In 1857, Koyama Yōju finally received a legitimate transmission. He had been working toward this goal at least since his vaccine theft of 1853. As Kasahara Ryōsaku noted in his journal in 1857, Koyama had also received vaccines from Fuchū’s society at one point, and vaccinators from Fuchū (a town close to Nishikata) once asked Kasahara whether they were allowed to share vaccines with Koyama. At that time, Kasahara still rejected this transfer between neighbors, arguing that Koyama was neither from Fuchū nor represented a “separate clinic” within Ōno domain. In other words, he deemed the transfer incompatible with the institutional framework he hoped to build for vaccinations in Echizen province. It seems that Kasahara was eager to have each vaccinators’ society overlap with a domain territory, and if the vaccine went extinct, he wanted domain governments to send a formal request for retransmission to their counterpart in Fukui. Perhaps Kasahara believed that with such a high hurdle for retransmission, physicians would try harder to preserve the vaccine. He might have seen this principle endangered by Koyama’s request.

In 1857, Kasahara and his colleagues in Ōno came up with a workaround to authorize Koyama’s operation without damaging their institutional framework. They probably felt pressured to act after Koyama and Naitō had stepped in to fill the gap and domain officials had tried to appoint an unintegrated vaccinator for Nishikata. First, Ōno’s physicians invited Koyama and “carefully instructed him in Ōno on the assessment of pocks and other things.” They transmitted the vaccine to him, then “went to his place and imposed on him rules about all kinds of things on the basis of an inspection.” This initiation turned Koyama into a legitimate vaccinator who could be trusted to act in a responsible manner.

Second, Koyama's operation received the status of a “separate clinic” (bekkan) of Ōno domain. As Kasahara explained to his Ōno colleagues, this status would allow Koyama to receive retransmissions from Sabae and Fuchū in case he lost his chain of supply. He cautioned that if Koyama requested a retransmission without such status, he could not receive one “without Ōno’s domain leadership sending a correspondence to the leading officials at the domain office in Fukui.” This was an outcome Kasahara was hoping to avoid because he felt it would taint the achievement of Ōno’s vaccinators, who “had not let the vaccine go extinct even once.” Clearly, Kasahara was hoping to maintain domain-authorized retransmission as a lever to discipline and motivate vaccinators within each domain. At the same time, he acknowledged that clinics in rural exclaves like Nishikata might require retransmissions from neighboring territories to remain feasible. When Ōno’s vaccinators notified Kasahara that they intended to follow his recommendation and open a “separate clinic” in Nishikata, Kasahara sent a letter to the chapters in Fuchū and Sabae to inform them of that fact.

In this manner, the perpetuation of vaccinations in Echizen province depended on the authority of domain rule, yet was impeded by its fragmentation. It took the abolition of domain rule in 1871 to bring the territorial geography in line with the vaccinators’ need for stronger and more centralized governmental control. But even centralization did not result in full coverage right away. In the second half of the 1880s, the vaccination rate in Fukui prefecture finally crossed the eighty-percent mark [Yanagisawa, 2018, p. 59]. This timeline shows that local structures of control and coordination remained crucial for the implementation of vaccinations, just as they had been under the Tokugawa regime.