In 1959, health inspectors and radio police desperately tried to search for an infant’s father – a taxi driver – at the centre of a smallpox outbreak in Singapore, but to no avail. Revealing the practice of contact tracing, a newspaper article titled “25 Contacts of Sick Baby go into Quarantine” reports how despite the threat of smallpox, many people still did not get the free vaccinations that were being provided by the government at the time.

This section features several artefacts and documents related to vaccination practices
and policies in Singapore over the years.

 

Portrait of Municipal Health Officer Dr W. R. C. Middleton

This oil painting of Dr William Robert Covin Middleton by the Russian artist, Anatole Shister, was one of three portraits placed in the committee room of the new Municipal Offices in 1929. The other two were that of Alex Gentle and Robert Pierce, and the trio was hailed as the “Three Servants of Singapore”.

Anatole Shister | 1928 | Oil on canvas | 71 x 54cm | HP-0060

Depicted in this portrait as a genial figure, Middleton served as the Municipal Health Officer for 27 years (1893−1920). He addressed major issues plaguing public health at the time and put in place several health measures which are still practised today. He also made several recommendations to improve local water supply and sanitation, which were key factors in controlling the spread of diseases such as cholera.

In 1920, the quarantine facility known as the Isolation Hospital (begun in 1913) on Moulmein Road was renamed Middleton Hospital. This became a branch of Tan Tock Seng Hospital (TTSH) in 1985, when it was renamed the Communicable Disease Centre (CDC). In 2018, the CDC was closed and its operations moved to the National Centre for Infectious Diseases (NCID), a new building opposite TTSH. This new facility with 330 beds was inaugurated in 2019.

Several institutional measures were put in place during Middleton’s time, such as the Registry of Births and Deaths, chemical and bacteriological examination of water, introduction of water-borne sewage systems, and the laying of the foundations for anti-malarial plans.

Vaccination certificate issued by the Municipal Vaccination Depot, Kreta Ayer

1932 | Paper | 14.3 x 16.5cm | XXXX-02415

This 1932 vaccination certificate mentions the Quarantine and Prevention of Disease Ordinance of 1915. The triangular seal shows that the Municipal Vaccination Depot was located at Kreta Ayer. The 1915 ordinance was put in place to make provisions for preventing the introduction and spread of infectious diseases such as plague, cholera, smallpox, yellow fever and others affecting human beings and animals. To prevent the introduction of infections from abroad, immigrants also had to be vaccinated before they entered the colony.

This bill also consolidated and amended eight other ordinances, including the requirement that all students enrolling into government schools had to be vaccinated, as mentioned in this certificate.

Vaccination certificate issued by National Quarantine Service, Amoy

1937 | Paper | 10.5 x 14.5cm | Gift of Yap Hong Gek | 2007-00037

Documents such as this certificate show how immigrants to Singapore had to carry proof of vaccination from their home countries. In an age when cross-border travelling was prevalent, the threat of an epidemic was always imminent. As such, land borders and ports began to be controlled through policies that restricted free travel.

As early as 1868, the Quarantine Ordinance (enacted in 1886) was approved to prevent and control contagious diseases. The immigration restriction ordinance introduced in 1928 and implemented in July 1930 ended the era of free immigration. In 1933, a fixed quota was introduced to limit the number of male adults of any race to be admitted to Singapore every month.

Amoy (present-day Xiamen) is part of the Southeast Fujian province in China and has been an active trading port since the 16th century. The region experienced a large-scale migration of Hokkien speakers to Singapore and other parts of Southeast Asia in the early 19th century.

Vaccination certificate issued by the Swatow Quarantine station

1937 | Paper | 10.5 x 13.7cm | 2008-01146

This vaccination certificate was one of the travel documents issued to Mdm Lee Ah Noi when she left China for Singapore in 1937. The document shows that she received inoculation against cholera. An infectious disease, cholera gained prominence in the 19th century when there was a deadly outbreak in 1817. Since then, there have been at least seven pandemics affecting people across the world.

Swatow (present-day Shantou, on the eastern coast of Guangdong in China) was one of the treaty ports from which many Teochew-speaking people travelled to Singapore and other parts of Southeast Asia in the 19th century.

Diploma of the Royal Jennerian Society
to Sir Thomas Stamford Raffles

This diploma was awarded to Sir Thomas Stamford Raffles (1781−1826) by the Royal
Jennerian Society on 30 March 1825 in recognition of his support for smallpox vaccination in Java.

1825 | Copper engraving, mounted in a gilt frame and signed in ink

47.1 x 40.1 x 1.6cm | Gift of Tang Holdings Pte Ltd | 2019-00364

The Royal Jennerian Society was founded on 19 January 1803 by Edward Jenner (1749−1823) to promote smallpox vaccination and eliminate the disease through inoculation. The Prince and Princess of Wales were patrons of the society. Jenner is represented in this diploma as a statue on a bas-relief depicting a cow with a milkmaid and children. He holds in his hands the dead python of disease – smallpox. The illustration alludes to his first experiment in which he took pus from cowpox lesions to provide protection against smallpox. A glimpse of London can be seen through the triumphal arch with the Royal Arms, which features scrolls bearing the names of the society’s members.

International certification of vaccination or revaccination against cholera

10 May 1961 | Paper | 20.4 x 15.9cm | 2008-01145

Issued by the Port Health Officer, this international certificate was among the various travel documents belonging to Mdm Lee Ah Noi. She probably received it while in Singapore en route to China from Muar in Malaya.

Cholera is an infection of the small intestine caused by the bacterium Vibrio cholerae − a discovery accorded to the German bacteriologist Robert Koch in the 1880s. This water-borne illness is characterised by severe diarrhoea and vomiting that causes dehydration. Occurring in both an endemic and epidemic manner, cholera outbreaks are commonly found in places with no proper water and sanitation.

In 1973, having found the whole-cell cholera vaccine ineffective, the World Health Organization abolished the requirement established by the International Health Regulations for a certificate of vaccination against cholera. Although oral vaccines are now available, such travel documents are no longer necessary.

Vaccination notice issued by Singapore Municipality

1940 | Paper | 37.1 x 18.8cm | 1995-01829

This bilingual notice was issued to a resident for not having vaccinated her child, whose birth had been registered. The penalty for not complying was a fine of ten dollars. The notice also lists the three Municipal Clinics located in Kreta Ayer, Prinsep Street and Joo Chiat Road, where free vaccinations were given.

Following the introduction of the Vaccination Ordinance in 1868 in conjunction with the introduction of the Registry of Births and Deaths, it was made mandatory for children whose births were registered in Singapore to receive vaccinations against infectious diseases such as smallpox before the age of six months. Providing vulnerable groups such as infants with antibodies at an early stage can help build resistance, hence lowering their chances of getting infected. In 1938, when vaccination against diphtheria was developed, it also came to be included.

A vaccination certificate issued during the Japanese Occupation

1942 | paper | 10.3 x 12.5cm | Gift of Low Sze Wee | 2008-06736

This certificate indicates that two vaccines for both smallpox and typhus were issued, listed here as “第一” (number one) and “第二” (number two). The certificate also includes space for the thumbprint of the person being vaccinated (“本人拇印”) and the doctor's name.

Fearing the spread of diseases, the Japanese implemented a system of compulsory vaccination against smallpox and typhus in April 1942. Those who were inoculated were issued with certificates such as the one featured here. The Shonan Shimbun claimed that, by June 1942, over 600,000 people had been vaccinated against typhoid and over 300,000 against smallpox, as compared to less than 30,000 before the war.

In 1943, the pre-war Medical Department and Sanitary Boards were replaced by a new department created by the Japanese, called the Eiseika.

CERTIFICATE OF BCG TESTING AND VACCINATION

1962 | Paper | 11.3 x 8cm | Gift of Heng Lee Kok | 1997-00127

Since the mid-1950s, this slip of paper has come to mark a rite of passage for Primary Six schoolchildren in Singapore, as is the resultant mark on their arm. The Bacille Calmette-Guérin (BCG) vaccination is meant to provide immunisation against tuberculosis meningitis among children.

The BCG vaccination was first introduced in Singapore in 1957, but was met with initial reservations within the medical community. In 1959, Dr N. C. Sen Gupta, Medical Director of Singapore’s Anti-Tuberculosis Association, wrote to The Straits Times to express his concern should the BCG vaccination be made compulsory, since the medical research behind the BCG was fairly new at the time. However, the efficacy of BCG vaccinations soon allayed these concerns.

In the past, children were required to receive BCG injections twice: once at the infant stage, with a revaccination done by health officials in schools about 12 years later. However, since 2001, BCG revaccination has been phased out by the Ministry of Health.