SYMHC Classics: Polio, The Dread Disease

This 2011 episode from prior hosts Sarah and Deblina covers polio, a threat in the early 20th century that often left victims paralyzed or dead. Vaccines caused an immediate drop in polio cases and today have nearly eradicated the disease. 

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Episode Transcript

Speaker 1 (00:02):
Happy Saturday. Polio has been in the news a lot
over the past several weeks after a report in July
of an unvaccinated person in Rockland County, New York, contracting polio.
After that, polio is detected in wastewater in New York
City and also three counties north of New York. Polio
had been eradicated in the US, and there has been

(00:25):
similar reporting in other places where it was previously eradicated
over this summer as well. So we are bringing out
our episode on polio and the development of the vaccines
that came close to eradicating it, and a lot of
points in this episode land very differently two plus years
into the COVID nineteen pandemic, Like shuttering businesses and quarantining

(00:47):
people is something a lot of us have lived through
in recent memory, not something we would associate with the renaissance. Yeah,
we we do not need anybody to call previous host
Sarah and Dablina sweet Summer children. Honestly, most of us
were so uh. This episode was by previous host Sarah
and Deblina. Originally came out on November one, eleven. Welcome

(01:14):
to Stuff You Missed in History Class A production of
I Heart Radio. Hello and welcome to the podcast. I'm
Sarah Dowdy and I'm Deblina Chalk Reboarding and Debilina. This year,
during Halloween, I put on a really fun, campy movie.
I know you like campy movies. This was a Boris

(01:37):
Karloff movie, but it wasn't one of his more famous
repertory and it like Frankenstein or The Mummy or something.
It was called The Ape and it was Yeah, it
was pretty wild movie. I'm not gonna lie. It was
about a mad scientist in a small town, but not
your typical mad scientists who's, you know, like rolling his

(01:59):
fingers and looking evil. He was a kindly sort of fellow.
He had a heart and he was trying to cure
something called paralysis. In the movie, my Netflix Q told
me though it was polio and I gotta love Netflix.
I gotta love Netflix, very informative um. But the doctor
Boris Karloff was trying to cure this paralysis and he

(02:20):
was going to do so by obtaining a serum, and
of course, because it's a campy horror movie, it goes
to the point where he dawns an ape suit and
goes about murdering people trying to obtain their spinal fluid.
But I also noticed though that the movie came out
in nineteen forty and as silly as it was, I mean,
it was enjoyable, I recommend it. But as silly as

(02:41):
it was, it was playing off of a very real
fear at the time. And that was of course the
paralysis in the movie Polio as we know it, because
since polio first started striking in epidemic proportions in the
late nineteenth century, it had only grown worse and wor
u and worst, people didn't know how to stop it,

(03:02):
they didn't know how it spread, and worst of all,
it was something that usually struck kids in the severest form,
killing them or paralyzing them for life of an extremely
disturbing disease. Yeah. In the United States, for instance, polio
epidemics would sweep across the country each summer, striking rural
and urban areas, poor and wealthy neighborhoods. Teens and adults

(03:24):
could get it to um and it was usually actually
worse for them to stop the spread. Modern cities would
revert to Renaissance like plague practices, no travel, no trade,
and they would sometimes put quarantines on the homes. The
Smithsonian Museum of American History has a New York Times
clipping from nineteen sixteen about a man who was unable
to find a physician for his sick child, and so

(03:47):
he drove around and around until the boy died, and
even then he couldn't find anyone to take the body. Yeah,
and it wasn't just the fear of catching polio. The
after effects of the epidemic were also extremely haunting. Kids
and wheelchairs and leg braces, patients in the dreaded iron
lung We're going to talk about that a little more later.

(04:07):
And in the early stages of the disease, the patient
would often be separated from his or her family for
about two weeks, followed by very limited contact, you know,
just an hour or so every now and then. And
these extended periods of separation made adjusting to life after
polio with all its consequences, a lot harder. But today

(04:28):
people if people have any understanding of polio, it usually
relates to FDR President Franklin Delano Roosevelt, who contracted the
disease as an adult in ninety one. Unless you're living
in one of the four countries where wild polio virus
is still present. The fear just isn't there anymore. You
couldn't put out a movie anymore about this um paralysis.

(04:52):
It needs to be some other sort of scary, contagious
virus because there's no longer any reason for somebody to
contract polio. So we're going to talk about the two
very different vaccines that have almost eliminated polio, the men
who created them, and the mass inoculations of the nineteen
fifties and the sixties that took place. But first we're

(05:13):
going to talk a little bit about what polio actually is.
It's paralytic poliomyelitis and is sometimes called infantile paralysis, and
it's caused by a virus, the poliovirus, which was discovered
in nineteen o eight by Karl's Landsteiner and Irwin Popper.
And today we know that the virus takes a fecal
oral route, meaning that contaminated fecal matter gets into the

(05:35):
mouth through the hands, or through food, or even through
droplets from an infected person's cough or sneeze, and once
the virus is in the mouth, it starts multiplying in
the gastro intestinal track and lymph nodes. From there it
spreads to the bloodstream. But here's the thing, that's where
it stops. For most people, which I didn't know before about.

(05:56):
People who contract polio don't experience severe symptoms. They might
feel like they have the flu, or maybe not notice
anything at all. These people become resistant to whichever strain
of polio they've contracted exactly. But if the poliovirus keeps going,
it attacks the central nervous system, destroying the motor cells
of the spinal cord and brainstem. And this usually ends

(06:19):
up affecting the limb muscles, so thus pollios association with
paralyzed legs. But it can also hit the facial muscles,
or the back and abdominal muscles, causing twisted spines. And
in the worst cases, it strikes muscles in the respiratory area,
which in the early days usually meant a death sentence.

(06:40):
The development of the iron lung in the nineteen twenties
helped keep these people alive. Interestingly, if you could get
through the the acute phase the first couple of weeks
um in an iron lung, your muscles could usually develop
enough strength or tone to start being able to breathe
on your own again, But it took a while to

(07:00):
get to that point. Even though the poliovirus wasn't discovered
until nineteen o eight, it's believed to have existed long
before that. The mummy of a nineteenth dynasty pharaoh, for example,
who lived between thirteen forty two and eleven ninety seven
b C. Even shows deformities that are characteristic of polio.
But still, polio must not have been widespread for many,

(07:22):
many centuries. It didn't begin appearing in medical texts until
the seventeen hundreds, and it wasn't until eighteen sixty eight
that the first epidemic occurred in Oslo. And I think
that's so interesting that there's this long dormant period essentially, Oh,
I mean not dormant. People are still getting polio, so
we believe, but not anywhere like the kind of polio

(07:43):
they were getting in the twentieth century. The first US
epidemic didn't happen until eighteen ninety four in Vermont, and
by that point doctors around the world were starting to
piece together the fact that you could get polio and

(08:06):
not have any symptoms or be resistant and not know
that you had ever had polio, um you know better
understanding the virus and the disease. But by the nineteen teens,
epidemics were Polio epidemics were becoming a regular summer occurrence.
New York City's first epidemic, for instance, happened in nineteen sixteen.

(08:27):
It affected nine thousand people and killed two thousand forty three.
So the race to find a cure for this or
create a vaccine to prevent it was definitely on. But
before we go on to discuss the attempts to create
a vaccine for polio, I think it will help to
know exactly what a vaccine is, I mean, just in

(08:49):
case anybody doesn't, and then better understand how people understood
vaccines in the twenty century, what they were going into
it with. Okay, So first, here's a scenario for you.
You had Type one polio before and you didn't get sick.
It would mean that your body had successfully produced antibodies
to fight it off. When you encounter the virus a

(09:10):
second time, your body would know what to do with that. Again.
A vaccine, of course, essentially attempts to mimic this response,
tricking the immune system into producing antibodies to fight off
a virus that's not actually the full strength real deal.
It's something similar but not as dangerous, or it's weakened,
or it's in a very small quantities, but it's enough

(09:31):
to teach your body what to do so that it's
ready when the real thing comes along, exactly. So humans
have been likely attempting self vaccination for thousands of years,
but immunization, as we understand it, really kicked off in
with Edward Jenner and he inoculated a young English boy
against smallpox using cow pox, which was not as scary,

(09:53):
not as deadly as smallpox, but still produced a similar
response with antibody. So the next big leap happened in
eighty five when Louis Pasteur used a syringe to vaccinate
a boy who had been bitten by a mad dog
against rabies. The boy would have definitely gotten sick, you
would have died from rabies um and the syringe proved

(10:17):
to be a way more reliable delivery method than the
earlier technique of using things like lances and pus from
pox and you know, kind of kind of gross but
also kind of unreliable methods. Uh. From their large scale
immunization started by World War One with dip theoria, and
it really became something that people were used to, at

(10:39):
least with a few specific diseases. But even though medical
researchers knew that a vaccine was also feasible for polio,
there were some advancements to be made, namely a better
understanding of the virus and how to grow it in
large enough quantities for a vaccine. In one Australian researchers
realized that polio came in different types, and that just

(11:00):
because you had resistance to one, it didn't mean that
you couldn't catch another. So this meant that any vaccine
would need to cover all types. That was why that
example you Deblina you gave earlier specifically was like if
you got polio type one, because if you had type
two and you encountered type one, then you wouldn't necessarily
have a resistance. Another big advancement happened in nineteen forty

(11:23):
one when dr Albert Sabin and Robert Ward showed that
poliovirus wasn't just a disease of the nervous system, even
though that was what people understood it as since that's
what it attacked, they realized that it entered through the
mouth and it first affected the digestive system, So that
suggested that a vaccine could possibly stop the virus while

(11:45):
it was still in the bloodstream, before it even got
to the nervous system and started causing so much damage.
Then in ninety nine, researchers at Johns Hopkins confirmed that
the one suggestion that polio came in different types was true.
There are three main varieties one, two, and three, and
again any vaccine had to work on all of them

(12:07):
to really work. And in nineteen forty nine Dr John Enders,
Thomas Weller, and Frederick Robin showed that the virus could
grow on other types of tissue than nervous tissue, like
embryonic skin or muscle tissue. So before this, cultivating the
virus meant that you had to use live monkeys to
grow it, which is something that was expensive and not

(12:28):
available to a small lab having huge amounts monkeys growing
polio virus. So these three guys ended up winning the
Nobel Prize in nineteen fifty four for their work, and
that finding was really crucial in developing a vaccine because
you've got to make large amounts of a vaccine if
it's going to do anything. So in the worst decades

(12:49):
of polio paranoia and fear, there were obviously these big
jumps in our understanding of the virus, but there were
also some setbacks. In nineteen Dr Maurice Brody and Dr
John Colemer each conducted separate human trials for their own
versions of a polio vaccine. The results were completely disastrous.

(13:10):
A lot of kids contracted polio, a few people died.
But by World War Two there were again some new
advancements and how vaccines were made, the introduction of um
commercially made vaccines for soldiers, manufacturing guidelines, definitely more stringent
rules about clinical testing. So it was setting the stage

(13:32):
again for this big revolution we're going to talk about
that happened in the nineteen fifties. Finding polio also became
an almost warlike matter for Fdr. In He said, quote
the dread disease that we battle at home, like the
enemy we oppose abroad, shows no concern, no pity for
the young. It strikes with its most frequent and devastating

(13:53):
force against children. And that is why much of the
future strength of America depends upon the success that we
achieve in combating this disease, But how are they going
to combat it with polio? There were two main ways
to go. They could use an inactive or killed virus
as the basis for the vaccine, or they could use
an attenuated or weakened virus as the basis for the vaccine.

(14:16):
So ironically, both of these ended up working well. But
there's one that got more of a glory, all right.
So enter Dr Jonas Edwards Salk, who was born October
nineteen fourteen in New York City to Russian and Jewish immigrants.
He was the first in his family to go to college,
and he earned his m d. From New York University

(14:36):
College of Medicine. But while he was studying there, Salk
worked under a microbiologist named Thomas Francis Jr. Who was
attempting to create a flu vaccine, which was later used
successfully in World War Two. So Salk got this early
exposure to making vaccines and trying to think about things

(14:57):
like that, and in nineteen the University of Pittsburgh recruited
him to work specifically on viruses and ultimately on the poliovirus,
and by nineteen fifty two his research had paid off.
He was ready to start testing a killed virus vaccine,
so a virus that had been killed with formalde hide,

(15:19):
but um it left enough of the structure intact to
trigger a response like it would live polio. So first
he tested it on kids who had already had polio
and recovered, and they showed boosted antibodies. Then he tested
it on institutionalized kids who were disabled or mentally handicapped,

(15:39):
as well as on himself, his wife, and his own kids.
And I mean that's a good point to note that
all of this polio research, um, it can come across
this kind of unethical today because of tests on institutionalized
kids and tests on prisoners, tests on your own family,
on on yourself, and also animal testing too. I think

(16:00):
more than one hundred thousand monkeys were killed during the
whole process of making these viruses or making the vaccinations rather.
So UM, just you know, something to throw out there.
And another random note, um testing it on his wife
and kids. It wasn't this wife, but Sulk's second wife
was Picasso's widow mistress sort of friend, sUAS Guillo, who

(16:24):
is the mother of Paloma. A little bit of an
unexpected connection there. I just I thought I had to
mention it since I sit next to a photo of
Picasso here in the studio. Actually yeah, I mean well,
there's another connection, Deblina sitting next to Tesla. I know
all of you on a podcast someday. I was about
to say, I think people might like my better. But

(16:45):
so no one got sick from these trials, and since
nineteen fifty two had also been polio's peak year in
the United States, with fifty seven thousand, six hundred twenty
eight cases, it was big news in nineteen fifty three
when Salk published his findings in the Journal of the
American Metal Coal Association. So by nineteen fifty four, Salk
had large amounts of an injectable vaccine and was ready

(17:06):
for large trials. The pilot program included fifteen thousand kids
in Pittsburgh, but the main field trial was massive one
point eight million kids in the US, Canada, and Finland
in grades one through three at two hundred and fifteen
test sites. The whole thing is directed by Dr Francis
Salk's mentor, and it featured a double blind process, which

(17:27):
meant that six hundred and fifty thousand people received the
vaccine seven hundred fifty thousand received a placebo and four
hundred thirty thousand received neither. And it took three hundred
thousand volunteers just to get out there and administer all
of these vaccines, and the record taking Francis ran a
tight ship. The record keeping was really immaculate, all sorts

(17:49):
of follow ups on these people. But by April nineteen
fifty five it was official. Francis declared Salk's vaccine to
be quote safe, effective, and potent in It became available
commercially just a few years later, and cases in the
US of polio dropped immediately, I mean eighty five to
nine percent. There was one big step back though, in

(18:12):
nineteen fifty five, a major scare when two hundred kids
were affected by the vaccine. It ended up being traced
back to one specific manufacturer. There was a not quite
dead virus included in the vaccine, but ultimately, once it
was determined it was from one specific place, people did

(18:32):
go back to Salk's inactivated polio virus vaccine, the i
p V, and the last US case of polio occurred
in nineteen seventy nine in an unvaccinated Amish population, and
Salk essentially became one of the most famous medical heroes
of the twentieth century. I read something interesting. His fame

(18:55):
almost alienated him from the medical community, just because he
was so celebrated, and because other researchers felt like they
didn't get any credit for things that they had contributed.
So interestingly, Salt continued his research, I think on HIV

(19:19):
kind of stuff, you know, continuing that viral research. But
we do have a second vaccine to talk about. We
said that there were two, and we said that one
sort of got all the glory. But what about the
vaccine made not from the killed virus but from the
weekend virus. Well, if you grew up in the US
and you were vaccinated before two thousand, you didn't get

(19:42):
Salk's IPv. Instead, you got Albert Saban's oral poliovirus vaccine
op V for short. And if you live outside of
the US or outside of Europe, you almost certainly got
the o p V. So why are there two and
what are the benefits and the dangers of each kind? Well?
Saban was a polished you who had immigrated to America
as a child, and he had, as we mentioned, discovered

(20:04):
in ninety one that the poliovirus was not just a
disease of the nervous system but one of the intestinal track.
So Saban had a problem with Salts idea for a
vaccine um even though while if prepared correctly, Salts vaccine
using the killed virus would definitely not give you polio
because it had a dead virus in it, it also

(20:26):
might not confer a lifetime of immunity. It wouldn't be
as strong. So Saban wanted to create something that was stronger,
stronger vaccine using live poliovirus, although of course that means
certain risks. So instead of just killing the virus and
creating a vaccine from there, he experimented on nine thousand

(20:47):
monkeys and one hundred gems. We did mention there were
a lot of primates involved here. Before he found a
strain of the virus that would reproduce in the intestinal
tract but not in the central nervous system, making that
Night and forty one discovery pretty important. So this meant
that he could use a live, weaker strain of the
virus and from that create a longer lasting vaccine. And

(21:10):
there's kind of a strange perk about the Saban vaccine,
and that when people who get it, go to the bathroom.
Their feces contains a weak inversion of the virus which
helps boost the immunity of the population as a whole,
which made it pretty desirable in certain areas. We'll talk
about that a little bit more. Though. Saban had a

(21:33):
problem though once he had finally perfected his O p
V version of the polio vaccine, yes, he was ready
to go forward with large scale tests right around the
time that Sulks vaccine was being celebrated as a medical miracle.
So he couldn't find enough people state side who were
willing to participate, because why I take a risk participating

(21:54):
in a trial if there's already a good cure out there, right,
So it's a prevention exactly. So Saban went to the
Belgian Congo and in the middle of the Cold War,
to the Soviet Union, and the government gave him a
medal for this. I mean, that's how badly they wanted
to handle polio, how bad polio was around the world,
that they would let this American guy, a a Polish

(22:19):
jew immigrant come into the Soviet Union and do this
wide scale medical task. But by the early sixties, Saban's
vaccine had caught on in the United States too. It
was cheaper, it was easier to produce UM. One big
perk is that it didn't require a shot because it
was an oral vaccine, so that makes it easier to

(22:41):
administer too. And it became completely vital for world eradication efforts,
which really took off in the nineteen seventies. And today
polio is endemic only in Nigeria, India, Afghanistan, and Pakistan.
Of the three types of viruses, polio virus two is
probably eradicated. The last case to the last known case

(23:03):
was in India, and polio virus three is probably also
close to eradication. Yeah, And in two thousand, the US
switched back to IPv after it was determined that you
were it wasn't worth the risk anymore having that live
virus in o p V because your risk of contracting

(23:25):
polio in North America wild polio was just pretty much nothing. UM.
You were only likely to to maybe pick it up
if you went to one of those countries where it
was still endemics. So the US switch back to IPv,
but there's still a big hurdle in eliminating polio in
some of those remaining countries, and that's fear and suspicion,

(23:46):
just not knowing exactly what U what people are coming
in to do when they're administering these O pv s. Yes.
For example, in two thousand three, the World Health Organization
launched a huge campaign to vaccinate fifteen million and kids
in Nigeria, but leaders they're spread word that vaccines had
been mixed with anti fertility drugs and the HIV virus.

(24:08):
So the World Health Organization has started from the bottom
up instead meeting with local leaders and winning their approval
first before going in and doing this in order to
to try to knock it out in Nigeria. One sort
of final note on the story and the men involved,
Salk and Saban both chose not to patent their vaccines.

(24:28):
I mean, they could have probably made huge amounts of
money off of this, but they considered the vaccine their
gift to humanity. Um. I was really I enjoyed researching
this and learning a little bit more about polio. I
hadn't known much about Saban at all, which is surprising
now that that I realized what a huge contribution he

(24:50):
had to to eradicating polio in most of the world. Yeah,
I thought it was pretty interesting too, And I think, um,
even in this day and age, it's important for people
to kind of understand what they're dealing with when they're
dealing with different vaccines because there's so much misinformation out
there and debate about vaccines today. UM, I think it
just helps. The more you know, the better. Thanks so

(25:14):
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(25:35):
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(25:58):
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