A Scientific Basis for Hope
How mass vaccination eradicated poliovirus, helped prevent repeat of 1918 flu pandemic
By the 1950s, the poliovirus had been ravaging the United States for decades. In the summer of 1916, for instance, polio had spread rapidly throughout New York City, panicking the city as it killed over 2,000 and left thousands more afflicted with lifelong paralysis. While the pathogen was not new to the world, the frequency of polio epidemics was increasing significantly, paralyzing or killing over 500,000 people worldwide each year. Images of children suffering from the paralytic effects of poliomyelitis circulated widely. Fears of ending up in an iron lung — a sealed, tubed machine designed in 1929 to offer breathing support — were genuine.
The vast majority of those exposed to the poliovirus were asymptomatic. Many experienced symptoms no worse than a mild flu. Yet, for some, if the virus entered their bloodstream and began attacking the nerves needed to control one's muscles, the effects were incapacitating and potentially deadly.
"The most intelligent thing for modern man to do is to join in the fight against this outrageous disease, for our own sake and for the sake of our children," wrote Erie Daily Times columnist Bill Walsh in 1952. He made a plea that everyone must assist "in this great campaign against one of the nation's worst threats to health and happiness."
The disease was making headlines daily in Erie by this point. Cases peaked in the U.S. that year with nearly 58,000 afflicted, 3,100 deaths, and over 20,000 left with paralysis of varying degrees.
"Probably nothing strikes more fear in a mother's heart than the word polio," Erie's March of Dimes chairman T.K. Welsh told the newspaper. He explained how children stricken with polio were quarantined at hospitals and parents often couldn't be with or even see their children for long periods of time, leaving a feeling of helplessness.
Special polio insurance could be purchased. "This is a smart move since it lessens the burden," Welsh said, but he added that while this helped individual families, the "purchase of such a policy makes no contribution toward the defeat of polio." Funds were needed for treatments, but they were also desperately needed for research to prevent its continued spread.
The organization Welsh represented, the March of Dimes, was founded as the National Foundation of Infantile Paralysis by President Franklin D. Roosevelt, who himself was afflicted with paralytic polio at 39. They took the lead in Erie County in the fight against the disease, recruiting an army of volunteers to raise money, mail informational pamphlets, and canvass to spread awareness. After a particularly rough previous year, local funds were depleting, so they organized to solicit donations, installing a wishing well at the downtown Warner Theatre and planning nighttime Mothers' Marches and Porch Light Parades throughout the county. During these events, homes wishing to contribute turned on their outside lights indicating their desire to donate. The Erie march alone included over 400 women and raised thousands of dollars.
Erie's Lakeview Municipal Hospital, which took in many of the county's polio patients, did not turn people down who couldn't pay, but expenses were rising and they had lost funding that helped pay for additional needed nurses. As a result, their daily rate increased from $5 to $12 per day. City Health Director Felix Shubert stated they did not and would not pressure families in need for payments, but the financial strain was challenging.
Local media recounted numerous stories of local hardships. There was a boy named Vern just shy of three years old who had to relearn to walk, a teenage football player told he'd never be able to play again, a young girl who could only move her eyes and required a feeder, and a brother and sister who both suffered paralysis. Elmer Ohl, a former Titusville High School football player and World War II veteran, was operating a trucking business out of Union City when he contracted polio. He was hospitalized for three years with complications and unable to move either of his legs. When he was finally discharged from the Veterans Administration hospital, he required a wheelchair, but he had also learned to walk slowly with crutches he designed himself.
The Zem Zem Hospital also assisted with polio rehabilitation. The nurses, who lived full-time on the second floor, used their warm swimming pool, daily exercises, and other activities for physical therapy. Families could visit on Sundays, but during the week, the atmosphere was described as positive, offering patients games, movies, and other entertainment to keep up morale. "Gloom or depression don't have a chance as the small patients struggle along trying a little harder each day to reach their ultimate goal — to walk without assistance," the Erie Daily Times reported.
"Instead of waiting to heal the ravages of polio after it strikes, we must prevent it," the head of one research organization leader declared. There were clinical trials involving a serum containing antibodies from the blood of polio survivors. It showed promise, but immunity waned within weeks.
Then in April 1955, there was a breakthrough: a safe and effective polio vaccine was announced to the world. It was developed by Dr. Jonas Salk, a virologist and medical researcher affiliated with the University of Pittsburgh. He conducted the first human trials in 1952, experimenting with a polio vaccine that would, against conventional scientific wisdom of the time, use injected dead rather than merely weakened polioviruses. The following year, he tested his vaccine on himself, his wife, and his three children, later saying that it had been "courage based on confidence, not daring" and that his "confidence [was] based on experience."
In 1954, the vaccine was then administered to around one million children — the "polio pioneers" — in what was the largest clinical trial in history. The results were overwhelmingly successful with 60 to 90 percent effectiveness depending on the strain. Now proven effective and safe, the next step was the promotion of mass immunization with the goal of containing and then wiping out polio entirely.
"The American public had greeted the first polio vaccine, released in 1954, with wild enthusiasm," writes historian of medicine Elena Conis in a recent article on vaccination resistance for The American Historian, noting that there were small pockets of polio vaccine resistance, but they made little impact. "Parents so dreaded polio that they were quick to seek the vaccine for their children, and coercive policies never became necessary."
There were mistakes made though, some even tragic. In what became known as the Cutter incident, a vaccine manufactured by the small California-based Cutter Laboratories did not properly deactivate the live virus, causing 200 children to experience paralysis in some form and killing ten. Although their vaccines were all withdrawn and Cutter kicked out of the program, it threatened public trust in the vaccine and fueled vaccine hesitancy for many. There was a massive push to regain that public trust. The March of Dimes even recruited a fresh-faced Elvis Presley to publicize a polio vaccination backstage before a performance on the The Ed Sullivan Show.
"Is the vaccine safe? The answer to this is yes," Dr. Hart E. Van Riper of the National Foundation of Infantile Paralysis stated. "The battle against polio ... will be won or lost this fall and winter. Success will depend on how many children are vaccinated."
Congress designated tens of millions of dollars towards vaccine production and distribution. In Erie, health officials, with funding from the state, began working in coordination with the public schools, parochial schools, St. Joseph's Home for Children, the Sarah Reed home, the Zem Zem hospital, private physicians, and infant clinics to vaccinate as many children as possible. 51,861 polio vaccines were administered in a joint city-school district vaccination program, targeting ages six months through 19 years old. It was described as "the largest public health project ever undertaken in the city."
"The 7th graders were brave," volunteer Ethel Hanes wrote of a group of North East students receiving their vaccination at school, adding that they were "indeed fortunate for having the opportunity to receive these shots."
For a day-long city event targeting adults between ages 20 and 40, thousands of vaccines were administered for free by physicians of the Erie County Medical Society at the National Guard Armory on Sixth and Parade. Nurses and volunteers coordinated this "city-wide battle" against polio.
It was a success. Total cases across Erie County fell to 97 that year. In 1956, countywide cases decreased to a stunning 15. Cases were halved nationwide. There was still work to do though.
In May 1957, a new program to coordinate and distribute the vaccine in Erie County was set in motion, overseen by Erie County Health Department Director Dr. James Googe. The "physicians, PTA's, county school officials, the medical auxiliary, and the city health department" all worked cooperatively to reach the unvaccinated, Googe told the newspaper.
"From our most recent reports, I would say it has been a most effective program," Googe observed. In what he described as "remarkable," there had been only one case and no deaths so far that year. "[I]t appears that paralytic polio, like diphtheria, smallpox, and typhoid fever may be on its way out. We can't let this good start lull us into a state of complacency — the program must be continued until all remaining susceptible groups of the population receive the vaccine."
As the spread of poliovirus was getting under control though, a new influenza pandemic threatened the world in 1957. City health director Shubert warned of a twin epidemic in Erie if people did not also get their flu shots, which were "feverishly produced" to make them available. Shubert stressed that they were "a safe and effective means of fighting the [influenza] disease" and reminded the public that the fight against polio was not total victory either until all eligible were vaccinated through "vigilance and continued inoculation."
Inoculation yet again proved its effectiveness. While the flu strain killed over 100,000 across the United States and millions worldwide — making it one of the deadliest on record — the vaccine helped prevent deaths on the catastrophic scale of the 1918 influenza pandemic. As for polio, cases were reduced by another two-thirds across the country. Whereas there had been nearly 58,000 cases nationwide in 1952, by 1957, cases fell to 7,500. In Erie County, polio was all but eradicated. Only five cases required hospital treatment in 1957. The Erie Daily Times reported how the city hospital's iron lungs were beginning to "gather dust" and compared what medical scientists accomplished to what space scientists were trying to do by reaching the moon.
A third polio booster shot was created for the vaccinated and was strongly being recommended for full immunity and "peace of mind in 1958."
"Polio can be prevented. This could not have been said two years ago," the editors for the Erie Daily Times wrote. "But it can be improved to read at some future date: Polio Has Been Eliminated. Vaccine is the weapon at your disposal to give the death blow to this crippling disease. … Polio will only be a menace again by reason of negligence or indifference."
Dr. Shubert stated that Erie could "end polio as an epidemic threat for all time" and that we had "the formula that will permit us to rid ourselves of this scourge." The formula? Three doses of the polio vaccine, continued mass inoculation programs, and the "eternal vigilance" of the health department who were still working diligently to get the unvaccinated vaccinated.
Medical experts warned the public from embracing a false sense of security, stating that an "increase in the number of cases could occur next year, unless a majority of the population is fully inoculated." By the beginning of 1958, it was estimated that 34 million people under 40 had all three polio shots, but that still left 15 million children and 40 million adults under 40 without any protection, which was described as a "matter of grave concern." Vaccination rates were slowing down. Demand had created a shortage of vaccine only months earlier, but there was now a backlog of nearly 28 million doses, which expired after six months of storage. Around this time, the Pennsylvania Welfare Department announced that all patients and employees in state institutions would be mandated to get polio immunizations, along with their smallpox, diphtheria, tetanus, typhoid, influenza, and tuberculosis vaccines.
That year marked an 80 percent decrease in polio from its peak. The entirety of Erie County had only one case of infantile paralysis. Crawford County had only two. There were no deaths in either county. Locally, the focus shifted from prevention and towards assisting the region's "post-polio patients."
"The fight against polio has been changed," Clarence C. Rapp, the new chairman of the March of Dimes campaign, stated. "Today, we must wage an all-out war against the ravages which old cases of polio have caused on human beings. More than 300,000 people living in America have had paralytic polio and they need help."
In 1961, a supplemental oral vaccine developed by Albert Sabin and Hilary Koprowski was made available. The following year, cases in the entire United States dropped to under 1,000. The United States has been polio-free since 1979 after an outbreak in Lancaster County. Since 1998, world polio rates have decreased by 99 percent, although in some parts of the world, it remains endemic.
"Our greatest responsibility is to be good ancestors," Dr. Jonas Salk once said. Even though the vast majority of those exposed to the poliovirus experienced no or few symptoms, he seemed hopeful for humanity, for there was a public willing to band together for the greater good to protect those who needed the most protection.
"Some people are constructive … Others are destructive," he observed in a 1991 interview with the Academy of Achievement. "It's this diversity in humankind that results in some making positive contributions and some negative contributions. It's necessary to have enough [people] who make positive contributions to overcome the problems of each age."
Salk spent his final years in pursuit of a vaccine for AIDS. While it eluded him before his 1995 death, his spirit and passion for the good of humanity, for the health of the public, and his idealistic hope he expressed lives on in the medical community today.
"What is important is that we — number one: Learn to live with each other," Salk mused in a later-life interview. "Number two: try to bring out the best in each other. I already see enough evidence for this optimism."
What was he looking for? A scientific basis for hope.
"I think I've found it," he said.
Jonathan Burdick runs the historical blog Rust & Dirt. He can be reached at firstname.lastname@example.org