Chapter 1: What was the significance of the Salk polio vaccine trials in 1954?
Imagine it's April 24th, 1955, in Pocatello, Idaho. You and your seven-year-old daughter Susan are sitting in an exam room at her pediatrician's office. The room smells of rubbing alcohol and floor polish. You hold your daughter next to you, her face drawn, her arm hanging uselessly by her side. And at last, the doctor enters the room, his gaze fixed on his clipboard.
All right, let's see, when did this start? You take a deep breath and run your fingers through Susan's hair, trying to stay calm for her sake. Yesterday, it began with a little neck stiffness, but by nighttime, she had a fever. When she woke up this morning, she couldn't move her left arm. Is this what I think it is? Does she have polio?
The doctor examines her quietly, moving her head, tapping her knees, testing her grip. You try to read his face, but it stays blank. That certainly seems that way, but we'll have to do a spinal tap to confirm. But how could this happen? She was vaccinated for polio only a few days ago, just this past Monday. Was there something wrong with the vaccine? I followed last year's field trials closely.
The vaccine is safe. It may not be perfect, but it's not dangerous. So what happened? Susan was probably exposed to the polio virus just before she received her injection. I'm sorry to say this is just a case of bad timing. The vaccine was unfortunately just too late to protect her. That doesn't make any sense. I don't know of anyone else who's sick with polio.
There have been no other cases in Susan's class. It's April. I've never heard of anyone getting polio this early in the year. Polio season usually starts when it warms up in June. Yes, but viruses don't always follow the calendar, you know? Let's not jump to conclusions.
We can confirm the diagnosis first, and I'll keep a close eye on things and make sure that Susan receives the best care possible. The doctor makes a note on his chart and then leaves the room. You squeeze your daughter's shoulder and try to give her a reassuring smile. But deep down, all you feel is dread.
As her eyelids flutter closed, your gut is telling you that something has gone horribly wrong.
From Wondery, I'm Lindsey Graham, and this is American History Tellers, our history, your story.
In April 1955, a seven-year-old girl in Idaho came down with polio just days after receiving a polio vaccine. And when similar cases surfaced, health officials began to question whether it was a coincidence or something far more troubling. One year had passed since the National Foundation of Infantile Paralysis executed an unprecedented field trial of Jonas Salk's polio vaccine.
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Chapter 2: How did the public react to the initial reports of polio cases after vaccination?
And it was all made possible by funding from the National Foundation of Infantile Paralysis. Salk received $400,000 in grants in 1953 alone. And he would need that money because his goal was to start large-scale field trials as soon as his vaccine was ready.
But in the early 1950s, the federal government had almost no machinery for guiding vaccine development, apart from the rudimentary Public Health Service, the forerunner to the Centers for Disease Control. So the privately funded National Foundation for Infantile Paralysis stepped in to support Salk's research.
And once Salk's vaccine was ready for field trials, it was the foundation that would control every aspect of the operation with critical support from local communities. And that spring, Salk felt confident enough with his formula to vaccinate himself and his family.
He had three boys under the age of 10, and blood tests showed that after their injections, all three had elevated levels of polio antibodies, and none of them had suffered side effects. Salk's laboratory staff also received injections. But while Salk had favorable data and the steadfast support of the National Foundation on his side, he could not escape the scrutiny of his fellow scientists.
In June 1953, Albert Sabin's simmering rivalry with Salk exploded into the open. At a national meeting of pediatricians, Sabin attacked Salk's vaccine and ridiculed the public's impression that a vaccine was almost ready for testing. Sabin's primary argument against Salk's killed virus vaccine was that it contained an inactivated version of an extremely potent strain of poliovirus.
Sabin argued that if anything went wrong with the inactivation process, it would be a recipe for disaster. In contrast, Sabin had spent more than two years working on a live virus vaccine containing a weakened version of a live poliovirus, and he insisted his approach was the only viable option. He also condemned the NFIP, declaring that the organization was publicity mad.
But Sabin's criticism did nothing to hinder the momentum for Salk's vaccine. In November 1953, NFIP director Basil O'Connor made the long-awaited announcement that large-scale polio vaccine trials would be held in the spring of 1954. It was a momentous decision. The foundation would be testing an experimental vaccine on hundreds of thousands of children across America.
To oversee the trials, O'Connor enlisted leading epidemiologist Thomas Francis, who was Salk's former mentor. Not only would Francis supervise the trials, but he would also evaluate their results at his lab at the University of Michigan. And to do all this, Francis planned a double-blind study focusing on children in the first, second, and third grades.
Roughly 420,000 children would receive the vaccine in three doses, while 200,000 children would receive saline placebos. Nobody involved would know who got what until the trials were over. A third group of 1.2 million children designated as a control group would receive nothing.
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Chapter 3: What were the logistical challenges faced during the vaccine trials?
So with the supply of vaccines secured, in February 1954, Thomas Francis opened the Vaccine Evaluation Center at the University of Michigan. He soon found himself inundated by questions from the community participants in the trials. Local health officers asked him whether he was certain there was no live virus in the vaccine, and they expressed their fears about potential contamination.
Francis worked hard to assuage concerns, but just before the trials were set to begin, a popular radio broadcaster sowed new doubts. Imagine it's early April 1954 in Lansing, Michigan. You're the virologist in charge of the Salk polio vaccine trials, which are scheduled to begin at the end of the month. And with time running out, you're suddenly fighting a new wave of public uncertainty.
That's why you're here at the medical practice of Dr. Baker, the president of the Michigan State Medical Society. Baker gives you a look of recognition as you sink into the wingback chair across from his desk. With a small sigh, he folds his newspaper neatly in half. May I help you, doctor? I hope so. I want to know what the hell you're thinking.
Recommending Michigan parents pull their children out of the vaccine trials? Well, what can I say? Walter Winchell hosts one of the most popular radio shows in the country. You can't expect people not to listen when they hear him calling the vaccine a killer. I've been fielding calls all day from spook parents. Walter Mitchell is a gossip commentator. He's trying to create sensation.
I mean, he's not an epidemiologist. He doesn't know what he's talking about. The Solve vaccine is triple-checked, while it seems clear that Winchell's so-called reporting isn't even checked once. Are you denying that problems were found with the commercially produced vaccine? I admit that a handful of batches failed to pass extremely rigid safety tests, but don't you see that's a good thing?
It's proof of how well the triple testing process is working. I don't see why Michigan children need to be guinea pigs. I'd feel better leaving it to the other states. But we need a large sample size, Dr. Baker. I can't have an entire state pull out of the trials. I don't know what more proof you need.
Dr. Salk has already inoculated hundreds of children in the Pittsburgh area, including his own three sons. Not a single mishap. And I'm glad to hear that. But I can't risk the public's trust. I expected you to know better. You shove your chair back and walk out of the office, anxiety coiling in your chest. You fear what all this means for the trials.
If they're not up and running by the start of the summer polio season, they'll have to be put off for a year, wasting months of effort and putting more American children at risk. On April 4, 1954, the famous gossip commentator Walter Winchell used his popular Sunday night radio show to attack the Salk vaccine.
He claimed that the vaccine may be a killer and announced that seven out of ten tested batches at one facility contained live poliovirus that killed several monkeys. He also claimed that the NFIP was stockpiling little white coffins in the expectation that the trial would cause fatalities.
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Chapter 4: What led to the Cutter Laboratories' vaccine recall in 1955?
Still, the vast majority of participants trusted the NFIP and planned to continue. So on April 25th, both the Vaccine Advisory Committee and the Public Health Service voted to approve the field trials on the Salk polio vaccine. The next day, April 26, 1954, a group of first graders lined up in the gymnasium of an elementary school in McLean, Virginia.
Cameras flashed as a six-year-old boy named Randy rolled up his sleeve and became the first to receive an injection. He boasted, I could hardly feel it. The same procedure was repeated thousands of times over the next several weeks. Each school had a five-member volunteer vaccination team, which included a doctor, a nurse, a recorder, and two aides.
Together, they oversaw identification, consent forms, preparation, injection, and disposal of syringes. But despite meticulous planning, logistical problems did arise, from children receiving extra or missed doses to doctors stealing vaccines to use on their own families.
But nonetheless, by late spring, more than 600,000 children had received an injection, with 95% of that number completing all three doses. This unprecedented achievement was a testament to the NFIP's careful planning and publicity, and the dedicated involvement of more than 300,000 volunteers. The field trials amounted to the largest peacetime mobilization of volunteers in American history.
But with the injections over, now all eyes turned to Thomas Francis, who faced a mammoth task of analyzing the data and determining whether Salk had finally created a safe and effective vaccine for polio, bringing an end to 40 years of fear. Hello, American History Tellers listeners. I have an exciting announcement. I am going on tour, coming to a theater near you.
The very first show will be at the Granada Theater in Dallas, Texas on March 6th. It's going to be a thrilling evening of history, storytelling, and music with a full band behind me. as we look back to explore the days that made America. And they aren't the days you might think. Sure, everyone knows July 4th, 1776, but there are many other days that are maybe even more influential.
So come out to see me live in Dallas, or for information on tickets and upcoming dates, go to AmericanHistoryLive.com. That's AmericanHistoryLive.com. Come see my Days That Made America tour live on stage. Go to AmericanHistoryLive.com. In the summer of 1954, Thomas Francis and his team in Ann Arbor, Michigan, began evaluating the results of the Salk polio vaccine.
Every day, bulging mail sacks arrived containing data in the form of letters, telegrams, laboratory reports, and health records. All of it needed to be collected and analyzed by statisticians that Francis hired from the U.S. Census Bureau, as well as dozens of Michigan graduate students. In total, 1.8 million children had participated in the trial.
So now, a staff of 120 kept records on all of them, constantly updating the files as new information arrived. Much of the data entry was done by hand, but Francis also sent some of it to Detroit to be processed by early IBM computers. But despite intense interest in the outcome of the trials, Francis refused to rush his work, insisting that it would be finished when it's finished.
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Chapter 5: How did the Cutter incident impact public trust in vaccines?
This remark came to symbolize the spirit of the polio crusade, a volunteer-driven effort made possible by millions of small donations. All across the country, Americans celebrated their shared victory. Schoolchildren cheered, church bells rang, and parents wept with relief. Salk returned to Pittsburgh to a hero's welcome. He was an instant celebrity, hailed as the man who conquered polio.
He explained that his vaccine had been built on ideas and techniques developed by many scientists before him, and by doing so, he acknowledged the critics who had long insisted that there was nothing novel about the science of his vaccine. But his comments did nothing to diminish his star power. The public credited him for single-handedly defeating polio.
And on April 22, the White House held a ceremony in Salk's honor. President Dwight D. Eisenhower fought back tears as he declared, I have no words to thank you. I am very, very happy. Eisenhower promised to give the vaccine formula to every country that welcomed the knowledge, including the Soviet Union, and called Salk a benefactor to mankind.
But though it was only hours after the release of the Francis Report that the Eisenhower administration approved the Salk vaccine for commercial use, supplies were still limited. All across the country, pediatricians were inundated with calls from parents demanding that their child be vaccinated, and 10 million doses were released over the next two weeks.
But most doses had already been promised to first and second graders, the age group considered most vulnerable to polio, and to children who had received placebos in the 1954 trials. This left most American children unprotected as summer approached. So Americans urged the federal government to step in. But the Eisenhower administration had made no plans to coordinate vaccine distribution.
Secretary Oveta Kulphavi, head of the newly formed Department of Health, Education, and Welfare, admitted as much. Many Americans reacted with disbelief when she told a Senate committee, I think no one could have foreseen the public demand. Letters flooded the White House calling her incompetent and heartless, and editorials demanded her resignation.
But Secretary Hobby and her colleagues in the Eisenhower administration insisted that the government's only role was to license the vaccine, not to distribute it. In the 1950s, at the dawn of the Cold War, even limited government intervention in the health industry sparked accusations of socialism.
And the pharmaceutical companies warned that government control of distribution would stifle innovation. But with supplies of the vaccine falling short of demand, price gouging became common. And although each shot cost $2, some doctors charged as much as $20 for a vaccination. Americans blamed Washington for the shortages, high prices, and poor planning.
Even Republican newspapers that supported the Eisenhower administration demanded federal leadership to safeguard their children. One editorial affirmed, This is an emergency answer to an emergency situation, not a step toward socialized medicine. Eisenhower responded to this public outrage by agreeing to a temporary federal role in vaccine distribution.
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Chapter 6: What were the consequences of the Cutter incident for vaccine production?
You straighten up in your chair, bracing yourself as Basil O'Connor barges into your office, raw anger written all over his face.
All right, give it to me straight. What are you planning to do?
You close your eyes in disbelief, letting out a long sigh. Mr. O'Connor, I see it wasn't enough to call me half a dozen times today. Well, I haven't gotten an answer. My advisors are urging me to pause the entire national vaccination program. You can't be serious. Do I look like I'm joking? I've got reports of 44 people with polio, all because of this vaccine.
44 is nothing compared to the millions who've received the vaccine with no problem. You can't punish the entire country just because of one sloppy laboratory. If you stop the program now, you'll be putting millions of children at risk of getting polio this summer. But the consequences of letting the inoculations continue might be worse.
No one is getting polio from any of the vaccines made by the other companies. I could have you fired, you know. Do I really need to explain that you have no authority over me? This isn't your foundation's call anymore. The government licensed this vaccine, and that means the government is in charge of making sure the vaccine is safe.
I cannot risk jeopardizing the public's trust, so I'm going to suspend the program. O'Connor shakes his head, his face bright red.
Oh, you're making a mistake. I'm telling you, you're gonna regret this.
O'Connor turns and storms out of your office. And as you face the likelihood of another sleepless night, a small part of you wonders if O'Connor is right. But you know you can't sit back and allow a man-made polio epidemic spiral out of control. As incidents of polio in vaccinated children climbed, experts urged Surgeon General Leonard Shealy to stop the vaccinations.
Basil O'Connor furiously disagreed, going so far as to threaten to have Shealy fired. Nevertheless, on May 8, 1955, Shealy went on national television and announced that the government was temporarily suspending the entire polio vaccination program, pending a review of all six manufacturers. It was a stunning turnaround, less than a month after the vaccine was declared a success.
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Chapter 7: How did the polio vaccine landscape change after the Cutter fiasco?
They had allowed virus mixtures to sit too long in storage, which permitted particles to clump together and shielded them from the formaldehyde used to kill the virus. Their negligence allowed live poliovirus to get into six lots of the vaccine. And as a result of the tragedy, manufacturers were now required to filter the virus liquid just before adding the formaldehyde.
It was one of several new rules and safety tests introduced in the wake of the fiasco. These reforms prevented a repeat of the Qatar incident, but it would take time to repair public trust. In the summer of 1955, several state and local health departments refused to administer the vaccine, insisting that starting the process that far into the polio season was not worth the risk.
But that summer, Boston and Chicago saw major polio outbreaks. In the end, there were 28,000 reported cases in 1955. Experts believed most of the cases could have been avoided. And for many Americans, the Cutter incident was proof of the need for greater government oversight of public health. And the next few years saw a major expansion in the federal health bureaucracy.
Vaccine testing became a major function of the National Institutes of Health, and the NIH budget soared from $81 million in 1955 to $400 million in 1960, marking a shift from private to government-led medical research. The 1954 polio field trial would be the last to be run entirely by a private organization. Public scrutiny also extended to the NFIP.
Many blamed Basil O'Connor's aggressive campaign for rushing an unsafe vaccine. Some scientists argued that polio had been exaggerated as a national menace, and journalists began questioning why a disease that was far less deadly than cancer and heart disease dominated public donations. The Cutter incident also had consequences for Cutter Labs.
They would pay out millions of dollars in damages to the victims of the botched vaccine lots, with Salk frequently testifying on the victims' behalf. But with improvements in testing, Salk's vaccine proved to be safe and highly effective. Polio cases plummeted in the late 1950s, from 28,000 in 1955 to 15,000 in 1956 to just 7,000 cases in 1957. The disease no longer caused widespread fear.
Swimming pools reopened in the summer of 1956, and newspapers stopped printing daily tallies of polio victims on their front pages. Still, gaps remained. Many lower-income children went unvaccinated, turning polio into a disease of the underprivileged. So in 1956, the NFIP introduced a new slogan, Polio Isn't Licked Yet, but enthusiasm and donations waned.
In the late 1950s, Basil O'Connor steered the March of Dimes in a new direction beyond polio, focusing on prenatal care and other children's health issues. It continues to this day. But the Cutter incident also had far-reaching implications for the field of polio research, shifting focus from the killed virus vaccine to a live virus alternative.
Albert Sabin received growing media attention for his argument that instead of killing an extremely virulent strain of virus, vaccines should be made from a live virus that is non-virulent to begin with. Sabin had been working away on his vaccine since 1951. His research progressed slowly because the process of weakening live polioviruses was far more complex than killing them.
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Chapter 8: What lasting impacts did the polio vaccination efforts have on public health policy?
Excuse me, do you have a moment? You glance at your watch and then shake your head. Oh, not really, Dr. Song. This won't take long. I just want to know why the AMA voted to endorse Albert Sabin's vaccine over mine. Since when did this organization start weighing in on scientific debates? Well, we needed to pick a side. Doctors are confused about the competing vaccines.
They wanted guidance and clarity from an unbiased source. Well, the AMA is hardly unbiased. I can name a half dozen of your colleagues who are friendly with Sabin. This reeks of favoritism. Well, there's plenty of evidence that Sabin's oral vaccine is both more effective and more easily administered than your vaccine. It's based on evidence, not favoritism. There's nothing wrong with my vaccine.
The only problem is it hasn't been used enough. Recent outbreaks all took place in neighborhoods with low vaccination rates, you know? This is a social problem, not a scientific one. But the AMA has continually refused to promote mandatory vaccination of my formula. Seems to me that you and your colleagues have blood on your hands. Hearing this, you ball your hands into fists, your anger rising.
Now, Dr. Salk, Sabin's live virus formula has the overwhelming support of researchers in the field. It's as simple as that. Nothing about this is simple. If the AMA won't see reason, I'll just have to go to the Surgeon General and convince him not to license Sabin's formula. Oh, Dr. Salk, you're facing a losing battle. I think it's time you accept that your vaccine is a relic of the past.
Now, please, if you'll excuse me. You push past Salk and hurry off to your presentation. Salk can rage all he wants, but you won't be swayed. His fame doesn't make him immune to scientific scrutiny. And as far as you're concerned, his command over the polio crusade is over.
Despite Jonas Salk's protests, in the summer of 1961, the American Medical Association endorsed Sabin's oral polio vaccine, and the federal government licensed it for commercial use. Sabin's vaccine became the dominant polio vaccine in America for the next three decades.
Salk's son Peter later reflected on his father's refusal to accept defeat, declaring, "...this was so terribly painful, so personally insulting to him as a scientist, that he couldn't let it go. It's no exaggeration to say that it haunted him for the rest of his life." Still, together, the Salk and Sabin vaccines brought an end to polio in the United States and throughout much of the world.
The last case of polio was reported in the U.S. in 1979. In the 21st century, the virus is only endemic in Afghanistan and Pakistan. Experts predict that polio will follow smallpox in becoming the second infectious disease to be eradicated worldwide. The crusade against polio stands as one of America's greatest public health victories.
For two decades, the March of Dimes harnessed the power of mass media and grassroots fundraising to unite the nation in a common cause. The vaccine research it funded led to the defeat of a dreaded disease and ushered in a new era of government leadership in public health. So that today, what was once one of the most feared diseases in the United States exists only in memory.
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