Future Tense

Nationalism Can’t Beat a Global Problem

“America First” is a fairly useless strategy in the quest for a COVID-19 vaccine.

A stone bust of Francisco Javier de Balmis outside a university building
Bust of Francisco Javier de Balmis at Miguel Hernández University in Alicante, Spain. Kokoo/Wikipedia

In mid-March, it emerged that the Trump administration had attempted to secure exclusive access to a potential vaccine for COVID-19, offering “large sums” to the company CureVac, based in Germany, if it would guarantee all supplies of a future vaccine to the U.S. In response, many were outraged that the U.S. would so selfishly hoard a vaccine. But there’s another reason to think that it would be a bad idea: Such a nationalistic “America First” response to a global infection unaware of borders doesn’t really work. Indeed, the history of the world’s first vaccine—against smallpox—provides a counterexample of a successful, planet-spanning collaborative effort to wipe out disease.

In 1796, Edward Jenner famously took pus from a cowpox pustule of a milkmaid and injected it into his gardener’s 8-year-old son, James Phipps. Cowpox was a comparatively harmless condition that farmworkers would contract from their charges, but it was related to the far deadlier disease of smallpox, which killed thousands each year. After a few days, Jenner proceeded to deliberately infect James with the deadly smallpox. Luckily for the boy, Jenner’s hunch proved correct: People who had a case of cowpox gained immunity against smallpox. The brave subject doubtless got a pat on the head, while Jenner won fame and prizes.

Jenner himself suggested that “the annihilation of … the most dreadful scourge of the human species” would be the final result of his invention. But that would take the global spread of vaccination—including to the Americas. Smallpox arrived in the New World soon after Columbus, and was one of the Old World diseases responsible for wiping out the considerable majority of the population of North and South America in the century after his voyages. But efforts to send vaccine material across the Atlantic in sealed glass were largely unsuccessful—temperature and time killed the cowpox virus. In 1803, a scant seven years after Jenner’s experiment, King Charles IV of Spain sponsored the “Royal Philanthropic Expedition of the Vaccine” to ensure the treatment was delivered across his empire, and put the effort under the direction of one of his physicians, Francisco Javier de Balmis.

Balmis left Spain on the corvette Marίa Pita on Nov. 30, 1803, with assistants, nurses, and staff, as well as 20 unvaccinated children from La Coruña’s orphanage, who would be infected in turn by cowpox on the journey. Children ages 3 to 9 were used because they could be more easily guaranteed to have avoided previous exposure to smallpox—that would make them ineffective vaccine carriers. They were carefully isolated until their turn to be injected with pus, two at a time, all across the Atlantic. Vicente Ferrer (7) and Pascual Aniceto (3) were the first two children vaccinated. Along with the orphans, Balmis brought 2,000 copies of a treatise on vaccination. They would provide guidance to the vaccination boards that the expedition would create to ensure a continuing reservoir of vaccines and local distributors.

The expedition stopped at the Canary Islands and Puerto Rico, then traveled onward to Venezuela.* At each stop, more children were drafted. In Lanzarote “five children of the poor class were sent in order for them to return vaccinated,” the expedition record notes. The new Caracas Board of Vaccination eventually immunized 100,000 people, beginning with the 2-year-old Luis Blanco. Balmis’ deputy Salvany then headed south, while Balmis himself traveled through Mexico. There he failed to persuade the viceroy to introduce compulsory vaccination, but the effort nonetheless may have vaccinated 100,000 more people. The director continued to the Pacific coast where, with the help of 26 Mexican children, the living chain of cowpox sufferers made it to the Philippines and on to Portuguese Macao and Canton, China, where he worked with the British East India Company to set up a vaccination center before returning to Madrid, three years after their departure.

The subdirector, Salvany, meanwhile, traveled through Cartagena to Quito, then on to Lima and Bolivia. Never in good health, the journey destroyed him—by the time he was crossing the Peruvian Andes, he had lost an eye, broken a wrist, and was suffering chest pains and fevers, potentially stricken by tuberculosis. He died in Cochabamba, Bolivia, on July 21, 1810, seven years after leaving Spain.

A few days before his death, Salvany wrote, “The lack of roads, the precipices, the large rivers, the deserted places we have encountered have not stopped us for even a moment, much less the waters, snows, hungers and thirsts we have suffered. … [T]hat cruel contagion … served as stimulus to bring a brilliant purpose to noble and humanitarian tasks.” His poetic self-promotion was surely deserved: Perhaps 1.5 million people were vaccinated by the Balmis-Salvany campaign.

The expedition was neither a complete practical triumph nor a complete moral triumph. Many local vaccination boards fell apart—the effort for a board of vaccination for New Spain foundered before it had even begun. The children who had carried the cowpox across the Atlantic were abandoned in Mexico City’s hospice. Again, the Spanish monarchy had selfish motives for spreading the vaccine—high mortality reduced the workforce available to mine precious metals. For all of that, though, Jenner was surely right to declare it “a glorious enterprise.” The Philanthropic Expedition likely saved thousands of lives and marked the start of global efforts to confront one of history’s greatest killers.

One hundred and sixty years after Salvany’s death and 174 after Jenner demonstrated his vaccine, the scourge of smallpox was finally defeated worldwide. In 1966, the 19th World Health Assembly called for intensified efforts to eradicate smallpox. The USSR donated over 140 million doses of the vaccine to the effort each year, while the U.S. provided more vaccines alongside advice and equipment. By 1980, the disease was declared eradicated worldwide. The eradication program that Jenner, his gardener’s son James, Balmis, and Salvany were a part of has saved around 40 million lives worldwide since the 1970s.

Policymakers in Washington might want to think about this history as they craft the longer-term response to COVID-19. For pandemics, the secret is to think and act global. Balmis provided vaccines to Spanish and Portuguese colonies and China alike. During the wars for independence in South America in the decades that followed, the two sides even declared ceasefires to allow for vaccination. And the effort was designed to be locally sustained: The vaccination boards were to ensure supplies of cowpox pus remained always available. We should be coordinating with Europe, China, and other countries that are researching coronavirus vaccines, pooling knowledge and then pooling production capacity. And the U.S. should join a global effort to ensure everyone gets vaccinated as rapidly as possible—and vaccination capacity remains in place over the long term. It may not be possible to eradicate COVID-19 like we eradicated smallpox, but we can turn a mass killer into a minor threat—if we follow the example of Francisco Javier de Balmis.

Future Tense is a partnership of Slate, New America, and Arizona State University that examines emerging technologies, public policy, and society.

Correction, March 31, 2020: This piece originally misspelled Venezuela.