Table of Con­tents | Arti­cle doi: 10.17742/IMAGE.IN.11.2.14 | PDF


The Vac­cine Archive Vic­ki Sung-yeon Kwon

How Fear is Disseminated––Memories and Records: The Vaccine Archive

Vic­ki Sung-yeon Kwon

Mem­o­ries and Records: The Vac­cine Archive explores both indi­vid­ual and col­lec­tive mem­o­ries of vac­ci­na­tion across geo­graph­ic bor­ders. This paper out­lines the devel­op­ment of The Vac­cine Archive and ana­lyzes the visu­al cul­ture of vac­cines man­i­fest­ed in the archive col­lec­tions. In exam­in­ing the vac­cine archives, the author argues that the visu­al cul­ture of vac­ci­na­tion rein­forces stereo­types and fear asso­ci­at­ed with vac­cines, form­ing and dis­sem­i­nat­ing the col­lec­tive mem­o­ry of vac­cines.

Mem­o­ries and Records: The Vac­cine Archive explore les sou­venirs indi­vidu­els et col­lec­tifs de la vac­ci­na­tion à tra­vers les fron­tières géo­graphiques. Cet arti­cle décrit le développe­ment de The Vac­cine Archive et analyse la cul­ture visuelle des vac­cins se man­i­fes­tant dans les col­lec­tions d’archives. En exam­i­nant les archives des vac­cins, l’auteur fait val­oir que la cul­ture visuelle de la vac­ci­na­tion ren­force les stéréo­types et la peur asso­ciés aux vac­cins, for­mant et dif­fu­sant la mémoire col­lec­tive des vac­cins.


Project Development

The Vac­cine Archive start­ed with two ques­tions: How is vac­ci­na­tion remem­bered and rep­re­sent­ed in the era of mass migra­tion and transna­tion­al activ­i­ties, when a nation is no longer an effec­tive unit for con­trol­ling and pre­vent­ing pan­dem­ic dis­eases? And how is fear asso­ci­at­ed with vac­cines cre­at­ed and dis­sem­i­nat­ed across bor­ders? These inquiries, in turn, stemmed from my mus­ings on the top­ic of achiev­ing “herd immu­ni­ty.” The term “herd immu­ni­ty” refers to a sit­u­a­tion in which “the risk of infec­tion among sus­cep­ti­ble indi­vid­u­als in a pop­u­la­tion is reduced by the pres­ence and prox­im­i­ty of immune indi­vid­u­als” (Fine et al. 911). This means that if enough mem­bers of the com­mu­ni­ty are vac­ci­nat­ed, the dis­ease won’t spread to the com­mu­ni­ty even if a few mem­bers of the com­mu­ni­ty remain unvac­ci­nat­ed. Dur­ing the first <Immune Nations> work­shop, in Ottawa in 2015, a senior vac­cine schol­ar on the project, Johan Holst, sug­gest­ed that achiev­ing herd immu­ni­ty is a pri­ma­ry goal for vac­cine sci­en­tists. Dr. Holst empha­sized how infec­tious dis­eases can rapid­ly spread among vul­ner­a­ble groups, even when only a few mem­bers of these groups remain unvac­ci­nat­ed. Measles has an espe­cial­ly high thresh­old for herd immu­ni­ty, requir­ing almost 95% of the com­mu­ni­ty to be vac­ci­nat­ed (Funk), which means that few­er unvac­ci­nat­ed peo­ple can be pro­tect­ed, and few­er can opt out. For that rea­son, the recent increase in par­ents opt­ing out from hav­ing their chil­dren vac­ci­nat­ed against measles is alarm­ing, as their deci­sion can cause harm to the com­mu­ni­ty (Hoff­man et al.).1

While lis­ten­ing to the con­ver­sa­tion, I imag­ined a com­mu­ni­ty with new mem­bers who may have a dif­fer­ent immu­niza­tion sta­tus than the rest of the com­mu­ni­ty. Com­mu­ni­ties are not fixed and closed enti­ties; peo­ple move in and out. As new mem­bers join a com­mu­ni­ty, the sta­tus of the herd pro­tec­tion of that com­mu­ni­ty may change. As the work­shop con­tin­ued, I found myself scrib­bling an illus­tra­tion of pan­dem­ic virus­es and med­ical doc­u­ments tag­ging along with trav­ellers. My scrib­ble depicts a scene in which virus­es, doc­u­ments, mem­o­ries, emo­tions, and culture—all these vis­i­ble and invis­i­ble substances—travel togeth­er with human bod­ies cross­ing bor­ders of com­mu­ni­ties, nations, and wider regions.

Pan­dem­ic dis­ease trav­el­ling along with a trav­eller was already a real­i­ty for me. Dur­ing my trip to South Korea in spring 2015, the out­break of the Mid­dle East res­pi­ra­to­ry syn­drome coro­n­avirus (MERS-CoV) sparked wide­spread pan­ic in South Korea and fear in the broad­er East Asian region. The out­break start­ed with a Kore­an man who had returned from the Mid­dle East with a latent infec­tion of the dis­ease. The dis­ease imme­di­ate­ly spread to med­ical staff and patients in the inten­sive care unit of the med­ical cen­tre where he was even­tu­al­ly treat­ed. Soon it spread through­out the nation, as those who had vis­it­ed patients at that hos­pi­tal trav­elled to oth­er regions by pub­lic trans­porta­tion. The MERS-CoV out­break in South Korea killed 36 peo­ple out of the 186 peo­ple with con­firmed cas­es and result­ed in more than 3,000 indi­vid­u­als being quar­an­tined (Lee et al.). This for­eign dis­ease drove the nation into a state of anx­i­ety, espe­cial­ly as the virus had no effec­tive vac­cine. Pub­lic fear devel­oped as the gov­ern­ment react­ed inad­e­quate­ly to the dis­ease and did not release infor­ma­tion in a time­ly man­ner (Kim).

The MERS-CoV out­break in South Korea soon threat­ened the broad­er com­mu­ni­ties in East Asia and South­east Asia. A South Kore­an who trav­elled to Huizhou, Chi­na, via Hong Kong was diag­nosed pos­i­tive for MERS-CoV, spark­ing anti-South Korea sen­ti­ment in both main­land Chi­na and Hong Kong.2 Sim­i­lar cas­es soon occurred in the Philip­pines.3 The MERS-CoV out­break in South Korea demon­strat­ed yet again that domes­tic con­trol of a pan­dem­ic dis­ease could eas­i­ly be under­mined due to trav­el with­in and across its bor­ders. As I vis­it­ed Tai­wan after Korea dur­ing this out­break, I was shunned by friends who were afraid of me trans­mit­ting the dis­ease to them. I was left afraid to cross bor­ders, as long as there is no vac­cine.

Achiev­ing com­plete con­trol of any pan­dem­ic dis­ease is impos­si­ble, whether the dis­ease has an effec­tive vac­cine or not. Cat­a­stroph­ic con­se­quences could result from peo­ple neglect­ing to report symp­toms to the author­i­ties or being unaware of their med­ical con­di­tion. Pan­dem­ic dis­ease con­trol requires not only appro­pri­ate han­dling by nation­al and transna­tion­al orga­ni­za­tions, but also indi­vid­ual aware­ness of one’s own health con­di­tion and of its poten­tial influ­ence on the broad­er com­mu­ni­ty. The porous nature of bor­der con­trol and the improb­a­bil­i­ty of pan­dem­ic dis­ease con­trol might be one of many rea­sons that the immu­niza­tion and vac­ci­na­tion agi­tate peo­ple and cause fear.

The cur­rent COVID-19 out­break demon­strates how an epi­dem­ic of a local dis­ease may be quick­ly turned into a pan­dem­ic by trav­ellers, and cause fear and antag­o­nism (Bel­luz). Orig­i­nat­ing in Wuhan, Chi­na in Decem­ber 2019, the nov­el coro­n­avirus has now spread to oth­er nations in Asia (Japan, South Korea, Sin­ga­pore, etc.), the Mid­dle East (Iran, Iraq, Israel, Afghanistan, Kuwait, and Bahrain), North Amer­i­ca (Cana­da and the Unit­ed States), and Europe (Ger­many, Italy, Spain, etc.) as of Feb­ru­ary 24, 2020 (“Coro­n­avirus Dis­ease 2019”). Fear spreads in advance of the virus, ignit­ing racism against Chi­nese peo­ple with­in Asia, and against Asians in gen­er­al in oth­er regions (Kasulis; Iqbal; Chen et al.). The media cre­ates an air of anx­i­ety by con­stant­ly show­ing med­ical staff wear­ing pres­sur­ized pro­tec­tive suits designed for Biosafe­ty Lev­el 4 (death­ly virus­es) (Huh). Med­ical staff in space suits and Asians wear­ing face masks have cre­at­ed the visu­al cul­ture of COVID-19. Such images are repeat­ed­ly broad­cast in news politi­ciz­ing gov­ern­ment reac­tion to not ban­ning Chi­nese people’s enter­ing one’s nation, espe­cial­ly South Korea, where I cur­rent­ly reside.

Think­ing about dis­eases trav­el­ling along with peo­ple and fear spread­ing faster than the dis­ease, I start­ed to think about immu­niza­tion records and mem­o­ra­bil­ia as his­tor­i­cal arti­facts that con­vey the indi­vid­ual and col­lec­tive mem­o­ries of vac­ci­na­tion. Accord­ing to Mau­rice Halb­wachs, col­lec­tive mem­o­ry is always social­ly framed (see also Mis­z­tal). He argues that indi­vid­ual mem­o­ry relies on social mem­o­ry, as mem­o­ry is shaped in rela­tion to the social envi­ron­ment sur­round­ing the indi­vid­ual (Halb­wachs). How are mem­o­ries relat­ed to vac­cines framed? Exam­in­ing the visu­al cul­ture of vac­ci­na­tion through vac­cine archives could enable us to con­sid­er how the col­lec­tive mem­o­ry of vac­cines is con­struct­ed and dis­sem­i­nat­ed. These vis­i­ble and tan­gi­ble objects con­struct the con­cept of vac­ci­na­tion for indi­vid­u­als, as peo­ple expe­ri­ence vac­ci­na­tion not only through hav­ing vac­cines admin­is­tered, but also through look­ing at images or touch­ing objects relat­ed to vac­cines. This pro­ce­dure is more a direct, cor­po­re­al expe­ri­ence than an indi­rect, edu­ca­tion­al expe­ri­ence. Also, despite the impor­tance of these arti­facts as his­tor­i­cal and med­ical records, peo­ple sel­dom keep their immu­niza­tion records secure. These doc­u­ments are often mis­placed for years some­where inside a draw­er or lost dur­ing migra­tion, espe­cial­ly among dis­placed pop­u­la­tions. As these records are eas­i­ly lost and/or for­got­ten, esti­mat­ing children’s vac­ci­na­tion relies heav­i­ly on par­ents’ frag­ment­ed mem­o­ries (Miles et al.; Bin­yaru­ka and Borghi). The Vac­cine Archive attempts to col­lect these frag­ment­ed mem­o­ries of vac­ci­na­tion, remem­bered and con­sumed ubiq­ui­tous­ly or dis­tinc­tive­ly in com­mu­ni­ties through­out the globe, as a way to invoke our “vac­cine imag­i­nary” in the con­text of increas­ing­ly fraught glob­al con­di­tions.

Analysis of The Vaccine Archive

The Vac­cine Archive con­sists of three parts: vac­cine arti­facts, par­tic­i­pant inter­views, and a view­er sur­vey. I col­lect­ed mass-pro­duced visu­al images that are wide­ly cir­cu­lat­ed across bor­ders, includ­ing postage stamps, post­cards, press images, and images insert­ed into immu­niza­tion cards or book­lets. Most of them were pro­duced to pro­mote immu­niza­tion and are cre­at­ed and dis­sem­i­nat­ed by nation­al health care orga­ni­za­tions and mul­ti­lat­er­al orga­ni­za­tions, such as the World Health Orga­ni­za­tion. These images are cir­cu­lat­ed as every­day objects. As visu­al data, they ren­der vis­i­ble the oth­er­wise invis­i­ble social dis­course sur­round­ing vac­ci­na­tion. They reveal vaccination’s entan­gle­ments with race, gen­der, inter­na­tion­al polit­i­cal dynam­ics, geopo­lit­i­cal­ly spe­cif­ic infor­ma­tion, and envi­ron­men­tal issues. What fol­lows is an analy­sis of some of the prob­lems of the visu­al cul­ture of vac­cines that are revealed in these col­lect­ed arti­facts.

Propagandistic Use of Life-Saving Vaccines

The life-sav­ing func­tion of vac­cines seems to be an effi­cient tool for use in polit­i­cal pro­pa­gan­da. For that rea­son, some resources that we4 col­lect­ed are from World War II, such as the press pho­to of a Chi­nese com­mu­nist sol­dier being held cap­tive in the Allied troops’ camp, mak­ing a sus­pi­cious and fear­ful face after being vac­ci­nat­ed. Some of the col­lect­ed images per­pet­u­ate stereo­typ­ing in the dis­course of vaccination—namely, the idea of priv­i­leged peo­ple in the West doing good work to help impov­er­ished peo­ple either in the same nation or in poor nations else­where.

Fig­ure 1: Anony­mous pho­tog­ra­ph­er, Unti­tled, 1969, pho­to­graph­ic print. Pho­to cred­it: Unit­ed Press Inter­na­tion­al Pho­to.

For exam­ple, the pho­to­graph Unti­tled (Fig­ure 1) is a press image for an unknown US news­pa­per in 1969. In it, an African Amer­i­can girl with braid­ed hair is gri­mac­ing either in fear of a nee­dle before vac­ci­na­tion or in pain after the event of vac­ci­na­tion. Slight­ly above her is Tri­cia Nixon, the elder daugh­ter of the 37th pres­i­dent of the Unit­ed States, Richard Nixon. Nixon is bend­ing her upper body for­ward and gaz­ing at the girl, as if com­fort­ing the child while over­see­ing the immu­niza­tion scene. The pho­to is accom­pa­nied by the fol­low­ing text: “A sym­pa­thet­ic Tri­cia Nixon watch­es a young Negro girl take an immu­niza­tion shot against Ger­man measles 11/3 at the Turn­er Ele­men­tary School. The President’s 23-year-old daugh­ter is tak­ing part in the mass immu­niza­tion pro­gram to focus nation­al atten­tion on the cam­paign to erad­i­cate Ger­man measles.” The accom­pa­ny­ing text clar­i­fies the bifur­ca­tion between “a young Negro girl” and Nixon, as a mem­ber of the white elite and a polit­i­cal fig­ure. The mes­sage of the pho­to­graph shows a benev­o­lent, white social elite help­ing save a black child’s life, with the not-so-dis­tant con­text of the Sec­ond World War and the defeat of the Ger­mans hov­er­ing in the semi­otic back­ground.

This stereo­type man­i­fests itself in the dif­fer­ent skin colour of the human fig­ures depict­ed, pro­duc­ing a code of a white-look­ing per­son pro­vid­ing med­ical aid to a non-white per­son. The phys­i­cal posi­tions of Nixon and the child in the pic­ture may sym­bol­i­cal­ly indi­cate their polit­i­cal posi­tions. Posi­tioned high­er than the child, Nixon is look­ing down on the girl like a care­giv­er. This com­po­si­tion rein­forces a famil­iar sto­ry of vac­ci­na­tion based on racial stereo­typ­ing: a com­pas­sion­ate mem­ber of the white elite help­ing a black child by offer­ing med­ical aid, which is the prod­uct of sci­en­tif­ic advances and civ­i­liza­tion.

The deci­sion to include the daugh­ter of the pres­i­dent of the Unit­ed States and a black child in the frame was, quite like­ly, polit­i­cal, intend­ed to over­come not only epi­dem­ic dis­ease but also racial con­flict. The wife and fam­i­ly of polit­i­cal lead­ers are often pressed into ser­vice to pro­mote pub­lic caus­es, and this image is typ­i­cal of that pat­tern. As it was pro­duced in 1969, this pro­pa­gan­dis­tic rep­re­sen­ta­tion may relate to the civ­il rights move­ment (1954-1968), a time of con­sid­er­able racial con­flict in the Unit­ed States. By giv­ing Nixon the role of the health care provider and the black child the role of the health care receiv­er, this image, how­ev­er, con­sol­i­dates the social class sys­tem based on eth­nic divi­sion in the Unit­ed States.

The eth­nic divi­sion in this pic­ture is con­struct­ed by the delib­er­ate exclu­sion of a third per­son, for the sake of high­light­ing the stark bifur­ca­tion of the white president’s daugh­ter and the black child. Upon clos­er inspec­tion, we see a man’s arm stretch­ing over from the bot­tom right cor­ner. His left hand, which is hold­ing the child’s arm, sug­gests that his skin colour is clos­er to the black child’s than to Nixon’s. The male figure’s role in this scene is ambigu­ous. He may be a health care provider, but, as he is not dressed in a white gown, he may be a teacher or staff at the school. What nee­dles me in this pho­to­graph is this male fig­ure, cropped out except for his left arm and part of his face, shown in the top right cor­ner. His nose and chin appear in an even high­er posi­tion than Nixon’s face. This may be anoth­er rea­son why this (per­haps) black male fig­ure is exclud­ed in this scene, as posi­tion­ing him high­er than Nixon could dimin­ish her posi­tion in con­trast to the black child. This male fig­ure could have been com­plete­ly cropped out had it not been for the fact that crop­ping his hand would have also erased the child’s arm and Nixon.

For me, this male fig­ure func­tions as a “punc­tum,” Roland Barthes’s term for a star­tling, small detail in pho­tog­ra­phy that “pricks” the view­er, like a nee­dle that leaves a tiny hole. In con­trast to punc­tum, Barthes sug­gests that “studi­um”—which he defines as “appli­ca­tion to a thing, taste for some­one, a kind of gen­er­al enthu­si­as­tic com­mit­ment, of course, but with­out spe­cial acu­ity” (26)—is the cul­tur­al­ly acquired skill or taste to under­stand a pho­to­graph with­out spe­cial acu­ity. Punc­tum breaks studi­um like a nee­dle, twist­ing our cul­tur­al under­stand­ing of the stereo­type in the image. In this pho­to­graph, the male pres­ence is a key (punc­tum) to catch the photographer’s manip­u­la­tion of the scene to present the sto­ry in a famil­iar cul­tur­al code (studi­um) to cre­ate suc­cess­ful pro­pa­gan­da: benev­o­lent white elites pro­vide vul­ner­a­ble, suf­fer­ing peo­ple of African descent in the Unit­ed States with med­ical care. This vac­cine pro­mo­tion­al image is care­ful­ly con­struct­ed to serve as polit­i­cal pro­pa­gan­da, although the gen­er­al pub­lic might not take the time to ana­lyze this manip­u­la­tion, view­ing the image while flip­ping through a news­pa­per.

Fig­ure 2: Anony­mous pho­tog­ra­ph­er, South Kore­an Sol­diers of Blue Drag­on Units in Viet­nam Admin­is­ter­ing Vac­cine on a Mon­tana Woman, 1967, the Nation­al Archive of the Repub­lic of Korea, Pho­tog­ra­phy Office of the Pub­lic Rela­tions Depart­ment, the Bureau of Pub­lic Infor­ma­tion.

A sim­i­lar mes­sage is pro­duced by Fig­ure 2. This pho­to­graph­ic print shows the South Kore­an sol­diers of the Blue Drag­on Units admin­is­ter­ing a vac­cine to a Viet­namese woman of the Mon­tana eth­nic minor­i­ty dur­ing the Viet­nam War. Fig­ure 2 is one of eight pho­tos cap­tur­ing the Blue Drag­on Units’ vac­ci­na­tion activ­i­ty among the Mon­tana peo­ple. An ally of the Unit­ed States, South Korea dis­patched 35,000 sol­diers to Viet­nam as com­bat troops for mon­e­tary ben­e­fit. Park Chung-hee’s mil­i­tary regime pro­mot­ed Kore­an sol­diers in Viet­nam as heroes who sac­ri­ficed them­selves for the sake of nation­al pros­per­i­ty and inter­na­tion­al democ­ra­cy, against the spread of com­mu­nism, as well as pro­tec­tors of the Viet­namese peo­ple from com­mu­nist attack. This image seems to be part of the cam­paign. The pho­to­graph por­trays Kore­an sol­diers as peace­keep­ers by pre­sent­ing them pro­vid­ing med­ical care to an eth­nic minor­i­ty woman of Viet­nam and a sol­dier (it is unclear whether he is Kore­an or South Viet­namese) hold­ing a baby in his arms.

The image, how­ev­er, shows uncom­fort­able aspects of wartime mil­i­tary pro­pa­gan­da images relat­ed to vac­ci­na­tion. The image cap­tures the Viet­namese eth­nic minor­i­ty woman, stripped of her top and thus expos­ing her under­wear, while being sur­round­ed by two Kore­an male sol­diers admin­is­ter­ing vac­cines to both of her arms. The fear, shame, and sus­pi­cion are present in her facial expres­sion, con­trast­ing with that of the sol­dier to the far right, who is beam­ing at the event. This con­trast sug­gests that the pho­to might have been tak­en in a light-heart­ed envi­ron­ment for the male sol­diers, while nonethe­less remain­ing awk­ward for the civil­ian woman.

Con­sid­er­ing Kore­an sol­diers’ atroc­i­ties in Viet­nam, includ­ing civil­ian mas­sacres and sex­u­al vio­lence, the polit­i­cal under­tones of this image are dis­turb­ing.5 The Blue Drag­on Unit was noto­ri­ous for being aggres­sive. One of its dis­closed atroc­i­ties is the Bình Hòa Mas­sacre, in which its sol­diers killed 79 civil­ians over three days in Bình Hòa, a vil­lage in Quảng Ngãi Province, in 1965 (Kwon). Most of the vic­tims were infants, women, and vil­lage elders. The paci­fi­er image of the Kore­an sol­diers in this series of the pho­tographs, as pro­vid­ing med­ical aid to the eth­nic minor­i­ty peo­ple of Viet­nam, may have been staged to empha­size the peace­keep­ing image of the troops, yet what it sig­nals most strong­ly is sex­u­al-based vio­lence through the gen­der and pow­er dichoto­my of the image. The woman’s com­pli­cat­ed facial expres­sion in Fig­ure 2 can be read as the fear of being vac­ci­nat­ed through nee­dle injec­tion by for­eign sol­diers, inter­min­gled with the fear of the poten­tial threat posed by the sol­diers, which was per­haps as alien to her as the vac­ci­na­tion expe­ri­ence.

Needle Fear

Most of the images that we col­lect­ed for The Vac­cine Archive depict a scene of vac­ci­na­tion involv­ing a nee­dle. Three postage stamps sim­ply illus­trate a nee­dle itself, with­out any fig­ure, as a sign of vac­ci­na­tion. One postage stamp from Guyana illus­trates a syringe and a por­trait of Dr. Jonas Salk, who invent­ed the polio vac­cine (Fig­ure 3).

Fig­ures 3 and 4: Postage stamp with the text “Jonas Salk Polio Vac­cine,” Guyana, date of issue unknown (left); postage stamp with the text “Journée Mon­di­ale de la San­té” (World Health Day), “San­té pour Tous Avant l’an 2000” (health for all by the year 2000), Guinea, date of issue unknown, pre­sumed to be 1986 (right).

Using a nee­dle as a sign of vac­ci­na­tion may con­jure up trau­mat­ic mem­o­ries relat­ed to nee­dles from child­hood vac­ci­na­tion. The pain and anx­i­ety asso­ci­at­ed with nee­dle injec­tion has been doc­u­ment­ed as a sig­nif­i­cant bar­ri­er to vac­ci­na­tion for both adults and chil­dren. Stud­ies show that up to 25% of adults report a fear or nee­dles, most of which devel­oped in child­hood, and that 10% of the pop­u­la­tion avoids nee­dles and nee­dle-relat­ed pro­ce­dures as a result (Hoff­man et al. 4). Yet the major­i­ty of postage stamps, one post­card, and four news­pa­per press images in the col­lect­ed archive depict the moment dur­ing which a health care provider is push­ing a nee­dle into the arm of a child cry­ing or gri­mac­ing in fear or pain.6

Fig­ure 5: Pho­to by an anony­mous pho­tog­ra­ph­er accom­pa­ny­ing text by Dale Swan­son of The Ore­gon­ian, Feb­ru­ary 6, 1987.

Take Fig­ure 5, a press image pho­to­graph released in 1987 that shows a child cry­ing dur­ing an event of injec­tion. An adult woman holds the child tight, while the child bends her body away from the vac­cine admin­is­tra­tor, as if she is try­ing to escape the nee­dle injec­tion.7 This image con­veys the fear and pain asso­ci­at­ed with nee­dles, which dis­tress not only the admin­is­tered chil­dren but also their par­ents and even the injec­tion admin­is­tra­tors. This neg­a­tive emo­tion asso­ci­at­ed with nee­dles seems to have been passed down to the use of jet injec­tors, which use air under high pres­sure instead of a syringe with a nee­dle to deliv­er the vac­cine. These injec­tors resem­ble a gun in appear­ance. A rel­a­tive­ly recent postage stamp from the Repub­lic of Guinea (Fig­ure 4), pre­sumed to be pro­duced in 1986, illus­trates a nurse hold­ing a jet injec­tor. Still, the child is bend­ing away from the injec­tor while look­ing down at his arm with a stern facial expres­sion. Although designed to pro­mote vac­ci­na­tion, these images high­light the pain and fear asso­ci­at­ed with vac­ci­na­tion.

Transcribed Interviews of Individual Memories

To pro­duce The Vac­cine Archive, I reached out to immi­grants and inter­na­tion­al stu­dents in Cana­da, as well as those who had trav­elled to Cana­da from var­i­ous loca­tions. These par­tic­i­pants rep­re­sent var­i­ous eth­nic groups, sex­u­al ori­en­ta­tions, and age cohorts. Each par­tic­i­pant offered their mem­o­ries relat­ed to vac­ci­na­tion, togeth­er with their emo­tion­al reac­tion and their social con­di­tion.

Per­haps unsur­pris­ing­ly, the expe­ri­ence of nee­dles, and anx­i­ety relat­ed to this, was dom­i­nant in the response of par­tic­i­pants. One par­tic­i­pant who emi­grat­ed from Argenti­na to Cana­da recalled her trau­ma around nee­dles as fol­lows:

It was short­ly after we arrived in Toron­to from Argenti­na in 1951. It is my first rather clear mem­o­ry. It was very trau­mat­ic. For about fifty years, I faint­ed when­ev­er I was giv­en a nee­dle (vac­ci­na­tion or blood test), unless I lay down on a bed. I faint­ed quite a bit in school, often land­ing between the desks. Some­times it was nec­es­sary for me to apol­o­gize to doc­tors about my resis­tance to hav­ing vac­ci­na­tions and blood tests and my result­ing poor behav­iour.”8

This par­tic­i­pant shud­dered as she recalled the mem­o­ry of the nee­dle. Some par­tic­i­pants respond­ed that they do not have any sig­nif­i­cant mem­o­ry about vac­ci­na­tions oth­er than the nee­dle. Nee­dle fear appears in the inter­views of par­tic­i­pants from Cana­da, Guyana, South Korea, Tai­wan, and the Unit­ed King­dom, as if it is the sine qua non of vac­ci­na­tion.

In con­trast, how­ev­er, a par­tic­i­pant from a coun­try of extreme poverty—a North Kore­an defec­tor now resid­ing in Canada—did not describe any fear of nee­dles; rather, she described fear of death due to a lack of sup­plies of nee­dles and vac­cines. She told me the most vivid and shock­ing mem­o­ry of a cholera out­break in Hamhe­ung that brought her and her sis­ter close to death. Below is an excerpt from her inter­view:

The stench from corpses piled up in the morgue, which was right next to her [the interviewee’s sister’s] room in the hos­pi­tal. […] My moth­er pur­chased antibi­otics and syringes from a mar­ket and brought them to the hos­pi­tal. She paid a doc­tor a bribe to get us the shots. Relief mate­ri­als from the UN were giv­en to gov­ern­ment offi­cials, then to the army, and then the left­overs were released on the open mar­ket.”9

She explained how North Kore­ans pur­chased glass or plas­tic syringes from the mar­ket and how the peo­ple in the vil­lage re-used the same nee­dle, hav­ing ster­il­ized it by apply­ing heat.

It should be not­ed that this was dur­ing the North Kore­an famine, known as the Ardu­ous March, from 1994 to 1998, and that the sit­u­a­tion described by the inter­vie­wee is not an every­day scene in North Korea. Still, her sto­ry exem­pli­fies peo­ple sit­u­at­ed at the dis­junc­ture of the glob­al sys­tem of epi­dem­ic dis­ease pre­ven­tion. Transna­tion­al orga­ni­za­tions have lim­it­ed access to the vul­ner­a­ble pop­u­la­tions affect­ed by epi­dem­ic dis­eases in such excep­tion­al polit­i­cal sit­u­a­tions. Her sto­ry high­lights the urgent need to devel­op a bet­ter pol­i­cy and sys­tem to dis­trib­ute relief sup­plies in zones of extreme pover­ty, as well as the need to pro­vide alter­na­tive meth­ods, such as vac­cine patch­es, instead of syringes, to pre­vent re-use of nee­dles. Nee­dle-free immu­niza­tion is desir­able in Glob­al South nations, as the nee­dles are often the sources of trans­mis­sion and dis­sem­i­na­tion of blood-borne pathogens, such as hepati­tis B and C, and HIV (Levine). Still, nee­dles are reused mul­ti­ple times to save on costs in the Glob­al South (Levine), exem­pli­fied in the North Kore­an defector’s inter­view.

Addi­tion­al con­cerns are the acces­si­bil­i­ty of vac­ci­na­tion and the preser­va­tion of the records of vac­ci­na­tion for dis­placed pop­u­la­tions after their set­tle­ment. The par­tic­i­pant from North Korea said that she did not receive any fur­ther vac­ci­na­tions after her arrival in Toron­to, except for hepati­tis B dur­ing the immi­gra­tion health check-up. All she expe­ri­enced in terms of med­ical check-ups was to fill out a ques­tion­naire list­ing the dis­eases and vac­ci­na­tion she had had. She had nev­er seen any type of record of her vac­ci­na­tion in North Korea or in Cana­da. Her case makes us ques­tion the reli­a­bil­i­ty of the agen­cies that are respon­si­ble for track­ing and doc­u­ment­ing the immu­niza­tion his­to­ry of mem­bers of vul­ner­a­ble pop­u­la­tions.

Conclusion

Start­ing from a quest to learn about the prob­a­bil­i­ty of herd immu­ni­ty, The Vac­cine Archive devel­oped into research on the visu­al cul­ture of vac­ci­na­tion that con­structs the col­lec­tive mem­o­ry of vac­cines. The archives thus assem­bled exem­pli­fy how images cre­at­ed and dis­sem­i­nat­ed to pro­mote vac­ci­na­tion often repro­duce stereo­typ­i­cal or neg­a­tive asso­ci­a­tions of vac­cines instead. Vac­cines’ life-sav­ing aspect is uti­lized in polit­i­cal pro­pa­gan­da to pro­mote the idea of priv­i­leged peo­ple of bet­ter-off nations pro­vid­ing med­ical care to impov­er­ished pop­u­la­tions. Nee­dle fear is ampli­fied by being repeat­ed­ly dis­sem­i­nat­ed as a sign of vac­ci­na­tion, pro­vok­ing neg­a­tive mem­o­ries asso­ci­at­ed with the nee­dle. And acces­si­bil­i­ty to vac­cines and med­ical aid sup­plies, includ­ing syringes, by vul­ner­a­ble com­mu­ni­ties hard­ly exists at the dis­junc­ture of glob­al pan­dem­ic dis­ease con­trol sys­tems.

Exam­in­ing The Vac­cine Archive sug­gests that insti­tu­tions that design and cir­cu­late mass-pro­duced pro­mo­tion­al goods about vac­ci­na­tion should pro­duce them with racial, eth­nic, gen­der, and cul­tur­al sen­si­tiv­i­ty, and use a more care­ful visu­al strat­e­gy in order to avoid rein­forc­ing stereo­types and ampli­fy­ing nee­dle fear. The stereo­typ­i­cal depic­tions of health care receivers in the visu­al rep­re­sen­ta­tion of vac­ci­na­tion are spread to glob­al audi­ences via the mass cir­cu­la­tion of these images, cre­at­ing neg­a­tive emo­tions sur­round­ing vac­ci­na­tion. The analy­sis of the mem­o­ries and records of The Vac­cine Archive also sug­gests that there are blind spots in the cur­rent sys­tems of epi­dem­ic dis­ease con­trol on the transna­tion­al stage.

Acknowledgements

Vic­ki Sung-yeon Kwon would like to acknowl­edge the sup­port of the Grad­u­ate Research Assist­ant­ship of the Glob­al Strat­e­gy Lab, the SSHRC Doc­tor­al Fel­low­ship, and the junior fel­low­ship of Kyu­jang­gak Insti­tute for Kore­an Stud­ies at the Seoul Nation­al Uni­ver­si­ty.

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Image Notes

Fig­ure 1: Anony­mous pho­tog­ra­ph­er, Unti­tled, 1969, pho­to­graph­ic print. Pho­to cred­it: Unit­ed Press Inter­na­tion­al Pho­to.

Fig­ure 2: Anony­mous pho­tog­ra­ph­er, South Kore­an Sol­diers of Blue Drag­on Units in Viet­nam Admin­is­ter­ing Vac­cine on a Mon­tana Woman, 1967, the Nation­al Archive of the Repub­lic of Korea. Pho­tog­ra­phy Office of the Pub­lic Rela­tions Depart­ment, the Bureau of Pub­lic Infor­ma­tion.

Fig­ure 3: Postage stamp with the text “Jonas Salk Polio Vac­cine,” Guyana, date of issue unknown.

Fig­ure 4: Postage stamp with the text “Journée Mon­di­ale de la San­té” (World Health Day), “San­té pour Tous Avant l’an 2000” (health for all by the year 2000), Guinea, date of issue unknown, pre­sumed to be 1986.

Fig­ure 5: Pho­to by an anony­mous pho­tog­ra­ph­er accom­pa­ny­ing text by Dale Swan­son of The Ore­gon­ian, Feb­ru­ary 6, 1987.

Notes


  1. Editor’s note: For more on herd immu­ni­ty, see Sahar et al., “Overview of Key Legal, Polit­i­cal, and Social Chal­lenges Fac­ing Glob­al Vac­ci­na­tion Efforts,” in this vol­ume.

  2. China’s strong antag­o­nism was par­tial­ly due to the trau­ma from the SARS out­break in 2002-2003, which began in Guang­dong Province, Chi­na, in Novem­ber 2002, and result­ed in more than 8,000 cas­es in 28 coun­tries and led to more than 770 deaths by May 2003 (“Severe Acute Res­pi­ra­to­ry Syn­drome”; “Update 62”).

  3. The dis­ease and sub­se­quent fear influ­enced the domes­tic econ­o­my and inter­na­tion­al rela­tions of South Korea, caus­ing a short­fall in con­sumer spend­ing and dev­as­tat­ing its tourism sec­tor (Shi and Li).

  4. This project was con­ceived by me and devel­oped in col­lab­o­ra­tion with Lath­i­ka Sritha­ran; see our dia­logue in the Reports and Dia­logues sec­tion of this vol­ume.

  5. In Viet­nam dur­ing the war, Kore­an sol­diers inter­nal­ized the racist atti­tudes and impe­ri­al­is­tic aspi­ra­tions of US sol­diers towards the Viet­namese peo­ple and thus com­mit­ted civil­ian mas­sacres and sex­u­al vio­lence (Nguyen 188).

  6. There are some excep­tions: postage stamps from Zam­bia (1985), India (1998), Kenya (1988), and Yemen (2005) illus­trate oral admin­is­tra­tion of the polio vac­cine.

  7. The text accom­pa­ny­ing the pho­to­graph indi­cates that a two-year-old child is being giv­en an immu­niza­tion for measles, mumps, and rubel­la (also known as Ger­man measles) by a com­mu­ni­ty health nurse while her moth­er lends sup­port, at North­east Health Cen­ter. Dale Swan­son, Title Unknown, The Ore­gon­ian, Feb­ru­ary 6, 1987.

  8. An inter­view with a par­tic­i­pant born in Argenti­na, resid­ing in Edmon­ton, Cana­da, Jan­u­ary 26, 2017. Due to research ethics involv­ing med­ical doc­u­ments, all par­tic­i­pants and I agreed that I would with­hold their names.

  9. An inter­view with a par­tic­i­pant born in Hamhe­ung, North Korea, resid­ing in Toron­to, Cana­da, Decem­ber 16, 2016. The inter­view was con­duct­ed in the Kore­an lan­guage and trans­lat­ed into Eng­lish by the author.

Vic­ki S. Kwon, with Lath­i­ka Sritha­ran and Mor­gan Wed­der­spoon, Mem­o­ries and Records: The Vac­cine Archive, UNAIDS, Gene­va, 2017. Archive col­lec­tion and prints on Pho­to Tex. Pho­to by Annik Wet­ter.
Vic­ki S. Kwon, with Lath­i­ka Sritha­ran and Mor­gan Wed­der­spoon, Instal­la­tion detail of the archive ded­i­cat­ed to moth­ers’ col­lec­tion of vac­cine records, Mem­o­ries and Records: The Vac­cine Archive, UNAIDS, Gene­va, 2017. Pho­to by Vic­ki S. Kwon.
Vic­ki S. Kwon, with Lath­i­ka Sritha­ran and Mor­gan Wed­der­spoon, Mem­o­ries and Records: The Vac­cine Archive, UNAIDS, Gene­va, 2017. Archive col­lec­tion and prints on Pho­to Tex. Video Still from Julien Duret.
Vic­ki S. Kwon in front of Mem­o­ries and Records: The Vac­cine Archive, UNAIDS, Gene­va, 2017. Archive col­lec­tion and prints on Pho­to Tex. Pho­to by Roman Levchenko.