Fearful Increase in Polio Causes Americans to Rally to Eradicate Disease

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Only a few countries suffer from polio; Bill Gates leads effort to eradicate it in six years.

In the 1950s, an uptick in  polio cases created fear among the public. In response, Dr. Jonas Salk and Dr. Albert Sabin developed two different polio vaccines that have pretty much  almost eradicated polio from the world.

Bill Gates, co-chair of the Bill & Melinda Gates Foundation, who has been in the forefront of  the battle to erase the disease completely, has set a 6-year goal to eradicate it from the world.

Today, experts say the potentially fatal infectious disease strikes children mainly under the age of five in countries in Asia and Africa.  Nigeria, Afghanistan and Pakistan are the countries with the most cases.

Polio can cause paralysis and sometimes death. Because there is no cure for polio, the best protection is prevention.  It can cause paralysis within hours, and polio paralysis is almost always irreversible. 

In the most severe cases, polio attacks the motor neurons of the brain stem, causing breathing difficulty or even death.

At the start of the 20th century, U.S. physicians and nurses made house-to-house searches to identify infected persons. Children suspected of being infected were taken to hospitals and the child's family was quarantined until they were no longer potentially infectious, even if it meant they could not go to their child's funeral if the child died in the hospital. In 1952 and 1953, the U.S. experienced an outbreak of 58,000 and 35,000 polio cases, up from a typical number of some 20,000 a year. Amid this U.S. polio epidemic, millions of dollars were invested in finding and marketing a polio.

There are many famous polio victims, most of whom were able to overcome their disabilities, while others were less fortunate. They include President Franklin Delano Roosevelt;  Itzhak Perlman, one of the world's finest violinists, was permanently disabled at age four and still plays sitting down; actor Donald Sutherland; writer Arthur C. Clarke; actress Mia Farrow; singer-musician Neil Young; actor Alan Alda; musician David Sanborn; singer Dinah Shore; singer Joni Mitchell; former Supreme Court Justice William O. Douglas;  and director Francis Ford Coppola.

In a recent interview,  Bill Gates said, We’ve got to raise the money – it’s about $1-billion a year spent on the vaccine and getting the vaccine out there – so we need people to rededicate themselves on the financial side. We need the agencies, the World Health Organization, UNICEF and others to step-up and to bring some innovations, some new thinking to the campaigns. And, of course, there are the countries themselves that are either trying to stay free of polio, or the three where we’ve never gotten to zero (Nigeria, Pakistan, Afghanistan) they need to step-up and help make sure we vaccinate every single child. We have made some great advances, with some new donations, including the Islamic Development Bank, and we have some side meetings planned with each of the key groups to talk about their roles.

Q: We know the problem areas are all Muslim countries, where there are issues with the Taliban in Afghanistan, and Muslim clerics in Nigeria and Pakistan opposing polio vaccination. Will the support of the Islamic Development Bank be enough to counter those fundamentalist religious obstacles?

“It’s really a positive development to have additional Middle East donors. A few years ago, Abu Dhabi came in and was very generous, now it’s the Islamic Development Bank with a significant gift of $227-million. And it’s not just financial involvement: They’re going out to Pakistan and meeting with people, talking to the religious community about how vaccination can be a positive thing. It’s always tough to communicate, to deal with rumours and misunderstandings, even in rich Western countries that’s a challenge, but we have to find a way. These new donors are a big help. This is not something imposed by the West. This is the whole world working together to eradicate polio.”

Q: Any worries that six-years won’t be enough, that we’ll miss yet another target date for eradication?

“It’s not a guarantee. There are no guarantees. I have to emphasize that everyone has to do their part – the donors, the teams that do the execution including UNICEF and WHO, the countries themselves right down to the local political level, the religious leaders, we need all these pieces to come together. But we’ve shown we can do it. So it’s got a good probability of success. Our foundation has spent more than $1-billion on polio so far and we’ll spend even more than that in the coming years. We’re doing that because we see a real chance of success.”

The Q & A interview with Bill Gates is available on The Globe and Mail website.

Gallo and SabinTwo polio vaccines are used throughout the world to combat polio. The first was developed by  Dr. Jonas Salk (1914-95)  and tested in 1952. Announced to the world by Salk on April 12, 1955, it consists of an injected dose of inactivated (dead) poliovirus. An oral vaccine was developed by Albert Sabin (1906-93) using live poliovirus. Human trials of Sabin's vaccine began in 1957 and it was licensed in 1962. The two vaccines have eliminated polio from most countries in the world.

The development of two polio vaccines led to the first modern mass inoculations. The last cases of paralytic poliomyelitis caused by endemic transmission of wild virus in the United States occurred in 1979, with an outbreak among the Amish community in several Midwest states.  A global effort to eradicate polio, led by the World Health Organization, UNICEF, and The Rotary Foundation, began in 1988 and has relied largely on the oral polio vaccine developed by Albert Sabin, pictured on the right, above. The disease was entirely eradicated in the Americas by 1994. Polio was officially eradicated in 36 Western Pacific countries, including China and Australia in 2000. Europe was declared polio-free in 2002.

As public concern grew about the increase in polio cases in the 1950s, , Salk, left, went on CBS radio to report a successful test on a small group of adults and children on March 26, 1953; two days later the results were published in JAMA.

Beginning February 23, 1954, the vaccine was tested at Arsenal Elementary School and the Watson Home for Children in Pittsburgh, Pennsylvania. Salk's vaccine was then used in a test called the Francis Field Trial, led by Thomas Francis; the largest medical experiment in history. The test began with some 4,000 children at Franklin Sherman Elementary School in McLean, Virginia, and would eventually involve 1.8 million children, in 44 states from Maine to California. By the conclusion of the study, roughly 440,000 received one or more injections of the vaccine, about 210,000 children received a placebo.

In 1958, the National Institutes of Health created a special committee on live polio vaccines. Large-scale clinical trials performed in the Soviet Union in late 1950s — early 1960s demonstrated safety and effectiveness of the vaccine. Based on these results, the Sabin strains were chosen for worldwide distribution.

Sabin also developed vaccines against other viral diseases, including encephalitis and dengue. In addition, he investigated possible links between viruses and some forms of cancer.

Polio was a medical oddity that baffled researchers for years. It was first recorded in 1835 and grew steadily more prevalent. It took a long time to learn that the virus was transmitted by fecal matter and secretions of the nose and throat. It entered the victim orally, established itself in the intestines, and then traveled to the brain or spinal cord.

The fight against polio did not really get under way until 1938 when the National Foundation for Infantile Paralysis was born. Basil O'Connor, the former law partner of President Roosevelt, headed it. That same year, the first March of Dimes fundraising program was set up, with radio networks offering free 30-second slots for promotion. Listeners were asked to send in a dime and the White House received 2,680,000 letters within days.

In early 2009, the American Public Broadcasting Service (PBS), aired the  documentary film, American Experience: The Polio Crusade. The documentary, available on DVD, can also be viewed online: PBS video, 1 hr.

 

 

Visit your local library to obtain resources on this topic.

Splendid solution: Jonas Salk and the Conquest of Polio
Jeffrey Kluger, (2004).

The Cutter Incident: how America’s First Polio Vaccine Led to the Growing Vaccine Crisis
Paul A. Offit,  (2005).

Polio: an American Story
David M. Oshinsky,   (2005).

Dirt and Disease: Polio Before FDR
Naomi Rogers, (1992).

Jonas Salk and the Polio Vaccine
The Dwight D. Eisenhower Presidential Library.
 

 

Images:

1. Article illustration: A Somali boy is injected with inactivated poliovirus vaccine (Mogadishu, 1993).

2. Rushing polio-stricken child to hospital, 1948

4. Magazine photo of Jonas Salk in laboratory.

5. 1963 poster featuring CDC’s national symbol of public health, the "Wellbee."

 

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