September 14, 2023 • 27 mins
Why has polio been so challenging to eradicate? Karen Torghele tells the story of two polio vaccines and the two rival scientists who developed them: Albert Sabin and Jonas Salk. Then, Dr. Ananda S Bandyopadhyay explains our best bet for eliminating the disease worldwide.
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Speaker 1 (00:02):
In the first decades of the twentieth century, parents in
the United States lived in terror of polio. CDC is
trying to solve the riddle of poliomyolsis, which kills or
paralyzes thousands of people every year. Doctors didn't know how
the disease spread or how to treat it. What they
(00:22):
did know is that it mainly struck children, and that
it left many of its victims paralyzed, often for life.
As the century progressed, the disease kept becoming more common.
In nineteen fifty two alone, polio paralyzed three thousand children
in the US. One pole of American parents found that
polio was their second greatest fear, right behind atomic apocalypse.
(00:46):
The science of understanding viruses and developing vaccines had come
a long way since the era of Edward Jenner that
we talked about last week. Still, by the middle of
the twentieth century, there was no vaccine to prevent polio,
but scientists were about to develop not one polio vaccine,
but two, and to this day we use these two
very different kinds of vaccines to immunize people around the
(01:09):
world against polio. On today's show, we'll tell the story
of the cutthroat scientific rivalry that resulted in one of
the greatest triumphs in American medicine, maybe two of the
greatest triumphs. I'm Jacob Goldstein. This is incubation. So both
(01:33):
of these vaccines protect people from polio, but they work
in profoundly different ways. This is also true of the
scientists who developed the vaccines, Jonah Salk and Albert Saban.
Speaker 2 (01:44):
Salk was everyone's idea of a hero. He was like Superman.
He was good looking, he was soft spoken, polite, He's
like the kind of guy you'd want your daughter to marry.
And Saban was this abusive, loud mouth, obnoxious person who
(02:07):
managed to offend even his best friends.
Speaker 1 (02:11):
This is Karen Torgaily. She's an epidemiologist and she's writing
a biography of Albert Saban. I asked her to tell
me more about Saban, this scientist who managed to offend
even his best friends.
Speaker 2 (02:21):
By all accounts, he had an explosive temper, He was
a perfectionist. He had little patience for people who weren't
as smart as him, which.
Speaker 1 (02:33):
Was basically everybody, right. He was very, very very smart, so.
Speaker 2 (02:36):
Pretty much everybody.
Speaker 1 (02:38):
Yeah, so that's Saban tell me about Jonah Sulk.
Speaker 2 (02:43):
They had some things in common, both from Jewish families.
He went to medical school at New York University, just
like Saban did, because it was one of the few
places that would take Jews in those days. Their paths crossed,
probably for the first time woods Whole in Massachusetts.
Speaker 1 (03:02):
Woods Hall the Marine Biology Institute.
Speaker 2 (03:06):
Yes, so they got to know each other and they
were friendly. Salk was kind of like the little brother
scientists to Saban, who was by then getting well known.
Speaker 1 (03:17):
Okay, and Salk at the time was maybe still in
medical school. Yes, yeah, how does he get from medical
school to working on polio?
Speaker 2 (03:25):
So Salk moved to ann Arbor, Michigan and worked on
a vaccine for flu. And the critical part of this
is that the flu vaccine was made from a killed virus,
not a live virus.
Speaker 1 (03:42):
Karen told me that working on this killed virus flu
vaccine was a key moment for Salk and really a
key moment in the history of vaccines because up until
this point, there was basically one way to make a
viral vaccine, use a virus that's still alive, but that's
attenuated or weak. But the flu vaccine that Salt helped
to create was different. It was made using a killed virus,
(04:06):
a virus that had been completely inactivated. So now there
were two potential strategies for developing a polio vaccine, attenuated
or killed, and there were real trade offs between the two.
An attenuated virus will multiply inside the body. This induces
a stronger, more robust immune response, which is good, but
(04:29):
if you're giving people this kind of vaccine, you better
be really sure that their immune system is strong enough
to handle it. Otherwise the vaccine might accidentally give people
the very disease that you're trying to prevent. So that's attenuated,
and then you have a vaccine made from killed virus,
which often requires boosters for long term immunity. And if
(04:49):
you're manufacturing a killed virus vaccine, you have to be
really sure that all those virus particles are actually dead,
that they're totally inactivated. So there are these two options
for the polio vaccine, and it really wasn't clear which
one would work better. For Salk and Saban. It was
a key fork in the road and they chose different paths.
(05:10):
Salk went to work on a killed virus vaccine. Saban
chose attenuated. What is Saban's path to choosing an attenuated
a weakened vaccine rather than a killed virus vaccine.
Speaker 2 (05:23):
His inspiration was Max Steiler, who was given the Nobel
Prize for developing yellow fever vaccine, and that was an
attenuated vaccine. He was convinced that the live attenuated virus
made sense for polio as well.
Speaker 1 (05:42):
So Salk sets out to build this killed virus vaccine
for polio. What are sort of the key moments in
that quest.
Speaker 2 (05:52):
There was this sort of elite group of virologists who
had their own sort of old boys club, and Sulk
was not really in it because he was younger and
they didn't see him as being up their caliber. They decided, though,
since he was interested in it, that they would put
him to work. One thing that he could do is
(06:15):
a project for typing the different kinds of polio and
figuring out which ones were the virulent ones to humans,
because that had not been done. He had been sort
of looking at the different strains and types and thinking, now,
if I was going to make a vaccine out of this,
which of these would I use? So he sort of
(06:37):
had half the work done by the time he was
finished typing these Oh.
Speaker 1 (06:41):
Interesting, So it seemed like the grunt work, but it
was actually like meaningful progress toward the vaccine, right.
Speaker 3 (06:49):
Yeah.
Speaker 2 (06:50):
So he really surprised everyone when he told them in
nineteen fifty three that he had a vaccine for polio
and he was ready to test it, and they had
to have this field trial. There were two million children involved,
(07:13):
and of the two million, they had a sample of
people who got the vaccine and people who thought they
were getting the vaccine but really didn't, so they were
a control group. There was an observed group too that
got nothing. Only about half a million actually got the vaccine.
Speaker 1 (07:33):
So they do this giant study and what happens.
Speaker 2 (07:37):
They got the results and they kept a very secret.
April twelfth, nineteen fifty five, came the day when they
were going to make the announcement, so people were invited
to come to ann Arbor on all people wanted to
know does it work? Is it safe? Says basically, yes
it's safe, and yes it's effective. And then and the
(08:00):
reporters all ran to their phones and they reported, and
the church bills rang. You know, there were big, huge
headlines in the newspapers. It was just like the end
of World War two. It was that happy of an occasion. Wow.
Speaker 1 (08:18):
And so Saban he doesn't have a vaccine yet, he's
in fact in the room when when this Sauk announcement
is made. How was he feeling at this point?
Speaker 2 (08:29):
He was pretty sad. His main worry was that his
funding would be cut off.
Speaker 1 (08:35):
So let's talk about where Saban is in his research.
At this point, he was.
Speaker 2 (08:41):
Within a year of having the vaccine that was made
from a weekend attenuated stream, and he had tried it
on his own daughters.
Speaker 1 (08:51):
He tried it on his own daughters.
Speaker 2 (08:53):
On his own daughters.
Speaker 1 (08:54):
Well, it's interesting to think about, right, because you can
think of him giving it to his daughters as like, oh,
prep scientist experimenting on his children. But you can also
think of it as no, he believes this thing works,
and there is this terrifying disease that could paralyze or
kill his children, and he has what he has good
reason to believe is like an elixir that will protect them.
Speaker 2 (09:15):
Yeah, of course he's going to give it to them. Yeah,
remember they had to Also, you don't just get the
vaccine and that's it. You have to be followed. Then
you have to have blood tests, you have to have
your stools analyzed to see if you're passing any virus
or your stools. So they had to take these little
cardboard boxes to school and if they had a bowel
(09:36):
movement at school, then they had to give it to
their teacher. So they said it was pretty embarrassing.
Speaker 1 (09:43):
Anytime my kids tell me that I'm going to embarrass them,
I'm going to tell.
Speaker 2 (09:46):
Them that story.
Speaker 1 (09:48):
On the other hand, I'm not coming up with a
vaccine for polio, So it's a trade off. So to
go back to before in the sort of first part
of the fifties, where Sulk and Saban aware that they
were racing with each other, did they feel like they
were racing with each other?
Speaker 2 (10:04):
Sulk was still the little brother scientist too. They thought, oh,
you know, he's nice, he's making progress, but you know,
he's not us. He also started to get sort of
what they thought of as being uppity in a way
that he wouldn't listen to anyone like.
Speaker 1 (10:20):
The know it all kid.
Speaker 2 (10:22):
Yeah, So for instance, Saban told him, you know, I
see that you plan to use the mahoney strain in
your vaccine. That is too dangerous to use in a vaccine.
If any one of those got through and wasn't killed,
it would kill whoever got it. And he said, oh, Albert,
(10:42):
I have already made my decision. I've done it on
my own experiments, and I'm going to stick with it.
So actually what happened was there was an accident and
children died from getting the Salk vaccine that was improperly
killed at one of the labs. That started this contention
(11:04):
between the two of them. They had been colleagues, they
had been friendly with each other, but then it got
into sort of open warfare.
Speaker 1 (11:14):
So they're having this basically a race, Salk and Saban.
They're developing their vaccines in parallel. Salk wins piece, you know,
like truly a national hero in the US. There's a
massive vaccination campaign, and then not long after that, Saban
essentially finishes developing his own vaccine, this very different vaccine,
(11:35):
and he winds up taking it to the Soviet Union.
Speaker 2 (11:37):
Right, the Soviet Union started to have these terrible polio
epidemics and they didn't have a vaccine, and they knew
the United States did. Saban was going over and he
would carry bials of this polio vaccine seed viruses in
his pockets in these boxes just you know, it is jacket.
(12:01):
He would show them how to make the vaccine, and
so they got very good at producing the vaccine, and
they actually immunized seventy seven million people. It stopped their
polio epidemics. It just stopped them cold.
Speaker 1 (12:15):
Uh huh. I know, the Salck vaccine is a dead
virus and the Saban vaccine is a live, attenuated virus.
But beyond that, what are the basic differences between them?
Speaker 2 (12:24):
Well, so the Salt vaccine was more expensive and it
was harder to make and store. The Saban vaccine was
easier because you could take it orally and you didn't
have to have a trained person to give it. And
so they just were able to train people to put
a couple of drops of the vaccine virus on cube
(12:46):
of sugar. And there's a great little story that goes
with that. This little boy he came home from school
one day and his dad was a songwriter for Disney,
and so he said, oh, son, what'd you do today?
And he said, I got my polio vaccine. He said, oh,
that must have hurt. I said, no, you just get
(13:06):
these little drops and on a sugar cube and that
was it, and so that's how his dad got the
idea for Mary Poppins. Spoonful of sugar helps the medicine
go down.
Speaker 1 (13:21):
So now we have these two effective vaccines in the world. Right,
the Sabin vaccine does get approved in the US not
long after the Soviet trial. We have the Salk vaccine
and the Sabin vaccine. How does that play out in
the world.
Speaker 2 (13:35):
So in the United States they stopped using the Salk vaccine.
Uh why because the Sabin vaccine was cheaper and there
was no need to give the Salk vaccine because you
could take the Sabin vaccine once and for most people
that last your lifetime. But with Salk you had to
(13:56):
take the three initial doses and then a booster. It
just made sense to switch to the to the Saban vaccine,
and most countries did that.
Speaker 1 (14:05):
We know that with the Salt vaccine there was that
manufacturing risk where in one instance it was manufactured wrong
and they made a deadly dose of vaccine. What are
the risks of the Saban vaccine.
Speaker 2 (14:19):
The Saban vaccine has something called vaccine associated paralytic polio,
and it is when someone gets the vaccine who may
have an immune disorder, and so even a very weakened
poliovirus can cause polio like one in every three million
(14:40):
doses or something.
Speaker 1 (14:42):
So in the eradication effort that has been going on
for the past few decades, which vaccine were they using?
Speaker 2 (14:50):
Mostly these Saban vaccine.
Speaker 1 (14:53):
Wow, So in a way, Salt was like the hair
and Saban was like the tortoise. Like in the end,
even though it seemed like Salk one Saban one.
Speaker 2 (15:02):
Yeah. Well, and actually the truth is it really takes
both vaccines because in our country now, what the recommendation
is by the vaccine committees is that you get the
Salk vaccine.
Speaker 1 (15:16):
Did they ever make up with each other?
Speaker 2 (15:21):
No, they didn't, and that It's interesting because one of
Sabin's friends said to him one day, Albert, you have
got to make up with Jonas. This is ridiculous. You
are two grown men, and you just have got to
make up. So he made him call Jonah Salk and
they had this long, pleasant sounding conversation and at the
(15:46):
end of it he said, Okay, well, it's been nice
talking to you, and he hung up the phone and
he said that Son of a Bitch.
Speaker 1 (15:59):
Karen's fourth book is Albert Sabin a fierce joy. It'll
be out in twenty twenty four. We'll be right back
because of Sock and Saban's polio vaccines. Transmission of polio
in the US ended in nineteen seventy nine, but the
(16:19):
disease kept spreading in many other parts of the world.
Ananda Bandio Patia is a deputy director for Polio at
the Bill and Milindigates Foundation. He told me he first
saw the impacts of polio when he was growing up
in India in the nineteen eighties.
Speaker 3 (16:33):
I grew up in Kolkata, a city in the eastern
part of India, and I would see polio paralyzed kids
in my own community used to play a lot of cricket,
as you can imagine, and in our neighborhood there would
be these sad instances of kids affected with polio and
(16:54):
then all on a sudden, they would stop coming to
the playing field. So it was very real.
Speaker 1 (17:00):
In nineteen eighty eight, organizations like the CDC and the
WHO came together and decided to do with polio what
the world had done with smallpox, to wipe it from
the face of the earth. At the time, it was
estimated that every single day polio paralyzed a thousand children.
Speaker 3 (17:19):
India led the way to really establish the proof of
concept that polio can be stopped forever, including in complex geographies.
And look at India. Now, it's not only the fact
that India stopped polio in twenty eleven, it maintained polio
(17:41):
free status for all these twelve years or so in between.
So that's really a strong message for global health principles
of eradication.
Speaker 1 (17:53):
Eradicating polio in India took a lot of work and
Ananda was part of it. In two thousand and six,
Ananda was sent by the WA to a remote part
of India, the Kosi River basin in the state of Bihar.
Speaker 3 (18:05):
What was going on was this persistence of transmission, which
essentially means we were seeing paralyzed children getting reported from
these difficult areas of Bihar in the Kosi Basin. Despite that,
attempts to vaccinate villages.
Speaker 1 (18:25):
In the Kosi River basin were really hard to reach.
Roads were fewer, non existent, floods were frequent, and frontline
workers like Ananda had to return again and again to
make sure that every last child was vaccinated.
Speaker 3 (18:37):
To go there, Jacob, just to take you through that journey.
I would initially take the project vehicle, it's kind of
an suv, and then we would get onto boats. It
would take us four hours sometimes five hours to reach
those remotest villages. So we would start at four am
(19:00):
on those boats. We would target to reach these villages
by a m. Nine am or so. Then we would
conduct the vaccination campaigns in coordination with the local government agencies,
the medical doctors, female frontline health workers, local villagers would
(19:22):
join in. It's almost like a festive you know day
it used to be.
Speaker 1 (19:28):
And the thing you have to do this is an
oral vaccine, right, so you have to put basically a
couple drops of this vaccine into the mouth of what
every person, every.
Speaker 3 (19:37):
Kid, Yes, two drops for all children aged under five.
Speaker 1 (19:43):
It's amazing that it's two drops. Like it really is
like you have this magic potion, right, like we have it,
we have enough of it. And the problem, the global problem,
it's like we have to put two drops, just two
drops of this potion into the mouth of every child
under five.
Speaker 3 (19:58):
Absolutely, Jacob. The strategy she was to reach each and
every children in those highest risk areas. When we talk
about the Kosi River and we talk about the floods.
Just to give you a sense of the scale. In
two thousand and six, two thousand and seven, the time
(20:18):
that I was in there, we are talking about about
two and a half million to up to three million
people displaced during these floods. I mean, this is almost
like the entire population of Mississippi. You know, when we
talk about these visits to these villages where you are
(20:41):
essentially operating under a very strict time restriction because you
got to get back to the mainland before the sunsets.
You know, in dark it becomes very difficult. We're talking
about remotest villages with a lot of difficulties. We were
(21:02):
not waiting for people to come to us to get vaccinated.
We were going to the folks, to the villagers, to
that last child, that last household.
Speaker 1 (21:19):
So just to zoom out, like this is this sort
of story of your experience broadly, like what is the
end of the story of polio in India?
Speaker 3 (21:29):
January thirteenth, twenty eleven, was the last time we detected
a polio paralyzed child, and interestingly, Jacob this time around,
this last child was living essentially ten miles away from
my home in Kolkata, So you know, it's very personal
(21:51):
when I look back into you know, these children, and
also the trajectory of India.
Speaker 1 (21:58):
Polio has not yet been eradicate. Where is there still
polio in the world and why.
Speaker 3 (22:04):
Right now as you and I speak, there are only
two countries, to be very precise, a few subnational areas
of these two countries, Pakistan and Afghanistan, where polio is
still endemic, which really means that in these subnational pockets
(22:25):
of these two countries polio has never been stopped or
interrupted for a long duration of time. I would say
the primary issue in Pakistan Afghanistan is of access, and
I think some of the reason is still the geographic complexity.
You can draw parallels to what we saw in a
(22:48):
Bihar in India where in some parts there were no
road connectivity. In some parts there were nomadic populations always
moving around. On top of that, there is the your
political unrest, the civil unrest, and also the political turmoil
that the two countries are going through.
Speaker 1 (23:08):
Let's talk about that in some detail, and we talked
about this one region parts of Pakistan and afghan understand
where polio is still endemic. And then there's a set
of countries primarily in Africa, where there is a risk
of reinfection. So, first of all, what does that mean.
Speaker 3 (23:24):
Reinfection means if we have a susceptible group of people
who are either under vaccinated or unvaccinated, there is always
a risk that polio will not only come back, but
come back and re establish circulation because poliovirus can essentially
(23:48):
travel through infected people into the polio free areas. And
if that area is not only getting exposed to such
population coming in, but if it is also under or unvaccinated,
then not only the virus comes in, but it comes
(24:08):
in and re establishes circulation in the susceptible, under vaccinated population.
Speaker 1 (24:16):
Right, Just so unclear these regions where there are problems
with reinfection, where are those cases coming from?
Speaker 3 (24:23):
It does vary. Given the only two endemic FOSIGN now
is in those subnational areas of Pakistan and Afghanistan, typically
the source would be from somewhere there.
Speaker 1 (24:37):
So if we could knock it out in Pakistan and Afghanistan,
we'd be done spot on.
Speaker 3 (24:42):
That's the primary and the central goal. We are not
only in the last mile, we're probably in that last
one hundred meter, you know, dash when it comes to
reaching our goals.
Speaker 1 (24:55):
So we're coming to the end of this story, right,
I mean I hope we're coming to the end of itself. Yes,
existing in the world. How are we going to get there?
And when? When is it going to happen?
Speaker 3 (25:08):
Jacob I wish I had a crystal ball and really
answered the when part of the question. However, let's look
into the data. Even within Pakistan, it's now cornered into
a few districts, a few provinces. But beyond that geographic shrinkage,
(25:30):
the genetic lineage shrinking is essentially telling us that the
virus is gasping. We need to ensure that we have
full momentum for this last push, the final push, to
maintain our resolve to reach that last child in that
(25:51):
last village of these areas. I'm very hopeful that it's
it's really going to be very soon that we'll see
that last child infected with polio and it will stop
at that and not spread.
Speaker 1 (26:09):
Thanks to my guest today Karen Turgaili and Ananda Bandiopatier
on our next episode, how the RSV vaccine could dramatically
reduce the number of babies coming into hospital emergency rooms
each winter. Also how the development of that vaccine unlocked
a whole new approach to targeting viruses.
Speaker 4 (26:32):
It's like, I don't know, we're sculptors, and now we
have the model of what we need to make the
sculpture of, and it allows us to make ideal mimics
of these proteins found on the surface of the virus.
Speaker 1 (26:48):
Incubation is a co production of Pushkin Industries and Ruby
Studio at iHeartMedia. It's produced by Gabriel Hunter Chang, Ariela Markowitz,
and Amy Gaines McQuaid. Our editors are Julia Barton and
Heron Shakerji, mastering by Anne Pope, fact checking by Joseph Friedman.
Our executive producers are Katherine Girardeau and Matt Romano. I'm
Jacob Goldstein. Thanks for listening.
Speaker 2 (27:19):
Foonful. The sugar helps the medicine go down. Medicine go down,
says the same thing over and over again. That's all
you have to say.
Speaker 1 (27:28):
Very good, very good.
In the first decades of the twentieth century, parents in
the United States lived in terror of polio. CDC is
trying to solve the riddle of poliomyolsis, which kills or
paralyzes thousands of people every year. Doctors didn't know how
the disease spread or how to treat it. What they
(00:22):
did know is that it mainly struck children, and that
it left many of its victims paralyzed, often for life.
As the century progressed, the disease kept becoming more common.
In nineteen fifty two alone, polio paralyzed three thousand children
in the US. One pole of American parents found that
polio was their second greatest fear, right behind atomic apocalypse.
(00:46):
The science of understanding viruses and developing vaccines had come
a long way since the era of Edward Jenner that
we talked about last week. Still, by the middle of
the twentieth century, there was no vaccine to prevent polio,
but scientists were about to develop not one polio vaccine,
but two, and to this day we use these two
very different kinds of vaccines to immunize people around the
(01:09):
world against polio. On today's show, we'll tell the story
of the cutthroat scientific rivalry that resulted in one of
the greatest triumphs in American medicine, maybe two of the
greatest triumphs. I'm Jacob Goldstein. This is incubation. So both
(01:33):
of these vaccines protect people from polio, but they work
in profoundly different ways. This is also true of the
scientists who developed the vaccines, Jonah Salk and Albert Saban.
Speaker 2 (01:44):
Salk was everyone's idea of a hero. He was like Superman.
He was good looking, he was soft spoken, polite, He's
like the kind of guy you'd want your daughter to marry.
And Saban was this abusive, loud mouth, obnoxious person who
(02:07):
managed to offend even his best friends.
Speaker 1 (02:11):
This is Karen Torgaily. She's an epidemiologist and she's writing
a biography of Albert Saban. I asked her to tell
me more about Saban, this scientist who managed to offend
even his best friends.
Speaker 2 (02:21):
By all accounts, he had an explosive temper, He was
a perfectionist. He had little patience for people who weren't
as smart as him, which.
Speaker 1 (02:33):
Was basically everybody, right. He was very, very very smart, so.
Speaker 2 (02:36):
Pretty much everybody.
Speaker 1 (02:38):
Yeah, so that's Saban tell me about Jonah Sulk.
Speaker 2 (02:43):
They had some things in common, both from Jewish families.
He went to medical school at New York University, just
like Saban did, because it was one of the few
places that would take Jews in those days. Their paths crossed,
probably for the first time woods Whole in Massachusetts.
Speaker 1 (03:02):
Woods Hall the Marine Biology Institute.
Speaker 2 (03:06):
Yes, so they got to know each other and they
were friendly. Salk was kind of like the little brother
scientists to Saban, who was by then getting well known.
Speaker 1 (03:17):
Okay, and Salk at the time was maybe still in
medical school. Yes, yeah, how does he get from medical
school to working on polio?
Speaker 2 (03:25):
So Salk moved to ann Arbor, Michigan and worked on
a vaccine for flu. And the critical part of this
is that the flu vaccine was made from a killed virus,
not a live virus.
Speaker 1 (03:42):
Karen told me that working on this killed virus flu
vaccine was a key moment for Salk and really a
key moment in the history of vaccines because up until
this point, there was basically one way to make a
viral vaccine, use a virus that's still alive, but that's
attenuated or weak. But the flu vaccine that Salt helped
to create was different. It was made using a killed virus,
(04:06):
a virus that had been completely inactivated. So now there
were two potential strategies for developing a polio vaccine, attenuated
or killed, and there were real trade offs between the two.
An attenuated virus will multiply inside the body. This induces
a stronger, more robust immune response, which is good, but
(04:29):
if you're giving people this kind of vaccine, you better
be really sure that their immune system is strong enough
to handle it. Otherwise the vaccine might accidentally give people
the very disease that you're trying to prevent. So that's attenuated,
and then you have a vaccine made from killed virus,
which often requires boosters for long term immunity. And if
(04:49):
you're manufacturing a killed virus vaccine, you have to be
really sure that all those virus particles are actually dead,
that they're totally inactivated. So there are these two options
for the polio vaccine, and it really wasn't clear which
one would work better. For Salk and Saban. It was
a key fork in the road and they chose different paths.
(05:10):
Salk went to work on a killed virus vaccine. Saban
chose attenuated. What is Saban's path to choosing an attenuated
a weakened vaccine rather than a killed virus vaccine.
Speaker 2 (05:23):
His inspiration was Max Steiler, who was given the Nobel
Prize for developing yellow fever vaccine, and that was an
attenuated vaccine. He was convinced that the live attenuated virus
made sense for polio as well.
Speaker 1 (05:42):
So Salk sets out to build this killed virus vaccine
for polio. What are sort of the key moments in
that quest.
Speaker 2 (05:52):
There was this sort of elite group of virologists who
had their own sort of old boys club, and Sulk
was not really in it because he was younger and
they didn't see him as being up their caliber. They decided, though,
since he was interested in it, that they would put
him to work. One thing that he could do is
(06:15):
a project for typing the different kinds of polio and
figuring out which ones were the virulent ones to humans,
because that had not been done. He had been sort
of looking at the different strains and types and thinking, now,
if I was going to make a vaccine out of this,
which of these would I use? So he sort of
(06:37):
had half the work done by the time he was
finished typing these Oh.
Speaker 1 (06:41):
Interesting, So it seemed like the grunt work, but it
was actually like meaningful progress toward the vaccine, right.
Speaker 3 (06:49):
Yeah.
Speaker 2 (06:50):
So he really surprised everyone when he told them in
nineteen fifty three that he had a vaccine for polio
and he was ready to test it, and they had
to have this field trial. There were two million children involved,
(07:13):
and of the two million, they had a sample of
people who got the vaccine and people who thought they
were getting the vaccine but really didn't, so they were
a control group. There was an observed group too that
got nothing. Only about half a million actually got the vaccine.
Speaker 1 (07:33):
So they do this giant study and what happens.
Speaker 2 (07:37):
They got the results and they kept a very secret.
April twelfth, nineteen fifty five, came the day when they
were going to make the announcement, so people were invited
to come to ann Arbor on all people wanted to
know does it work? Is it safe? Says basically, yes
it's safe, and yes it's effective. And then and the
(08:00):
reporters all ran to their phones and they reported, and
the church bills rang. You know, there were big, huge
headlines in the newspapers. It was just like the end
of World War two. It was that happy of an occasion. Wow.
Speaker 1 (08:18):
And so Saban he doesn't have a vaccine yet, he's
in fact in the room when when this Sauk announcement
is made. How was he feeling at this point?
Speaker 2 (08:29):
He was pretty sad. His main worry was that his
funding would be cut off.
Speaker 1 (08:35):
So let's talk about where Saban is in his research.
At this point, he was.
Speaker 2 (08:41):
Within a year of having the vaccine that was made
from a weekend attenuated stream, and he had tried it
on his own daughters.
Speaker 1 (08:51):
He tried it on his own daughters.
Speaker 2 (08:53):
On his own daughters.
Speaker 1 (08:54):
Well, it's interesting to think about, right, because you can
think of him giving it to his daughters as like, oh,
prep scientist experimenting on his children. But you can also
think of it as no, he believes this thing works,
and there is this terrifying disease that could paralyze or
kill his children, and he has what he has good
reason to believe is like an elixir that will protect them.
Speaker 2 (09:15):
Yeah, of course he's going to give it to them. Yeah,
remember they had to Also, you don't just get the
vaccine and that's it. You have to be followed. Then
you have to have blood tests, you have to have
your stools analyzed to see if you're passing any virus
or your stools. So they had to take these little
cardboard boxes to school and if they had a bowel
(09:36):
movement at school, then they had to give it to
their teacher. So they said it was pretty embarrassing.
Speaker 1 (09:43):
Anytime my kids tell me that I'm going to embarrass them,
I'm going to tell.
Speaker 2 (09:46):
Them that story.
Speaker 1 (09:48):
On the other hand, I'm not coming up with a
vaccine for polio, So it's a trade off. So to
go back to before in the sort of first part
of the fifties, where Sulk and Saban aware that they
were racing with each other, did they feel like they
were racing with each other?
Speaker 2 (10:04):
Sulk was still the little brother scientist too. They thought, oh,
you know, he's nice, he's making progress, but you know,
he's not us. He also started to get sort of
what they thought of as being uppity in a way
that he wouldn't listen to anyone like.
Speaker 1 (10:20):
The know it all kid.
Speaker 2 (10:22):
Yeah, So for instance, Saban told him, you know, I
see that you plan to use the mahoney strain in
your vaccine. That is too dangerous to use in a vaccine.
If any one of those got through and wasn't killed,
it would kill whoever got it. And he said, oh, Albert,
(10:42):
I have already made my decision. I've done it on
my own experiments, and I'm going to stick with it.
So actually what happened was there was an accident and
children died from getting the Salk vaccine that was improperly
killed at one of the labs. That started this contention
(11:04):
between the two of them. They had been colleagues, they
had been friendly with each other, but then it got
into sort of open warfare.
Speaker 1 (11:14):
So they're having this basically a race, Salk and Saban.
They're developing their vaccines in parallel. Salk wins piece, you know,
like truly a national hero in the US. There's a
massive vaccination campaign, and then not long after that, Saban
essentially finishes developing his own vaccine, this very different vaccine,
(11:35):
and he winds up taking it to the Soviet Union.
Speaker 2 (11:37):
Right, the Soviet Union started to have these terrible polio
epidemics and they didn't have a vaccine, and they knew
the United States did. Saban was going over and he
would carry bials of this polio vaccine seed viruses in
his pockets in these boxes just you know, it is jacket.
(12:01):
He would show them how to make the vaccine, and
so they got very good at producing the vaccine, and
they actually immunized seventy seven million people. It stopped their
polio epidemics. It just stopped them cold.
Speaker 1 (12:15):
Uh huh. I know, the Salck vaccine is a dead
virus and the Saban vaccine is a live, attenuated virus.
But beyond that, what are the basic differences between them?
Speaker 2 (12:24):
Well, so the Salt vaccine was more expensive and it
was harder to make and store. The Saban vaccine was
easier because you could take it orally and you didn't
have to have a trained person to give it. And
so they just were able to train people to put
a couple of drops of the vaccine virus on cube
(12:46):
of sugar. And there's a great little story that goes
with that. This little boy he came home from school
one day and his dad was a songwriter for Disney,
and so he said, oh, son, what'd you do today?
And he said, I got my polio vaccine. He said, oh,
that must have hurt. I said, no, you just get
(13:06):
these little drops and on a sugar cube and that
was it, and so that's how his dad got the
idea for Mary Poppins. Spoonful of sugar helps the medicine
go down.
Speaker 1 (13:21):
So now we have these two effective vaccines in the world. Right,
the Sabin vaccine does get approved in the US not
long after the Soviet trial. We have the Salk vaccine
and the Sabin vaccine. How does that play out in
the world.
Speaker 2 (13:35):
So in the United States they stopped using the Salk vaccine.
Uh why because the Sabin vaccine was cheaper and there
was no need to give the Salk vaccine because you
could take the Sabin vaccine once and for most people
that last your lifetime. But with Salk you had to
(13:56):
take the three initial doses and then a booster. It
just made sense to switch to the to the Saban vaccine,
and most countries did that.
Speaker 1 (14:05):
We know that with the Salt vaccine there was that
manufacturing risk where in one instance it was manufactured wrong
and they made a deadly dose of vaccine. What are
the risks of the Saban vaccine.
Speaker 2 (14:19):
The Saban vaccine has something called vaccine associated paralytic polio,
and it is when someone gets the vaccine who may
have an immune disorder, and so even a very weakened
poliovirus can cause polio like one in every three million
(14:40):
doses or something.
Speaker 1 (14:42):
So in the eradication effort that has been going on
for the past few decades, which vaccine were they using?
Speaker 2 (14:50):
Mostly these Saban vaccine.
Speaker 1 (14:53):
Wow, So in a way, Salt was like the hair
and Saban was like the tortoise. Like in the end,
even though it seemed like Salk one Saban one.
Speaker 2 (15:02):
Yeah. Well, and actually the truth is it really takes
both vaccines because in our country now, what the recommendation
is by the vaccine committees is that you get the
Salk vaccine.
Speaker 1 (15:16):
Did they ever make up with each other?
Speaker 2 (15:21):
No, they didn't, and that It's interesting because one of
Sabin's friends said to him one day, Albert, you have
got to make up with Jonas. This is ridiculous. You
are two grown men, and you just have got to
make up. So he made him call Jonah Salk and
they had this long, pleasant sounding conversation and at the
(15:46):
end of it he said, Okay, well, it's been nice
talking to you, and he hung up the phone and
he said that Son of a Bitch.
Speaker 1 (15:59):
Karen's fourth book is Albert Sabin a fierce joy. It'll
be out in twenty twenty four. We'll be right back
because of Sock and Saban's polio vaccines. Transmission of polio
in the US ended in nineteen seventy nine, but the
(16:19):
disease kept spreading in many other parts of the world.
Ananda Bandio Patia is a deputy director for Polio at
the Bill and Milindigates Foundation. He told me he first
saw the impacts of polio when he was growing up
in India in the nineteen eighties.
Speaker 3 (16:33):
I grew up in Kolkata, a city in the eastern
part of India, and I would see polio paralyzed kids
in my own community used to play a lot of cricket,
as you can imagine, and in our neighborhood there would
be these sad instances of kids affected with polio and
(16:54):
then all on a sudden, they would stop coming to
the playing field. So it was very real.
Speaker 1 (17:00):
In nineteen eighty eight, organizations like the CDC and the
WHO came together and decided to do with polio what
the world had done with smallpox, to wipe it from
the face of the earth. At the time, it was
estimated that every single day polio paralyzed a thousand children.
Speaker 3 (17:19):
India led the way to really establish the proof of
concept that polio can be stopped forever, including in complex geographies.
And look at India. Now, it's not only the fact
that India stopped polio in twenty eleven, it maintained polio
(17:41):
free status for all these twelve years or so in between.
So that's really a strong message for global health principles
of eradication.
Speaker 1 (17:53):
Eradicating polio in India took a lot of work and
Ananda was part of it. In two thousand and six,
Ananda was sent by the WA to a remote part
of India, the Kosi River basin in the state of Bihar.
Speaker 3 (18:05):
What was going on was this persistence of transmission, which
essentially means we were seeing paralyzed children getting reported from
these difficult areas of Bihar in the Kosi Basin. Despite that,
attempts to vaccinate villages.
Speaker 1 (18:25):
In the Kosi River basin were really hard to reach.
Roads were fewer, non existent, floods were frequent, and frontline
workers like Ananda had to return again and again to
make sure that every last child was vaccinated.
Speaker 3 (18:37):
To go there, Jacob, just to take you through that journey.
I would initially take the project vehicle, it's kind of
an suv, and then we would get onto boats. It
would take us four hours sometimes five hours to reach
those remotest villages. So we would start at four am
(19:00):
on those boats. We would target to reach these villages
by a m. Nine am or so. Then we would
conduct the vaccination campaigns in coordination with the local government agencies,
the medical doctors, female frontline health workers, local villagers would
(19:22):
join in. It's almost like a festive you know day
it used to be.
Speaker 1 (19:28):
And the thing you have to do this is an
oral vaccine, right, so you have to put basically a
couple drops of this vaccine into the mouth of what
every person, every.
Speaker 3 (19:37):
Kid, Yes, two drops for all children aged under five.
Speaker 1 (19:43):
It's amazing that it's two drops. Like it really is
like you have this magic potion, right, like we have it,
we have enough of it. And the problem, the global problem,
it's like we have to put two drops, just two
drops of this potion into the mouth of every child
under five.
Speaker 3 (19:58):
Absolutely, Jacob. The strategy she was to reach each and
every children in those highest risk areas. When we talk
about the Kosi River and we talk about the floods.
Just to give you a sense of the scale. In
two thousand and six, two thousand and seven, the time
(20:18):
that I was in there, we are talking about about
two and a half million to up to three million
people displaced during these floods. I mean, this is almost
like the entire population of Mississippi. You know, when we
talk about these visits to these villages where you are
(20:41):
essentially operating under a very strict time restriction because you
got to get back to the mainland before the sunsets.
You know, in dark it becomes very difficult. We're talking
about remotest villages with a lot of difficulties. We were
(21:02):
not waiting for people to come to us to get vaccinated.
We were going to the folks, to the villagers, to
that last child, that last household.
Speaker 1 (21:19):
So just to zoom out, like this is this sort
of story of your experience broadly, like what is the
end of the story of polio in India?
Speaker 3 (21:29):
January thirteenth, twenty eleven, was the last time we detected
a polio paralyzed child, and interestingly, Jacob this time around,
this last child was living essentially ten miles away from
my home in Kolkata, So you know, it's very personal
(21:51):
when I look back into you know, these children, and
also the trajectory of India.
Speaker 1 (21:58):
Polio has not yet been eradicate. Where is there still
polio in the world and why.
Speaker 3 (22:04):
Right now as you and I speak, there are only
two countries, to be very precise, a few subnational areas
of these two countries, Pakistan and Afghanistan, where polio is
still endemic, which really means that in these subnational pockets
(22:25):
of these two countries polio has never been stopped or
interrupted for a long duration of time. I would say
the primary issue in Pakistan Afghanistan is of access, and
I think some of the reason is still the geographic complexity.
You can draw parallels to what we saw in a
(22:48):
Bihar in India where in some parts there were no
road connectivity. In some parts there were nomadic populations always
moving around. On top of that, there is the your
political unrest, the civil unrest, and also the political turmoil
that the two countries are going through.
Speaker 1 (23:08):
Let's talk about that in some detail, and we talked
about this one region parts of Pakistan and afghan understand
where polio is still endemic. And then there's a set
of countries primarily in Africa, where there is a risk
of reinfection. So, first of all, what does that mean.
Speaker 3 (23:24):
Reinfection means if we have a susceptible group of people
who are either under vaccinated or unvaccinated, there is always
a risk that polio will not only come back, but
come back and re establish circulation because poliovirus can essentially
(23:48):
travel through infected people into the polio free areas. And
if that area is not only getting exposed to such
population coming in, but if it is also under or unvaccinated,
then not only the virus comes in, but it comes
(24:08):
in and re establishes circulation in the susceptible, under vaccinated population.
Speaker 1 (24:16):
Right, Just so unclear these regions where there are problems
with reinfection, where are those cases coming from?
Speaker 3 (24:23):
It does vary. Given the only two endemic FOSIGN now
is in those subnational areas of Pakistan and Afghanistan, typically
the source would be from somewhere there.
Speaker 1 (24:37):
So if we could knock it out in Pakistan and Afghanistan,
we'd be done spot on.
Speaker 3 (24:42):
That's the primary and the central goal. We are not
only in the last mile, we're probably in that last
one hundred meter, you know, dash when it comes to
reaching our goals.
Speaker 1 (24:55):
So we're coming to the end of this story, right,
I mean I hope we're coming to the end of itself. Yes,
existing in the world. How are we going to get there?
And when? When is it going to happen?
Speaker 3 (25:08):
Jacob I wish I had a crystal ball and really
answered the when part of the question. However, let's look
into the data. Even within Pakistan, it's now cornered into
a few districts, a few provinces. But beyond that geographic shrinkage,
(25:30):
the genetic lineage shrinking is essentially telling us that the
virus is gasping. We need to ensure that we have
full momentum for this last push, the final push, to
maintain our resolve to reach that last child in that
(25:51):
last village of these areas. I'm very hopeful that it's
it's really going to be very soon that we'll see
that last child infected with polio and it will stop
at that and not spread.
Speaker 1 (26:09):
Thanks to my guest today Karen Turgaili and Ananda Bandiopatier
on our next episode, how the RSV vaccine could dramatically
reduce the number of babies coming into hospital emergency rooms
each winter. Also how the development of that vaccine unlocked
a whole new approach to targeting viruses.
Speaker 4 (26:32):
It's like, I don't know, we're sculptors, and now we
have the model of what we need to make the
sculpture of, and it allows us to make ideal mimics
of these proteins found on the surface of the virus.
Speaker 1 (26:48):
Incubation is a co production of Pushkin Industries and Ruby
Studio at iHeartMedia. It's produced by Gabriel Hunter Chang, Ariela Markowitz,
and Amy Gaines McQuaid. Our editors are Julia Barton and
Heron Shakerji, mastering by Anne Pope, fact checking by Joseph Friedman.
Our executive producers are Katherine Girardeau and Matt Romano. I'm
Jacob Goldstein. Thanks for listening.
Speaker 2 (27:19):
Foonful. The sugar helps the medicine go down. Medicine go down,
says the same thing over and over again. That's all
you have to say.
Speaker 1 (27:28):
Very good, very good.
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