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How 22 Spanish orphans became ‘the vaccine’ to beat smallpox in the Americas

This is the unlikely story of how in 1803 one doctor, one ship and 22 Spanish orphans serving as human fridges helped the world beat smallpox by carrying out the first international vaccination campaign.

How 22 Spanish orphans became 'the vaccine' to beat smallpox in the Americas
British physician Edward Jenner may have administered the first vaccine but it was a Spanish doctor that helped to export the inoculation around the world. Painting: Ernest Board (1806)

We’re living through a time in history where the emergence and resurgence of viruses is becoming more prevalent, from the ongoing Covid-19 pandemic to the appearance of monkeypox, with several cases recently recorded in Spain, Portugal and the UK.

Monkeypox is a similar virus to smallpox, a devastating illness that was finally eradicated in 1980. The virus causes high fever, body aches, headaches and chills, as well as a rash of boils or sores. 

READ ALSO: Eight suspected monkeypox cases detected in Spain

While historians and scientists believe that smallpox has been around for the last 3,000 years, monkeypox was first discovered in 1958 when two outbreaks occurred in a group of monkeys kept for research. The first human case of monkeypox was recorded in 1970 in the Democratic Republic of Congo.

The first vaccine

During the 18th century, smallpox was rife throughout the world and was killing millions. It was around this time that English doctor Edward Jenner saw that people who caught the milder bovine virus of cowpox never actually caught the deadlier smallpox.

So in 1796, he took the pus from a cowpox lesion on a milkmaid’s hand and inoculated an eight-year-old boy named James Phipps, rendering him immune to smallpox and creating the world’s first vaccine.

But it was in fact Spain that played a pivotal role in getting this vaccine out to the masses and helping to bring the smallpox virus under control. 

How did they transport vaccines in the 18th and 19th century?

Even today, transporting vaccines proves to be problematic, best evidenced by the specific temperature and storage requirements of some of the Covid-19 vaccines, as well the logistical delays and other distribution obstacles.

But back in the early 19th century, doctors and scientists came up against even more problems.

Health professionals at the time invented an ingenious method of taking the puss-like fluid from the sores of those with cowpox and placing it on a piece of material to dry out.

They would then travel to the next town and mix the dried puss with water, before scratching it into people’s skin to infect them with cowpox, thus protecting them from smallpox.

This method seemed to work in Europe, where distances between towns were relatively close.

The arrival of Spain’s Conquistadores in America led to the spread of viruses such as smallpox among native populations, killing millions, including the Aztecs of present-day Mexico.

However, the vaccine wouldn’t stay fresh long enough to take it further across the seas to the Americas. It wouldn’t even work for distances from one European capital to the next, only from town to town. 

Children become the vaccine carriers

This is where Spain comes in. The colonial power was desperate to send the vaccine over to its South American territories, where the virus was running rampant throughout the population, killing around half of those it infected.

In 1803, a doctor from Alicante in eastern Spain, Francisco Javier de Balmis, came up with a plan and asked Spain’s King Carlos IV, whose own daughter had died of smallpox, to fund a new mission.

His plan was to sail to the Americas with 22 Spanish orphans on board, infecting them with cowpox along the way, a plan that wouldn’t have much chance of being approved in this day and age due to human rights laws, but this was the early 18th century.

Francisco Javier de Balmis was integral in helping the first international vaccine campaign. Source: Foundling / WikiCommons

The cowpox vaccine only survived in the body for up to 12 days, so at the beginning of the journey only two of the orphans were infected with smallpox. Then, ten days later when they were sick enough and had boils all over their skin, doctors on board would lance these sores and infect two more boys. The aim was to keep this going every ten days until they reached South America.

Miraculously, the plan of using the orphans as vessels for the virus worked, and although all the children got sick, none of them died.

By the time the ship docked in Venezuela in March 1804, one boy still had fresh sores and puss which could be used to vaccinate the local population. 

Balmis and his team set about vaccinating the locals straight away and then split up, with half the team travelling through what is today Colombia, Ecuador, Peru, and Bolivia and the other half up to Mexico.

Amazingly, using this method of lancing boils and moving from town to town, they managed to vaccinate around 200,000 people, most of whom were children.

Locals who received news of their arrival would greet the heroes with all the flamboyance of a Spanish fiesta – complete with music, bullfights and fireworks. 

The mission was not yet complete

Balmis left the 22 original orphans with adoptive families in Mexico and then set out on a new voyage with a brand new set of children for the Spanish colony of the Philippines.

The ship arrived in April 1805 and again astonishingly the plan worked. Here, Blamís and his team were able to vaccinate a further 20,000. 

This vaccination plan was so successful again, that Balmis took the vaccine to China to keep inoculating the population there too. 

Thanks to the ingenious methods of one Spanish doctor and the bravery of 22 Spanish orphans, Jenner’s original vaccine was able to reach the far corners of the world, vaccinating hundreds of thousands and saving countless lives. 

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HEALTH

What is Spain’s trouble-ridden Dependency Law?

The landmark legislation introduced in 2006 was supposed to widen the safety net for dependent people, but a person on the waiting list for services offered by Spain's Dependency Law died every 13 minutes in 2023.

What is Spain's trouble-ridden Dependency Law?

What is Spain’s Ley de Dependencia?

Spain’s Dependency Law (Ley de Dependencia) was passed in 2006 under the Zapatero government.

It was essentially put together in order to try and construct a social, psychological and financial framework of support for dependent people. In the words of the law itself, the aim was to: “to regulate the basic conditions that guarantee equality in the exercise of the subjective right of citizenship to the promotion of personal autonomy and care for dependent persons.”

To do this, it created the System for Autonomy and Care for Dependency (SAAD), and the benefits and services offered were put in place to give dependent people not only more support but dignity.

READ ALSO: What’s life in Spain like for people with physical disabilities?

However, the law (and system) has been dogged by backlogs and delays ever since. In 2021 the Spanish government injected hundreds of millions into the system to try and improve performance, but recent reports in the Spanish media suggest that things have barely improved — as of December 31st 2023 there were 296,431 people still on the waiting list.

How does the Dependency Law work?

The support available depends on the level of dependency, something which is examined by a medical expert and then graded on a scale. In theory, the dependency level can be changed depending on how the recipient’s needs develop over time.

The law outlines the Basic Activities of Daily Living (ABVD) that the SAAD is designed to assist with: “the most basic tasks… which allow them to function with a minimum of autonomy and independence, such as: personal care, basic domestic activities, essential mobility, recognising people and objects, finding their way around, understanding and carrying out simple orders or tasks.”

The three degrees of dependency are as follows:

  • Moderate dependency (1st degree) – someone who needs help once a day to complete basic activities.
  • Severe dependency (2nd degree) – someone who needs help 2/3 times a day to complete basic activities.
  • Great dependency (3rd degree): someone who needs ongoing, permanent assistance to manage their basic needs and activities.

What are the different types of dependency?

Dependencies can be wide-ranging and often have crossovers. The law defines dependency as “the permanent state of people who, for reasons of age, illness or disability, and linked to the lack or loss of physical, mental, intellectual or sensory autonomy, require the care of another person or persons or substantial help to carry out basic activities of daily living or, in the case of persons with intellectual disabilities or mental illness, other support for their personal autonomy.”

So the four main dependency categories are physical, mental, sensory, and mixed.

  • Physical – disability or mobility issues due to age, injury or illness, that makes someone dependent on another for physical support.
  • Mental – when a mental condition (such as dementia, for example) means a person is no longer capable of making decisions or problem solving and rely on someone else to do it for them.
  • Sensory – a loss of a sense, such as blindness, makes someone dependent on another for help.
  • Mixed – someone who suffers from two or more types of dependency

What does the law offer to dependent people?

Essentially care, whether in the home or at a residency centre, or financial assistance for people caring for loved ones.

The degree of dependency is tied to the care coverage:

1st degree: 10-20 hours/month
2nd degree: 21-45 hours/month
3rd degree: 46-70 hours/month

The average amount of home help is 33.8 hours per month, which rises to 57.9 hours for 3rd degree dependencies.

The financial benefit received by those who care for a dependent relative at home is €240.17 — €369.6 in the case of 3rd degree decencies.

The average amount of state benefit linked to a residential place for 3rd degree dependents is €575: less than a third of the real cost of these services.

READ ALSO: Can I claim UK Personal Independence Payments (PIP) in Spain?

Why is the law trouble-ridden?

However, as progressive as the legislation is on paper, in reality things haven’t worked out like that.

In 2023 alone, 40,447 people died while waiting to be assessed or cared for. This works out to 111 people dying a day in Spain while on the Dependency Law waiting list.

As of 31 December 2023 there were 296,431 people still on the waiting list. The time it takes to even process a dependency application and arrange care intervention takes almost a year (324 days).

But these failures aren’t for a lack of trying (or more specifically, money) by the government. In 2021, Spain’s Ministry of Social Rights approved a shock plan that increased state funding for the SAAD to the tune of €600 million. This money was mainly used to try and resolve the backlog in case applications and widen the coverage of benefits offered.

However, the plan hasn’t really worked as anticipated.

This seems to be for two main reasons: firstly, the complexity of the procedures taking a patient from application to dependency diagnosis and finally to care — in other words, slow bureaucratic processes getting in the way.

Secondly, the cutting of funding at a regional level has made an already overwhelmed system even more stretched.

Much of the money for the Dependency Law comes from regional authorities, and in 2023 nine regions reduced their funding for dependency services, including Catalonia (by 57.3 million), Andalusia (51.6 million), Valencia (40.6), Madrid (15 million), Extremadura (11), Asturias (10.8), Cantabria (8.7), Castilla y León (7.4) and Murcia (1).

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