, skill, and luck that must go into large-scale medical campaigns while also highlighting the assets of steady hands and basic research. The book also touches on a number of interesting side issues, including the tense and contradictory relationship between international organizations housed in the West and newly formed postcolonial states still sensitive to any sign of Western imperialism. The reliance of public-health campaigns on the compulsive power of the state also comes into the picture.

A number of important points, however, escape the author’s attention. Bhattacharya only briefly mentions the “widespread [belief in the goddess Sitala] among Hindu communities in northern, central, and eastern India” (239).” For such believers, Sitala was the divine source of smallpox, for good or ill. This particular fact raises many thorny social and cultural issues: What is the role of religion more broadly in embracing or resisting public-health campaigns? How does one escape an Orientalist framework in approaching such issues? Bhattacharya does not address these questions in any rigorous way; nor does he provide an adequate analytical frame to understand them. Indeed, the smallpox campaign also encompassed issues of caste, class, gender, and region, all of which require much more contextualization. Expunging Variola would greatly have benefited from a much more extensive engagement with relevant contemporary scholarly literature, which would have allowed Bhattacharya to further frame his study in relation to twentieth-century anti-vaccination movements or larger debates about sovereignty and citizenship, among other possibilities. Bhattacharya’s nearly exclusive focus on smallpox places serious limitations on this work.

The elimination of smallpox in India is an inherently exciting tale; the termination of one of the world’s oldest and most powerful killers took place amid rampant neo-imperialism, the international dynamics of the Cold War, a host of challenging new intellectual philosophies, and the blights of poverty, caste, and communalism. Bhattacharya is to be commended for guarding against sensationalism and romanticism in his approach, but he might have been a little too restrained. Interested primarily in the bureaucracy, he has written an extensively bureaucratic tract, reminiscent more of a government report than of a compelling social, political, or medical history, as illustrated by his heavy reliance on long quotations throughout the book. This material appears to serve the purpose of public disclosure more than to provide analysis. As Bhattacharya explains at the end of his introduction, “Large parts of this study are based on materials that have not systematically been used in academic studies before. . . . As this material is relatively difficult to access, this book quotes in detail from some of the interesting items, not least as some scholars might find this information useful” (11).

These limitations notwithstanding, Expunging Variola is an excellent source for understanding important aspects of one of the world’s largest public...