Health ties between Spain and Philippines

Here is a beautiful story from our medical history. It tells the story of how smallpox was eradicated from the Philippines and the world. I wrote this article to commemorate the close ties between Spain and the Philippines.

Two centuries ago, on April 15, 1805, Dr. Francisco Xavier De Balmis and 25 Mexican children reached the port of Manila, carrying with them the lifesaving vaccine for smallpox. Using the orphan children as living repositories for the vaccine, Dr. Balmis initiated the anti-smallpox campaign in the Philippines. From this seminal beginning, we can better appreciate the WHO declaration of a world free of smallpox in 1980.

Discovery of the smallpox vaccine

Edward Jenner describes smallpox as the “severest scourge known to humanity.” In Europe, in the late 18th century, an average of 400,000 people died yearly of smallpox. Through hard work and persistence, Jenner discovered a means to prevent smallpox by injecting the exudates from a cowpox pustule to the arm of eight-year-old James Phipps on May 14, 1796. Jenner’s vaccine elicited much debate, but his discovery was later accepted by the medical community.

A few years after this breakthrough, the King of Spain’s son died of smallpox, and the king swore to help rid the world of smallpox using the method discovered by Jenner. Thus, on September 1, 1803, King Charles IV issued a royal order for an ambitious vaccination expedition to Spain’s colonies, including the Philippines. King Charles appointed Spanish physicians, Dr. Francisco De Balmis and Dr. Jose Salvany, to lead this mission of mercy.

The balmis expedition

On November 30, 1803, Balmis and his associates left the Spanish harbor of La Coruna and travelled to Puerto Rico and Venezuela, vaccinating thousands of people along the way. Reaching Venezuela, they divided into two groups. First, Dr. Salvany journeyed to various countries in South America, where the rigors of travel and work took their toll and Salvany died at 34 years old

Fortunately, Dr. Balmis travelled to Mexico, Central America, and the Philippines. In Mexico, Dr. Balmis took 25 orphan children, ages four to six years old, from the provinces of Morelia, Guadalajara, Queretaro, Zacatecas, Fresnillo, and Sombrerete, and set sail on February 5, 1805.

Why were the Mexican kids so crucial to the trip? We must remember that in those times, there were neither ice plants yet to preserve the vaccine nor were there airplanes for quick transport. Thus, the smallpox vaccine had to be kept alive by arm-to-arm vaccination from one child to another during the many months of ship travel.

Each child would be a repository of the vaccine for around 10 days. After which, an extract from the child’s arm lesion (lymphatic fluid) would be placed into the next child, and so forth. Balmis vaccinated two kids at a time for safety, just in case something terrible happened to one. Thus, by computation, 25 kids could carry the vaccine for a three- to four-month trip, if all went well.

Dr. Balmis arrives in manila

As fate would have it, just two months later, Balmis and the children successfully arrived in Manila with much fanfare and rejoicing. Quickly, Balmis guided the Spanish authorities in Manila on how to perpetuate the vaccine. Balmis wrote with much foresight that their goals were 1) to spread the benefit of vaccination to the Philippines and 2) to assure its perpetuation. Balmis said that Manila was the ideal site for a central board of vaccination to coordinate a nationwide vaccination campaign.

Did Balmis’ efforts succeed? Probably. By 1806, a smallpox institute and vaccination board were established in Manila. Two years later, immunizations were already being administered in the provinces.

In 1850, borrowing a new technique perfected in Italy, local authorities set up a vaccine farm using carabao calves. Thereafter, detailed regulations regarding smallpox vaccination were issued in 1851, 1873, and 1893. But despite these efforts, smallpox epidemics still occurred, most prominently in 1886.

When the Americans arrived in 1898, one of their first efforts was to build the Bureau of Science, where smallpox vaccines and other vaccines were produced in large quantities. By 1905, rigid and systematic efforts on vaccination were enforced.

The last serious smallpox epidemic occurred in 1918. And by the time the Americans left in the 1940s, smallpox had ceased to be a major public health threat. In 1980, the WHO finally declared the world free of this deadly virus.

Lessons

Even now, the world still remembers fondly the exploits of Dr. Balmis, who sacrificed and endured great peril to start the Philippine smallpox campaign. Filipino historian Jose Bantug writes that the introduction of vaccination in the Philippines “reads like an epic poem” worthy of pride and praise.

The great Edward Jenner refers to the Balmis expedition as follows: “I don’t imagine the annals of history furnish an example of philanthropy so noble, so extensive as this.”

But more than a beautiful story, the Balmis expedition underlines the close link between Spain, Mexico, and the Philippines.

Today, our world is threatened not just by deadly viruses but also by war, conflict, and the spread of terrorism. It may serve us well to remember the courage and the legacy of Dr. Balmis and 25 Mexican children who, two centuries ago, spread a message of hope and peace in this part of the world.