This article explores the tensions between well-intentioned humanitarianism and coercive colonialism during smallpox outbreaks in eighteenth-century Guatemala, when the state extended inoculation programmes to its predominant, culturally diverse Maya communities. Evidence from anti-epidemic campaigns shows public debates broadly comparable to the current COVID-19 crisis: debates about the measurably higher mortality rates for indigenous people and other marginalized groups; debates about the extent of the state’s responsibility for the health of its peoples; and debates on whether or not coercion and violence should be used to ensure compliance with quarantines and public health campaigns. While inoculations provided medical assistance and material help to Maya communities, and resulted in demonstrably lower mortality rates from smallpox, at the same time they functioned as avenues for the expansion of colonial power to intervene in the daily lives of people in those communities, characterized by colonial actors as necessary for their own good, and for the broader public good.

Drawing on the rich but mostly overlooked history of Guatemala's anti-smallpox campaigns in the 1780s and 1790s, this paper interweaves an analysis of the contribution of colonial medical knowledges and practical experiences with the construction and implementation of imperial science. The history of the anti-smallpox campaigns is traced from the introduction of inoculation in Guatemala in 1780 to the eve of the Spanish Crown-sponsored Royal Maritime Vaccination Expedition in 1803. The paper first analyses the development of what Guatemalan medical physician José Flores called his ‘local method’ of inoculation, tailored to material and cultural conditions of highland Maya communities, and based on his more than twenty years of experience in anti-smallpox campaigns among multiethnic populations in Guatemala. Then the paper probes the accompanying transformations in discourses about health through the anti-smallpox campaigns as they became explicitly linked to new discourses of moral responsibility towards indigenous peoples. With the launch of the Spanish Vaccination Expedition in 1803, anti-smallpox efforts bridged the New World, Europe and Asia, and circulated on a global scale via the enactment of imperial Spanish health policy informed, in no small part, by New World and specifically colonial Guatemalan experiences with inoculation in multiethnic cities and highland Maya towns.