SYMHC Classics: Polio, The Dread Disease

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Speaker 1: 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 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 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 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 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 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 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 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, 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 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 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. 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 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. 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 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 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. 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 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. 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 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, 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 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 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. 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 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 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 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, 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 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 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 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 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 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 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 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 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. 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 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 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. 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 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 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, 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, 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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, 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. 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. 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 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 much for joining us on this Saturday. Since this episode is out of the archive, if you heard an email address or a Facebook U r L or something similar over the course of the show, that could be obsolete now. Our current email address is History Podcast at i heart radio dot com. Our old health stuff works email address no longer works, and you can find us all over social media at missed in History and you can subscribe to our show on Apple podcasts, Google podcasts, the I heart Radio app, and wherever else you listen to podcasts. Stuff you Missed in History Class is a production of I heart Radio. 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