During the 1950s, a vaccine was created which would eradicate polio in much of the developed world. Polio had been around for Millennia. There are paintings and carvings from Ancient Egypt which show young people walking with canes and adults with withered limbs. It is also believed by some historians that the Roman Emperor Claudius was stricken with Polio as a child and was the reason for his limp. In the 1800s and 1900s Polio plagued major cities, especially in the summer months. Polio’s full name is poliomyelitis. The name is derived from two Greek words – Polios which means grey and Myelos which means matter, referring to grey matter within the spinal cord. Polio first emerged in the United States in scattered outbreaks during the late 19th century. Initially, these outbreaks were relatively small, confined to certain areas, and the disease was not well understood. Polio was the third viral disease discovered by scientists. The first two were smallpox and rabies. Polio is a highly contagious viral illness primarily affecting children. The sudden appearance of this paralyzing illness caught communities off guard, and they had very little success at treating the disease.
Medical records of the time describe cases of children suddenly becoming paralyzed, often without any clear explanation. These sporadic outbreaks led to increased concern among parents and healthcare providers. The lack of knowledge about the disease’s transmission and its severe impact on young victims contributed to a climate of anxiety. What makes polio especially dangerous is that 75% of cases are asymptomatic. Polio is spread through either fecal or oral transmission. A person can be contagious and spread polio for up to 6 weeks, even if they don’t have symptoms. In mild cases, people can have a fever or a sore throat. Non-paralytic polio may present with mild, flu-like symptoms such as fever, sore throat, headache, vomiting, fatigue, and stiffness in the neck and back. These symptoms usually resolve within a week or two.
In more severe cases, the virus can invade the central nervous system, leading to paralytic polio. This form is less common but far more serious. Symptoms of paralytic polio include severe muscle pain, loss of reflexes, and sudden onset of paralysis, typically affecting the legs but sometimes other parts of the body. In rare cases, the paralysis can affect the respiratory muscles, leading to difficulty in breathing and requiring mechanical assistance. The severity and extent of paralysis can vary, and while some individuals recover fully, others may experience permanent muscle weakness or paralysis.
The iron lung, officially known as a negative pressure ventilator, emerged as a critical medical device during the height of polio epidemics. Its development was spurred by the urgent need to assist patients whose respiratory muscles were paralyzed by the virus. The first iron lung was developed in 1928 by Dr. Philip Drinker and Dr. Louis Agassiz Shaw at Harvard University. This bulky machine encased the patient’s body up to the neck, using varying air pressure to stimulate breathing. The iron lung was a bulky machine and expensive. In the 1930s, an iron lung cost about $1,500. That was the same cost as a home at that time. You can imagine that the long term treatment as patients, especially children, often had to spend weeks, months, or even years inside these machines to survive. The device worked by creating a vacuum that forced the chest to expand and contract, mimicking natural breathing. Though cumbersome, the iron lung saved countless lives and became a symbol of the era's medical challenges and ingenuity. I read an interesting story about a man named Paul Alexander who lived in an iron lung for 70 years after being infected with Polio at the age of 6. He recently died at the age of 78. You can read the book he wrote about his life. He wrote every word himself holding the pen with his mouth. He became known as The man in the iron lung. His will to survive and his drive to achieve his goals are nothing short of inspirational. He read books, painted (again he would hold the paint brush with his mouth. He graduated high school and fought for the opportunity to attend college which he did. He passed the Bar exam and became a lawyer. Further proof that where there is a will there is a way.
As the 20th century unfolded, the frequency and intensity of polio outbreaks increased dramatically. By the early 1900s, epidemics became more common, reaching a climax in the late 1940s and early 1950s. The worst recorded outbreak in the United States occurred in 1952, claiming the lives of over 3,000 people. When outbreaks became especially bad, some major cities took drastic measures. Public fear was rampant, and polio's impact was felt not just physically but socially as well. Communities were often paralyzed by the fear of infection, leading to quarantines and restricted public activities. The names and addresses of individuals with confirmed polio cases were published daily in the press, their houses were identified with placards, and their families were quarantined. The disease's ability to strike suddenly and without warning made it a public health crisis of unparalleled proportions. Schools, theaters, swimming pools and even beaches would be shut down. People in crowded cities practiced social distancing as much as they could. For those of us today who were old enough to remember the strangeness of the first few weeks of lockdown during the early stages of the Covid19 epidemic, we understand this reality all too well. You can imagine the fear of parents across not only the United States but the world of Polio affecting their child. Just to give an idea of how palpable that fear was, A 1952 survey found that Americans feared only nuclear annihilation more than polio.
Researchers faced numerous challenges, including understanding the virus's behavior and developing a method to safely produce a vaccine. A significant breakthrough came in 1949 when John Enders, Thomas Weller, and Frederick Robbins successfully cultivated the poliovirus in human tissue at Boston Children’s Hospital.
Their pioneering work earned them the 1954 Nobel Prize and paved the way for vaccine development. The role of government and private organizations was crucial during this time, as they provided essential funding and resources to fuel research efforts. This collective endeavor laid the groundwork for the ultimate creation of a viable polio vaccine.
The early 1950s marked a pivotal moment in the fight against polio with the development of the first successful vaccine by American physician Jonas Salk. Jonas Salk was a virologist. In 1947, he accepted a position as a professor at The University of Pittsburgh School of Medicine. It was there that he began working on a project to determine how many different types of Polio Viruses there were. Salk worked for 7 years to develop a vaccine. Salk's dedication to eradicating the disease led him to test his experimental killed-virus vaccine on himself and his family in 1953.
Salk's approach was based on inactivating the virus using formaldehyde, ensuring that the virus could not cause the disease but still triggered an immune response. This method was distinct from other vaccine development strategies at the time, which often involved using weakened live viruses. The use of inactivated virus particles was a calculated risk; it aimed to produce a safe vaccine that would not cause the disease but still trigger the body to build immunity.
Salk's research also involved collaboration with other scientists, public health officials, and funding organizations. One notable partnership was with the National Foundation for Infantile Paralysis, now known as the March of Dimes. This organization provided essential financial and logistical support, helping to overcome some of the resource limitations that could have hindered progress. The foundation was also started by former President Franklin Roosevelt who himself had been paralyzed by Polio after contracting the disease.
Salk's killed-virus vaccine significantly reduced the risks associated with live-virus vaccines, such as causing the disease in vaccinated individuals or allowing mutations to create new strains. After successful trials of tests on monkeys, children at two Pittsburgh Institutions, one for crippled children, the other for children with mental retardation were given the vaccine. Salk also gave the vaccine to himself, his wife and his two children. This was followed by field trials.
The scale and success of the 1954 field trials were unprecedented. Known as the Francis Field Trial, after its director Dr. Thomas Francis Jr., this massive undertaking and those involved were dubbed "Polio Pioneers." Over 1.8 million children participated in these field trials, a number that was unprecedented at the time and demonstrated the importance of the effort to fight the disease.
The trials were meticulously designed to ensure the safety and efficacy of the vaccine. Results from the trials were promising, with the vaccine showing a significant ability to prevent the onset of polio, thus setting the stage for its public release.
The double-blind study design ensured that neither the participants nor the administrators knew who received the vaccine or the placebo, making the results scientifically robust. The trial's success was publicly announced on April 12, 1955, a date that became a milestone in medical history. The announcement was met with widespread relief and celebration, as the vaccine's efficacy was confirmed to be between 80 to 90 percent.
Following the successful trials, the vaccine was rapidly licensed, and mass immunization campaigns began almost immediately. The National Foundation for Infantile Paralysis, now known as the March of Dimes, played a crucial role in funding and organizing these campaigns. Their efforts ensured that the vaccine reached millions of children across the country, significantly reducing the incidence of polio within a few years.
Salk's achievement did not come without controversy. Despite the overwhelming evidence of the vaccine's effectiveness, there were initial concerns about its safety. Jonas Salk became a national hero, celebrated for his role in combatting one of the most feared diseases of the time. Interestingly, Salk chose not to patent his vaccine, famously stating, "Could you patent the sun?" This decision ensured that the vaccine was widely accessible, accelerating its distribution and impact. Parents, in particular, were overjoyed, as they had lived in constant fear of their children contracting polio. Schools and communities, which had been deeply affected by the disease, saw this announcement as a turning point. The public's enthusiasm was palpable, with celebrations and parades organized to honor Salk and the medical community. Fundraisers and public events highlighted the communal relief and appreciation for the work done to develop the vaccine.
Government officials and public health leaders were quick to endorse the vaccine, understanding its importance in addressing a national health crisis. Plans for widespread immunization campaigns were swiftly put into place, and efforts to distribute the vaccine across the country were accelerated. Health departments coordinated with schools and clinics to ensure that the vaccine was administered efficiently and effectively.
The announcement also had a global impact, as other countries looked to the United States for guidance in combating polio. International health organizations began to collaborate on efforts to distribute the vaccine worldwide, marking the beginning of a concerted global fight against the disease. Today, thanks to continued immunization efforts, polio has been eradicated from most of the world, with only a few pockets remaining.
