There were in fact more sustainable ways than the village relay method for getting the protective cowpox virus under the skin of rural children. Yanagisawa Fumiko has identified one such method in Echizen province by investigating the case of Sabae domain.

Read the two research papers (in Japanese) that have informed this page: Yanagisawa 2019 and Yanagisawa 2021. 

Sabae domain was the last domain to be established in Echizen province. It was pieced together in 1720 from scattered lands formerly governed by the shogunate and other entities and given as a fief to the descendant of a formerly powerful shogunal courtier.

Sabae's physicians had received transmissions from Kasahara in 1850, and in 1859 and 1860 they conducted vaccination campaigns in Ikeda, a group of mountain villages governed by Sabae domain about 20 km away from the domain headquarters and the clinic. Many details about these campaigns remain unknown, but it is clear that they were large-scale undertakings, covering almost all of the domain's villages in this area (35 villages in 1859 and 31 in 1860). In that sense, they were more successful than Kasahara's campaign to the coast.

The few sources surviving from these campaigns (which might have taken place also in other years) show that Sabae's physicians did not try to build chains between villages. Instead, they went to one village at a time and used it as a base camp to vaccinate children from up to three village communities. Vaccination events were held every six days during the spring, summer, and fall, but the date for each community was determined by lot rather than geographic proximity. Village headmen were asked to report the names of two local children who could be sent to Sabae as "pox bases" to prepare for the big day. This method gave physicians greater flexibility than village relay. First, they could easily line up villages of different population sizes on their itinerary because they did not depend on "pox bases" from a previously visited village. Second, they could rearrange the schedule to suit villagers' needs, especially their agricultural calendar. Third, they did not need to fear interruptions due to transportation problems—a major worry in a mountainous area such as Ikeda. By 1859, vaccinations in Echizen province, including Sabae, were probably established enough to send teams of vaccinators into the mountains. 

Like village relay, this system, too, could not have functioned without governmental coordination. But Sabae domain was more effective than Fukui domain in involving local leaders. The village group headman (ōjōya) of the village group in Ikeda (38 villages) was in charge of coordinating the vaccination schedule, and village headmen below him regularly identified unvaccinated children to be used as "pox bases." As wealthy peasants, these leaders were deeply familiar with local conditions in their communities. What is more, Sabae's village group headmen, though no samurai, were unusually powerful, perhaps precisely because this domain territory was so incoherent and the grasp of domain government weak.

In Fukui domain, by contrast, Kasahara found it difficult to gain the cooperation of village headmen, especially those whose villages had already been vaccinated. Although subjects on the coast were quite eager to have their children vaccinated, it seems that their village leaders perceived vaccination management as a burden, adding another difficulty to the implementation of village relay that was not inherent in the procedure itself. Failure to involve local leaders also thwarted part of Sabae's own vaccination campaign. In the case of one particularly remote exclave, Shikadani in the Ōno district (see the map above), Sabae's domain physicians did not consult many of the local village headmen in advance and thus received no help from them in persuading skeptical villagers and setting up vaccination stations. Among the villagers of that exclave, only those with the will and means to travel to the castle town of Ōno domain, which was closer than the main village of Sabae domain, thus had regular access to smallpox vaccinations [Yanagisawa 2021, 70-73].

In the absence of a strong central government, reliance on local community leaders was the next best solution. These conditions persisted long into the Meiji period, and local leaders therefore remained central to vaccinations in the Ikeda area for decades to come.

Follow the link below to explore the next two pathways on vaccination practice in Ōno, another domain in Echizen with a relatively scattered territory.