Epidemics of Fever

In an impending world of real and imagined pandemics spawned by ‘natural’ and simulated bioterrorist attacks, is there a place for alternative therapies as a public health strategy during an epidemic? When the Public Health Departments of the South Indian states pressed the Indian Systems of Medicine and Homeopathy into service in the face of the Chikungunya epidemic of 2006, this rather novel move was publicly denounced in two editorials of The Hindu. This article attempts to make sense of the denouncement, offers a genealogy of the act and attempts to argue that neither the denouncement nor the attempt to offer alternative cures to seemingly incurable diseases are new. It proceeds to argue that part of the reason stems from seeing many of the epidemics of fever through a particular epistemic lens that posits them as being incurable; and in virtually all these instances the attempt is to find a prophylactic vaccine with the smallpox vaccine as the prototype of this continuing quest. By the same token this jaundiced vision is unable to consider other forms of therapy as a possible solution. This may have important implications for science and public health policy in this country and I hope this paper will provoke us to think this through.

Introduction
If the Americans were allowed to write the ‘public health response to pandemics’ script, then the dividing line between ‘natural’, simulated and engineered pandemics may become utterly fuzzy if not altogether passé. Given their predilection for doomsday scenarios and a long preoccupation with the apocalypse, along with the current evangelical literature on the coming of the anti-Christ, all natural disasters or pandemics, rather than signalling a history of social neglect in their effects, may well signal supernatural causes at work with terrorists as mere handmaidens! In any case, simulated war games from the closing decade of the last millennium, increasingly played in real time by high powered mathematical modelling has meant that current and future epidemics may no longer be ‘natural’.

One example of this was a war game played a few months before 9/11 called Dark Winter. It simulated a smallpox attack on the American Homeland and predicted that in the case of a real one “civil society” in America would collapse due to massive civilian unrest brought about by a collapse of the medical services.

The solution to such a scenario offered by those who scripted the game came in two forms: the manufacture of 286 million doses of smallpox vaccine; and the rather self-confident assertion that in the case of an outbreak it could be contained, if not eradicated, by 'search and destroy' methods, whose hallmark was the ring vaccination strategy perfected in India. This assertion was made as some of the key participants in the war game had personally crafted and participated in the last great and monumental operation launched against smallpox in the Indian sub-continent.

It is quite clear that at the heart of this strategy were the vaccine and its mode of deployment. But in a replay of the past there was a widespread suspicion of the State; the fear of vaccine related morbidity and mortality; questions about whether vaccination was likely to set up an epidemic; and whether the vaccination programmes were at all necessary. The suspicion was made worse by the claim that the American Senate had approved a clause in the MOU with the manufacturers of the vaccine which said that they may not be held responsible for vaccine related deaths or morbidity.

It is interesting that this public debate centred largely on the vaccine and its possible fallout. Although it seemed to question the motives of the war game and saw it as a ruse to legitimize the ‘war against terror’, it mimicked in a fundamental way the terms of the game. In what little has been put out on the game, the emphasis is not on the individual patient: not on the temporal movement of the disease or the virus through the person but its movement across a collective body; and not on the course of the illness and the possible treatment protocol but a tracking of the virus in terms of its collective effects. Under the twin heads of search and containment, patients are seen as actual and potential carriers of the virus; and containing its spread by segregation, quarantine and vaccination is seen as the primary task.

Persons here figure as patients primarily under the head of quarantine on the presumption that the disease has no 'cure'. Hence, smallpox patients with pustules all over them and very often inside them - the eyes, the throat, the intestines and the bones - can only be 'managed'. We can easily presume that in the event of an attack, and the ensuing epidemic, their number may overwhelm the medical facilities leading to a run on them. The state then is bound to be accused of doing both too little and too much: of not providing enough services of care, and of being ham-handed and draconian in its attempt to segregate, quarantine and vaccinate. Moreover, if history is any guide, it is eminently possible that there will be a crisis of faith not merely in the possible fallout of the vaccine but in the very power of the vaccine to protect. And if one couples this with the mode of deployment of the vaccine we may well have what the war game predicted: massive civilian unrest and the ensuing violation of democratic processes.

Chikungunya, South India, 2006
In the light of this, we may well want to ask if the 2006 epidemic of chikungunya in South India was a bioterrorist attack. A fact-sheet on chemical and biological weapons at www.cbwinfo.com 2 describes the chikungunya virus (CV) thus: ‘highly infective and disabling but … not transmissible between people’. Hence, ‘it would most likely be dispensed as an aerosol or by the release of infected mosquitoes. The disabling joint pain and fever, the lack of a suitable animal reservoir in western countries and its lack of lethality make it a very "clean" weapon that could be used against key civilian installations’.

This wonderful little ‘analysis’ of the CV leaves me a bit puzzled. Is it a “clean” virus that can be used in the West by terrorists from elsewhere, since there is no animal reservoir for the virus there? Or, is it a clean virus that the West can use elsewhere, since it cannot come home to roost because there is no animal reservoir in the West for it to take root? While I let the reader ponder over the puzzle, the fact is that its ostensible lack of lethality (“It doesn’t kill,” said Dr. Ramadoss, our Union Minister for Health; “It kills”, said the Kerala government)3 certainly makes it a “clean” and lovely weapon: it disables but does not kill! The same cannot be said for other epidemic fevers including dengue. They kill. And in the case of other potential bio-weapons like smallpox, they can be lethal, especially to people worldwide below the age of 25. This young population is supposedly vulnerable as the disease was globally eradicated by around 1980, leaving us with a virgin population of non-immunised young people who could die in droves if there were an outbreak of smallpox, given the fact that it is supposedly has a 30 per cent strike rate!

Why am I raising this? There are two reasons for doing so.

The first is prompted by the possible return of chikungunya in the spring of 20074, which is based on my travel in December of 2006 and January of 2007 across Ampara district in the South East of Sri Lanka. I was repeatedly told that the district was in the throes of a huge outbreak of chikungunya. According to our host, who was a leading doctor in the town and ran a poly-clinic and nursing home, there were 18,000 cases of chikungunya in Ampara alone. This seems to have been borne out by the fact that virtually everyone I met in the 10 days I was there had either suffered from it themselves or had had more than one member of their family come down with it.

It appears to me (and I hope I am wrong) that since the weather in Sri Lanka is warm round the year, the chikungunya epidemic is likely to be sustained in the island and may return later this year to South India. If it does, we will be faced with a very debilitating illness, which is seen by the allopathic profession as a self-limiting viral disease with no known treatment. But the fact remains that this self-limiting disease is accompanied by severe joint pain, and this pain very often persists from days to months even after the fever has passed5.

This brings me to the second reason for raising this issue. And the issue is about a possible course of action if it returns. I suspect we may see a replay of what we witnessed last year. And what did we witness?

Two editorials appeared in The Hindu toward the end of September and in early October 2006, saying that Chikungunya is a non-fatal and self-limiting disease.6 It has (like most viral fevers, including dengue) neither a vaccine nor a cure. Therapy is merely symptomatic and supportive. Hence, The Hindu editorials were unable to comprehend how alternative systems of medicine can claim to cure chikungunya when there is no cure; and how the state can possibly pander to this “quackery,” by not merely endorsing it, but by actively distributing homeopathic, ayurvedic and other Indian systems of medicine (ISM) drugs. It then proceeded to warn its readers of this unwarranted move and advised the state governments to only endorse supportive allopathic therapy and wait for the French and Americans to give us a vaccine that had been promised in a year.

Is it the case that in the case of chikungunya, purely on the strength of its supposedly non-fatal nature, The Hindu had the luxury to make this claim? Would we see a similar editorial in the case of dengue or some other fever epidemic that is fatal and has neither a vaccine nor a cure? I suspect we will. Would we see a similar editorial if there were an outbreak of smallpox, which has the oldest and the most well-established vaccine but no cure, and the state began to distribute ISM drugs to cure smallpox? I suspect the editorial will be shrill, irrespective of the fact that India and most of the world, with the exception of America and perhaps the UK, has no vaccine, and it may take quite a bit of money and time to produce a few hundred million doses of the vaccine7. I can prophesy the editorial claiming that when it is perfectly well known that smallpox has no cure and the only way to address it is through a prophylactic vaccine, how dare the state endorse and distribute unproven8 ISM drugs that claim to cure smallpox? It would probably say that we should get the vaccine from the Americans, irrespective again of the fact that the Americans may have only 286 million doses – one for each of their citizens?, though just the other day the American population crossed the 300 million mark – of the vaccine and may not be willing to give any unless it suits their self-interest9.

Are The Hindu editorials surprising? Are they either overtly or covertly functioning as the mouthpieces of the allopathic profession when they say that allopathic practitioners are worried by the turn of events and the state endorsement of alternative medicine?10 I believe not. It would be easy to say that they are partisans of a particular profession. But I believe they are partisans of a profession only because they genuinely believe that the allopathic profession is privy to a body of knowledge that is both universal and true. And if this body of knowledge claims that a virus is the cause then it is indeed the cause; and if it claims that viral fevers/infections have no cure, then there is indeed no cure. Hence, it is not surprising that the editorials are outraged by contrary claims, even if they are endorsed by a legal and expert entity of the state, called the Directorate of the Indian Systems of Medicine and Homeopathy.

The Hindu editorials are symptomatic of a set of widespread beliefs that are of longstanding. One of these is that ‘viral fevers’, or fevers caused by a virus, are invariably not curable. In some instances, like smallpox, they have a preventive in the form of a vaccine. It has been presumed, ever since Jenner, and his supposed discovery of the smallpox vaccine, that prevention is better than cure and, in fact, prevention is indeed the only way to tackle the problem, as there is no cure, quite like it is with dengue or chikungunya today. Or a better example is the case of polio, and the current pulse polio campaign in India through the Oral Polio Vaccine (OPV) to eradicate polio.

What is the genealogy of these beliefs? Is there a historical and exemplary prelude to such a point of view, or are we confronted by something new?

Let me now turn to an exemplary and prototypical instance of this argument to show a historical precedent that is likely to be instructive both for its similarity and its difference. This prototype will show how the present is both a replay of the past, with The Hindu crying foul symptomatic of this replay, and the fact that it is forced to cry foul, being symptomatic of a departure.

Majumdar’s Oxymoronic Treatise of 1939
In 1939, a Bengali gentleman called Nagendra Kumar Majumdar publishes a book on smallpox and calls it “Smallpox: An Exposition of the Indian Systems of Treatment” (Majumdar 1939). I want the reader to note that this book is virtually an oxymoron. It flies in the face of then, and now, received wisdom that there is no treatment of smallpox and hence, as you can see, it is a text that cries out for an exegesis.

Majumdar reviews the prevailing state of smallpox in the Bengal presidency and in British India, and says quite rightly that allopathy has no way of treating smallpox and it only addresses the issue by a prophylactic vaccine. He then proceeds to review the history of this prophylactic effort and shows that despite the continuous rise in smallpox vaccination, the mortality due to smallpox, according to the 1931 census, ‘had gone up to the appalling figure of 711,762 during the preceding decennial period’ ( Ibid: p.6).

The question then is: what is one to do about those who contract smallpox? Presumably, one offers supportive therapy, for about two-thirds to recover and the other one-third to die, given the case fatality ratio of about 30%. But the fact is that those who do survive, may survive with a sequel of pitting, blindness and scarring, that may lead at least some of them to wish that they were dead, and probably others with a lifelong stigma. In response to this rather distressing situation, Majumdar offers an exposition of the Indian system of treatment for smallpox, and lays out not one, but a number of possible therapeutic protocols that include drugs, diet and a regimen. It addresses different stages of the disease, its distressing after-effects and the question of how to prevent pitting, scaring and blindness in patients who do recover from the disease.

But it is not an insular text, as it takes into account the then ‘allopathic’ measures in terms of personal hygiene, fumigation, waste disposal, segregation and the type and quality of nursing that is required in treating smallpox patients. It also calls for a diligent pursuit of the various public health and sanitation measures put in place by the state. In other words, his monograph is not a substitute but a complement to the vaccination and sanitation programmme, and offers an alternative only in so far as he also offers a number of prescriptions of drugs that he says will prevent the onset of smallpox.

But his book was certainly an alternative, if not the only treatise, that directly addressed the 315,000 people who contracted and suffered from smallpox: that is, all those people, who in 1936, took the vaccine and were still afflicted, or all those whom the vaccine never reached. And by extension, all those who, year after year, were probably ‘persuaded’ by the state to take the vaccine in the belief that it was a sure prophylactic, only to come down with the smallpox; and all the others whom the vaccine never reached and was never going to reach. Although these ‘untouched’ may have been better off, as they may have followed some other indigenous protocol like the widespread practice of inoculation, which had a far better take rate and was accompanied by an attendant regimen that may have prevented many of the sequel in case they did contract the disease.11

Does it not resonate with the present? It indeed does. But there is a cardinal difference. Majumdar produced his treatise because after successfully treating smallpox in the Mymensingh Municipality (now in Bangladesh), his treatment was brought to the notice of the government by a member of the Medical Board. The government, after an enquiry, replied that they were aware of some indigenous methods of treatment, but they had no previous knowledge of the particular method referred to “… though they understand that the services rendered by the gentleman … during a recent outbreak of smallpox has been widely appreciated locally”. Majumdar than proceeds to say that he was asked as to whether he would give a demonstration in a recognised hospital in Calcutta, and what remuneration he would charge for his time and trouble. Majumdar sent a reply stating that he was perfectly willing, and would not charge anything for his time and trouble, only never to hear from the government again.

Majumdar’s oxymoronic treatise was the result, he says, of the Government’s deaf ear. His aim was to inform the educated public of the fact that smallpox could be treated and the afflicted need not lose hope. That fact that it could also be prevented by ways other than vaccination, which had a notoriously poor ‘take rate’ due to the poor quality of the vaccine and several other factors (Naraindas 1998), was probably a bonus.

What distinguishes 2006 from 1939? ISM and homeopathy practitioners, in the year 2006, not only hear from the state but, presumably, their therapeutic protocols are endorsed and actively and widely distributed. For someone like me, who has studied and written on the history of smallpox from 1700 to 1980 (Naraindas 1998, 2003a, 2003b), this is quite amazing. Perhaps, for the first time (I need to carefully research this) alternative medicines are being pressed into service for treating acute rather than chronic diseases. Perhaps, for the first time these acute diseases are fevers with a well-established allopathic aetiology; and the icing on the cake is that it is being pressed into service during an epidemic.

I see the editorial outrage from The Hindu as a symptom of this completely new phenomenon. The editorial bears witness to a transgression: how dare the state allow these non-scientific practices and beliefs12 into the hallowed portals of public health? Alternative medicines are all very well for ill-defined syndromes, psychosomatic diseases, for the alleviation of pain, and for all those chronic disorders for which allopathy has no answer. But fever? And not idiopathic fever but fever with an aetiology!

Does the entry of homeopathy, and especially ISM, into public health mark something new? I believe it does, and is probably part of a long-standing process after Independence, culminating (though not in any straightforward and linear way) in what is now called the “Mainstreaming of the Indian Systems of Medicine”. This is a whole new institutional form that needs to be studied and on which I am currently working. Does it also mean that alternative medicine has never been pressed into service for epidemic fevers? The answer to that is ambiguous and instructive for the present. It is ambiguous because by and large the state, almost by definition, cannot and has not endorsed these systems for such diseases. But community initiatives and personal and professional initiatives by practitioners have been widespread.

While the nineteenth century protest in India against vaccination and the continued turn to native inoculation is the obvious example, the best (and to some of our readers, a surprising) example of this comes from nineteenth century England, where what is now called naturopathy (also then called hydrotherapy or the water cure) was widely used as a cure for the smallpox and as a mark of protest against forced vaccination of the state by the anti-vaccination leagues and other such groups that were present throughout the length and breath of England. One of the better-known instances is the Gloucester epidemic toward the end of the nineteenth century.

Such movements spread well beyond England and produced, among others, the conscientious objection act13, and Mohandas Gandhi. Gandhi, an ardent advocate of the water cure, persuaded the South African health authorities to hand over one ward of plague patients to him. They did and the rest is history. All those who volunteered and offered to try his water cure survived the plague. Many of the others in the ward, including the poor nurse whom Gandhi could not persuade, died. Unfortunately, those who write on him treat his experiments with curing as some kind of idiosyncratic fad, or some moral and spiritual pursuit (which it certainly was), without realising that he was part of a very widespread movement that is now ironically a full-fledged degree course (under the same Directorate of ISM), is fully legal and licensed by the Indian State, and is called a Bachelor’s in Naturopathy and Yoga.

Are these naturopaths likely to be pressed into service if there is an outbreak of smallpox tomorrow? I suspect not. Do they have the wherewithal to be asked to be called upon? I do not think so. The reasons for that are partly self-evident and partly complex. But in the near future, if the current ISM intervention with chikungunya is ‘seen’ to be successful, then they may have the courage and be called upon!

If these alternative systems are indeed called upon, as they were for chikungunya and dengue, are they likely to work? They may not. But if they do not work, how are we to address and ‘judge’ their failure? Are we to merely compile statistics and say their rate of cure is insignificant? Are they to be judged by the canons of allopathy? Or, is it that they may not work for any number of reasons, none of which may have anything to do with the epistemic status of these systems?

They may not work because there may be a translation problem: the symptoms of chikungunya as defined by allopathy may not readily translate into a single category in another system. There may be an interpretation problem: alternative practitioners may interpret the symptoms differently and arrive at a diagnosis that may vary. There may be prescription problem: ISMs usually consist of drugs, diet and a regimen which may not be fully put out as information by the public health department or adhered to by patients. There may be a problem with the quality of drugs: drugs of poor quality may have been sourced by the state, bound as it is by a tender system, where the lowest bidder gets the contract and supplies substandard drugs, which are then ‘passed’ due to a corrupt health bureaucracy. There may be a problem with the competence of those advising the government on the protocols and methods of delivery, leading to the wrong choice of drugs. But the fact remains that while all this may have an enormous and critical bearing on the efficacy and success of the programme, they may not immediately call into question these systems as a valid body of knowledge, which is precisely what The Hindu editorials tacitly do. In other words, one is welcome to be critical of statecraft and its deployment of alternative medicines but one must do so for the right reasons. In fact, this is precisely what The Hindu advocated in another editorial on the clemency petition, where it said that the circumstances surrounding the Afzal case made it right for a grant of clemency: but for reasons other than the ones usually put out.

What may we learn from all this? That when a cure is offered by the alternative systems of medicine for diseases that have no cure in allopathy they ought not to be dismissed a priori. Other systems of medicine, premised on other theories, and not merely based on unbridled empiricism, may have other ways of reading the body and its ailments. In fact, the non-allopathic systems seem to turn an epidemic on its head by primarily focusing on the individual rather than the collective, on curing rather than preventing, on a cause inside the body in the form of the derangement of a humour, and on a therapeutic protocol that is ideally (though not necessarily in practice) individualised and includes drugs, diet and a regimen. All of these may have, and in fact do have enormous consequences and pose huge challenges in delivery during an epidemic and need to be addressed: but addressed in their own right. But where there is no preventive vaccine or cure, to rule these systems out of court a priori is unwarranted; and even when we do have a vaccine we must keep in mind that it (the disease) might still afflict a large number of people crying out to be cured.

The Epidemic as Serial Killer: the Paradigm of Prevention
The introduction of smallpox inoculation from Turkey into England in the 1710s heralds the paradigm of prevention. Being rather alien, it was absorbed within a paradigm of therapeutics and the management of disease (Naraindas 2003a; Miller 1957, 1981). But with the advent of Jenner and vaccination, the paradigm of prevention is truly inaugurated and rules supreme. Thereafter, histories of public health are all about the saga of the epidemic and its spread (a faceless serial killer who wages war on populations rather than individuals), or about the saga of the war that is fought against the faceless serial killer by vector control, vaccine, or a magic bullet.

There is not a single study of the saga of the care of those who are afflicted: they die quickly and leave no record, or recover quickly and may be scarred for life. Acute infections do not seem to lend themselves to an extended narrative mode, as is the case with chronic diseases.

Only in 2005, ironically because of the real or imagined fear of a bioterrorist attack on the ‘American Homeland’, and almost three decades after its global eradication, is it now acknowledged by the Americans that in the case an outbreak of smallpox, a mass vaccination campaign may not be either the right or the only route to take. After working furiously post 9/11 with monkeypox viruses, recent findings claim that anti-viral therapy is far better than post-infection vaccination. And the new argument is that even under the threat of an impending attack, since mass vaccination runs the risk of post-vaccinal mortality and large-scale morbidity in an increasingly immuno-compromised population, curing people infected with smallpox or preventing it by drugs rather than a vaccine should now be an integral part of a public health strategy (Jahrling 2005; Sittelaar 2006).

What lessons can we learn from this for chikungunya and dengue in India where there is no vaccine or anti-viral drug? Are we supposed to do what The Hindu advocates: wait for the Americans and the French to give us a vaccine! Or, are we to do what the colonial state did in 1939 to Majumdar? Or, do we laud what the state did in 2006 and urge our academic fraternity to study what the state did critically and carefully: that is, its turn toward a promise of cure and prevention by indigenous methods?

What indeed do we do if there is an outbreak of smallpox tomorrow?14 Wait for the Americans to give us vaccines or the still very experimental (and perhaps very expensive) anti-viral Cidofovir? Or, do we go back and re-read Majumdar’s treatise diligently and consult local and contemporary experts to see if it can be immediately pressed into service? If we do so we may find, as it is now being claimed by ISM doctors for chikungunya, that many of these drugs can be locally sourced, are widely available15, may be administered at home, and probably at a fraction of the cost.

‘IN KERALA, RAMADOSS INVITES IRE’ – this was the headline in the Indian Express of October 6, 2006. In response to Ramdoss’ remark that, “Chikungunya by itself can’t kill”, the Express said: ‘An angry Chief Minister VS Achuthanandan, whose government has begun forking out Rs 25,000 each to kin of those killed by the epidemic, retorted that he stood by his convictions that the deaths were caused by the blight alone. "If not, those making such statements should prove what else is killing so many," he said. The Congress-led UDF in the Opposition denounced Ramadoss' claim as "totally unacceptable", while senior UDF leader KM Mani slammed the minister for talking out before any scientific study on this aspect had been completed’.

7 After the global eradication of smallpox in the late ’70s, all stockpiles of the vaccina virus were destroyed except two: one in the Soviet Union and the other in the USA. From these stocks the spectre of smallpox has begun to haunt the world again, albeit through a new a genre: bio weapons and bio terrorism. This, as we pointed out above, spawned a series of war games (simulated exercises) by the Americans pre 9/11, with the most well known being Dark Winter run in June 2001. The scenario it created just needed 9/11 for the American government to start a vaccine production programme and subsequently to have its military and paramedical staff vaccinated. With the exception of the UK, that attempted to follow suit and some faint noises from Japan and possibly Brazil, the rest of the world may not posses any vaccine and appears to be a virgin field and seems starkly vulnerable in the case of a pandemic spawned by a bioterrorist attack.

8 The question of proof and evidence with respect to alternative medicine is thorny. I have broached this in a recent article called, ‘Of spineless babies and folic acid: Evidence and efficacy in biomedicine and ayurvedic medicine’. In Part Special Issue Edited by Helen Lambert, Elisa Gordon and Elizabeth Bogdan-Lovis: ‘Gift Horse or Trojan Horse? Social Science Perspectives on Evidence-based Health Care’, Social Science & Medicine, 62, 11: 2658-2669, 2006. The entire special issue is worth looking at. For now, all I can say is that if you set up protocols based on allopathic theory they may result in proving ayurvedic medicines as inefficacious.

9 The American investment in the global eradication of smallpox was between 1 and 2%. They recovered their investment every 26 days the world was free of smallpox. (A world free of smallpox meant that the enormous amount of money invested by them in early warning systems to prevent an importation from the third world, and its subsequent tracking down and eradication in case there was one, was now saved). The bulk of the expenditure was borne by the third world and, to paraphrase the then chief of WHO: this is a two billion dollar gift from the third world to the first world; and not a one-off gift but a gift given in perpetuity! See Naraindas (2003b) and Brilliant (1985).

11 Smallpox inoculation or variolation (these two words are interchangeably used), as opposed to smallpox vaccination, is the introduction of ‘live’ smallpox matter from the pustules or dried crusts of another smallpox patient. It was practiced throughout the world, and in India it was backed by professional variolators and a presiding deity. With the advent of vaccination, which was originally cowpox, variolation was portrayed both in India and Britain as a form of treason that needed to be outlawed on the ground that it set up epidemics, and hence was a public threat. Cowpox, in opposition, was portrayed as something that could not be communicated from patient to patient. I have argued elsewhere that the preference for variolation may have been due to the continuous failure of vaccination, making it a risky venture for individual patients. Variolation may have been preferred not only because it was tied to worship, but also because it was surer to ‘take’, and was a moment in a larger therapeutic structure. See Naraindas (1998 and 2003a)

12 There are a standard set of (often contradictory) ‘lay’ binaries that one is saddled with: Alternative therapies for chronic diseases and allopathic medicines (note how I unconsciously use the word medicines rather than therapies in conjunction with the word allopathy) for acute ones; the former for minor conditions and the latter for serious ones, and finally alternative therapies are preventive and allopathy is curative. This article inverts (not in any straightforward way) this usual stereotype and posits alternative therapies as being curative rather than being preventive. This parallels a cardinal and cognate binary in medical anthropology where alternative therapies are said to heal rather than cure - that is, they may heal a patient’s (subjective) illness rather than his (objective) disease. The tacit, and at times clearly stated, presumption in these binaries, especially the scholarly ones, is that non-biomedical or non-allopathic systems are systems of belief and not systems of ‘fact’. Hence the oft repeated phrase: ‘rituals of healing’ or ‘healing rituals’. But I am yet to come across ‘rituals of curing’ or ‘curing rituals’! The former seems idiomatically perfect (at least in English), while the latter sounds odd to say the least. For a part elucidation of these binaries, see Naraindas (2006).

13 People could say that their conscience, on religious grounds, did not allow them or their children to be vaccinated. This ‘conscious and conscientious’ religious dissent, I suspect, was not permitted in India. This notion of ‘dissent’ continues today, albeit selectively as in the past and in continuation with the past. For example, if you are Mennonite in America today you may not be drafted in the army because you believe in pacifism according to your tenets. When Muhammad Ali, however, claimed he was pacifist after converting to Islam and refused to be drafted, the claim was laughed out of court and he was invited to spend time in prison.

14 If one were to go by what the Americans believe and in turn have done it seems more than likely! They have vaccinated their armed forces and a significant part of their paramedical staff; and the continuous war games they run with simulated smallpox attacks seem to indicate that it is not whether there will be an attack but only a question of when it is likely to happen. And these war games, while on the one hand, may be seen as state craft by a war mongering state, and on the other as a continuation of a long tradition of obsession with the apocalypse, it is nevertheless eerie as it can also be seen as a self-fulfilling prophecy like 9/11, which was played out again and again in Hollywood. And the script for these medical war games is also written by Hollywood! And if this prophecy comes true, you may have a pandemic and a vulnerable world with no vaccine and the Americans with a vaccine: an all too familiar script!