By Jessica Pearson-Patel
As Ebola to ravage communities in Sierra Leone, Liberia, and Guinea, and as international health organizations fight to develop a vaccine that will conquer the epidemic, the history of vaccinations in Africa seems now to be more relevant than ever. The World Health Organization has recently come under fire for a discovery that WHO representatives deliberately held off on declaring the epidemic to be an international health emergency out of fear of that such a declaration “could anger the African countries involved, hurt their economies or interfere with the Muslim pilgrimage to Mecca.” Indeed although Guinean health officials announced the Ebola outbreak in March of last year, it would not be until August that the WHO declared the epidemic to be an international public health emergency.
If we take the press response to this discovery to be any indication, this revelation was a shocking one for those who trust that the physical well-being of Africans is and has been the number one driving force behind the development of public health infrastructure in Africa—including the development of vaccines and the expansion of campaigns against epidemic disease. The reality, however, is that these processes have always been shaped by broader political imperative—both colonial and international.
The first steps towards developing public health infrastructure in sub-Saharan Africa at the beginning of the twentieth century were not intended to protect Africans at all, but rather to make these spaces safe for European colonization. When colonial doctors did start developing public health campaigns aimed at Africans, these measures were part and parcel of a broader “civilizing mission” intended to justify the project of empire, based on the notion, according to historian Alice Conklin, that “colonial subjects were too primitive to rule themselves.” Vaccines, along with school hygiene programs, infant and maternal health clinics, and anti-malaria DDT campaigns, were an integral part of this project.
As colonial doctors set out to build healthcare infrastructure, some of the health challenges that they faced look familiar to those they had confronted in Europe, including the plague, cholera, yellow fever, syphilis, smallpox, leprosy, measles, and tuberculosis were by no means unknown on the European continent. Other—yaws, sleeping sickness, malaria, onchocerciasis, and schistosomiasis—were less familiar, especially for European colonial doctors coming from Northern Europe. For diseases that were preventable with vaccinations, European medical research laboratories in Africa—particularly the Pasteur Institutes—worked in conjunction with their counterparts in Europe to develop vaccine serums and to devise schemes to distribute them. By 1938, four Pasteur Institutes were operational in North Africa, and four in sub-Saharan Africa.
The three major vaccination campaigns in French sub-Saharan Africa before the Second World War were smallpox, yellow fever, and tuberculosis. As early as 1904, French laws about compulsory smallpox vaccinations were applied to the colonies, although these laws were harder to implement in rural Africa than they were in France. Both the Belgian and British colonial governments also required smallpox vaccinations. Although, according to historian William Schneider, the effectiveness of these vaccinations is difficult to evaluate, colonial reports show that the numbers of Africans vaccinated was quite high. Reports from the post-1945 period put the number of inoculations performed in the tens of thousands, and for some vaccines, in the millions.
The Second World War proved to be a difficult time in the history of vaccination in Africa, since the occupation of France and the installation of the collaborationist Vichy regime all but completely cut ties between medical institutions in metropolitan France and those in the colonies. Once supplies lines were restored French colonial doctors faced other obstacles in implementing vaccination programs. Although Africans in the postwar period were becoming increasingly involved in public health services (able, for the first time in 1944 to receive full medical degrees), people living in more rural areas claimed that these campaigns were coercive and used their new citizenship rights to protest vaccination campaigns on the grounds that they violated their liberties as citizens of the French Union.
Today in the context of the Ebola epidemic, we see similar clashes between Africans and “Western” medicine, in many ways echoing the legacies of coercion, violence, and mistrust that characterized the implantation of colonial medicine. Perhaps nowhere was this more apparent than in the murder of eight health workers in Guinea in September last year. As we follow the Ebola vaccine trials in West Africa today, and as international organizations struggle to put the wellbeing of Africans in the forefront of this process, we should do our best to keep in mind the complex historical relationship between power politics and the provision of public health services in Africa.
Jessica Pearson-Patel is an Assistant Professor of European Studies in the College of International Studies at the University of Oklahoma. Her research interests include the French empire, public health in Africa, decolonization, and the history of international organizations. She is currently revising a book manuscript entitled The Colonial Politics of Global Health: France and the United Nations in Postwar Africa.
 Maria Cheng and Raphael Satter for the Associated Press, “Emails: UN health agency resisted declaring Ebola emergency,” 20 Mar 2015, http://bigstory.ap.org/article/2489c78bff86463589b41f3faaea5ab2/emails-un-health-agency-resisted-declaring-ebola-emergency
 Maeve Kennedy, “WHO declares Ebola outbreak an international public health emergency,” The Guardian, 8 Aug 2015,http://www.theguardian.com/society/2014/aug/08/who-ebola-outbreak-international-public-health-emergency
On health care and medical advice for Europeans living in tropical regions, see Dr. F. Hénaff, “Hygiène de l’Européen aux pays chauds,” in J. Charles-Roux, Exposition Coloniale de Marseille, 1906: Compte rendu des travaux du Congrès Colonial de Marseille (Paris: Challamel, 1907), 313-335. On the development of health service for Africans, see Jean-Paul Bado, Médecine colonial et grandes endémies en Afrique (Paris: Karthala, 1996) and Alice Conklin, A Mission to Civilize: The Republican Idea of Empire in France and West Africa, 1895-1930 (Stanford, Calif: Stanford University Press, 1997).
 On sleeping sickness in sub-Saharan Africa, see Deborah J. Neill, Networks in Tropical Medicine: International, Colonialism, and the Rise of a Medical Specialty (Stanford: Stanford University Press, 2012). On malaria, see James L.A. Webb, Jr., The Long Struggle Against Malaria in Tropical Africa (New York: Cambridge University Press, 2014).
 On the history of the Pasteur Institute in global perspective, see Anne Marie Moulin, “The Pasteur Institutes between the two world wars: The transformation of the international sanitary order,” in International Health Organisations and Movements, 1918-1939, ed. Paul Weindling (Cambridge: Cambridge University Press, 1995).
William H. Schneider, “The Long History of Smallpox Eradication: Lessons for Global Health in Africa,” in Global Health in Africa: Historical Perspectives on Disease Control, eds. Tamara Giles-Vernick and James L.A. Webb, Jr. (Athens, OH: Ohio University Press, 2013.
 Jessica Pearson-Patel, “From the Civilizing Mission to International Development: France, the United Nations, and the Politics of Family Health in Postwar Africa, 1940-1960” (PhD diss., New York University, 2013).
 Abby Phillip, “Eight dead in attack on Ebola team in Guinea,” Washington Post, 18 Sept 2014, http://www.washingtonpost.com/news/to-your-health/wp/2014/09/18/missing-health-workers-in-guinea-were-educating-villagers-about-ebola-when-they-were-attacked/