Lessons from pandemics

Vaccines today come in glass vials and are injected using a sterile syringe. Transport is easy and cold storage readily available. These were not available to Francisco Xavier de Balmis, head of the Royal Philanthropic Vaccine Expedition under the patronage of Carlos IV, when he arrived in Manila on April 15, 1805. Imagine the long voyage that set off from Spain in November 1803 and arrived in Venezuela in March 1804. From Venezuela, the expedition then split into two teams: Balmis’ assistant proceeded to Bolivia, Colombia, and Ecuador, and Balmis himself headed for Mexico and eventually the Philippines and China.

The smallpox vaccine he was transporting was not carried in vials, but transported live via a group of healthy orphan boys. Lymph was harvested from the sores of an infected person with a lancet, then was scratched on the arm of a pair of orphans before departure. Within 10 days, sores would appear on the first pair of vaccinated boys; ripe pus was then harvested from them with a lancet and scratched on the arms of the second pair, and so on until the expedition arrived at its destination with a pair of boys with sores ready for collecting and distribution as a vaccine.

What were the names of the Mexican orphans who transported the vaccine to Manila, and what became of them? What were the names of the Filipino orphans from Manila who served as vaccine mules to China? What became of them, too?

Arm-to-arm transport of the smallpox vaccine was more effective compared to transport of harvested dried pus in vials that were reconstituted at the destination with water and scratched on people, with varying rates of success. Live vaccine was farmed in Manila and its suburbs using healthy children. The collected pus was placed in vials and sent to the provinces.

Detailed instructions and procedures provided in the 1873 Reglamento de Vacuna, published in Manila, describe the materials needed. In the absence of lancets, a vacundarcillo could repurpose sewing needles by heating them on a fire till they turned red, reshaping the tip by hammering, and further sharpening it with a stone. The main challenge was overcoming resistance to vaccination, keeping accurate records, and making sure the vaccinators always had a ready supply of dried extracted pus.

The vacunador, the giver, and the receiver should all be seated for arm-to-arm transmission: “…the one who extracts, in front of the creature who is to give the pus, the person to be vaccinated is seated on the side and offers his arm. Vacunador holds the arm of the giver steady so that he is not injured during extraction. First, the film that surrounds the grain of the sore is lifted, the tip of the lancet is soaked in the pus, being careful not to draw blood. The receiver’s arm is held firmly by the vacunador’s left hand and with his right palm rightly rubs the skin to warm it before scratching the vaccine into it.”

While the Spanish vaccine manual sounds good on paper, Ken de Bevoise says otherwise in his book “Agents of the Apocalypse: Epidemic Disease in the Philippines” (1995). By 1898, the end of the Spanish period, there were only 122 underpaid vacunadores for the entire archipelago, and they were unable to vaccinate everyone. The smallpox vaccine was not always effective due to source, collection, storage, or transport problems. Archival records state that 9,136 vaccinations were recorded in Manila from 1894 to 1898, compared to the Americans who vaccinated 103,931 in 1899 alone.

The current pandemic is not new. History has a lot to teach us about how the Philippines and Filipinos have responded to epidemics since the 19th century, and these can frame the way we combat COVID-19 in 2021. Disease spreads through contact, so then as now efficient contact tracing is a must. Personal hygiene as the foundation of public health requires both education and compliance. Spitting, for example, used to be common until American sanitation officials successfully campaigned against it in the early 20th century. But didn’t spitting stem from betel nut chewing? Did anti-spitting ordinances encourage the shift from betel nut chewing to smoking?

Aside from death, panic, and quarantine, this pandemic has a lot in common with previous ones in terms of social engineering. While modern science trumps disease in time, epidemics remind people, the hard way, to reform their behavior and develop personal hygiene for the common good.

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