In April 1955, almost sixty years ago, reporters crowded into the University of Michigan lecture hall. Up on the dais, Dr. Thomas Francis Jr., director of the Poliomyelitis Vaccine Evaluation Center of the University of Michigan droned on for a while before reaching the climax everyone had come to hear:
“In placebo-controlled areas, the poliomyelitis vaccination was 68 percent effective against polio Type I, 100 percent effective against Type II, and 92 percent effective against Type III,” he said. “The vaccine works. It is safe, effective, and potent.”
One of mankind’s fearsome scourges was officially conquered.
When Dirt was Good
The poliomyelitis, or polio, virus has a nasty susceptibility to invade a victim’s central system, enter individual nerves, and hijack their mechanisms to produce thousands of copies of themselves in a few hours. In worst scenario cases, the disease can scar the gray matter that runs down the center of the spinal cord (hence the name poliomyelitis, the Greek for “inflammation of the gray marrow”) or kill muscular nerves.
Polio was a new threat. Ironically, the 19th century battle to sanitize society was the chance polio had been waiting for since at least the days of ancient Egypt. An artist’s depiction from those times shows a shrivel-legged man limping with the help of a long stick; this is thought to represent a crippled survivor of a polio attack.
Until today, a cure for polio remains evasive. In the 1700s, doctors thought polio was a teething disease and tried to cure children by bleeding them with leeches or burning them with hot irons.
From the 1890s on, the disease took an ever-rising toll. Polio breeds in the innards and transfers to others through contact with human waste. It is thought that in less hygienic times, babies exposed to the virus at a very early age gained protection from their mothers’ antibodies and built a lasting resistance to the bug. But as city fathers cleaned the streets and covered sewers, the threat of polio grew. This is why the first big epidemics struck at sanitized places likeNew York, hit by its first epidemic in 1916.
One victim of theNew Yorkepidemic, Anthony DiBona, described the simple method mother’s used to gauge their babies’ health:
“They used to tell the mothers to tickle the babies underneath their feet,” he wrote. “If they would retract them, they were all right. My mother tickled my feet, the right one I withdrew and when she tickled my left one, I stood still. There was a hospital on 42nd Street called Hospital for Crippled Children. I was there for a couple of years… My mother used to have to come down twice a day to feed me -she would take the trolley car.”
The disease spread nationwide. In August that year, the Los Angeles Times reported desperate efforts to stop the disease’s spread:
“Many inspectors… stationed themselves at the railroad stations, ferries, and boat landings along the Delaware River… to bar all children under sixteen years of age who attempted to cross into [Pennsylvania] without certificates of health.”
Nationwide, the epidemic of that year caused 9,000 cases and 2,343 deaths.
From then onwards, not a year passed without an epidemic. During the 40s and 50s, the disease infecting millions, leaving 640,000 children with paralyzed legs or lungs. The latter spent weeks, months, or the rest of their lives in iron lungs, box-like machines that created a fluctuating vacuum around the patient’s chest, enabling the lungs to gasp in air. During the 1930s, this life saving contraption cost about $1,500, enough money to buy a house. 1,200U.S.citizens were still using iron lungs by 1959.
Polio panicked people. During annual epidemics, polio patients were social outcasts. Cardboard signs pasted on their homes warned:
“INFANTILE PARALYSIS, Polionyelitis. All persons not occupants of these premises are advised of the presence of Infantile Paralysis in it and are advised not to enter. The person having Infantile Paralysis must not leave the apartment until the removal of this notice by an employee of the Department of Health. By order of the BOARD OF HEALTH.”
During epidemics, some towns hung up signs warning: “CHILDREN UNDER 16 NOT ALLOWED TO ENTER THIS TOWN.” Swimming pools closed down and theaters were deserted.
1952 was a record epidemic year with 57,628 cases of polio reported in the United States. At its peak in the early 50s, polio infected people at the rate of 13.6 cases per 100,000 people. One out of 200 infections led to irreversible paralysis, and among those paralyzed, five to ten percent died when their breathing muscles shut down.
Salk Versus Sabin
President Franklin D. Roosevelt suffered from polio as a teenager and his legs became paralyzed. During political photo shoots, he generally sat down to hide this disability. To provide the millions of dollars guzzled by polio research,Rooseveltfounded the March of Dimes Organization in 1938 whereby donors were encouraged to give small change to the cause. Advertising gimmicks included a collection box shaped like a miniature iron lung. The donations added up; a dime was worth a cup of coffee in those days.
In the early 1950s, the Jewish medical pioneer, Dr. Jonas Edward Salk (co-inventor of the first influenza vaccine during World War II) developed a dead virus vaccine. This works by fooling the body into thinking it is infected with polio and spurring it to produce antibodies against the imaginary threat. Then, if real polio strikes some time in the future, the body has plenty antibodies to stop the disease in its tracks before it gets out of control.
In 1954, Salk tested his vaccine in a trial that included 650,000 children in 211 health districts of forty-four states. It succeeded, despite rumors that little white coffins were being stockpiled in readiness for victims of the test. Ever since, polio in the States has bit the dust. The number of reported cases plummeted to3,000 in1960 and eventually to zero. The last cases of naturally occurring polio were found in four states in 1979, all of them the fault of Amish folk who refused vaccination in line with their rejection of modern advances.
Meanwhile, another Jewish researcher, Dr. Albert Sabin, was developing a different vaccine based on live viruses bred in laboratories or animals to become virile enough to induce the body to produce antibodies, but too weak to cause disease. Had the PETA organization existed in those times, it may have objected to the 100,000 monkeys that sacrificed their lives for his cause. Much of his testing was conducted in Soviet Russia; fear of polio temporarily outweighed the Communists’ allergy to Capitalist America.
For years, the two camps slogged it out, live vaccine adherents versus dead vaccine enthusiasts. Dr. Salk’s dead-virus camp rightfully claimed that live viruses vaccines had a chance of afflicting people with the disease they were trying to prevent, while Dr. Sabin’s live-virus camp claimed that their vaccine was easier to administer (oral versus injection) and required less booster shots.
Ever since Sabin’s live vaccine was licensed in 1961, health agencies have wracked their brains deciding between live and dead vaccines. Initially, the United States switched to live vaccine due to its greater efficiency, accepting the risk of inflicting polio paralysis at the annual rate of four per million. Due to this small risk, and the danger that children newly vaccinated with live-virus can pass the disease to people with weak immune systems, the Centers for Disease Control reverted to dead-virus vaccine in 2000.
A Global Battle
In 1988, the World Health Assembly adopted a resolution to eradicate polio worldwide, similar to the inoculation program that has eradicated smallpox since 1973. Since 1988, over two billion children were immunized in 122 countries and polio has decreased by over 99% from about 350,000 cases in 1988 to 1,352 known cases in 2010. It is estimated that this has prevented five million cases of paralysis and 250,000 deaths.
But all is not well. According to the Polio Global Eradication Initiative, despite immunization programs costing billions, Polio remains endemic in three countries – Afghanistan, Nigeria and Pakistan – and has re-established transmission in three countries that were previously polio-free, Angola, Chad and Democratic Republic of the Congo. Several more countries had ongoing outbreaks in 2011 due to importations of the virus.
The reason persistent pockets of polio survive in northern Nigeria, Afghanistan, and Pakistan are various. Nigeria had a tremendous setback in 2003 when politicians in northern Nigeria canceled vaccination campaigns for nearly a year, claiming the vaccine was a Western plot to reduce the Muslim population. That year, polio exploded and leaped to two dozen other countries. Many Muslims still believe the myth and the Nigerian government is having a tough time talking round concerned parents. To make things worse, a 2007 epidemic in Nigeria was instigated by the vaccine itself. As mentioned earlier, oral vaccines use live viruses that can infect a portion of inoculated people.
Afghanistan is still a polio zone due to conflict and insecurity that make it difficult to maintain thorough vaccination programs, and the disease spreads from there to neighboring Pakistan.
It is crucial to defeat polio in its last strongholds because the battle against polio is all or nothing. So long as one child remains infected with polio, he or she poses a threat to every child in the world.
(Sources: Julie Silver and Daniel Wilson, Polio Voices: an Oral History from the American Polio Epidemics and Worldwide Eradication Efforts, Praeger Printers, Westport, 2007; The Smithsonian National Museum of American History; Jeffrey Kluger, Conquering Polio, Smithsonian magazine, April 2005)