Kasahara Hakuō was limited in his ability to share the vaccine by his role as an envoy of the domain. Although he was a town doctor by status, he had been ordered and funded to obtain the vaccine by the domain, and thus had to prioritize the domain's needs by bringing the vaccine to Fukui. At the same time, Hakuō was also indebted to his professional network of physicians of Dutch medicine, which included his teacher Hino Teisai as well as many of his fellow pupils. These physicians eagerly awaited transfers and Hakuō was aware of the importance of this network. In his 1848 proposal for importation of the vaccine from China, he proposed distributing the vaccine to physicians along the way from Nagasaki to Fukui to be prepared for the event of a sudden disruption [Fukui-ken igakushi, p. 175]. Rather than abiding by the domain's territorial claim and rejecting his colleagues' requests, he emphasized that some sharing with people in other territories was in the domain's best interest. 

On 11/1, while Hakuō was still in Kyoto, three physicians including Teisai's younger brother Katsumin visited from Osaka and Sakai and asked Hakuō for a transmission. Hakuō accepted their request after considerable hesitation. In a written statement addressed to the two men from Osaka, he stressed that he had not yet completed his mission of bringing the vaccine to Fukui, hinting that he considered any distraction from that mission potentially inappropriate. Yet, he added that he had decided to approve this transmission because he had been ordered to establish a vaccination clinic in Kyoto to serve as a resupplier for Fukui, and that the same logic might apply to Osaka [Senkyōroku, p. 5, 6]. 

Upon transmission, Hakuō issued a certificate that specified the purpose of the Osaka transfer as "multiplication" (hanshoku no tame). On 11/7, Osaka's first vaccination clinic opened in the neighborhood of Furutemachi in a formal ceremony, with Kasahara Hakuō and Hino Teisai in attendance. Torn between loyalty to his domain and to the more far-flung network of his profession, Hakuō connected the two by emphasizing the spatial requirements of vaccine preservation.