Sugar Ice Cubes or a Shot? #3
“Did our daughter get a shot or a liquid vaccine for Polio?” I asked my wife.
We both looked it up since who can remember anything that happened more than an hour ago these days?
It was a shot.
I had just read David Oshinsky's 2005 Pulitzer prize-winning book Polio, and I wanted to know how my baby got her vaccine. We asked our parents who received it as a sugar cube in elementary school- an oral vaccine.
So why did she get the shot instead of the liquid vaccine? Oshinsky's compelling book on the topic sheds light on the switch, and it is a story relevant for today.
As it turns out, she received the Jonas Salk version of the vaccine, the killed-virus version (inactivated). This is the version of the vaccine everyone thought was unsafe after they first thought it was the safest version.
On April 12th, 1954, the national media descended upon Ann Arbor for a medical announcement. Thomas Francis, who led the Polio Institute at Michigan, hosted Dr. Jonas Salk and announced to the gaggle they were ready to release a polio vaccine. It was a day that many would remember decades later. As the Time Magazine cover story asked, is this the year that a polio vaccine finally is discovered?
For the previous two decades, an incredible amount of resources were dedicated to the crippling yet rare disease. The National Foundation (March of Dimes) became the first non-profit fundraising engine. They understood the power of small donors, and partnered with the film industry, and raised tens of millions of dollars by soliciting moviegoers before the film. A majority of the virologists who played an essential role in eradicating Polio were funded by the March of Dimes. Oshinsky helps us understand the crucial role the foundation played, and the book is not just a lesson about science, but also how the money behind the research represents an outsized role.
Salk should not even have been there that day in front of reporters from around the country. He was Jewish (when anti-Semitism in the medical community was widespread), son of immigrants with no formal education, without the connections that would predict groundbreaking medical work.
It was a time of meritocracy, at least for white men. If you worked hard, were at the top of your class, you could get into City College in New York-- for free. Our government helped scientists that would save millions of lives because they offered a good public education to immigrant communities, and then funded academic institutions to continue to invest in the research.
I am learning that immunization science depends on others' advances and discoveries. Like any artistic work, legal precedents, or the development of computer code, medical advances stand on previous ones' shoulders. Salk could not get a patent for his vaccine because others so heavily influenced it. John Enders learned that a virus could be cultivated in vitro (test tube). Dorothy Horstmann, a female scientist in the 1940s, discovered the anti-bodies for Polio, creating the groundwork for a vaccine working. Also, RIP to the 100,000 monkeys that died so we could learn more about Polio.
Salk created an inactivated or killed polio vaccine. The side effects are mostly mild since it is not a live virus, in most cases. And the exception, which was a tragic blunder, turned out to be a significant manufacturing error.
The roll-out of the vaccine draws parallels to our current pandemic, or what the future may hold. Political careers and economies are relying on an effective vaccine on Covid-19. Unfortunately, you can not rush science, and the story of Polio is a critical case study on this issue. "Scientists must set their own pace, oblivious to outside pressure," Oshinsky writes. Also, to get to wide-spread immunity from a vaccine, at least 90% of people need to take it. When trials are rushed during an election year, it is hard for many people to trust a safe vaccine.
After the country celebrated Salk as the savior, there was a tragic error at Cutter Manufacturing in California. It appears that a rush to speed up production time caused breakdowns in the checks and balances of the vaccine. A vaccine that was supposed to contain a killed virus was administered with the live-vaccine. Not only were some children crippled and passed away, but it also caused community spread.
The Cutter live poliovirus mistake should never have happened. It was example number 4059201392 when a woman discovered a problem, started asking questions and was ignored.
After doing her research, Dr. Bernice Eddy went to a colleague and asked about the monkeys they tested with Cutter's vaccine. Paul Offit, in his book The Cutter Incident, writes about this exchange.
"What do you think is wrong with this monkey?"
"They were given Polio, the researcher speculated. No, Eddy replied, They were given the polio vaccine." She told her superior, but it was never brought to the attention of the licensing board. (Offit's book came out the same year as Oshinsky's and seemed to be an essential part of the story, and I have now added it to my to-read list).
In a recent Philadelphia Inquirer interview, Dr. Offit says he wants to write his next book on learning curves.
We are now about to make a vaccine against the novel coronavirus. It is elusive. The disease has a number of effects we couldn't have imagined — loss of the sense of smell and COVID toes, for instance. The virus has done so many things we couldn't have anticipated. We are meeting it with every strategy we have, and all at warp speed, which I can't imagine puts anyone at ease.
I think we are going to learn things in a couple of years that we wish we knew now.There will be tragedies. There always are. But people never expect that. They expect to have major breakthroughs without a price. I think we are going to have major breakthroughs, but it will come with a cost because it always does.
After one of the most significant vaccine errors of the 20th Century, a different scientist stepped in, Albert Sabin, to carry the polio vaccine mantle. Sabin (born Saperstein in Poland) leveraged connections he made in public schools in Patterson, NJ, to work at Bellevue Hospital. At the hospital, he saw Polio up close. John Paul wrote, "No one ever contributed so much effective information- and so continuously over so many years, to so many aspects of polio, as Sabin."
Oshinsky skillfully elevates the tension between Sabin and Salk like two marathon runners moving ahead and then falling behind. While they shared similar backgrounds and interests, they had very different philosophies about solving the Polio pandemic. As it turns out, Sabin was rightfully worried about the speed of the Salk trials and vaccine. "Why rush into field trials with an unfinished product? We have only just begun to learn, and it would be wise to make haste slowly...The point...is that the time is not yet----perhaps soon, but not yet." This was much more practical advice than his more petty remarks about Salk, "You could go into the kitchen and do what he did."
It is quite a remarkable turn of events for the reader that Salk, the national hero on vaccines, has to play second fiddle to Sabin by the early 1960s. Forty years later, Sabin's oral immunization with a live virus eradicated the disease in the United States.
And with the virus no longer spreading in the US, the CDC recommended pediatricians return to Salk's killed-virus vaccine. "The vaccine war had come full circle. Though the Sabin vaccine would continue as a staple in much of the developing world, its thirty-year reign in the United States was over--at least for now. As Darrell Salk put it, simply: My father would have been pleased."
Polio helps put into context our current predicament with Covid-19 and gives the historical background to the varying types of vaccines. The world will be thinking of killed virus (inactivated) vaccines versus live virus vaccines for a while now, and at least I now know, we have always been thinking about that. You have to find comfort where you can!
So in before times or after-times, remember, you can not rush the science, and what may seem like the best answer first, may not be the best answer in the end.
P. S. Oshinsky writes about an award dinner for Sabin in the late 1980s and mentions one of the distinguished guests, a man, by the name of Anthony Fauci. It was like seeing your favorite movie star in a bit part from a few decades ago. There he is! Fauci!