America Conquered Polio

How America Conquered Polio

For obvious reasons, I’ve been wondering lately what makes America great. What if we made a top 10 for America, the way ESPN does for Michael Jordan or Tom Brady?  What accomplishments would make the list? Surely defeating the Nazis in WWII and landing on the moon would make it.  We can’t ignore the writing of our founding documents.  But what about the polio vaccine?

That’s right, the polio vaccine.  Ask the average person today about polio and they’ll look at you dumbfounded.  Ask them if they received their vaccine and their answer will more likely be “huh” versus firm “yes.”  And that’s the point.

Below is the story of Paul Alexander.  This excellent piece puts a face to the struggle of so many through the 20th century before the polio vaccine.

Story on Polio Eradication in USA

Thanks in large part to the Bill and Melinda Gates’ Foundation, according to the World Health Organization’s number there were 22 case of wild poliovirus worldwide.  And these cases are restricted to 2 countries, Afghanistan and Pakistan.

As per the CDC, during 1951-1954, there were an average of 16,316 cases of paralytic polio and average of 1879 deaths caused by polio.1   1952 was a particularly bad year.  There were more than 58,000 cases reported nationwide and more than 3,000 deaths.  My hometown, Houston (Harris county) was racking up more than 700 cases.  Fortunately, that year there were less than 20 deaths in the Houston area.  This was not a one-time event like Hurricane Harvey, but rather the wave of infection came year after year (see below).2

So, what happened?  America took on the challenge and succeeded.  And I don’t mean the way our Olympic team trains in anonymity and wins medals, while the American public cheers on.  I mean everyone got involved.  EVERYONE.

When did things change?  See that spike above 1921.  It’s not the biggest uptick, but it’s the one in which Franklin D. Roosevelt was infected.  President Roosevelt was 39.  Children are most prone to polio as it is spread through feces to the mouth.  FDR serendipitously attended a boy scout rally and then soon fell ill.

Our 32nd president was soon paralyzed from the chest down.  President Roosevelt is a giant in history, but he had help.  In the fight against polio, help came in the form of Daniel Basil O’Connor, known to his friends as “Doc.”

O’Connor was an interesting man with humble beginnings.  Born into an Irish-American family recently immigrated to America, he described himself as an “Irishman one generation removed from servitude.” The talented debater, how he won the loan to pay for Harvard Law School, and industrious man met our former president at the 1920 Democratic convention.  Doc soon became a trusted advisor and in 1942, and the two formed a law firm together.

President Roosevelt wanted to make Americans “polio conscious.”  His national efforts started with the President Birthday Balls, under the guidance of O’Connor.  On FDR’s birthday, people across the country “danced so that others might walk.”  In 1934, the events raised more than 1 million dollars.  But this was not going to be enough, so in 1937 President Roosevelt commissioned the National Foundation for Infantile Paralysis (NFIP) with O’Connor as its President.  The March of Dimes, which was the NFIP’s first major fundraiser and later would become its adopted name, was launched in 1938.  The first year, the March of Dimes raised $1,823,000.4

President Roosevelt passed in 1945, but the monumental effort was well on the way.  In 1947, the NFIP held its first round table, where the strategy was hammered out.  Bringing the fight closer to home, O’Connor’s daughter Bettyann Culver was paralyzed on her left side from polio.  Determined to conquer the disease, Doc gathered the greatest American virologists and immunologists.  Amongst them were Drs. Jonas Salk and Albert Sabin. Salk was a first generation Jewish American and brilliant laboratory scientist.  Sabin was a naturalized Jewish American and a tremendous intellect.  The competition between Salk and Sabin would lead to the injectable and oral polio vaccines.  The development of the polio vaccines, which I won’t get into here, is an inspiring story which I recommend every medical student read.  For these two physician scientists showed research saves lives.

The two, particularly Salk, inspired the American public.  Jonas Salk, starting with the CBS program The Scientist Speaks for Himself, appeared on tv to persuade Americans.  The American public funded the March of Dimes, which in turn funded Jonas Salk.

Progress was steady and on April 26, 1954, the NFIP initiated its polio vaccine trial.  “Never before and never again in the history of medicine would there be a trial this monumental in size, conducted solely on children, financed and run by volunteers… The field trial consisted of two concurrent studies.  The primary trial—a randomized placebo-control study—would involve approximately 750,000 first, second, and third graders, the group known to have the highest of incidence of polio.  It would be run through elementary schools, where students in each classroom would be assigned by random draw to receive either vaccine or placebo.  Coding assured that no one, neither the child, parent, nurse, nor the NFIP, knew who received which injection until the code was broken.  At the end of December, Thomas Francis and his statistician would compare the number cases between the two groups.  In the second, parallel trial—the observed-control study—four hundred thousand second graders in selected areas would be offered vaccine on a voluntary basis.  The rate of polio among this group would be compared to approximately 725,000 first and third graders in the same community, who would receive no injections, serving as the observed controls.”4

Conducting this trial was a herculean effort and required coordination on a massive scale.  The NFIP had to obtain consent from more than 1 million parents, coordinate vaccination and blood collection, thoroughly review every side effect and death.  Melvin Glaser, the chief of field operations for the International Red Cross during WWII, at the behest of O’Connor lead the 20,000 physicians and public health officials, 40,000 nurses, 14,000 elementary principals, 50,000 teachers, and 220,000 volunteers.

Americans also volunteered their children for the trial and world’s greater good.  O’Connor’s words were included with the consent sent home with children: “This is one of the most important projects in medical history. Its success depends on the cooperation of parents. We feel sure you will want your child to take part.”5 At the risk of contracting polio, as had happened with previous misguided potential vaccines, 1 million American children were enrolled in the trial.

After vaccination, data needed to be collected and analyzed.  Thomas Francis, Jr., the son of Welsh immigrants and chairman of the Department of Bacteriology, lead the data analysis effort.  Francis and his statisticians finally received more than 144 million pieces of data.4

On April 12, 1955, the anniversary of President Roosevelt’s death, Dave Garroway announced the vaccine’s success on NBC’s Today.

So, what should we take away from our battle with polio?  First, we should not forget the scientific contributions Americans have made.  Second, American generosity has fueled advancement for all of humankind.  Next America, at its best, is a meritocracy where the best are recognized no matter their back ground.

So, what makes America great?  I would suggest, it’s our ability to come together, give what we can, and conquer the great challenges that plague humanity.  In the next couple of years, polio will be eradicated, probably without fan fare, but I for one will lead the chant: U-S-A! U-S-A!

 

References

1.     “Achievements in Public Health, 1900-1999 Impact of Vaccines Universally Recommended for Children — United States, 1990-1998,” Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention. April 02, 1999 / 48(12);243-248. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/00056803.htm.

2.     George, Cindy (2016, June 6).  Polio struck terror in Houston and across the nation, Houston Chronicle. Retrieved from https://www.chron.com/local/history/medical-science/article/Polio-struck-terror-in-Houston-and-across-the-7964777.php#photo-10196892.

3.     Beaubien, Jason (2012, October 15). Wiping Out Polio: How The U.S. Snuffed Out A Killer, NPR.  Retrieved from https://www.npr.org/sections/health-shots/2012/10/16/162670836/wiping-out-polio-how-the-u-s-snuffed-out-a-killer.

4.     DeCroes Jacobs, C. (2015). Jonas Salk: A Life [Kindle version]. Retrieved from Amazon.com

5.      Oshinsky D. (2005). Polio: An American Story [Kindle version]. Retrieved from Amazon.com.

 


I grew up in Salt Lake City and a suburb of Houston. I completed my MD and MBA in the great state of Texas. I gravitated to Austin and have found a home base for my journey. I spend my time working as a Hospitalist (inpatient internal medicine doctor), consuming information, writing, working out, investing, traveling, and hanging with my dog.

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