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Madras Week | The city’s tryst with epidemics and vaccination

From smallpox vaccine to pulse polio immunisation, and now, COVID-19 vaccines, the city has come a long way in not only in handling disease outbreaks but also in overcoming challenges in vaccinating its population

Wherever we go, there it is. The COVID-19 pandemic has overwritten several scripts, laid to waste the plans of everyone. And this year, as the city celebrates Madras Day, in commemoration of a pact inked 382 years ago, it makes sense to anchor the overarching theme to the disruptions a pandemic causes. For a week from now, these columns will open a window to the past to examine aspects of the city that are in some way connected to such disruptions. While Madras Day events are low key and the usual pomp and frenetic activity that Chennaiites see during this week in August are missing, people have taken the online route, as with most things these past couple of years. For Chennai is still a city that its residents love, and harking back to its connect with good ol’ Madras is an annual ritual that has come to stay

Chennai, earlier Madras, has an extensive history when it comes to taking vaccination to its people. From smallpox vaccine to pulse polio immunisation, and now, COVID-19 vaccines, the city has come a long way in not only in handling disease outbreaks but also in overcoming challenges in vaccinating its population.

A leaflet on ‘Vaccination against Influenza’ from a document at the library of the Directorate of Public Health (DPH) and Preventive Medicine, draws similarities between the past and present: “The vaccine against influenza has been prepared and tested by doctors both in Europe and in this country. This vaccine tends to prevent you from being attacked by influenza. Inoculations which have been carried out in India indicate that those who are vaccinated are less likely to get influenza than those who are not vaccinated and even if they do get influenza, the danger from the disease will be less.”

In the late 19th century when the British wanted to eradicate smallpox, the city turned home to premier institutes such as King Institute of Preventive Medicine (1899) and BCG Vaccine Laboratory, Guindy.

Compulsory vaccination

It all started with smallpox, ostensibly. The government had made preventive vaccination compulsory and even terminated unvaccinated employees who got infected. In 1884, the municipal commissioners of Madras city amended bylaws to make vaccination compulsory. The amendment was publicised through local dailies in English, Tamil, Telugu and Hindustani languages, besides being gazetted. The copies of the printed bylaws were displayed prominently in the municipal office.

“We have always had a history of opposing vaccination. In 1802, when the smallpox vaccine came, people expressed their opposition by not getting vaccinated. There were a lot of rumours… The government had to employ Indian vaccinators to go around and convince people that they had to get vaccinated. Incentivisation of vaccines had to be done. They were given a reward based on the number of people they vaccinated. Similarly, people had to be enticed. They were given a bag of rice if they came for vaccination. All of this happened in 1802 and 1803. There were reports of vaccinators and doctors being attacked, people saying that vaccination was only a method of collecting data of where you live so that later they will come and serve a tax notice,” V. Sriram, historian, said.

The Communicable Diseases Hospital (CDH) at Tondiarpet was world famous for work on smallpox under Dr. A. Ramachandra Rao, according to T. Jacob John, retired professor of virology, Christian Medical College, Vellore.

Great breakthrough

It was at the CDH that a great breakthrough in the eradication of smallpox happened, Mr. Sriram said, adding: “Dr. Rao, an authority on the subject, was the first person to identify that smallpox came in tri-annual cycles — first year it would be a major pandemic, second year a medium grade pandemic and third year, it would hardly be there. He said that every time when it comes to the year where the numbers are falling, we need to vaccinate a lot more so that we need to prepare for next year’s pandemic.”

At that time, it was believed that newborns did not benefit from the smallpox vaccine. Internationally, this was the opinion. But Dr. Rao instructed that all babies born in corporation medical centres and hospitals should be compulsorily vaccinated. When that happened, they found that there was a huge drop in smallpox cases. He went on to become a consultant to the World Health Organization (WHO), and travelled around the world, lecturing about smallpox, he added.

This was not all. There is a memorial to W.S. Swamy Naick, who really made smallpox popular in 1802 on Harris Road, Pudupet, now Adithanar Road, he said.

Aruna Palaniappan, who headed vaccine production at King Institute, recalled that when she and her team went in the late 1970s to promote smallpox vaccine in villages, people were ready to take it as by then awareness of its benefit had grown.

The BCG Vaccine Laboratory was established in 1948 with assistance from the Statens Serum Institut (SSI), Copenhagen. The seed strain used at the laboratory was initially obtained from the SSI through the WHO for production of liquid BCG vaccine against childhood tuberculosis and supply for the immunisation programme. Later, the laboratory started preparing its own BCG seed, called Madras Working Seed Lot, according to the website.

Between 1953 and 1957, influenza occupied much public discourse. In 1953, the King Institute, which was one of the three WHO research centres in the country, transferred its “virus section” to the Pasteur Institute in Coonoor, citing a lack of research facilities.

In 1957, a passenger ship from Penang arrived with 1,800 passengers, of which 250 were found to be infected with the influenza virus. Researchers from Pasteur Institute went aboard the ship and took samples, which were to be used to prepare the vaccine.

In just a span of five days as many as 5,000 people were infected, the government said. But the vaccination drive for flu did not take off.

For decades, King Institute was the only centre in Tamil Nadu to give Yellow Fever vaccination to prospective travellers to Northern African countries, Dr. John added.

In 1979, measles vaccination was rolled out in Vellore, Salem, Coimbatore and Madras, in that sequence under the Rotary Movement. The programme was led by Rotary Club of Madras, supported by its wing in Vellore, he recalled.

“After pulse polio immunisation in Vellore in 1982 and 1983, Madras was the second city to do pulse polio immunisation with three doses of oral polio vaccine (OPV) in 1985. In 1986, Tamil Nadu adopted a five-dose OPV schedule based on the Vellore and Madras experiences. Tamil Nadu became the very first State in India to achieve zero wild virus polio in 1999,” he said.

There was resistance to polio immunisation as well. Nalini Ramamurthy, former director of King Institute, recalled: “It was the middle and upper class people who were against the vaccine,” she said.

“Chennai is a trendsetter because of the population, risk, exposure and size. It witnesses issues early. The proportion of urban slums here is high when compared to other parts of the State. It faces numerous challenges. From having the first exposure to COVID-19, the city has taken the lead in vaccination,” T.S. Selvavinayagam, DPH, said.

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