{"content_id":"2ukaqqdnhq","slug":"balmis-expedition-1803-smallpox-vaccine-transport","locale":"en","schema_type":"Article","category":"case_study","category_name":"Case Study","title":"Balmis Expedition Smallpox Vaccine Transport in 1803","summary":"The Balmis Expedition carried the smallpox vaccine across oceans by vaccinating children in succession. Drawing on 1804 official correspondence about disputes over ship preparations and issues with the children's care, it distinguishes the challenges of transport from the achievements of local vaccination systems.","sponsorship_disclosure":null,"affiliate_disclosure":null,"commerce_disclosure":null,"author":{"name":"Injoys Editorial Team","url":"https://injoys.com/ko/about"},"key_points":["The Balmis Expedition departed from A Coruña, Spain, on November 30, 1803.","Vaccinating children in succession kept the vaccine viable during the long voyage.","Official correspondence from 1804 records uncertainty about departure and disagreements over food and lodging arrangements.","Training local medical workers and establishing vaccination boards were measures to keep vaccinations going after the expedition.","The success of vaccine distribution should be evaluated separately from the children's treatment and the eradication of smallpox in 1980."],"content_markdown":"The Balmis Expedition was a smallpox vaccination campaign that set sail in 1803. It overcame the limits of transport without refrigeration by vaccinating children in sequence. It is remembered for bringing the vaccine to the Americas and the Philippines and leaving local vaccination systems in place.\n\nThis article draws on the PARES record listings of Spain's General Archive of the Indies and historical research, checked in October 2026.\n\n## Why did the Balmis Expedition begin?\n\nThe Balmis Expedition aimed to bring smallpox vaccination to overseas territories. King Carlos IV of Spain supported the campaign. Francisco Javier de Balmis led the expedition. Its official name was Real Expedición Filantrópica de la Vacuna. [PARES expedition overview](https://pares.cultura.gob.es/ParesBusquedas20/catalogo/autoridad/134600)\n\nThe expedition arose amid smallpox outbreaks and the spread of a new vaccination method. In 1796, Edward Jenner administered a vaccine using cowpox. Cowpox is an infectious disease found in cattle. Vaccination using it was intended to prevent smallpox in humans. [WHO smallpox overview](https://www.who.int/emergencies/situations/smallpox/)\n\nThe expedition's task went beyond delivering the vaccine once. It also needed people and organizations to continue vaccination locally. The Spanish Empire's administrative network provided the foundation for this work. The political conditions differed from those of public health cooperation between independent countries today.\n\n## How was the vaccine transported without refrigeration?\n\nThe expedition kept the vaccine viable by vaccinating children in sequence. Here, viable means it could still be used to vaccinate the next person. Vaccination material could also be placed between pieces of glass for transport. But it might not survive a long voyage and high temperatures.\n\nSequential vaccination used fluid from a blister at one person's vaccination site to vaccinate the next person. It did not involve vaccinating the same child repeatedly. New recipients were needed in turn. The timing of vaccinations therefore had to match the voyage schedule. [Universidad de Alicante researchers' study of child carriers](https://balmis.org/articulos/articulo-2/)\n\n| Transport requirement | Response at the time | Potential point of failure |\n|---|---|---|\n| Keeping vaccination material viable | Sequential vaccination from person to person | Failing to obtain material for the next vaccination |\n| Finding the next recipients | Recruiting children in several places along the route | Children having had smallpox or already been vaccinated |\n| Maintaining vaccination intervals | Observing vaccination sites and managing the sequence | Material being transferred through contact before the scheduled vaccination |\n| Sustaining a long voyage | Preparing food, shelter, and care | Deteriorating health and living conditions for the children |\n\nThis method used children's bodies to transport the vaccine. It required both medical observation and daily care. Successful transport alone does not establish that the children were treated appropriately.\n\n## A timeline through the Americas and the Philippines\n\nThe expedition split into several branches in the Americas. A detachment led by José Salvany headed to South America. Balmis's group traveled through Cuba and Mexico to the Philippines. Some activities continued after Balmis himself returned. [2009 study of the expedition's history](https://pubmed.ncbi.nlm.nih.gov/19329842/)\n\n| Period | Event | Source |\n|---|---|---|\n| November 30, 1803 | The María Pita set sail from A Coruña, Spain | PARES expedition overview |\n| Late 1803 through 1804 | Traveled through the Canary Islands and Puerto Rico to Venezuela | 2009 study of the expedition's history |\n| 1804 | Activities divided between the South American route and the Cuba and Mexico route | 2009 study of the expedition's history |\n| October and November 1804 | Personnel, food, and lodging for the voyage to the Philippines discussed in official correspondence | PARES file on expenses |\n| February 1805 | Pacific crossing began from Acapulco, Mexico | 2026 study of the Asian route |\n| April 1805 | Arrived in Manila with the vaccine still viable | 2026 study of the Asian route |\n| Second half of 1805 | Balmis traveled toward Macau and Guangzhou | 2009 study of the expedition's history |\n| 1806 | Balmis returned to Spain | 2004 study of Balmis's travels |\n| 1807 | Expedition personnel who had worked in the Philippines returned to Mexico | 2009 study of the expedition's history |\n\nStudies differ on whether the arrival in Manila was on April 15 or 16. The timeline therefore gives only the month confirmed by both. It also does not treat the South American detachment's activities as Balmis's personal travels.\n\n## What conflicted during preparations for the ship in 1804?\n\nThe issue in the official correspondence was how far preparations should go when departure was uncertain. The PARES file on expenses contains copies of correspondence from both sides. The account below summarizes the archive's descriptions of the individual documents.\n\n| Document date | Sender | Contents described in the record listing |\n|---|---|---|\n| October 29, 1804 | Balmis | Informed Captain Ángel Crespo of the number of passengers and their needs for lodging and food |\n| October 29, 1804 | Ángel Crespo | Replied that, because departure was uncertain, he could not promise to prepare the necessary food |\n| October 30, 1804 | Balmis | Reported the difficulties of preparation and the need to train local medical personnel to the viceroy |\n| November 6, 1804 | Viceroy of New Spain | Ordered measures to prepare for boarding and provide for passengers' convenience |\n| March 20, 1805 | Balmis and Ángel Crespo | Complaint and reply concerning the children's meals, lodging, and treatment |\n\nThe 1804 orders did not guarantee conditions aboard the ship. The complaint written during the voyage in 1805 shows the gap. Balmis's complaint, however, cannot be treated as the result of an independent investigation. The captain's reply is also preserved in the same file. [PARES listing of correspondence on expenses](https://pares.cultura.gob.es/ParesBusquedas20/catalogo/description/13455908)\n\n## What difficulties did the children face?\n\nThe children's meals and lodging were a vulnerable part of the expedition. A 2026 study of the Pacific voyage examined Balmis's report. It included complaints about conditions aboard the ship that differed from what had been promised. It also described unscheduled vaccinations occurring in cramped quarters.\n\nIn the case of accidental vaccination summarized by the study, 7 children were involved. If vaccinations happened ahead of schedule, fewer recipients remained for later use. This could break the chain that kept the vaccine viable. Even so, the expedition delivered a viable vaccine to Manila in April 1805. [2026 study of the Asian route](https://academic.oup.com/jtm/article/33/6/taag076/8770931)\n\nThe children's origins and routes differed. Records list 22 children in the group that set sail from Spain. A group of 26 was recruited in Mexico to transport the vaccine across the Pacific. The same 22 children did not carry the vaccine on every route. [Full text of the 2009 study of the expedition's history](https://gwern.net/doc/history/2009-mark.pdf), [study of child carriers](https://balmis.org/articulos/articulo-2/)\n\nIn Cuba, the expedition had difficulty finding new carriers. Research also records the purchase of enslaved girls. Some of the children recruited in Mexico had parents. It is inaccurate to describe all participants as orphans or volunteers. [Study of records on the recruitment and travel of the children](https://balmis.org/articulos/articulo-2/)\n\nIsabel Zendal Gómez was responsible for caring for the expedition's children. Care staff accompanied them during sea travel and activities on land. But the presence of a caregiver is not evidence of appropriate treatment. Whether promises of protection and education were kept must be checked separately. [Spanish Ministry of Culture CIDA guide to the expedition](https://www.cultura.gob.es/en/cultura/areas/archivos/mc/centros/cida/4-difusion-cooperacion/4-1-guias-de-lectura/homenaje-personal-sanitario/expedicion-balmis.html)\n\n## The shift from vaccine delivery to local vaccination systems\n\nContinued vaccination required local organizations to take responsibility. Vaccination material had to be kept viable after the expedition left. Central and regional vaccination boards were designed to take on this work. The board in Venezuela became a model for later organizations. [The warm chain on vaccination boards](https://pubmed.ncbi.nlm.nih.gov/12340730/)\n\nTraining local medical personnel served the same purpose. They needed to learn how to preserve and use vaccination material. The expedition's goals also included free vaccination for residents. Vaccination boards were intended to manage records as well. [Study of the expedition's goals](https://gwern.net/doc/history/2009-mark.pdf)\n\nIn the Philippines, local networks of cooperation supported the expansion of vaccination. A 2026 study explains the role of Manila's regulations. They set out the responsibilities of those in charge and the management of vaccination records. This was a way to transfer the traveling expedition's work to local organizations. [Study of Manila's vaccination system](https://academic.oup.com/jtm/article/33/6/taag076/8770931)\n\n## How far did the expedition's achievements extend?\n\nThe expedition helped deliver the vaccine over long distances and establish a basis for local vaccination. It was not, however, the first to introduce the vaccine in every place it visited. It sometimes encountered medical personnel who had already begun vaccinating people.\n\nTomás Romay administered vaccinations in Cuba before the expedition arrived. He obtained vaccination material from Puerto Rico in February 1804. Vaccination was underway when Balmis arrived in May of that year. Romay later led the local vaccination board. [CIDA account of vaccination history in Cuba](https://www.cultura.gob.es/en/cultura/areas/archivos/mc/centros/cida/4-difusion-cooperacion/4-1-guias-de-lectura/homenaje-personal-sanitario/expedicion-balmis.html)\n\nThe Balmis Expedition did not eradicate smallpox worldwide. WHO intensified its eradication campaign in 1967. It then pursued vaccination alongside surveillance of cases. The World Health Assembly declared global eradication on May 8, 1980. [WHO account of the eradication campaign](https://www.who.int/emergencies/situations/smallpox/), [World Health Assembly resolution WHA33.3](https://www.who.int/publications/i/item/WHA33-3)\n\n| Category | Achievement documented for the Balmis Expedition | Outcome requiring separate evidence |\n|---|---|---|\n| Transport | Delivery of a viable vaccine to destinations | Reliable supply afterward |\n| Vaccination | Vaccinations administered in several places | Vaccination rates across entire areas and long-term effects |\n| Organization | Training and establishment of vaccination boards | Continued operation after the expedition |\n| Disease control | Spread of a means to prevent smallpox | An end to global transmission and eradication |\n\n## How should expense records be distinguished from vaccination outcomes?\n\nExpense records show the campaign's preparations and disputes. They do not, by themselves, measure the effects of vaccination. This distinction also matters when organizing official correspondence as historical data. The following table distinguishes what can be inferred from each type of record.\n\n| Record item | What it can establish | What cannot be assumed from it alone |\n|---|---|---|\n| Requests to prepare food and lodging | Needs and plans at the time of the request | The quality of meals and lodging actually provided |\n| Preparation orders or expense approvals | Administrative decisions and responsibilities | Whether orders were carried out on site |\n| Balmis's complaint | Problems reported by Balmis | A final judgment that also considers the other party's account |\n| Reports of vaccination totals | Vaccination activity counted by the person reporting it | A complete end to smallpox transmission |\n\nThe date a document was written and the date an event occurred are also different pieces of information. The 1804 correspondence about voyage preparations must be distinguished from records of the actual departure. When combining documents, their authors and the scope of their reports must be retained. Otherwise, plans and actions may be mistakenly combined into a single event.\n\nSpain's UNESCO nomination describes the scope of the related records. The collection also includes administrative documents from before and after the expedition. It would therefore be inaccurate to read the full date range of the collection as the expedition's duration. [Description of the records submitted to UNESCO](https://media.unesco.org/sites/default/files/webform/mow001/royal-philanthropic-expedition-of-the-smallpox-vaccine_nom_en.pdf)\n\n## Records and interpretation\n\n### What the records directly support\n\nThe PARES listings establish the dates, senders, and main contents of the correspondence. They include discussions and complaints about the ship's preparation. This article has not presented the listing descriptions as quotations from the original letters. The exact wording of any particular passage should be checked against the linked images of the originals.\n\n### What historical studies commonly emphasize\n\nThe studies reviewed address both sequential vaccination and the role of local organizations. The technique for keeping the vaccine viable was not enough on its own to complete the campaign. Training medical personnel and administrative cooperation determined whether it could continue. This interpretation considers the history of transport alongside the history of public health.\n\n### Differences between sources and remaining limits\n\nThe expedition's end year varies with the scope of the account. The PARES event title uses 1803 through 1810. A 2009 study covers subsequent activities through 1813. Balmis's return in 1806 cannot be taken as the end of the entire campaign.\n\nSome voyage dates still differ between studies. Nor can the children's long-term lives as a whole be reconstructed from one file. Promises of protection and the support actually provided require separate checks. A total number vaccinated across the expedition would also be misleading without specifying what the count includes.\n\n## Why read this as part of the history of vaccine delivery today?\n\nThis case shows the relationship between preservation methods and delivery organizations. At the time, the vaccine was kept viable through vaccination from person to person. Vaccine delivery today manages storage conditions specific to each product. Although the technology differs, people and systems of responsibility are still needed to maintain supply.\n\nThe historical points of connection are:\n\n- Preservation: Keeping the vaccine usable until it reaches its destination.\n- Operations: Whether local staff can continue vaccination and record management.\n- Care: Assessing the campaign's achievements separately from its treatment of participants.\n- Evaluation: Distinguishing the amount transported, vaccination totals, and reductions in disease.\n\nThe expedition's use of children as carriers is not a model for vaccination today. What can be compared are the preservation and operational problems it sought to solve. The children's experiences show who bore the burden of that solution.\n\n## Frequently asked questions\n\n### Were the children given smallpox?\n\nThe expedition carried cowpox vaccination material intended to prevent smallpox. This differs from variolation, which used material from smallpox patients. The use of people's bodies for transport must nonetheless be assessed separately.\n\n### Did the 22 children who first set sail carry the vaccine all the way to the Philippines?\n\nDifferent groups carried the vaccine on different routes. In Mexico, 26 children were recruited for the Pacific crossing. The 22 children present at departure should not be counted as the participants for the entire expedition.\n\n### Do the 1804 letters show that the expedition failed?\n\nThe letters show disagreement over preparations for the ship. A dispute during preparations does not, by itself, mean the entire campaign failed. A viable vaccine reached the Philippines in 1805.\n\n### What were local medical personnel taught?\n\nThey were taught how to preserve the vaccine and administer vaccinations. The training was meant to enable local staff to continue vaccination after the expedition. Vaccination boards were responsible for organizing this work.\n\n### Did the Balmis Expedition eradicate smallpox?\n\nThe expedition helped spread vaccination in the early 19th century. Global smallpox eradication was achieved through an international campaign much later. The official declaration was made on May 8, 1980.","content_html":"\u003cp\u003eThe Balmis Expedition was a smallpox vaccination campaign that set sail in 1803. It overcame the limits of transport without refrigeration by vaccinating children in sequence. It is remembered for bringing the vaccine to the Americas and the Philippines and leaving local vaccination systems in place.\u003c/p\u003e\n\u003cp\u003eThis article draws on the PARES record listings of Spain's General Archive of the Indies and historical research, checked in October 2026.\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#why-did-the-balmis-expedition-begin\" class=\"anchor\" id=\"why-did-the-balmis-expedition-begin\"\u003e\u003c/a\u003eWhy did the Balmis Expedition begin?\u003c/h2\u003e\n\u003cp\u003eThe Balmis Expedition aimed to bring smallpox vaccination to overseas territories. King Carlos IV of Spain supported the campaign. Francisco Javier de Balmis led the expedition. Its official name was Real Expedición Filantrópica de la Vacuna. \u003ca href=\"https://pares.cultura.gob.es/ParesBusquedas20/catalogo/autoridad/134600\"\u003ePARES expedition overview\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003eThe expedition arose amid smallpox outbreaks and the spread of a new vaccination method. In 1796, Edward Jenner administered a vaccine using cowpox. Cowpox is an infectious disease found in cattle. Vaccination using it was intended to prevent smallpox in humans. \u003ca href=\"https://www.who.int/emergencies/situations/smallpox/\"\u003eWHO smallpox overview\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003eThe expedition's task went beyond delivering the vaccine once. It also needed people and organizations to continue vaccination locally. The Spanish Empire's administrative network provided the foundation for this work. The political conditions differed from those of public health cooperation between independent countries today.\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#how-was-the-vaccine-transported-without-refrigeration\" class=\"anchor\" id=\"how-was-the-vaccine-transported-without-refrigeration\"\u003e\u003c/a\u003eHow was the vaccine transported without refrigeration?\u003c/h2\u003e\n\u003cp\u003eThe expedition kept the vaccine viable by vaccinating children in sequence. Here, viable means it could still be used to vaccinate the next person. Vaccination material could also be placed between pieces of glass for transport. But it might not survive a long voyage and high temperatures.\u003c/p\u003e\n\u003cp\u003eSequential vaccination used fluid from a blister at one person's vaccination site to vaccinate the next person. It did not involve vaccinating the same child repeatedly. New recipients were needed in turn. The timing of vaccinations therefore had to match the voyage schedule. \u003ca href=\"https://balmis.org/articulos/articulo-2/\"\u003eUniversidad de Alicante researchers' study of child carriers\u003c/a\u003e\u003c/p\u003e\n\u003cdiv class=\"overflow-x-auto\"\u003e\u003ctable\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth\u003eTransport requirement\u003c/th\u003e\n\u003cth\u003eResponse at the time\u003c/th\u003e\n\u003cth\u003ePotential point of failure\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Transport requirement\"\u003eKeeping vaccination material viable\u003c/td\u003e\n\u003ctd data-label=\"Response at the time\"\u003eSequential vaccination from person to person\u003c/td\u003e\n\u003ctd data-label=\"Potential point of failure\"\u003eFailing to obtain material for the next vaccination\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Transport requirement\"\u003eFinding the next recipients\u003c/td\u003e\n\u003ctd data-label=\"Response at the time\"\u003eRecruiting children in several places along the route\u003c/td\u003e\n\u003ctd data-label=\"Potential point of failure\"\u003eChildren having had smallpox or already been vaccinated\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Transport requirement\"\u003eMaintaining vaccination intervals\u003c/td\u003e\n\u003ctd data-label=\"Response at the time\"\u003eObserving vaccination sites and managing the sequence\u003c/td\u003e\n\u003ctd data-label=\"Potential point of failure\"\u003eMaterial being transferred through contact before the scheduled vaccination\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Transport requirement\"\u003eSustaining a long voyage\u003c/td\u003e\n\u003ctd data-label=\"Response at the time\"\u003ePreparing food, shelter, and care\u003c/td\u003e\n\u003ctd data-label=\"Potential point of failure\"\u003eDeteriorating health and living conditions for the children\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e\n\u003cp\u003eThis method used children's bodies to transport the vaccine. It required both medical observation and daily care. Successful transport alone does not establish that the children were treated appropriately.\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#a-timeline-through-the-americas-and-the-philippines\" class=\"anchor\" id=\"a-timeline-through-the-americas-and-the-philippines\"\u003e\u003c/a\u003eA timeline through the Americas and the Philippines\u003c/h2\u003e\n\u003cp\u003eThe expedition split into several branches in the Americas. A detachment led by José Salvany headed to South America. Balmis's group traveled through Cuba and Mexico to the Philippines. Some activities continued after Balmis himself returned. \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/19329842/\"\u003e2009 study of the expedition's history\u003c/a\u003e\u003c/p\u003e\n\u003cdiv class=\"overflow-x-auto\"\u003e\u003ctable\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth\u003ePeriod\u003c/th\u003e\n\u003cth\u003eEvent\u003c/th\u003e\n\u003cth\u003eSource\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Period\"\u003eNovember 30, 1803\u003c/td\u003e\n\u003ctd data-label=\"Event\"\u003eThe María Pita set sail from A Coruña, Spain\u003c/td\u003e\n\u003ctd data-label=\"Source\"\u003ePARES expedition overview\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Period\"\u003eLate 1803 through 1804\u003c/td\u003e\n\u003ctd data-label=\"Event\"\u003eTraveled through the Canary Islands and Puerto Rico to Venezuela\u003c/td\u003e\n\u003ctd data-label=\"Source\"\u003e2009 study of the expedition's history\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Period\"\u003e1804\u003c/td\u003e\n\u003ctd data-label=\"Event\"\u003eActivities divided between the South American route and the Cuba and Mexico route\u003c/td\u003e\n\u003ctd data-label=\"Source\"\u003e2009 study of the expedition's history\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Period\"\u003eOctober and November 1804\u003c/td\u003e\n\u003ctd data-label=\"Event\"\u003ePersonnel, food, and lodging for the voyage to the Philippines discussed in official correspondence\u003c/td\u003e\n\u003ctd data-label=\"Source\"\u003ePARES file on expenses\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Period\"\u003eFebruary 1805\u003c/td\u003e\n\u003ctd data-label=\"Event\"\u003ePacific crossing began from Acapulco, Mexico\u003c/td\u003e\n\u003ctd data-label=\"Source\"\u003e2026 study of the Asian route\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Period\"\u003eApril 1805\u003c/td\u003e\n\u003ctd data-label=\"Event\"\u003eArrived in Manila with the vaccine still viable\u003c/td\u003e\n\u003ctd data-label=\"Source\"\u003e2026 study of the Asian route\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Period\"\u003eSecond half of 1805\u003c/td\u003e\n\u003ctd data-label=\"Event\"\u003eBalmis traveled toward Macau and Guangzhou\u003c/td\u003e\n\u003ctd data-label=\"Source\"\u003e2009 study of the expedition's history\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Period\"\u003e1806\u003c/td\u003e\n\u003ctd data-label=\"Event\"\u003eBalmis returned to Spain\u003c/td\u003e\n\u003ctd data-label=\"Source\"\u003e2004 study of Balmis's travels\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Period\"\u003e1807\u003c/td\u003e\n\u003ctd data-label=\"Event\"\u003eExpedition personnel who had worked in the Philippines returned to Mexico\u003c/td\u003e\n\u003ctd data-label=\"Source\"\u003e2009 study of the expedition's history\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e\n\u003cp\u003eStudies differ on whether the arrival in Manila was on April 15 or 16. The timeline therefore gives only the month confirmed by both. It also does not treat the South American detachment's activities as Balmis's personal travels.\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#what-conflicted-during-preparations-for-the-ship-in-1804\" class=\"anchor\" id=\"what-conflicted-during-preparations-for-the-ship-in-1804\"\u003e\u003c/a\u003eWhat conflicted during preparations for the ship in 1804?\u003c/h2\u003e\n\u003cp\u003eThe issue in the official correspondence was how far preparations should go when departure was uncertain. The PARES file on expenses contains copies of correspondence from both sides. The account below summarizes the archive's descriptions of the individual documents.\u003c/p\u003e\n\u003cdiv class=\"overflow-x-auto\"\u003e\u003ctable\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth\u003eDocument date\u003c/th\u003e\n\u003cth\u003eSender\u003c/th\u003e\n\u003cth\u003eContents described in the record listing\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Document date\"\u003eOctober 29, 1804\u003c/td\u003e\n\u003ctd data-label=\"Sender\"\u003eBalmis\u003c/td\u003e\n\u003ctd data-label=\"Contents described in the record listing\"\u003eInformed Captain Ángel Crespo of the number of passengers and their needs for lodging and food\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Document date\"\u003eOctober 29, 1804\u003c/td\u003e\n\u003ctd data-label=\"Sender\"\u003eÁngel Crespo\u003c/td\u003e\n\u003ctd data-label=\"Contents described in the record listing\"\u003eReplied that, because departure was uncertain, he could not promise to prepare the necessary food\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Document date\"\u003eOctober 30, 1804\u003c/td\u003e\n\u003ctd data-label=\"Sender\"\u003eBalmis\u003c/td\u003e\n\u003ctd data-label=\"Contents described in the record listing\"\u003eReported the difficulties of preparation and the need to train local medical personnel to the viceroy\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Document date\"\u003eNovember 6, 1804\u003c/td\u003e\n\u003ctd data-label=\"Sender\"\u003eViceroy of New Spain\u003c/td\u003e\n\u003ctd data-label=\"Contents described in the record listing\"\u003eOrdered measures to prepare for boarding and provide for passengers' convenience\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Document date\"\u003eMarch 20, 1805\u003c/td\u003e\n\u003ctd data-label=\"Sender\"\u003eBalmis and Ángel Crespo\u003c/td\u003e\n\u003ctd data-label=\"Contents described in the record listing\"\u003eComplaint and reply concerning the children's meals, lodging, and treatment\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e\n\u003cp\u003eThe 1804 orders did not guarantee conditions aboard the ship. The complaint written during the voyage in 1805 shows the gap. Balmis's complaint, however, cannot be treated as the result of an independent investigation. The captain's reply is also preserved in the same file. \u003ca href=\"https://pares.cultura.gob.es/ParesBusquedas20/catalogo/description/13455908\"\u003ePARES listing of correspondence on expenses\u003c/a\u003e\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#what-difficulties-did-the-children-face\" class=\"anchor\" id=\"what-difficulties-did-the-children-face\"\u003e\u003c/a\u003eWhat difficulties did the children face?\u003c/h2\u003e\n\u003cp\u003eThe children's meals and lodging were a vulnerable part of the expedition. A 2026 study of the Pacific voyage examined Balmis's report. It included complaints about conditions aboard the ship that differed from what had been promised. It also described unscheduled vaccinations occurring in cramped quarters.\u003c/p\u003e\n\u003cp\u003eIn the case of accidental vaccination summarized by the study, 7 children were involved. If vaccinations happened ahead of schedule, fewer recipients remained for later use. This could break the chain that kept the vaccine viable. Even so, the expedition delivered a viable vaccine to Manila in April 1805. \u003ca href=\"https://academic.oup.com/jtm/article/33/6/taag076/8770931\"\u003e2026 study of the Asian route\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003eThe children's origins and routes differed. Records list 22 children in the group that set sail from Spain. A group of 26 was recruited in Mexico to transport the vaccine across the Pacific. The same 22 children did not carry the vaccine on every route. \u003ca href=\"https://gwern.net/doc/history/2009-mark.pdf\"\u003eFull text of the 2009 study of the expedition's history\u003c/a\u003e, \u003ca href=\"https://balmis.org/articulos/articulo-2/\"\u003estudy of child carriers\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003eIn Cuba, the expedition had difficulty finding new carriers. Research also records the purchase of enslaved girls. Some of the children recruited in Mexico had parents. It is inaccurate to describe all participants as orphans or volunteers. \u003ca href=\"https://balmis.org/articulos/articulo-2/\"\u003eStudy of records on the recruitment and travel of the children\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003eIsabel Zendal Gómez was responsible for caring for the expedition's children. Care staff accompanied them during sea travel and activities on land. But the presence of a caregiver is not evidence of appropriate treatment. Whether promises of protection and education were kept must be checked separately. \u003ca href=\"https://www.cultura.gob.es/en/cultura/areas/archivos/mc/centros/cida/4-difusion-cooperacion/4-1-guias-de-lectura/homenaje-personal-sanitario/expedicion-balmis.html\"\u003eSpanish Ministry of Culture CIDA guide to the expedition\u003c/a\u003e\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#the-shift-from-vaccine-delivery-to-local-vaccination-systems\" class=\"anchor\" id=\"the-shift-from-vaccine-delivery-to-local-vaccination-systems\"\u003e\u003c/a\u003eThe shift from vaccine delivery to local vaccination systems\u003c/h2\u003e\n\u003cp\u003eContinued vaccination required local organizations to take responsibility. Vaccination material had to be kept viable after the expedition left. Central and regional vaccination boards were designed to take on this work. The board in Venezuela became a model for later organizations. \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/12340730/\"\u003eThe warm chain on vaccination boards\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003eTraining local medical personnel served the same purpose. They needed to learn how to preserve and use vaccination material. The expedition's goals also included free vaccination for residents. Vaccination boards were intended to manage records as well. \u003ca href=\"https://gwern.net/doc/history/2009-mark.pdf\"\u003eStudy of the expedition's goals\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003eIn the Philippines, local networks of cooperation supported the expansion of vaccination. A 2026 study explains the role of Manila's regulations. They set out the responsibilities of those in charge and the management of vaccination records. This was a way to transfer the traveling expedition's work to local organizations. \u003ca href=\"https://academic.oup.com/jtm/article/33/6/taag076/8770931\"\u003eStudy of Manila's vaccination system\u003c/a\u003e\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#how-far-did-the-expeditions-achievements-extend\" class=\"anchor\" id=\"how-far-did-the-expeditions-achievements-extend\"\u003e\u003c/a\u003eHow far did the expedition's achievements extend?\u003c/h2\u003e\n\u003cp\u003eThe expedition helped deliver the vaccine over long distances and establish a basis for local vaccination. It was not, however, the first to introduce the vaccine in every place it visited. It sometimes encountered medical personnel who had already begun vaccinating people.\u003c/p\u003e\n\u003cp\u003eTomás Romay administered vaccinations in Cuba before the expedition arrived. He obtained vaccination material from Puerto Rico in February 1804. Vaccination was underway when Balmis arrived in May of that year. Romay later led the local vaccination board. \u003ca href=\"https://www.cultura.gob.es/en/cultura/areas/archivos/mc/centros/cida/4-difusion-cooperacion/4-1-guias-de-lectura/homenaje-personal-sanitario/expedicion-balmis.html\"\u003eCIDA account of vaccination history in Cuba\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003eThe Balmis Expedition did not eradicate smallpox worldwide. WHO intensified its eradication campaign in 1967. It then pursued vaccination alongside surveillance of cases. The World Health Assembly declared global eradication on May 8, 1980. \u003ca href=\"https://www.who.int/emergencies/situations/smallpox/\"\u003eWHO account of the eradication campaign\u003c/a\u003e, \u003ca href=\"https://www.who.int/publications/i/item/WHA33-3\"\u003eWorld Health Assembly resolution WHA33.3\u003c/a\u003e\u003c/p\u003e\n\u003cdiv class=\"overflow-x-auto\"\u003e\u003ctable\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth\u003eCategory\u003c/th\u003e\n\u003cth\u003eAchievement documented for the Balmis Expedition\u003c/th\u003e\n\u003cth\u003eOutcome requiring separate evidence\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Category\"\u003eTransport\u003c/td\u003e\n\u003ctd data-label=\"Achievement documented for the Balmis Expedition\"\u003eDelivery of a viable vaccine to destinations\u003c/td\u003e\n\u003ctd data-label=\"Outcome requiring separate evidence\"\u003eReliable supply afterward\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Category\"\u003eVaccination\u003c/td\u003e\n\u003ctd data-label=\"Achievement documented for the Balmis Expedition\"\u003eVaccinations administered in several places\u003c/td\u003e\n\u003ctd data-label=\"Outcome requiring separate evidence\"\u003eVaccination rates across entire areas and long-term effects\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Category\"\u003eOrganization\u003c/td\u003e\n\u003ctd data-label=\"Achievement documented for the Balmis Expedition\"\u003eTraining and establishment of vaccination boards\u003c/td\u003e\n\u003ctd data-label=\"Outcome requiring separate evidence\"\u003eContinued operation after the expedition\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Category\"\u003eDisease control\u003c/td\u003e\n\u003ctd data-label=\"Achievement documented for the Balmis Expedition\"\u003eSpread of a means to prevent smallpox\u003c/td\u003e\n\u003ctd data-label=\"Outcome requiring separate evidence\"\u003eAn end to global transmission and eradication\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e\n\u003ch2\u003e\n\u003ca href=\"#how-should-expense-records-be-distinguished-from-vaccination-outcomes\" class=\"anchor\" id=\"how-should-expense-records-be-distinguished-from-vaccination-outcomes\"\u003e\u003c/a\u003eHow should expense records be distinguished from vaccination outcomes?\u003c/h2\u003e\n\u003cp\u003eExpense records show the campaign's preparations and disputes. They do not, by themselves, measure the effects of vaccination. This distinction also matters when organizing official correspondence as historical data. The following table distinguishes what can be inferred from each type of record.\u003c/p\u003e\n\u003cdiv class=\"overflow-x-auto\"\u003e\u003ctable\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth\u003eRecord item\u003c/th\u003e\n\u003cth\u003eWhat it can establish\u003c/th\u003e\n\u003cth\u003eWhat cannot be assumed from it alone\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Record item\"\u003eRequests to prepare food and lodging\u003c/td\u003e\n\u003ctd data-label=\"What it can establish\"\u003eNeeds and plans at the time of the request\u003c/td\u003e\n\u003ctd data-label=\"What cannot be assumed from it alone\"\u003eThe quality of meals and lodging actually provided\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Record item\"\u003ePreparation orders or expense approvals\u003c/td\u003e\n\u003ctd data-label=\"What it can establish\"\u003eAdministrative decisions and responsibilities\u003c/td\u003e\n\u003ctd data-label=\"What cannot be assumed from it alone\"\u003eWhether orders were carried out on site\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Record item\"\u003eBalmis's complaint\u003c/td\u003e\n\u003ctd data-label=\"What it can establish\"\u003eProblems reported by Balmis\u003c/td\u003e\n\u003ctd data-label=\"What cannot be assumed from it alone\"\u003eA final judgment that also considers the other party's account\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Record item\"\u003eReports of vaccination totals\u003c/td\u003e\n\u003ctd data-label=\"What it can establish\"\u003eVaccination activity counted by the person reporting it\u003c/td\u003e\n\u003ctd data-label=\"What cannot be assumed from it alone\"\u003eA complete end to smallpox transmission\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e\n\u003cp\u003eThe date a document was written and the date an event occurred are also different pieces of information. The 1804 correspondence about voyage preparations must be distinguished from records of the actual departure. When combining documents, their authors and the scope of their reports must be retained. Otherwise, plans and actions may be mistakenly combined into a single event.\u003c/p\u003e\n\u003cp\u003eSpain's UNESCO nomination describes the scope of the related records. The collection also includes administrative documents from before and after the expedition. It would therefore be inaccurate to read the full date range of the collection as the expedition's duration. \u003ca href=\"https://media.unesco.org/sites/default/files/webform/mow001/royal-philanthropic-expedition-of-the-smallpox-vaccine_nom_en.pdf\"\u003eDescription of the records submitted to UNESCO\u003c/a\u003e\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#records-and-interpretation\" class=\"anchor\" id=\"records-and-interpretation\"\u003e\u003c/a\u003eRecords and interpretation\u003c/h2\u003e\n\u003ch3\u003e\n\u003ca href=\"#what-the-records-directly-support\" class=\"anchor\" id=\"what-the-records-directly-support\"\u003e\u003c/a\u003eWhat the records directly support\u003c/h3\u003e\n\u003cp\u003eThe PARES listings establish the dates, senders, and main contents of the correspondence. They include discussions and complaints about the ship's preparation. This article has not presented the listing descriptions as quotations from the original letters. The exact wording of any particular passage should be checked against the linked images of the originals.\u003c/p\u003e\n\u003ch3\u003e\n\u003ca href=\"#what-historical-studies-commonly-emphasize\" class=\"anchor\" id=\"what-historical-studies-commonly-emphasize\"\u003e\u003c/a\u003eWhat historical studies commonly emphasize\u003c/h3\u003e\n\u003cp\u003eThe studies reviewed address both sequential vaccination and the role of local organizations. The technique for keeping the vaccine viable was not enough on its own to complete the campaign. Training medical personnel and administrative cooperation determined whether it could continue. This interpretation considers the history of transport alongside the history of public health.\u003c/p\u003e\n\u003ch3\u003e\n\u003ca href=\"#differences-between-sources-and-remaining-limits\" class=\"anchor\" id=\"differences-between-sources-and-remaining-limits\"\u003e\u003c/a\u003eDifferences between sources and remaining limits\u003c/h3\u003e\n\u003cp\u003eThe expedition's end year varies with the scope of the account. The PARES event title uses 1803 through 1810. A 2009 study covers subsequent activities through 1813. Balmis's return in 1806 cannot be taken as the end of the entire campaign.\u003c/p\u003e\n\u003cp\u003eSome voyage dates still differ between studies. Nor can the children's long-term lives as a whole be reconstructed from one file. Promises of protection and the support actually provided require separate checks. A total number vaccinated across the expedition would also be misleading without specifying what the count includes.\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#why-read-this-as-part-of-the-history-of-vaccine-delivery-today\" class=\"anchor\" id=\"why-read-this-as-part-of-the-history-of-vaccine-delivery-today\"\u003e\u003c/a\u003eWhy read this as part of the history of vaccine delivery today?\u003c/h2\u003e\n\u003cp\u003eThis case shows the relationship between preservation methods and delivery organizations. At the time, the vaccine was kept viable through vaccination from person to person. Vaccine delivery today manages storage conditions specific to each product. Although the technology differs, people and systems of responsibility are still needed to maintain supply.\u003c/p\u003e\n\u003cp\u003eThe historical points of connection are:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003ePreservation: Keeping the vaccine usable until it reaches its destination.\u003c/li\u003e\n\u003cli\u003eOperations: Whether local staff can continue vaccination and record management.\u003c/li\u003e\n\u003cli\u003eCare: Assessing the campaign's achievements separately from its treatment of participants.\u003c/li\u003e\n\u003cli\u003eEvaluation: Distinguishing the amount transported, vaccination totals, and reductions in disease.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe expedition's use of children as carriers is not a model for vaccination today. What can be compared are the preservation and operational problems it sought to solve. The children's experiences show who bore the burden of that solution.\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#frequently-asked-questions\" class=\"anchor\" id=\"frequently-asked-questions\"\u003e\u003c/a\u003eFrequently asked questions\u003c/h2\u003e\n\u003ch3\u003e\n\u003ca href=\"#were-the-children-given-smallpox\" class=\"anchor\" id=\"were-the-children-given-smallpox\"\u003e\u003c/a\u003eWere the children given smallpox?\u003c/h3\u003e\n\u003cp\u003eThe expedition carried cowpox vaccination material intended to prevent smallpox. This differs from variolation, which used material from smallpox patients. The use of people's bodies for transport must nonetheless be assessed separately.\u003c/p\u003e\n\u003ch3\u003e\n\u003ca href=\"#did-the-22-children-who-first-set-sail-carry-the-vaccine-all-the-way-to-the-philippines\" class=\"anchor\" id=\"did-the-22-children-who-first-set-sail-carry-the-vaccine-all-the-way-to-the-philippines\"\u003e\u003c/a\u003eDid the 22 children who first set sail carry the vaccine all the way to the Philippines?\u003c/h3\u003e\n\u003cp\u003eDifferent groups carried the vaccine on different routes. In Mexico, 26 children were recruited for the Pacific crossing. The 22 children present at departure should not be counted as the participants for the entire expedition.\u003c/p\u003e\n\u003ch3\u003e\n\u003ca href=\"#do-the-1804-letters-show-that-the-expedition-failed\" class=\"anchor\" id=\"do-the-1804-letters-show-that-the-expedition-failed\"\u003e\u003c/a\u003eDo the 1804 letters show that the expedition failed?\u003c/h3\u003e\n\u003cp\u003eThe letters show disagreement over preparations for the ship. A dispute during preparations does not, by itself, mean the entire campaign failed. A viable vaccine reached the Philippines in 1805.\u003c/p\u003e\n\u003ch3\u003e\n\u003ca href=\"#what-were-local-medical-personnel-taught\" class=\"anchor\" id=\"what-were-local-medical-personnel-taught\"\u003e\u003c/a\u003eWhat were local medical personnel taught?\u003c/h3\u003e\n\u003cp\u003eThey were taught how to preserve the vaccine and administer vaccinations. The training was meant to enable local staff to continue vaccination after the expedition. Vaccination boards were responsible for organizing this work.\u003c/p\u003e\n\u003ch3\u003e\n\u003ca href=\"#did-the-balmis-expedition-eradicate-smallpox\" class=\"anchor\" id=\"did-the-balmis-expedition-eradicate-smallpox\"\u003e\u003c/a\u003eDid the Balmis Expedition eradicate smallpox?\u003c/h3\u003e\n\u003cp\u003eThe expedition helped spread vaccination in the early 19th century. Global smallpox eradication was achieved through an international campaign much later. The official declaration was made on May 8, 1980.\u003c/p\u003e\n","tags":["Smallpox","History of medicine"],"faqs":[{"question":"When and where did the Balmis expedition depart?","answer":"It sailed from A Coruña, Spain, aboard the María Pita on November 30, 1803. It was a smallpox vaccination campaign supported by the Spanish royal court."},{"question":"How was the vaccine transported without refrigeration?","answer":"The vaccine material was kept active by inoculating children in sequence. Material taken from one inoculation site was transferred to the next person."},{"question":"Were the children inoculated with smallpox?","answer":"The expedition carried cowpox material for smallpox vaccination. This was different from variolation, which used material from smallpox patients."},{"question":"Did the 22 children who first set sail serve on every leg of the journey?","answer":"New groups of children helped carry the vaccine on different legs of the journey. The 22 children who departed from Spain should be distinguished from the group of 26 recruited in Mexico to carry it across the Pacific."},{"question":"Were all the children who took part in the expedition orphans?","answer":"They were not all necessarily orphans. Some of the children recruited in Mexico had parents. Research also documents the purchase of enslaved girls in Cuba."},{"question":"What was the disagreement over preparations for the ship in 1804?","answer":"Balmis requested accommodations and food for the voyage to the Philippines. The captain replied that he could not promise to make the preparations because the departure was uncertain."},{"question":"Why did unscheduled inoculations threaten the transport of the vaccine?","answer":"The sequence of inoculations required people who could be inoculated later. If contact caused inoculations to happen ahead of schedule, it could become difficult to maintain the chain during the later part of the voyage."},{"question":"What role did Isabel Zendal Gómez play?","answer":"She cared for the children on the expedition. Looking after their daily needs and health was necessary to maintain the sequence of inoculations."},{"question":"Had the vaccine been used in any places before the expedition arrived?","answer":"In Cuba, Tomás Romay carried out vaccinations before the expedition arrived. It would be inaccurate to say the expedition introduced the vaccine for the first time in every place it visited."},{"question":"Why were training for local medical practitioners and vaccination boards needed?","answer":"Vaccinations had to continue after the expedition left. Medical practitioners learned how to preserve the vaccine and administer vaccinations. The boards organized vaccination activities and recordkeeping."},{"question":"Why do sources give different end dates for the Balmis expedition?","answer":"Balmis's own return, the activities of the expedition's detachments, and follow-up efforts took place over different periods. PARES uses 1803 to 1810 in the event title. A 2009 study covers activities through 1813, including follow-up efforts."},{"question":"Did the Balmis expedition eradicate smallpox?","answer":"The Balmis expedition was an early effort that helped distribute the vaccine. Global eradication was achieved through later vaccination and case surveillance efforts. The World Health Assembly declared smallpox eradicated on May 8, 1980."},{"question":"Where can I find the exact wording of the 1804 official letter?","answer":"It can be found in a file concerning the Balmis expedition’s expenses on Spain’s archival portal PARES. The description of each document should be read separately from its original image."}],"sources":[{"url":"https://pares.cultura.gob.es/ParesBusquedas20/catalogo/autoridad/134600","title":"PARES: Real Expedición Filantrópica de la Vacuna, 1803-1810","type":"source"},{"url":"https://pares.cultura.gob.es/ParesBusquedas20/catalogo/description/13455908","title":"PARES: List of official correspondence in the file on the costs of the Balmis Expedition","type":"source"},{"url":"https://pubmed.ncbi.nlm.nih.gov/19329842/","title":"Catherine Mark·José G. Rigau-Pérez, The world's first immunization campaign: the Spanish Smallpox Vaccine Expedition, 1803-1813, 2009","type":"source"},{"url":"https://gwern.net/doc/history/2009-mark.pdf","title":"Original PDF of Mark·Rigau-Pérez's 2009 study of the expedition's history","type":"source"},{"url":"https://academic.oup.com/jtm/article/33/6/taag076/8770931","title":"Jose Tuells, Preserving vaccination across the Pacific and beyond: the Asian route of the Royal Philanthropic Vaccine Expedition, 2026","type":"source"},{"url":"https://balmis.org/articulos/articulo-2/","title":"José Tuells·José Luis Duro-Torrijos, El viaje de la vacuna contra la viruela: una expedición, dos océanos, tres continentes y miles de niños","type":"source"},{"url":"https://www.cultura.gob.es/en/cultura/areas/archivos/mc/centros/cida/4-difusion-cooperacion/4-1-guias-de-lectura/homenaje-personal-sanitario/expedicion-balmis.html","title":"Spanish Ministry of Culture CIDA: Expedición Balmis, 1803-1810","type":"source"},{"url":"https://pubmed.ncbi.nlm.nih.gov/12340730/","title":"J. Z. Bowers, The warm chain, 1985","type":"source"},{"url":"https://pubmed.ncbi.nlm.nih.gov/15108831/","title":"J. Antonio Aldrete, Smallpox vaccination in the early 19th century using live carriers: the travels of Francisco Xavier de Balmis, 2004","type":"source"},{"url":"https://media.unesco.org/sites/default/files/webform/mow001/royal-philanthropic-expedition-of-the-smallpox-vaccine_nom_en.pdf","title":"UNESCO Memory of the World nomination form for the Royal Smallpox Vaccine Expedition records in Spain's national archives","type":"source"},{"url":"https://www.who.int/emergencies/situations/smallpox/","title":"WHO: Smallpox","type":"source"},{"url":"https://www.who.int/publications/i/item/WHA33-3","title":"World Health Assembly WHA33.3: Declaration of global eradication of smallpox, May 8, 1980","type":"source"}],"images":[{"id":1598,"url":"https://injoys.com/rails/active_storage/blobs/proxy/eyJfcmFpbHMiOnsiZGF0YSI6MjM5NzcsInB1ciI6ImJsb2JfaWQifX0=--e5c0ada9d4d8c786ef84d0a639f1f2bdc8c9d2a7/ai-dd6d5583.webp","is_representative":false,"generation_method":"ai_semi","license":"ai_generated","mime_type":"image/webp","width":1536,"height":1024,"translations":{"ko":{"alt":"항구에서 아이들이 보호자와 함께 범선으로 향하고, 선원들이 통과 짐을 싣는다.","caption":"긴 항해를 위한 식량과 숙소 준비는 원정의 주요 난관이었다.","description":null},"en":{"alt":"Children and a caregiver approach a sailing ship as sailors load barrels and supplies at a harbor.","caption":"Preparing provisions and lodging for the long voyage was a major challenge for the expedition.","description":null},"ja":{"alt":"港で子どもたちと付き添い人が帆船に向かい、船員が樽や荷物を積み込んでいる。","caption":"長い航海に向けた食料と宿泊場所の準備は、遠征の大きな難題だった。","description":null},"es":{"alt":"Un grupo de niños y su cuidadora se acerca a un velero mientras cargan barriles y provisiones en el puerto.","caption":"Preparar víveres y alojamiento para la larga travesía fue un gran desafío de la expedición.","description":null},"id":{"alt":"Anak-anak dan seorang pengasuh mendekati kapal layar saat para pelaut memuat tong dan perbekalan di pelabuhan.","caption":"Menyiapkan perbekalan dan tempat tinggal untuk pelayaran panjang menjadi tantangan besar ekspedisi.","description":null},"pt":{"alt":"Crianças e uma cuidadora se aproximam de um veleiro enquanto marinheiros carregam barris e mantimentos no porto.","caption":"Preparar provisões e alojamento para a longa viagem foi um grande desafio da expedição.","description":null},"zh-hant":{"alt":"港口裡，孩子們與照顧者走向帆船，水手正搬運木桶和補給品。","caption":"為漫長航程準備食物與住宿，是遠征的一大難題。","description":null},"de":{"alt":"Kinder und eine Betreuerin gehen im Hafen auf ein Segelschiff zu, während Seeleute Fässer und Vorräte verladen.","caption":"Verpflegung und Unterkunft für die lange Überfahrt vorzubereiten, war eine große Herausforderung der Expedition.","description":null}}},{"id":1599,"url":"https://injoys.com/rails/active_storage/blobs/proxy/eyJfcmFpbHMiOnsiZGF0YSI6MjM5ODMsInB1ciI6ImJsb2JfaWQifX0=--23b9935bf6cb5de950a14e36764cd1c5502f5657/ai-5a99a498.webp","is_representative":false,"generation_method":"ai_semi","license":"ai_generated","mime_type":"image/webp","width":1536,"height":1024,"translations":{"ko":{"alt":"열대 지방 건물 안뜰에서 의료인들이 탁자 주위에 모이고 가족들이 회랑 그늘에서 기다린다.","caption":"현지 의료인 교육은 원정 이후에도 접종을 이어가기 위한 장치였다.","description":null},"en":{"alt":"Practitioners gather around a table in a tropical courtyard while families wait under a shaded arcade.","caption":"Training local practitioners helped sustain vaccination after the expedition.","description":null},"ja":{"alt":"熱帯の建物の中庭で医療従事者が机を囲み、家族が回廊の日陰で待っている。","caption":"現地の医療従事者への教育は、遠征後も接種を続けるための取り組みだった。","description":null},"es":{"alt":"Profesionales sanitarios se reúnen junto a una mesa en un patio tropical mientras varias familias esperan bajo los arcos.","caption":"Formar a profesionales locales ayudó a mantener la vacunación después de la expedición.","description":null},"id":{"alt":"Tenaga kesehatan berkumpul di sekitar meja di halaman tropis, sementara keluarga menunggu di bawah serambi.","caption":"Pelatihan tenaga kesehatan setempat membantu vaksinasi berlanjut setelah ekspedisi.","description":null},"pt":{"alt":"Profissionais de saúde reúnem-se à volta de uma mesa num pátio tropical, enquanto famílias aguardam sob os arcos.","caption":"A formação de profissionais locais ajudou a manter a vacinação após a expedição.","description":null},"zh-hant":{"alt":"熱帶建築的庭院裡，醫護人員圍在桌旁，家屬在遮蔭的廊道下等候。","caption":"培訓當地醫護人員有助於在遠征結束後持續接種。","description":null},"de":{"alt":"Medizinisches Personal versammelt sich an einem Tisch in einem tropischen Innenhof, während Familien unter Arkaden warten.","caption":"Die Ausbildung örtlicher Fachkräfte half, Impfungen nach der Expedition fortzuführen.","description":null}}}],"published_at":"2026-10-02T16:56:34+09:00","updated_at":"2026-10-02T16:56:34+09:00","license":"cc_by","translation_status":"reviewed","available_locales":["ko","en","ja","es"],"data_locales":["ko","en","ja","es","id","pt","zh-hant","de"],"url":"https://injoys.com/en/articles/balmis-expedition-1803-smallpox-vaccine-transport"}