The First Anti-Vaxxers: Vaccine Hesitancy in the Spanish Empire

As medical professionals and political authorities around the world grapple with the challenging logistics of vaccinating billions of people against Covid-19, they are frequently frustrated by the vaccine hesitancy in many communities, particularly, but not only, in minority and marginalized populations. Suspicions about the safety and efficacy of the vaccines, distrust of government officials in charge of vaccination efforts, obstacles to access, and disbelief in the severity or scope of the pandemic have all contributed to many people’s unwillingness to get vaccinated.1For instance, see Sheera Frankel, “Black and Hispanic Communities Grapple with Vaccine Misinformation,” New York Times, March 10, 2021. While these issues often seem to be the product of twenty-first-century culture, they would be remarkably familiar to the Spanish and Spanish American authorities charged with promoting the first-ever vaccine, which was developed to provide immunity to smallpox at the end of the eighteenth century. Spain’s smallpox vaccination campaign reveals that vaccine hesitancy goes far beyond current political and cultural conflicts and has deep roots in the very first vaccinations.

Inoculating the Spanish Empire

Smallpox was one of the most frightening and devastating diseases of the early modern period. Europeans and their colonial subjects suffered through one smallpox epidemic after another until inoculation was introduced from the Ottoman Empire at the beginning of the eighteenth century. In this process, the live virus was implanted into incisions in the arm and usually produced a less severe infection followed by immunity, although it would also lead to full-blown cases of smallpox and even death. Inoculation found few proponents in the Spanish Empire and was not regularly practiced until the 1770s. It was only after King Charles IV’s (r.1788–1808), brother, sister-in-law, and daughter died of the disease that the distraught king first ordered the inoculation of the royal household in 1798 and then made inoculation widely available to his subjects. Soon after, King Charles was made aware of the English physician Edward Jenner’s work on the use of cowpox to provide immunity against smallpox. Although the preferred mechanism of transmission was the same (arm-to-arm transmission of infected fluid into a skin lesion), the use of cowpox rather than smallpox provided the desired immunity without the accompanying ill effects or mortality. Responding to pleas from colonial administrators, King Charles accepted a proposal from Dr. Francisco Xavier de Balmis y Berenguer (1753–1819) to head what would become the first global health initiative, the Royal Philanthropic Expedition to bring Smallpox Vaccination to the Spanish Empire.

The Royal Philanthropic Expedition consisted of Balmis, another physician, José Salvany, and a dozen or so medical assistants, nurses, and servants, as well as 22 boys between 3 and 9 years old. Conscripted from a charity hospital and orphanage, the boys had not yet been infected with the disease and Balmis used them to keep the cowpox virus alive during the Atlantic crossing by vaccinating them sequentially. The Expedition left La Coruña on November 30, 1803, stopping to conduct vaccinations in the Canary Islands, Puerto Rico, and Venezuela. At the Venezuelan coast, Balmis and Salvany split up. Balmis took the vaccine to Cuba and New Spain (Mexico), going as far as the Philippines and China. While Balmis circumnavigated the globe, returning to Europe in 1806, Salvany and his crew carried the vaccine to South America. From Caracas, he provided vaccinations along the route from Cartagena to Santa Fe de Bogotá and across Peru until his death in 1810.

Vaccine hesitancy in the Viceroyalty of Peru

As word spread about the efficacy of the cowpox lymph in providing immunity against smallpox, Peru was suffering an intense epidemic of the disease. As a result, the Viceroy of Peru, the Marquis de Avilés, and other government officials were very enthusiastic about the life-saving potential of the vaccine. In fact, well ahead of Salvany’s arrival, Peruvian authorities worked to acquire the cowpox lymph, first from a ship making the journey from Cádiz to the Philippines and after that lymph died out, in October 1805, the viceroy successfully obtained it from Buenos Aires, where it had arrived in the arms of enslaved people on a ship from Rio de Janeiro. Six months later, Salvany finally arrived in the region also carrying the cowpox lymph.

Having obtained the vaccine, the governmental authority charged with overseeing the vaccination campaign, the Central Committee for the Preservation and Propagation of the Vaccine, named two doctors to head the vaccination campaign, the Spaniard Pedro Belomo and a Peruvian of African descent, José Manuel Dávalos (1758–1821). Both men were highly regarded by Lima’s intellectual and medical elites. Dávalos, the most well-known of Lima’s Afro-Peruvian physicians, would play a key role in the spread of vaccination across the region.

Reaching high into the Andes, the Viceroyalty of Peru’s population was predominately Indigenous, but it was also home to a significant population of mixed-race people, as well as people of African descent, both enslaved and free, and a smaller White population. However, as it undertook efforts to extend vaccination, the Central Committee just assumed that the fear of the disease was so deeply entrenched that these diverse communities would accept the vaccine without question. They were wrong. Both the doctors, one in charge of the vaccination campaign in Lima and Salvany vaccinating in the rural areas, were met with vaccine hesitancy, particularly from Peru’s non-White populations.

Vaccine hesitancy in the region was grounded in the deep distrust and resentment of Spanish authorities. Centuries of exploitation and the fact that Europeans had been the source of smallpox in the Americas left Peru’s large Indigenous populations unsurprisingly wary of their medical interventions. Moreover, most Indigenous people remained unassimilated, poor, and burdened by oppressive taxes and exploitative labor practices that led to more than 120 revolts during the eighteenth century. As late as 1780, the southern highlands had erupted in violent rebellion against Spanish colonial rule, led by the messianic Indigenous leader Tupac Amaru. In terms of the population of people of African descent, the discriminatory practices of slave society left even free Afro-Peruvians and mixed-race people socially and economically marginalized.

As a result, after some initial enthusiasm, the minutes of the Central Committee note that the doctors were generally only vaccinating a few dozen people each month and that across the region, the cowpox lymph was being lost because so few people would submit to vaccination. Like other authorities across the Spanish Empire, the Central Committee attributed the hesitancy to fear of novelty and often referred to “popular concerns,” which they never even attempted to define.2Manuel García-Plata, “Libro de Reales Ordenes y Actas a la Expedición Filantrópica de la vacuna; y la mejor conservación y propagación del fluido” (12 Septiembre 1807), Biblioteca Nacional de Perú, Sig 13105, esp. fol. 16. To keep the lymph alive, Salvany said that he had to wander the streets “like a beggar” asking if anyone would be vaccinated.3AGI, Indiferente General, legajo 1558a, fol.1332v. Years later, Dávalos recalled that in Lima he had to persuade, beg, and reward mothers to submit their children to vaccination4José Manuel Dávalos, “Informe que dio el doctor Dávalos a la Junta Central sobre el estado actual de la vacuna,” Gaceta del Gobierno de Lima, 59 (17 de agosto de 1818), 495..

Although the Central Committee may not have understood people’s reluctance to get vaccinated, Salvany’s letters to the Crown reveal the intense distrust that the Indigenous population had of the vaccine and of Europeans more generally. From the town of Chocope, Salvany reported that when the “Indians” saw how simple the procedure was, “they began to doubt it and there were even some who said that it was false, and when I promised that it would protect them from smallpox, they did not believe me and called me the Antichrist.” Salvany acknowledged that race was an issue, noting that the Indigenous were “accustomed to doubt everything and more so that proposed by the White man.”5Archivo General de Indias (AGI), Indiferente General 1558ª, fol. 1325v. In a letter reprinted in a Lima newspaper, he lamented the “natural distrust” that Indigenous people had and that they had “closed their ears to all reasoning.”6José Salvany, “Peru, Lima 14 de Mayo, Oficio de D. Jose Salvani [sic] a esta Superioridad,” Minerva Peruana (14 de Mayo de 1806), 146. In addition, Salvany believed that Dávalos and Belomo had focused too much on Lima and had not dedicated enough time and energy to vaccinating the large Indigenous populations outside of the capital.7→AGI, Indiferente General, legajo 1558a, fol.1332v.
→For a modern parallel that examines Peru’s Covid-19 response and how it left behind Indigenous Amazonian communities, see Deborah Delgado Pugley and Dámaris Herrera Salazar, “Were Indigenous Peoples’ Vulnerable or Resilient? Strategies to Cope with Covid-19 in the Peruvian Amazon Basin,” in “Covid-19 and the Social Sciences,” series, Items (August 19, 2021).

The archive provides less insight into the reasons behind the hesitancy of Peru’s diverse urban population, many of whom were African or of African descent. Although authorities were required to take down the name, age, and parents of the person being vaccinated, those lists rarely indicate the person’s race, making it difficult to assess how the campaign played out across racial lines (although they do sometimes indicate enslaved/free status). However, as historian José R. Jouve Martín notes, the Afro-Peruvian population was fractured not only by slavery, but by ethnicity, education, and gender.8José R. Jouve Martín, The Black Doctors of Colonial Lima: Science, Race, and Writing in Colonial and Early Republican Peru (Montreal: McGill-Queen’s University Press, 2014), xviii. Thus, merely having an Afro-Peruvian doctor in charge of the vaccination campaign was not sufficient to mitigate people’s fears. Enslaved and poor Afro-Peruvians would have seen themselves as having little in common with literate, professional men like Dávalos and distrusted his association with Spanish political and medical authorities to vaccination.

The failure of government officials to act aggressively also hindered the vaccination campaign. In other parts of the Spanish Empire, civil and ecclesiastical authorities put on elaborate spectacles that included bands, fireworks, and religious services designed to attract people to the vaccinations and allay their anxieties, but in Lima neither political nor medical officials invested in similar events. In fact, Arequipa was the only major city in the Viceroyalty to fete Salvany’s arrival with a Te Deum and a mass.9AGI, Indiferente General, legajo 1558a, fol.1435. As a result, concerns about the vaccine festered. Dávalos later remarked that the masses continued to believe that “the vaccine is an evil and not an antidote.”10Dávalos, “Informe,” 494.

Long-lasting hesitancy

Despite its life-saving potential and the enthusiasm of medical and political authorities, initial attempts to vaccinate the Peruvian population met with little success largely because the vaccination campaign failed to take into account the racial and cultural diversity of colonial society. Now more than two hundred years later, political and medical officials are again grappling with how to persuade diverse populations to submit to Covid-19 vaccination. As the smallpox vaccination campaign shows, they are only the next in a long line of authorities who have encountered significant populations who were unwilling to submit to vaccination.

Banner image: Wellcome Collection.