POLIO VACCINE

One time, we got it right.

There are so many stories in this book about quacks and bad medicine that it’s nice to sometimes consider the times when we got it right. The story of polio treatment is a story with some real heroes in it. Also, since half of the authors of this book are doctors, it is nice when a story isn’t about how dumb or evil they are.

Polio is a virus, classified as an enterovirus, and it is usually fairly benign in the way it interacts with the human body: It enters through what is known as the fecal-oral route.

Wait, I’m no Latin expert, but am I correct in assuming that means . . .

Yes, that’s exactly what it sounds like.

Polio takes a while to incubate, up to twenty days in some cases, and surprisingly, may not result in much at all. As scary as polio may be, 95 percent of those who contract the disease are symptom-free and don’t even know they have it. Unfortunately, though, they can still pass it on to other people. In about 4 percent of cases, you get some mild symptoms, maybe a cough or runny nose, or perhaps some abdominal pain and nausea, or maybe just body aches and malaise. The scary part is that in about one percent of cases, the virus invades the central nervous system, and this is when it can result in paralysis. While those may seem like good odds, the polio virus is highly infectious, which means a whole lot of folks are exposed during an outbreak, and well, it means a lot of very sick people.

Plus, I mean, one percent isn’t that low, right? Like, if I heard there was a one-in-one-hundred chance to hit the Powerball, I’d hock everything to buy more tickets. I’d sell my kids on the black market. Well, one of my kids. . . . Okay, none of my kids, but I’d sell my Nonnee on the grandma black market, and I love my Nonnee.

While throughout most of medical history we can credit sanitation for improvements in disease outcomes, polio is an anomaly. Improved sanitation probably actually made things a little worse in terms of the severity of polio. Initially, most cases were among infants who actually had a lower chance of suffering long-term effects from contracting polio. The rate of paralysis increases significantly as you age. Once we understood the importance of sanitation, babies were among the first to benefit from less exposure to disease. But fewer people contracting polio when they were an infant meant the average age of incidence rose from between six months and four years, to between five and nine years old. There were also many more cases of teens and adults contracting polio, which tragically meant many more cases of paralysis and death.

We’re getting a little ahead of ourselves, though. Polio is a disease that goes all the way back to the beginning, with recorded cases throughout antiquity. There are paintings and descriptions from ancient Egypt that depict a type of paralysis that occurred in children. While we can’t be sure these images of children with canes reflected polio, it’s very likely. It is also likely that Roman Emperor Claudius had polio. Sir Walter Scott got polio in 1773, and lost the use of one leg as a result. In his account of the illness, he refers to it as a “severe teething fever.” Polio may have also crossed over into fiction: Many believe polio plagued the beloved, doomed Tiny Tim before Scrooge saved the day. Again, it’s impossible for us to say for sure.

For centuries, polio outbreaks only popped up sporadically. It was known by many names, it was unpredictable, and its cause was unknown. We weren’t forced to answer many questions about the mysterious illness until the 1900s when more frequent epidemics robbed us of the luxury of ignoring polio. Doctors began seeing cases with more and more frequency throughout the United States and Europe, culminating—at least, in North America—during the summer of 1916.

THE DEEP END

Kids in 1916 spent their summer vacation time much like kids today. They stood outside stores. They played . . . well, obviously not the PlayStation 4 in 1916; we couldn’t have been further along than PlayStation 2 back then. But also, they filled the public pools and beaches, looking for a spot to cool off and relax with their friends. However, that summer, all this would change. What had started with scattered cases throughout several major cities was now turning into an epidemic. There were 27,000 cases of Polio diagnosed that summer, and 6,000 of them proved the be fatal. New York City was hit especially hard, with a full third of those deaths occurring within the city limits.

As the illness spread and number of affected families climbed, people began to scatter from the city to surrounding rural areas. Public places like pools, amusement parks, and beaches were closed. Terrified parents avoided water fountains. The names and addresses of confirmed cases were published in the paper, and those who’d been affected were quarantined. Families who had been stricken by polio put up signs in their windows warding off visitors. It was the first of a few dozen years where summer meant parents living in fear of polio.

Without a firm understanding of what was happening or why, desperate patients tried all manner of strange treatments that were rumored to work. Poultices with mustard, slippery elm, and chamomile were frequently employed, as well as baths in almond meal. Doctors didn’t have much better advice. They handed out prescriptions for quinine, caffeine, gold, and water that had been exposed to radiation and was thought to contain healing powers. In order to reverse the paralysis, some attempted applying electricity to the legs. Then as now, vitamin C was recommended when doctors ran out of ideas.

Boy, I don’t care if you’re talking about Tylenol or spring water imbued with ten parts per million of mountain daisy; there’s just nothing that sounds like real medicine when you describe it as having “healing powers.”

As epidemics continued every summer, new therapies were tried. President Franklin Delano Roosevelt, having recovered from polio as a child, brought attention to hydrotherapy as a treatment. Hydrotherapy had been around for many centuries already at this point and encompassed a variety of water-based treatments including mineral spas, warm and cold compresses, whirlpool baths, and sometimes, just taking a bath. The use of hydrotherapy for polio largely consisted of physical therapy performed in water, the use of various pressures and temperatures, and bathing in mineral springs. FDR himself had used hydrotherapy and credited it with his impressive recovery. To expand the availability of this therapy, he bought Warm Springs in Georgia, turning it into a polio rehabilitation facility.

DARKEST BEFORE THE DAWN

For nearly forty years, the polio problem continued on a dangerous trajectory, with increasingly frequent epidemics. 1952 would see the largest outbreak in U.S. history. There were over 57,000 cases, over 3,000 deaths, and over 21,000 people left paralyzed. At this point, surgeons were going to even greater lengths, attempting procedures like tendon and nerve grafting and limb lengthening to reverse the effects of polio. When surgery wasn’t enough, polio victims had to rely on newly created and improved devices, including casts, braces, canes, crutches, and wheelchairs to restore their mobility.

One of the key breakthroughs to support those who had suffered some of the most life-threatening effects of the disease was the iron lung. The prototype was initially just an electric motor hooked to two vacuum cleaners. The device would apply positive pressure to make you breath out and then negative pressure to make you breath in. While it would save many lives, the people who were unfortunate enough to have needed it still ended up with a 90-percent mortality rate overall. In modern times, the iron lung has been replaced by ventilators.

One effective treatment that originated during the 1920s was called the “Kenny Regimen.” This therapy was developed by and named for Australian nurse Sister Elizabeth Kenny. (No, she wasn’t a nun; “Sister” was the British title for a chief nurse in World War I.) At the time, it was thought that casting patients and keeping them immobile was the best way to prevent contractures. In fact, this only made things worse by causing muscle atrophy. She introduced a regimen of heat, early physical therapy, and exercise that was much more effective in maintaining muscle bulk and flexibility, as well as easing pain. It was so revolutionary that it is actually still the basis for therapies used today.

HERE COMES THE SUN

The solution to polio, though, was in finding a way to prevent it from infecting people in the first place with an effective vaccine. Before doctors could really take the fight to polio, they had to discover how to grow the virus in a culture. This feat was achieved by John Enders in 1949 and won him the Nobel prize a few years later. Now that the virus could be pinned down in a lab, scientists could get to work formulating a vaccine to stop it.

By the 1950s, two doctors, Jonas Salk and Albert Sabin, were hard at work trying to solve the puzzle.

Jonas Salk was a virologist who was tasked with finding an inactivated vaccine by the National Foundation for Infantile Paralysis, established by FDR. A killed virus vaccine was thought to be a safer option. This injection would likely prevent the worse outcomes of polio, but would not stop the initial infection from taking hold in the intestines. Meanwhile, Albert Sabin, a physician and first-generation American immigrant, was working in his own lab to develop a live oral vaccine that, while thought to have more risks, would be able to prevent the initial infection in the intestines.

Salk was a little bit ahead of Sabin, and was the first to start clinical trials. He was either desperate or confident enough in his cure that himself and his family were among the first injected with the vaccine. After his preliminary tests, he asked for children to test the vaccine on and was met with over a million parents willing to sign their children up for the trials. So great was the fear of polio at the time that parents were willing to risk their children’s lives to give them the experimental immunization.

It was nothing short of an astounding success. By 1965, polio cases in the United States had fallen into the double digits, down from over 57,000 just thirteen years earlier. By the 1990s, there were less than ten infections a year—with many years boasting zero cases.

Meanwhile, Sabin had developed an oral immunization that was easier to take and distribute, but was feared by many because it was made with weakened—but live—viruses. Despite successful trials in Ohio, Sabin could not get the oral vaccine the support it needed to have it used nationwide. The Public Health Service was considering its use, but the Salk vaccine was spreading faster with the preferential support of the March of Dimes. The Sabin vaccine did become the standard outside the United States, though, saving millions of lives in the former Soviet Union, Japan, Mexico, Singapore, and parts of eastern Europe.

It’s an incredible triumph, but this might be the most astounding thing: Both of these doctors refused to patent their vaccines. They had both found effective solutions for preventing a devastating disease and stood to make millions of dollars by selling the rights. Neither would do so. Sabin never made a dollar off of his vaccine, living only on the salary he received as a professor. Salk even hated the publicity he received surrounding his achievement. When Salk was asked during an interview with Edward R. Murrow who owned the patent for the polio vaccine, Salk replied, “Well, to the people I would say. There is no patent. Could you patent the sun?”

Sydnee’s Fun Medical Facts

There are different ways for us to create immunizations. Some involve the use of live viruses that have been attenuated, or inactivated, so that they can no longer infect a person. Others are made with killed viruses or pieces of viruses that will also invoke an immune response in the person receiving them. Both can be safe and effective when made correctly.

IS THIS STILL A PROBLEM?

In places where either of the vaccines are in widespread use, polio has essentially been eradicated. The World Health Assembly has had an initiative to completely eliminate the disease since 1988, and they are still making progress. Unfortunately, there are still parts of the world where transmission exists. There is no treatment or cure, so vaccination is still essential as a preventative measure.

But of course, we don’t have to tell you how great vaccines are, right?

RIGHT?