To Vax or Not to Vax: The Debate as Old as Vaccines Themselves

ENDNOTES

Since 2020, the modern world has been bombarded with the latest pandemic, COVID-19, and countries around the world have launched vaccination efforts to mitigate its effects. Along with the virus, vaccine controversy has also spread. Just as COVID-19 is not the world’s first pandemic, this is not the first time that vaccines have been debated. The first vaccination campaign was aimed against smallpox, a variola virus that has existed for approximately 3000 years and has been the source of epidemics across the old world since the eleventh century.1 The Spanish Royal Philanthropic Expedition (SRPE), aimed to eradicate smallpox through a widespread vaccination program in the Americas in 1803. It had philanthropic motivations on the surface, which hid the Spanish colonizers’ need to ensure a healthy, exploitable labour force. This vaccination campaign was riddled with minority exploitation, European arrogance, and untested science. What are the major similarities and differences with the current pandemic and the first vaccination campaign in 1803? While the SRPE was less effective, researched, and widespread than COVID-19 vaccines, it received much of the same backlash started humanity’s use of vaccines to fight viruses. Smallpox epidemics had devastating effects on the Indigenous populations, but with the novel introduction of Edward Jenner’s vaccine, the Spanish monarchy decided to try and stop the spread.2 After smallpox was introduced to the Americas in 1518, Indigenous Americans experienced smallpox case-fatality rates over fifty percent.3 Europeans were not as drastically affected by smallpox after the introduction of variolation in 1717.4 While variolation, the introduction of contents of a pustule from an infected person to a healthy person, was commonly practiced, it still had a 2% fatality rate and was accompanied by a plethora of complications such as the transmission of syphilis and severe scarring.5 In 1797, Edward Jenner discovered that individuals could be inoculated with the contents of cowpox pustules to protect them from the smallpox virus.6

Edward Jenner vaccinating a child with his new cowpox vaccine, University of Alicante, “Balmis Bicentennial Images.” Balmis Bicentennial, 2019. Fair use.

Figure 2: The Spanish Royal Philanthropic Expedition’s ship, the María Pita, departing from La Coruña in 1803, University of Alicante, “Balmis Bicentennial Images,” Balmis Bicentennial, 2019. Fair use.

This was the first official vaccination and the first step in breaking the cycle of smallpox epidemics plaguing the Atlantic world.7 Smallpox had devastating effects on the Americas and catalyzed the invention of the smallpox vaccine. After a severe outbreak of smallpox in 1802 in Nueva Granada, the colonial administrators requested that the Spanish king send a vaccination program to the Americas.8 In response, the SRPE, led by Francisco Xavier Balmis, departed on the ship named María Pita in 1803 (Figure 2), with a commission to vaccinate people in the Spanish colonies.9

Considering the advancements in science since the eighteenth century, the vaccine manufacturing, transport method, and distribution of the premier smallpox and COVID-19 vaccination efforts are vastly different. Consider the issue of securing ultra-low temperature freezers to transport and store the mRNA vaccines for COVID-19.10 This logistical issue has made access to the vaccines difficult in our contemporary world, especially in developing nations where access to extremely cold storage is limited.11 During the early nineteenthcentury smallpox epidemic, Balmis also encountered the challenge of transporting the vaccine as the vaccine fluid could not be kept alive on the transatlantic voyage. In the era before electricity, Balmis used a method that, while ingenious for the time, is frightening to the modern reader. To circumvent this obstacle, he transferred the vaccine fluid from one orphan child to another throughout the voyage.12 These children, essentially portable vaccine manufacturers, were infected with the disease so that they generated blisters (Figure 3); then Balmis drained the pus and transferred it to the next child.13 Using this human chain method, he was able to transport the vaccine across the Atlantic to the people of the Americas.14 The Spanish government justified what we might consider a grave ethical injustice by promising any surviving orphans a formal education after the expedition.15 Balmis’s free vaccine with onsite manufacturing differs greatly from the pharmaceutical company rivalry in the recent pandemic.

The scope and documentation of the SRPE and the current COVID-19 pandemic are vastly different. The SRPE was a worldwide vaccination effort, spearheaded solely by Balmis, which differs from the current government-led COVID-19 vaccination programs. The 2021 vaccine distribution campaign has been spearheaded by the

governments of individual countries and provincial or state health authorities within those countries who required vaccination documentation. Some provinces required proof of vaccination which acted as a passport to allow entry to non-essential activities. This led to backlash over the past year. The SRPE sailed to the Caribbean, Mexico, Guatemala, Venezuela, down the coast of South America, the Philippines, and China distributing vaccines worldwide. Balmis’s expedition independently vaccinated many different populations without any documentation.16 When Balmis landed in San Juan de Puerto Rico, the government officials rejected him as the area had already been vaccinated by another independent physician.17 However, Balmis was convinced his was the only true vaccine and he proceeded to reinoculated the people unsuccessfully.18 Despite the vaccine documentation debates in the COVID-19 pandemic, they have been effective in preventing these types of miscommunications.

The social perceptions of the two vaccination campaigns are surprisingly similar. Edward Jenner, the inventor of the vaccine, wrote in a letter to a friend that Dr. Moseley, who had written an anti-vaccination article, had “slain more men than the sword of Bonaparte.”19 This quotation demonstrates the two sides that modern readers are bound to recognize: support for and opposition against vaccination. Like today, those who opposed the first vaccine had no experience in vaccinations, and in later years Dr. Moseley confessed that his claims against the smallpox vaccination had been made “on the basis of theory” and that he could not actually recall where he had found such information.20 In the current pandemic, most governments endorsed mandatory vaccinations, and while the Spanish colonies endorsed the smallpox vaccination, they had no universal way to enforce it systematically. Many Indigenous peoples who were physically forced to receive the smallpox vaccination were not informed of what the vaccine pertained, resulting in the belief that their children were being poisoned.21 Balmis wrote that twenty Indigenous mothers whose children were vaccinated against their will “went to the apothecary, demanding an antidote against the venom that

Figure 4: Vaccination method in 2022 using Pfizer-BioNTech COVID-19 vaccine in Toronto, Canada. CBC news, Fair use.

had just been introduced into the arm of [their children].”22 In contrast, today’s governments used privilege incentives to encourage vaccinations and launched many COVID-19 education campaigns, a much more ethical vaccination process. Even so, in both the eighteenth and twenty-first centuries, humanity’s tendency to protest what is unknown prevailed in both cases and led to similar social perceptions of the vaccines.

Balmis’s methods may not have been ethical and in accordance with today’s health and safety regulations; his worldwide administration of the smallpox vaccine marked the initiation of vaccinations which have allowed humanity to rise against disease. Vaccination manufacturing through biotechnology, refrigerated modes of transportation, and globally enforced health standards have improved vaccine efficacy, transportation, and regulations. Unfortunately, one thing that has not changed is how disadvantaged people groups lack access to vaccines and are often taken advantage of by authority figures. Balmis used orphans as vaccine hosts to vaccinate Spain’s dying Indigenous workforce. Today racial and ethnic minorities and developing nations are neglected due to lack of funds, supplies, and personnel. Smallpox is a perfect case study for how effective vaccination programs can be. It took over 150 years, but in 1980, the World Health Assembly declared the world free of smallpox: a feat solely due to global vaccination efforts.23 Despite ethical concerns, the first vaccination program was eventually successful in protecting people from smallpox, and with global cooperation, humanity has a fighting chance against the pathogens that plague us today.

Map of Francisco Xavier Balmis’s expedition, University of Alicante, “Balmis Bicentennial Images – Expedition of Francisco Balmis,” Balmis Bicentennial, 2019. Fair use.

Haley Friesen

Biology major, Chemistry minor