Also known as the Balmis Expedition, it was a medical mission led by the Spanish physician Francisco Javier Balmis, a military doctor serving the King of Spain, Charles IV, from 1803 to 1806. Its main objective was to bring the smallpox vaccine to the Spanish colonies in America and Asia; the first medical campaign in the history of humanity, the most memorable journey in the annals of history.
Smallpox landed in the New World with the Spaniards who arrived there, leading to a dramatic population decline as the indigenous people had never come into contact with the virus and were therefore completely defenseless against it.
Let us remember that Jenner's vaccine was based on inoculation with the cowpox virus, which caused a much milder infection and conferred immunity against human smallpox.
The first and most challenging problem was finding a way to transport the live virus on a journey that, at best, would take no less than two months. The idea of embarking cows, the natural carriers of the virus, was considered, but the amount of fodder needed for their feed made it very problematic. Finally, Balmis conceived the idea of using children who, once inoculated, would transport the live virus. But which parents would consent to their children being inoculated with a virus that caused panic at the time? How could they be convinced of the minimal risk such inoculation entailed? Moreover, the Atlantic crossing itself was a significant risk. Solution: If parents were a problem, they would have to choose children without parents, that is, according to the terminology of the time, "foundlings," or children from orphanages.
Balmis contacted Isabel Zendal, the Rector of the Charity Hospice in La Coruña, to supply the necessary children. She agreed on the condition that she personally supervise the entire journey for as long as necessary.
Isabel Zendal is considered by the World Health Organization to be the First International Nurse, and Balmis himself said of her: "Through excessive work and different climates, she has lost her health. Tirelessly night and day, she has showered all her tenderness on the children like the noblest and most dedicated of mothers."
The children, numbering 22, were embarked on the Spanish Navy corvette "María Pita," which departed from the port of La Coruña on November 30, 1803. They were vaccinated in pairs every nine days.
The first leg of the journey took them to the Canary Islands, where they administered the vaccine to the local population. Subsequently, they crossed the Atlantic and arrived in Puerto Rico and Venezuela, where they also inoculated many inhabitants. The journey continued through the Viceroyalty of New Spain, where Balmis and his team established vaccination centers and trained local doctors to continue the vaccination campaign. From Mexico, Balmis and some members of the expedition, including some children, continued to the Philippines in 1805. There, they also administered the vaccine and established vaccination centers. Balmis even extended the mission to Macao and Canton in China, where he promoted vaccination among European and Chinese communities. Other members of the expedition continued through the Viceroyalties of Peru and La Plata.
The Royal Philanthropic Vaccine Expedition was a remarkable success in the history of medicine. Thousands of people were vaccinated, and the foundations for the eradication of smallpox were established. The expedition not only demonstrated the power of the vaccine but also the importance of international collaboration in public health.
The use of orphaned children, although controversial from a modern perspective, was considered a necessary and noble sacrifice at the time. The children were cared for during the journey, and at the end of the expedition, many were adopted in the places they reached.
Many years after this fantastic epic, ignored by the world and forgotten in Spain, a beautiful square in Alicante is named after Dr. Balmis, complete with a bust, and a hospital in Madrid is named after Isabel Zendal.
Gonzalo Fernández de Córdoba López
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