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Long before vaccination became a routine part of public health, variolation confronted communities with a difficult choice: accept a managed risk or face the greater uncertainty of smallpox. This history follows the movement of the practice across cultures and borders, the disputes it provoked, and the institutions that tried to build public confidence. It examines medical evidence, religious and political arguments, personal fear, and unequal access without treating resistance as simple ignorance. The result is a grounded account of how prevention became a public responsibility.