Wednesday, January 12, 2011

The Polio Vaccine: Dead or Alive

Science Wednesday: Great Scientific Advances

Having children made us look differently at all these things that we take for granted, like taking your child to get a vaccine against measles or polio.
Melinda Gates, co-chair of Bill & Melinda Gates Foundation
 
When I was about 9, I had polio, and people were very frightened for their children, so you tended to be isolated. I was paralyzed for a while, so I watched television.
—Francis Ford Coppola, American film director

Edward R. Murrow: Who owns the patent on this vaccine?
Dr. Jonas Salk: Well, the people, I would say. There is no patent. Could you patent the sun?
See It Now, April 12, 1955



Nation's Gratitude: Shopkeeper expresses a nation's gratitude for Dr. Salk's discovery: April 13, 1955.
Photo Credit: March of Dimes Birth Defects Foundation.
Source: March of Dimes Birth Defects Foundation; in book: Smith, Jane S. (1990). Patenting the Sun: Polio and The Salk Vaccine. New York: William Morrow. ISBN 0688094945
Poliomyelitis, or simply the word polio would strike fear in the hearts of families before a vaccine was developed in the 1950s. Polio, a viral infection that can damage nerve cells in the spinal cord, lead in some cases to paralysis. About one person in a hundred infected with the polio virus becomes paralyzed. That was the chief fear when polio was pandemic during the first fifty years of the 20th century. The fear can be boiled down to this: your child would become paralyzed or die, a natural enough fear that is hard to overcome.

Until an effective polio vaccine was developed by Jonas Salk in 1952, polio was often a crippling disease that affected thousands of people each year. It didn't discriminate between rich and poor, young or old, urban or country. Well-known polio victims include Francis Ford Coppola, the American film director, Joni Mitchell, the Canadian singer-songwriter, and Arthur C. Clarke, the British science fiction writer.

Also included on most lists is United President President Franklin Delano Roosevelt, who contacted polio at age 39 while on vacation in Canada in 1921. Some recent scholarship, such as Dr. Goldman's article in The Journal of Medical Biography: Nov. 2003, suggest that President Roosevelt's symptons appear more like  Guillain-Barré syndrome. But this is not the accepted opinion. For now he is listed as among the more famous victims of polio.

Polio has been around for thousands of years. For those interested, here is the timeline on polio: its history as a crippling disease and its virtual eradication from the world. By 1910, much of the world experienced a dramatic increase in polio cases and frequent epidemics became regular events, primarily in cities during the summer months. These epidemics—which left thousands of children and adults paralyzed—provided the impetus for a "Great Race" towards the development of a vaccine.

Franlin D. Roosevelt: The United States President was also a victim of polio. Since he was never seen in public in a wheelchair, this is a rare photograph, one of only two known photographs of him in a wheelchair. It is at Hill Top Cottage in Hyde Park, N.Y. President Roosevelt's life changed on August  10, 1921, at age 39, when he was stricken with poliomyelitis while vacationing at his summer home in Campobello Island, New Brunswick.
Photo Credit: Margaret Suckley
Source: Franklin Delano Roosevelt Library, Library ID 73113:61 http://docs.fdrlibrary.marist.edu/images/photodb/fdr300.gif

With good reason. In 1937, for example, the Canadian province of Ontario reported more than 2,500 polio victims and 119 deaths, the majority children under ten, reports Dr. Christopher J. Rutty in a fascinating and comprehensive article, The Middle Class Plague in the Canadian Bulletin of Medical History, 1996:
The 1937 Ontario "infantile paralysis" epidemic recorded a total of 2,546 cases, at a case rate of 70 per 100,000, and claimed 119 lives. Of this total, 758 cases and 31 deaths were registered in the City of Toronto (population 648,309) at a case rate of 117.(26) Since the majority of cases occurred among children under 10 years of age, the age-specific incidence rate in this group in Toronto was 510. Just over half of the number of provincial cases exhibited paralytic symptoms, and by the following March, 839 remained paralyzed to varying degrees.The size, severity and dramatic intensity of this epidemic came as a major shock to Ontario. Such an epidemic situation has not been repeated in the province by polio or any other infectious disease.(27)
In the United States, between 1951 and 1954, "65,000 cases of paralytic polio were reported," notes the Canadian Coalition for Immunization Awareness & Promotion, an Ottawa-based health advocacy group. So there was good reason for the fear and the push for a vaccine to prevent this debilitating disease.

Two names are associated with the development of the polio vaccine:  1) Dr. Jonas Salk of the University of Pittsburgh, who developed the inactivated poliovirus vaccine, or  IPV, in 1952, essentially an injectable "dead" virus; and 2) Dr. Albert Sabin of the University of Cincinnati who developed the oral polio virus, or OPV, an oral "live" virus, in 1957. Both took years of clinical trials before being licensed for use to the general public.

Dr. Salk's vaccine was licensed on April 12, 1955, ten years after the death of  President Roosevelt. He was hailed as a national hero, a miracle worker. the news treated as a celebration: "And when the news was heard, the fire sirens blew again and the church bells rang again, and the people took to the streets again, this time to dance and sing and shout and clap their hands."

The Sabin vaccine would wait another five years, until March 1962, before being licensed in Canada and the United States. A majority of the trials were done outside North America, primarily because He had to go outside North America as to not interfere with the Salk vaccine program, which was well underway. By the time the Sabin oral vaccine gained approval in the U.S., for example, more than 90 million people in the Soviet Union had received the OPV. There is a fine article on the Salk-Sabin (dead vs live) debate in The Harvard Crimson: March 2, 1963.

Polio Vaccine: A child In Bangladesh receives the oral polio vaccine. Albert Sabin developed the "live" oral polio vaccine (OPV).The  Sabin oral vaccine is used now in most of the world, since it is cheaper and easier to administer than the Salk vaccine.
Source: Source: USAID Bangladesh
In his trials, Dr. Sabin worked and collaborated closely with Dr. Mikhail Petrovich Chumako of the Soviet Union to prove the oral vaccine's efficacy, chiefly because he thought that he could better Dr. Salk's vaccine. It is a rare joint effort during the height of the Cold War, proving that the fear of polio was greater than any political differences. Dr Sabin was honored with a medal from the Soviet government during the height of the Cold War.

Such is the true spirit of science that benefits humanity. Between 1955 and 1960, the oral vaccine was tested on at least 100 million people in the USSR, parts of Eastern Europe, Singapore, Mexico and the Netherlands.
{Sabin] wanted to mimic the real-life infection as much as possible; that meant using a weakened form of the live virus. He experimented with more than 9,000 monkeys and 100 chimpanzees before isolating a rare form of poliovirus that would reproduce in the intestinal tract but not in the central nervous system. In 1957 he was ready for human trials of an vaccine people could swallow, not get in a shot. It was tested in other countries, including the Soviet Union and Eastern Europe.

In 1958 other researchers tested a strain in the U.S. and they tried to cast doubts on Sabin's "communist vaccine." In spite of this, his vaccine was licensed in 1962 and quickly became the vaccine of choice. It was cheaper to make and easier to take than Salk's injectable vaccine.
Following the overwhelming success in the USSR, the United States held clinical trials on the Sabin vaccine in April 1960 on 180,000 Cincinnati school children. It was highly successful, effectively eradicating polio in Cincinnati.

No doubt, both scientists have made a contributions that are noteworthy and beneficial to humanity, as are the many other lesser known names, such as Mikhail Petrovich Chumako, Hilary Koprowski and H.R. Cox,who worked assiduously and with the utmost dedication to such a noble cause—the eradication of polio. Both polio vaccines, Salk and Sabin, changed the lives of many, bringing the fear of polio to the Western Hemisphere and in the majority of the world.

Neither Drs. Jonas Salk nor Albert Sabin patented their vaccines; they donated the rights as gifts to humanity. The effects of the vaccine have been both heartening and  dramatic:
A global effort to eradicate polio began in 1988, led by the World Health Organization, UNICEF, and The Rotary Foundation.[71] These efforts have reduced the number of annual diagnosed cases by 99%; from an estimated 350,000 cases in 1988 to a low of 483 cases in 2001, after which it has remained at a level of about 1,000 cases per year (1,606 in 2009).[72][73][74] Polio is one of only two diseases currently the subject of a global eradication program, the other being Guinea worm disease
Polio is no longer the disease that strikes fear in the hearts of men, thanks in great part to scientists like Dr. Jonas Salk, who once said: " have had dreams, and I have had nightmares. I overcame the nightmares because of my dreams."


2 comments:

  1. Science works. I remember when I was a child and the world was terrified of polio. The world has made progress in the fight against other diseases as well, although we still face many medical problems that have not been solved.
    Reason, questioning, testing, examining evidence, and opennes to new information are all characteristics of the scientific method. And as I always say, democracy is the political realization of the scientific method.
    http://www.jochnowitz.net/Essays/Blessed.html

    ReplyDelete
  2. Thank you, Prof Jochnowitz, for your comments. I plan to write a brief essay on Modern Science and the Scientific Method for next week's edition of Science Wednesday. Its contribution to our mode of thought, to our reasoning, and to our development as a democracy, as you have cited, is undeniable.

    ReplyDelete

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