Vaccine Hesitancy – Egypt 1866

Archaeological evidence suggests that smallpox has been present in Egypt for some 3000 years and later was a recurrent problem across the Islamic world, as well as Europe. Accurately described by the physician al-Razi in the 10th century, vaccination or variolation (transferring matter from a smallpox scab from one person to another through a scratch or up the nose) had been practised in China since the 6th century A.D. and perhaps even earlier in India.

In Egypt, around 1800, there are reports of 60 000 deaths each year. The Ottoman ruler, Muhammad Ali Pasha, began in 1819 to institute a plan for general vaccinations and the logical people to carry this out were the barber-surgeons, known and trusted by the locals. While the Bedouin had long been enthusiastic about protecting their children in this way, the fellahin (peasantry) was reluctant, largely because they did not trust the government and thought it was a way of “marking” their children for conscription. Religious objections and concerns about mixing Muslim and Christian blood also played their part, and attempts to bribe the vaccinators were not uncommon.

After the serious epidemic of 1836, official efforts intensified, with barber-vaccinators being trained and records kept. Gradually, the message got through and by 1850, the decline in child mortality was affecting the population statistics. The following anecdote, describes a perhaps surprising pocket of vaccine hesitancy.

We have just had a scene, rather startling to notions about fatalism, etc. Owing to the importation of a good deal of cattle from the Sudan, there is an expectation of the prevalence of small-pox, and the village barbers are busy vaccinating in all directions. To prevent the infection brought, either by the cattle or, more likely, by their drivers. Now, my made had told me she had never been vaccinated, and I sent for Hajji Mahmood to cut my hair and vaccinate her. To my utter amazement the girl, who had never shown any religious bigotry and does not fast, or make any demonstrations, refused peremptorily.

It appears that the priests and sisters appointed by the enlightened administration of Prussia instil into their pupils and penitents that vaccination is a “tempting of God” Oh oui, she said, je sais bien que chez nous mes parents pouvaient recevoir un procès verbal, mais il vaut mieux cela que d’aller contre la volonte de Dieu. Si Dieu le veut, j’aurai la petite vérole, et s’il ne le veut pas, je ne l’aurai pas”*. I scolded her pretty sharply, and said it was not only stupid, but selfish.

“But what can one do?” as Hajji Mahmood said, with a pitying shake of his head, “these Christians are so ignorant!” He blushed, and apologized to me, and said, “It is not their fault; all this want of sense is from the priests who talk folly to them for money, and to keep them afraid before themselves. Poor things, they don’t know the Word of God – ‘Help thyself, oh my servant, and I will help thee’” This is the second contest I have had on this subject. “Last year it was with a Copt, who was all Allah kareem** and so on about his baby, with his child of four dying of smallpox. “oh man”, said Shaikh Yusuf, “if the wall against which I am now sitting were to shake above my head, should I fold my feet under me and say Allah kareem, or should I use the legs God has given me to escape from it?

*Oh yes, she said, I know that my parents could well be subject to an official report, but that is better than going against God’s will. If God so wishes, I will catch smallpox, and if He doesn’t, I won’t.

** God is generous

Letters from Egypt 1862-1869, Lady Duff Gordon, re-edited with additional letters, Gordon Waterfield, Routledge and Kegan Paul, London 1969, pp 249-50.

Lady Duff Gordon went to Egypt in 1862, suffering from consumption, and died there in 1867. Her charming, sympathetic, entertaining and highly informative letters were originally edited by her mother and now by her great grandson, Gordon Waterfield.

There is a vast literature on smallpox and vaccination, but for further details on vaccination in Egypt, see Lives at Risk, Public Health in Nineteenth-century Egypt, LaVerne Kuhnke, University of California Press, 1990 and on-line at wwwpublishing.cdlib.org/ucpressebooks.

N.B. In case I have infringed copyright on any occasion, please notify me and I will immediately delete the post.

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