14 Injections of Fact and Folklore Surrounding the first “Killed” Vaccine

Just 60 years ago, polio was one of the most feared killers in the U.S.

Every year, as the warmer months approached, panic over polio intensified. Late summer was dubbed “polio season.” Public swimming pools were shut down. Movie theaters urged patrons not to sit too close together to avoid spreading the disease. Insurance companies started selling polio insurance for newborns.

The fear was well grounded. By the 1950s, polio had become one of the most serious communicable diseases among children in the United States. In 1952 alone, nearly 60,000 children were infected with the virus; thousands were paralyzed, and more than 3,000 died. Hospitals set up special units with iron lung machines to keep polio victims alive.

Then in 1955, the U.S. began widespread vaccinations. By 1979, the virus had been completely eliminated across the country. Now polio is on the verge of being eliminated from the world. The virus remains endemic in only two parts of the globe: northern Nigeria and the border between Afghanistan and Pakistan.

On this day, June 23rd, 1995, the creator of the first ever “killed” vaccine, which started the US down the path of eliminating the disease, died. Dr. Jonas Salk was 80 years old. Here are a few facts about the medical genius and the disease he and his colleagues worked to eradicate.

Although polio was the most feared disease of the 20th century, it was hardly the top killer.
The first major polio epidemic in the United States hit Vermont in 1894 with 132 cases. A larger outbreak struck New York City in 1916, with more than 27,000 cases and 6,000 deaths. As the number of polio cases grew, the paralytic disease changed the way Americans looked at public health and disability.

Polio, while definitely on a meteoric rise in the 1950’s, was not the rampant killer it has been portrayed to be. During the 50s and 60s, 10 times as many children died in accidents and three times as many succumbed to cancer. Polio inspired such fear because it struck without warning, and researchers were unsure of how it spread from person to person. In the years following World War II, polls found the only thing Americans feared more than polio was nuclear war.

Salk was rejected by multiple laboratories after medical school.
After graduating from medical school at New York University and completing his residency training, Salk applied to laboratories to work in medical research. Rather than treat patients as a practicing physician, Salk hoped to work on the influenza vaccine, a research area he began studying in medical school.

Although he was rejected from multiple labs, perhaps due to quotas that discriminated against Jewish people, he didn’t get discouraged. “My attitude was always to keep open, to keep scanning. I think that’s how things work in nature. Many people are close-minded, rigid, and that’s not my inclination,” he revealed in his Academy of Achievement interview.

Franklin D. Roosevelt and Harry Truman proved instrumental in the vaccine’s development.
A year after his nomination as a Democratic vice presidential candidate, rising political star Franklin D. Roosevelt contracted polio while vacationing at his summer home on Campobello Island in 1921. The disease left the legs of the 39-year-old future president permanently paralyzed. In 1938, five years after entering the White House, Roosevelt helped to create the National Foundation for Infantile Paralysis, later renamed the March of Dimes Foundation, which became the primary funding source for Salk’s vaccine trials. Employing “poster children” and enlisting the star power of celebrities from Mickey Rooney to Mickey Mouse, the grassroots organization run by Roosevelt’s former Wall Street law partner Basil O’Connor was raising more than $20 million per year by the late 1940s.

In 1946, President Harry Truman declared polio a threat to the United States and called on Americans to do everything possible to combat it. “The fight against infantile paralysis cannot be a local war,” Truman declared in a speech broadcast from the White House. “It must be nationwide. It must be total war in every city, town and village throughout the land. For only with a united front can we ever hope to win any war.”

Science initially failed
Early attempts to develop a vaccine ran into numerous hurdles. A vaccine tested on 10,000 children by two researchers at New York University provided no immunity and left nine children dead. Other vaccine trials used “volunteers” at mental institutions.

Salk challenged prevailing scientific orthodoxy in his vaccine development.
While most scientists believed that effective vaccines could only be developed with live viruses, Salk developed a “killed-virus” vaccine by growing samples of the virus and then deactivating them by adding formaldehyde so that they could no longer reproduce. By injecting the benign strains into the bloodstream, the vaccine tricked the immune system into manufacturing protective antibodies without the need to introduce a weakened form of the virus into healthy patients.

Many researchers, such as Polish-born virologist Albert Sabin, who was developing an oral “live-virus” polio vaccine, called Salk’s approach dangerous. Sabin even belittled Salk as “a mere kitchen chemist.” The hard-charging O’Connor, however, had grown impatient at the time-consuming process of developing a live-virus vaccine and put the resources of the March of Dimes behind Salk.

Since Sabin and Cincinnati Children’s Hospital couldn’t gain political support in the U.S. for what he viewed as his superior vaccine, he moved testing to the Soviet Union instead.

Salk tested the vaccine on himself and his family.
After successfully inoculating thousands of monkeys, Salk began the risky step of testing the vaccine on humans in 1952. In addition to administering the vaccine to children at two Pittsburgh-area institutions, Salk injected himself, his wife and his three sons in his kitchen after boiling the needles and syringes on his stovetop. Salk announced the success of the initial human tests to a national radio audience on March 26, 1953.

The clinical trial was the biggest public health experiment in American history.
On April 26, 1954, six-year-old Randy Kerr was injected with the Salk vaccine at the Franklin Sherman Elementary School in McLean, Virginia. By the end of June, an unprecedented 1.8 million people, including hundreds of thousands of schoolchildren, joined him in becoming “polio pioneers.” For the first time, researchers used the double-blind method, now standard, in which neither the patient nor person administering the inoculation knew if it was a vaccine or placebo. Although no one was certain that the vaccine was perfectly safe—in fact, Sabin argued it would cause more cases of polio than it would prevent—there was no shortage of volunteers.

Salk did not patent his vaccine.
On April 12, 1955, the day the Salk vaccine was declared “safe, effective and potent,” legendary CBS newsman Edward R. Morrow interviewed its creator and asked who owned the patent. “Well, the people, I would say,” said Salk in light of the millions of charitable donations raised by the March of Dimes that funded the vaccine’s research and field testing. “There is no patent. Could you patent the sun?” Lawyers for the foundation had investigated the possibility of patenting the vaccine but did not pursue it, in part because of Salk’s reluctance.

Although a tainted batch of the Salk vaccine killed 11 people, Americans continued vaccinating their children.
Just weeks after the Salk vaccine had been declared safe, more than 200 polio cases were traced to lots contaminated with virulent live polio strains manufactured by the Cutter Laboratories in Berkeley, California. Most taken ill became severely paralyzed. Eleven died. In the haste to rush the vaccine to the public, the federal government had not provided proper supervision of the major drug companies contracted by the March of Dimes to produce 9 million doses of vaccine for 1955. Although the United States surgeon general ordered all inoculations temporarily halted, Americans continued to vaccinate themselves and their children. Outside of the “Cutter Incident,” not a single case of polio attributed to the Salk vaccine was ever contracted in the United States.

A rival vaccine supplanted Salk’s in the 1960s.
Once Sabin’s oral vaccine finally became available in 1962, it quickly supplanted Salk’s injected vaccine because it was cheaper to produce and easier to administer. Ultimately, both vaccines produced by the bitter rivals nearly eradicated the disease from the planet. According to the World Health Organization (WHO), there were only 416 reported cases of polio worldwide in 2013, mostly confined to a handful of Asian and African countries. Since Sabin’s live-virus vaccine, which is responsible for about a dozen cases of polio each year, is seen as the final obstacle to eliminating the disease in most of the world, the WHO has urged polio-free countries to return to Salk’s killed-virus vaccine.

Salk was the stepfather of Pablo Picasso’s Children
In 1970, Salk married Françoise Gilot, a French artist who had two children, Claude and Paloma, with Pablo Picasso. In an interview in 1980, Paloma remembered the fear people had of polio, and that as a child, she didn’t visit her father’s house in the South of France due to a polio outbreak. She also revealed that she got along well with her stepfather: “He’s very cute. He’s a wonderful person,” she said. After his death in 1995, Gilot continued her late husband’s legacy by working at the Salk Institute for Biological Studies.

Salk worked on cures for cancer and AIDS
After Salk developed the polio vaccine, he tried to develop vaccines for cancer, AIDS, and multiple sclerosis. Although he wasn’t ultimately successful, he did patent Remune, a vaccine for AIDS to delay the progression of HIV into AIDS. In 2001, six years after Salk died, Pfizer stopped funding clinical trials for Remune due to a lack of evidence that it worked.

Salk was much maligned by the medical community
At the University of Pittsburgh, Salk launched what was then the largest human trial in history and introduced new scientific rigor now used as the gold standard in development of new treatments and tests for pathology. When it was announced that his vaccine worked, Salk was hailed as a humanitarian hero. By 1957, new polio cases had fallen below 6,000.

While heads of state around the globe rushed to celebrate him, many in the medical community derided his efforts. According to Dr. Charlene Jacobs in a interview with the Oxford Press, this was for many reasons:

  1. He preferred the “killed” vaccine, which most in medicine feared would be too weak.
  2. He worked in secret and with a small team.
  3. They claimed he grabbed the limelight and failed to share credit with others.
  4. It appeared he pandered to the press, crossing an imaginary line medicine had set up between science and the media.

Salk won few awards for what is still considered one of the greatest medical breakthroughs
While nominated several times, he did not win the Nobel Peace prize, and he was blackballed from the Academy of Sciences. He won a great deal of social celebrity, for sure, but his insistence on using intuition as much as rigor left many wondering what he really was doing. His dismissal in actual scientific communities is attributed to envy by many who review the history of the time.

Over the years, polio was found to be a highly contagious disease that spread, not in movie theaters or swimming pools, but from contact with water or food contaminated from the stool of an infected person. Along with the vaccine, much was done to improve hygiene in the Americas, The U.S. recorded its last case of polio in 1979, among isolated Amish communities in several states. Then the effort to eradicate polio globally began in earnest. The Western Hemisphere reported its last case, in Peru, in 1991.

Both Salk’s and Sabin’s vaccines are still used today. Although Jonas Salk is credited with ending the scourge of polio because his killed-virus vaccine was first to market, Albert Sabin’s sweet-tasting and inexpensive oral vaccine continues to prevent the spread of poliomyelitis in remote corners of the world. While the later version, which requires just two drops in a child’s mouth, proved much easier to use in mass immunization campaigns, today, it is being marked as the final barrier to truly eliminating polio – it does occasionally infect patients. The complete return to Salk’s vaccine has been promoted by the World Health Organization (WHO) since 2000.

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sources:

npr.org

pbs.org

Nytimes.com

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