The Case of Saga Domain
An event in the early history of vaccinations in Saga domain (Hizen province) illustrates the risks of sharing the smallpox vaccine widely without establishing a sound framework for maintaining accountability and coordination. Saga's domain physicians were not only central to importing the cowpox vaccine, but eventually built one of the most successful vaccination programs in the entire country. Even here, however, the program was off to a difficult start. Saga domain's vaccination office (intōkata), founded in 1849 and located in the castle town, initially transmitted the vaccine to multiple physicians and allowed them to conduct vaccinations at sites of their own choosing. But by the summer of 1850 the vaccine had gone extinct, and the domain government reacted by ordering the re-concentration of operations to the vaccination office in town, arguing that many receiving physicians had failed to "connect" their chain of transmission and parents had gotten confused about where to take their children. It seems that a high number of inexperienced vaccinators actually increased the risk of extinction, especially if they acted without any bureaucratic apparatus coordinating their efforts. At the time, Saga domain was able to obtain a re-transmission from Koshiro, one of its branch domains (Aoki 2018, 128).