Vaccine does not Equal Cure
Founded in 1938 by Franklin D. Roosevelt and his former law partner, Basil O’Connor, the National Foundation for Infantile Paralysis began as a non-profit aimed at funding research on poliomyelitis and providing rehabilitative care to its victims. The organization’s most famous campaign, the March of Dimes – from which the organization eventually took its name – encouraged small donations from all individuals to fund the fight against polio. These funds made possible the development and testing of the first successful vaccine, licensed in 1955.
In the wake of the National Foundation’s mass vaccination drives, cases of paralytic polio fell from an average of 15,000 per year, to fewer than one hundred cases annually after 1967. Polio was no longer a major threat to health, however, that assumption forgot about the thousands of individuals who had contracted the disease either before or in the early days of the vaccine’s debut, who were still struggling with the long-term effects of disease. This pamphlet from the National Foundation informed readers that additional funds raised by the March of Dimes would go towards research on improving mechanical breathing aids (such as the iron lung) and assistive mobility devices so that those who survived polio could regain independence and live fuller lives beyond the polio ward. Nevertheless, even the National Foundation for Infantile Paralysis soon realized its efforts would be better spent elsewhere, and in 1958 announced a new focus on chronic diseases and birth defects.
The Medical Community Responds to the Salk Vaccine Debut
The March of Dimes campaign was not the first fundraising drive to focus on small donors – Christmas Seals Campaigns to raise money for tuberculosis patients beat them to that – but the National Foundation for Infantile Paralysis was unique in its use of marketing strategies to generate large sums and to use those funds to directly fund research on prevention and treatment. Prior to these campaigns in the 1940s, funding for medical research came from three major sources: university research programs, state health departments and the US Public Health Service, and large private donors (for example, the famed Rockefeller Foundation). As the National Foundation was governed by a board of directors and solicited donations from the general public, it was policy to share news of progress directly with the public. According to surveys, at least 90 percent of the American public was familiar with the vaccine before it had been approved, making the polio vaccine one of the first national “medical breakthrough” news stories.
The NFIP contributed research funding to several scientists working on polio, but two men have received acclaim for development of the two types of vaccine that have been used: Jonas Salk and Albert Sabin. Salk’s research worked on the “killed-virus principle” – that a dead virus would not be able to transmit the disease but would still prompt the body’s immune system to create antibodies. Sabin however, along with many other scientists, believed only a live virus could stimulate the body to produce effective antibodies, and focused on creating a live attenuated vaccine – that is, one that would replicate in the body and provoke an immune response, but be too weak to make the patient ill. Sabin’s live attenuated virus also had the advantage of being administered orally, making it quicker to deliver and painless to the patient. However, Salk’s research was favored by the National Foundation, who sponsored field trials in 1954 and, once the vaccine was licensed by the Department of Health, Education, and Welfare (now the Department of Health & Human Services) in 1955, purchased and distributed the vaccine widely to elementary school children.
Sabin continued to develop his oral vaccine, and in 1957, approached the Ministry of Health for the Soviet Union to conduct field trials of his formula (field trials in the U.S. would not be possible, as too great a fraction of the population had already been vaccinated with the Salk injected vaccine). The USSR trials were successful, and in 1960, the Sabin Oral Polio Virus was licensed for use in the U.S.
Doctors Aid in Polio Vaccine Trials
This article from the Fort Wayne News Sentinel, reprinted in the Journal of the Indiana State Medical Association, reports on Allen County’s participation in the national trials of the Salk vaccine in 1954. Fort Wayne (Allen County, Indiana) was the third largest city in Indiana in 1950, and had an active March of Dimes chapter. The article commends the selfless volunteer service doctors and support staff, who would administer the vaccine to 3,500 second-graders – in a series of three shots – and perform blood test as controls on thousands of first- and third-graders. The control blood tests were used to ascertain the overall presence of polio in the county, through the presence of antibodies that would have been created if the child had had a previous case of polio, and it would determine the number of active, but undetected, cases of polio.
Maryland State Board of Health Weighs in on Polio Vaccine Trials
This statement by the Maryland State Board of Health captures the attitude of several within the medical profession: cautious optimism, with an emphasis on the cautious. Members of the medical profession expressed some concern that, given all the publicity given to Salk’s research, the general public would start assuming that the vaccine was already complete and available, and, it follows, begin demanding doctors administer a vaccine to their children that did not yet exist. Worse was the unstated scenario: what if the vaccine trials failed and the preparation proved useless? How then might the public react?
“The National Foundation is running this thing like a soap opera”
Public health initiatives – and vaccination campaigns in particular – have long been the subject of commentary in state and county medical society journals. This editorial from the Sacramento County Medical Bulletin (republished in a 1955 issue of the Bulletin of the Mahoning County [Ohio] Medical Society) captures a sense of the unprecedented nature of the National Foundation for Infantile Paralysis’s March of Dimes drive to fund research into polio prevention and treatment. Some physicians, however, felt that the foundation had gone around traditional professional authorities to release their results directly to the public, when it should have first been published in a medical journal with the attendant data so that physicians could be the ones to interpret the results to their patients. Dr. Korngold’s discontent with the announcement may have also been inspired by much of the confusion surrounding the debut of Salk’s vaccine. Supplies fell short of demand in the first months of the vaccine drive, and many questioned whether the vaccine ought to be given to other groups in addition to the NFIP’s priority demographic: first- and second-grade school children.
The Cutter Incident
In the aftermath of the announcement that the polio vaccine worked, manufacturers ramped up production in order to meet supply: the National Foundation was funding distribution of the vaccine free to children in grades one and two, and each child required three shots to achieve full immunity. Supplies of the vaccine were short from the beginning, and to make matters worse, it was revealed on April 25, 1955, that vaccine manufactured by Cutter Laboratories had led some children to develop full cases of polio. This report by Dr. Malcolm H. Merrill, director of the California State Department of Health to the California Medical Association annual meeting, describes how the cases of polio resulting from the vaccine were discovered by the Board of Health and their instructions to physicians. They immediately informed doctors to stop using the Cutter-manufactured vaccine but to continue use of the others; a week after this meeting, the U.S. Surgeon General suspended the national vaccination program until all six manufacturers’ product could be tested. Merrill specifically notified his colleagues that it was not recommended to administer gamma globulin – a biological product that has been used to stimulate the immune system to fight off disease – to inoculated children, but instead to carefully monitor them for the time and report any cases.
The Cutter Incident, as it has become known, did lead to several significant reforms, including the new Division of Biologics Standards (now the Division of Biological Standards and Quality Control of the Food and Drug Administration), which is responsible for developing and maintaining products testing standards.
Sabin Vaccine Drive in Britain
In September 1961, a polio outbreak hit the English port city of Kingston upon Hull. The Hull Health Authority requested the use of the Sabin Oral Vaccine (or OPV), in what became the first mass distribution of the vaccine in Western Europe. Albert Sabin’s vaccine was made from a live attenuated virus that could be administered orally, making distribution faster, simpler, and for those afraid of needles, less stressful. This documentary film is meant to educate public health officials and the general public on the process of performing mass vaccination with the new formula. It shows the process of preserving the oral vaccine for transport, preparing it for distribution, and how the town used public facilities and education campaigns to ensure that over 90 percent of residents were vaccinated. The film ends with a short interview with the head of the vaccination campaign to discuss what lessons his department’s experiences could lend to others.