First, Hakuō was acting on behalf of Fukui domain and his trip to Kyoto had been funded by the domain. On 11/1, while Hakuō was still in Kyoto, three physicians, including Teisai's younger brother Katsumin, visited from Osaka and Sakai and asked Hakuō for a transmission. Hakuō accepted their request after considerable hesitation. In a statement addressed to the two men from Osaka, he stressed that he had not yet completed his mission of bringing the vaccine to Fukui, suggesting that any distraction from that mission might be inappropriate. Yet, he added that he decided to approve this transmission because he had been ordered to establish a vaccination clinic in Kyoto to serve as a resupplier for Fukui and was able to apply the same logic to Osaka [Senkyōroku, p. 5, 6]. 

Upon transmission, Hakuō issued a certificate that specified the purpose of the Osaka transfer as "multiplication" (hanshoku no tame). On 11/7, Osaka's first vaccination clinic opened in the neighborhood of Furutemachi in a formal ceremony, with Kasahara Hakuō and Hino Teisai in attendance. Torn between loyalty to his domain and his profession, Hakuō connected the two by emphasizing the practical requirements of vaccine preservation.