Polio vaccine

Vaccine description
Target disease	Polio virus
Type	Killed/Inactivated
Clinical data
AHFS/Drugs.com	Multum Consumer Information
Pregnancy cat.	C (both OPV and IPV)
Legal status	Administered by or under the supervision of a health care professional.
Routes	Parenteral (IPV), Oral drops (OPV)
Identifiers
ATC code	J07BF01 J07BF02 J07BF03
N (what is this?)  (verify)

Two polio vaccines are used throughout the world to combat poliomyelitis (or polio). The first was developed by Jonas Salk and first tested in 1952. Announced to the world by Salk on April 12, 1955, it consists of an injected dose of inactivated (dead) poliovirus. An oral vaccine was developed by Albert Sabin using attenuated poliovirus. Human trials of Sabin's vaccine began in 1957 and it was licensed in 1962.^[1] Because there is no long term carrier state for poliovirus in immunocompetent individuals, polioviruses have no non-primate reservoir in nature, and survival of the virus in the environment for an extended period of time appears to be remote. Therefore, interruption of person to person transmission of the virus by vaccination is the critical step in global polio eradication.^[2] The two vaccines have eliminated polio from most countries in the world,^[3][4] and reduced the worldwide incidence from an estimated 350,000 cases in 1988 to 1,652 cases in 2007.^[5][6][7]

Development[link]

In generic sense, vaccination works by priming the immune system with an 'immunogen'. Stimulating immune response, via use of an infectious agent, is known as immunization. The development of immunity to polio efficiently blocks person-to-person transmission of wild poliovirus, thereby protecting both individual vaccine recipients and the wider community.^[2]

In 1936, Maurice Brodie, a research assistant at New York University, attempted to produce a formaldehyde-killed polio vaccine from ground-up monkey spinal cords. His initial attempts were hampered by the difficulty of obtaining enough virus. Brodie first tested the vaccine on himself and several of his assistants. He then gave the vaccine to three thousand children, many of whom developed allergic reactions, but none developed immunity to polio.^[8] Philadelphia pathologist John Kolmer also claimed to have developed a vaccine that same year, but it too produced no immunity and was blamed for causing cases of paralytic polio, nine of them fatal.^[9]

Mass polio vaccination in Columbus, Georgia during the early days of the National Polio Immunization Program.

A breakthrough came in 1948 when a research group headed by John Enders at the Children's Hospital Boston successfully cultivated the poliovirus in human tissue in the laboratory.^[10] This group had recently successfully grown mumps in cell culture. In March 1948 Weller was attempting to grow varicella virus in embryonic lung tissue. He had inoculated the planned number of tubes when he noticed that there were a few unused tubes. He retrieved a sample of mouse brain infected with polio virus and added it to the remaining test tubes, on the off chance that the virus might grow. The varicella cultures failed to grow but the polio cultures were successful.

This development greatly facilitated vaccine research and ultimately allowed for the development of vaccines against polio. Enders and his colleagues, Thomas H. Weller and Frederick C. Robbins, were recognized in 1954 for their labors with a Nobel Prize in Physiology or Medicine.^[11] Other important advances that led to the development of polio vaccines were: the identification of three poliovirus serotypes (Poliovirus type 1 — PV1, or Mahoney; PV2, Lansing; and PV3, Leon); the finding that prior to paralysis, the virus must be present in the blood; and the demonstration that administration of antibodies in the form of gamma-globulin protects against paralytic polio.^[6][12]

Albert Sabin (right) with Robert Gallo, circa 1985

In 1952 and 1953, the U.S. experienced an outbreak of 58,000 and 35,000 polio cases, respectively, up from a typical number of some 20,000 a year. Amid this U.S. polio epidemic, millions of dollars were invested in finding and marketing a polio vaccine by commercial interests, including Lederle Laboratories in New York under the direction of H. R. Cox. Also working at Lederle was Polish-born virologist and immunologist Hilary Koprowski, who claims to have created the first successful polio vaccine, in 1950. His vaccine, however, being a live attenuated virus taken orally, was still in the research stage and would not be ready for use until five years after Jonas Salk's polio vaccine (a dead injectable vaccine) had reached the market. Koprowski's attenuated vaccine was prepared by successive passages through the brains of Swiss albino mice. By the seventh passage, the vaccine strains could no longer infect nervous tissue or cause paralysis. After one to three further passages on rats, the vaccine was deemed safe for human use.^[13][14] On February 27, 1950, Koprowski's live, attenuated vaccine was tested for the first time on an 8-year-old boy living at Letchworth Village, an institution for the physically and mentally disabled located in New York. After the child suffered no side effects, Koprowski enlarged his experiment to include 19 other children.^[13][15]

The development of two polio vaccines led to the first modern mass inoculations. The last cases of paralytic poliomyelitis caused by endemic transmission of wild virus in the United States occurred in 1979, with an outbreak among the Amish in several Midwest states.^[16] A global effort to eradicate polio, led by the World Health Organization, UNICEF, and The Rotary Foundation, began in 1988 and has relied largely on the oral polio vaccine developed by Albert Sabin.^[17] The disease was entirely eradicated in the Americas by 1994.^[18] Polio was officially eradicated in 36 Western Pacific countries, including China and Australia in 2000.^[19][20] Europe was declared polio-free in 2002.^[21] As of 2008, polio remains endemic in only four countries: Nigeria, India, Pakistan, and Afghanistan.^[5] Although poliovirus transmission has been interrupted in much of the world, transmission of wild poliovirus does continue and creates an ongoing risk for the importation of wild poliovirus into previously polio-free regions. If importations of poliovirus occurs, outbreaks of poliomyelitis may develop, especially in areas with low vaccination coverage and poor sanitation. As a result, high levels of vaccination coverage must be maintained.^[18]

Inactivated vaccine[link]

Administration of the polio inoculation, including by Salk himself, in 1957 at the University of Pittsburgh where he and his team had developed the vaccine

The first effective polio vaccine was developed in 1952 by Jonas Salk at the University of Pittsburgh, but it would require years of testing. To encourage patience, Salk went on CBS radio to report a successful test on a small group of adults and children on March 26, 1953; two days later the results were published in JAMA.^[22]

The Salk vaccine, or inactivated poliovirus vaccine (IPV), is based on three wild, virulent reference strains, Mahoney (type 1 poliovirus), MEF-1 (type 2 poliovirus), and Saukett (type 3 poliovirus), grown in a type of monkey kidney tissue culture (Vero cell line), which are then inactivated with formalin.^[6] The injected Salk vaccine confers IgG-mediated immunity in the bloodstream, which prevents polio infection from progressing to viremia and protects the motor neurons, thus eliminating the risk of bulbar polio and post-polio syndrome.

Beginning February 23, 1954, the vaccine was tested at Arsenal Elementary School and the Watson Home for Children in Pittsburgh, Pennsylvania.^[23] Salk's vaccine was then used in a test called the Francis Field Trial, led by Thomas Francis; the largest medical experiment in history. The test began with some 4,000 children at Franklin Sherman Elementary School in McLean, Virginia,^[24] and would eventually involve 1.8 million children, in 44 states from Maine to California.^[25] By the conclusion of the study, roughly 440,000 received one or more injections of the vaccine, about 210,000 children received a placebo, consisting of harmless culture media, and 1.2 million children received no vaccination and served as a control group, who would then be observed to see if any contracted polio.^[13] The results of the field trial were announced April 12, 1955 (the tenth anniversary of the death of Franklin D. Roosevelt; see Franklin D. Roosevelt's paralytic illness). The Salk vaccine had been 60–70% effective against PV1 (poliovirus type 1), over 90% effective against PV2 and PV3, and 94% effective against the development of bulbar polio.^[26] Soon after Salk's vaccine was licensed in 1955 children's vaccination campaigns were launched. In the U.S, following a mass immunization campaign promoted by the March of Dimes, the annual number of polio cases fell from 35,000 in 1953 to 5,600 by 1957.^[27] By 1961 only 161 cases were recorded in the United States.^[28]

A Somali boy is injected with inactivated poliovirus vaccine (Mogadishu, 1993)

An enhanced-potency IPV was licensed in the United States in November 1987, and is currently the vaccine of choice in the United States.^[16] The first dose of polio vaccine is given shortly after birth, usually between 1–2 months of age, a second dose is given at 4 months of age.^[16] The timing of the third dose depends on the vaccine formulation but should be given between 6–18 months of age.^[29] A booster vaccination is given at 4 to 6 years of age, for a total of four doses at or before school entry.^[30] In some countries, a fifth vaccination is given during adolescence.^[29] Routine vaccination of adults (18 years of age and older) in developed countries is neither necessary nor recommended because most adults are already immune and have a very small risk of exposure to wild poliovirus in their home countries.^[16]

In 2002, a pentavalent (5-component) combination vaccine (called Pediarix) containing IPV was approved for use in the United States. The vaccine also contains combined diphtheria, tetanus, and acellular pertussis vaccines (DTaP) and a pediatric dose of hepatitis B vaccine.^[16] In the UK, IPV is combined with tetanus, diphtheria, pertussis and Haemophilus influenzae type b vaccines.^[29] When the current formulation of IPV is used, 90% or more of individuals develop protective antibody to all three serotypes of poliovirus after two doses of inactivated polio vaccine (IPV), and at least 99% are immune to poliovirus following three doses. The duration of immunity induced by IPV is not known with certainty, although a complete series is thought to provide protection for many years.^[31]

Oral vaccine[link]

This 1963 poster featured CDC’s national symbol of public health, the "Wellbee", encouraging the public to receive an oral polio vaccine.

Oral polio vaccine (OPV) is a live-attenuated vaccine, produced by the passage of the virus through non-human cells at a sub-physiological temperature, which produces spontaneous mutations in the viral genome.^[32] Oral polio vaccines were developed by several groups, one of which was led by Albert Sabin. Other groups, led by Hilary Koprowski and H.R. Cox, developed their own attenuated vaccine strains. In 1958, the National Institutes of Health created a special committee on live polio vaccines. The various vaccines were carefully evaluated for their ability to induce immunity to polio, while retaining a low incidence of neuropathogenicity in monkeys. Large-scale clinical trials performed in the Soviet Union in late 1950s — early 1960s by Mikhail Chumakov and his colleagues demonstrated safety and high efficacy of the vaccine.^[33][34] Based on these results, the Sabin strains were chosen for worldwide distribution.^[13]

There are 57 nucleotide substitutions which distinguish the attenuated Sabin 1 strain from its virulent parent (the Mahoney serotype), two nucleotide substitutions attenuate the Sabin 2 strain, and 10 substitutions are involved in attenuating the Sabin 3 strain.^[6] The primary attenuating factor common to all three Sabin vaccines is a mutation located in the virus's internal ribosome entry site (IRES)^[35] which alters stem-loop structures, and reduces the ability of poliovirus to translate its RNA template within the host cell.^[36] The attenuated poliovirus in the Sabin vaccine replicates very efficiently in the gut, the primary site of infection and replication, but is unable to replicate efficiently within nervous system tissue. OPV also proved to be superior in administration, eliminating the need for sterile syringes and making the vaccine more suitable for mass vaccination campaigns. OPV also provided longer lasting immunity than the Salk vaccine.

In 1961, type 1 and 2 monovalent oral poliovirus vaccine (MOPV) was licensed, and in 1962, type 3 MOPV was licensed. In 1963, trivalent OPV (TOPV) was licensed, and became the vaccine of choice in the United States and most other countries of the world, largely replacing the inactivated polio vaccine.^[8] A second wave of mass immunizations led to a further dramatic decline in the number of polio cases. Between 1962 and 1965 about 100 million Americans (roughly 56% of the population at that time) received the Sabin vaccine. The result was a substantial reduction in the number of poliomyelitis cases, even from the much reduced levels following the introduction of the Salk vaccine.^[37]

OPV is usually provided in vials containing 10-20 doses of vaccine. A single dose of oral polio vaccine (usually two drops) contains 1,000,000 infectious units of Sabin 1 (effective against PV1), 100,000 infectious units of the Sabin 2 strain, and 600,000 infectious units of Sabin 3. The vaccine contains small traces of antibiotics— neomycin and streptomycin—but does not contain preservatives.^[38] One dose of OPV produces immunity to all three poliovirus serotypes in approximately 50% of recipients.^[16] Three doses of live-attenuated OPV produce protective antibody to all three poliovirus types in more than 95% of recipients. OPV produces excellent immunity in the intestine, the primary site of wild poliovirus entry, which helps prevent infection with wild virus in areas where the virus is endemic.^[30] The live virus used in the vaccine is shed in the stool and can be spread to others within a community, resulting in protection against poliomyelitis even in individuals who have not been directly vaccinated. IPV produces less gastrointestinal immunity than does OPV, and primarily acts by preventing the virus from entering the nervous system. In regions without wild poliovirus, inactivated polio vaccine is the vaccine of choice.^[30] In regions with higher incidence of polio, and thus a different relative risk between efficacy and reversion of the vaccine to a virulent form, live vaccine is still used. The live virus also has stringent requirements for transport and storage, which are a problem in some hot or remote areas. As with other live-virus vaccines, immunity initiated by OPV is probably lifelong.^[31]

Iatrogenic (vaccine-induced) polio[link]

A major concern about the oral polio vaccine (OPV) is its known ability to revert to a form that can achieve neurological infection and cause paralysis.^[39] Clinical disease, including paralysis, caused by vaccine-derived poliovirus (VDPV) is indistinguishable from that caused by wild polioviruses.^[40] This is believed to be a rare event, but outbreaks of vaccine-associated paralytic poliomyelitis (VAPP) have been reported, and tend to occur in areas of low coverage by OPV, presumably because the OPV is itself protective against the related outbreak strain.^[41][42]

Doses of oral polio vaccine are added to sugar cubes for use in a 1967 vaccination campaign in Bonn, Germany

As the incidence of wild polio diminishes, nations transition from use of the oral vaccine back to the injected vaccine because the direct risk of iatrogenic polio (VAPP) due to OPV outweighs the indirect benefit of immunization via subclinical transmission of OPV. When IPV is used, reversion is not possible but there remains a small risk of clinical infection upon exposure to reverted OPV or wild polio virus. Following the widespread use of polio vaccines in the mid-1950s, the incidence of poliomyelitis declined rapidly in many industrialized countries. The use of OPV was discontinued in the United States in 2000 and in 2004 in the UK, but it continues to be used around the globe.^[16][29]

The rate of vaccine-associated paralytic poliomyelitis (VAPP) varies by region but is generally about 1 case per 750,000 vaccine recipients.^[43] VAPP is more likely to occur in adults than in children. In immunodeficient children, the risk of VAPP is almost 7,000 times higher, particularly for persons with B-lymphocyte disorders (e.g., agammaglobulinemia and hypogammaglobulinemia), which reduce the synthesis of protective antibodies.^[40] The World Health Organization considers the benefits of vaccination to far outweigh the risk of vaccine derived polio. Outbreaks of vaccine derived polio have been stopped by multiple rounds of high-quality vaccination, in order to immunize the entire population.^[44]

Outbreaks of VAPP occurred independently in Belarus (1965–66), Canada (1966–68), Egypt (1983–1993), Hispaniola (2000–2001), Philippines (2001), Madagascar (2001–2002),^[45] and in Haiti (2002), where political strife and poverty have interfered with vaccination efforts.^[46] In 2006 an outbreak of vaccine-derived poliovirus occurred in China.^[47] Cases have been reported from Cambodia (2005–2006), Myanmar (2006–2007), Iran (1995, 2005–2007), Syria, Kuwait and Egypt.^[48] Since 2005, The World Health Organization has been tracking vaccine-caused polio in northern Nigeria caused by a mutation in live oral polio vaccines.^[49]

Contamination concerns[link]

In 1960, it was determined that the rhesus monkey kidney cells used to prepare the poliovirus vaccines were infected with the SV40 virus (Simian Virus-40).^[50] SV40 was also discovered in 1960 and is a naturally occurring virus that infects monkeys. In 1961, SV40 was found to cause tumors in rodents.^[51] More recently, the virus was found in certain forms of cancer in humans, for instance brain and bone tumors, pleural and peritoneal mesothelioma, and some types of non-Hodgkin's lymphoma.^[52][53] However, it has not been determined that SV40 causes these cancers.^[54]

SV40 was found to be present in stocks of the injected form of the polio vaccine (IPV) in use between 1955 to 1963.^[50] It is not found in the OPV form.^[50] Over 98 million Americans received one or more doses of polio vaccine between 1955 to 1963 when a proportion of vaccine was contaminated with SV40; it has been estimated that 10–30 million Americans may have received a dose of vaccine contaminated with SV40.^[50] Later analysis suggested that vaccines produced by the former Soviet bloc countries until 1980, and used in the USSR, China, Japan, and several African countries, may have been contaminated; meaning hundreds of millions more may have been exposed to SV40.^[55]

In 1998, the National Cancer Institute undertook a large study, using cancer case information from the Institutes SEER database. The published findings from the study revealed that there was no increased incidence of cancer in persons who may have received vaccine containing SV40.^[56] Another large study in Sweden examined cancer rates of 700,000 individuals who had received potentially contaminated polio vaccine as late as 1957; the study again revealed no increased cancer incidence between persons who received polio vaccines containing SV40 and those who did not.^[57] The question of whether SV40 causes cancer in humans remains controversial however, and the development of improved assays for detection of SV40 in human tissues will be needed to resolve the controversy.^[54]

During the race to develop an oral polio vaccine several large scale human trials were undertaken. By 1958, the National Institutes of Health had determined that OPV produced using the Sabin strains were the safest.^[13] Between 1957 and 1960, however, Hilary Koprowski continued to administer his vaccine around the world. In Africa, the vaccines were administered to roughly one million people in the Belgian territories, now the Democratic Republic of the Congo, Rwanda and Burundi.^[58][59] The results of these human trials have been controversial,^[60] and accusations in the 1990s arose that the vaccine had created the conditions necessary for transmission of SIV from chimpanzees to humans, causing HIV/AIDS. These hypotheses have, however, been refuted.^[58] By 2004, cases of poliomyelitis in Africa had been reduced to just a small number of isolated regions in the western portion of the continent, with sporadic cases elsewhere. However, recent opposition to vaccination campaigns has evolved,^[61][62] often relating to fears that the vaccine might induce sterility.^[63] The disease has since resurged in Nigeria and in several other African nations, which epidemiologists believe is due to refusals by certain local populations to allow their children to receive the polio vaccine.^[64]

See also[link]

• Polio eradication

References[link]

External links[link]

• History of Vaccines Website – History of Polio History of Vaccines, a project of the College of Physicians of Philadelphia
• CGDev.org — 'Vaccines for Development', Center for Global Development
• PBS.org — 'People and Discoveries: Salk Produces Polio Vaccine 1952', PBS
• Carlsen W (2001-07-15). "Rogue virus in the vaccine: Early polio vaccine harbored virus now feared to cause cancer in humans". San Francisco Chronicle. http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2001/07/15/MN193825.DTL. Retrieved 2008-11-29. 
• Documents regarding Jonas Salk and the Salk Polio Vaccine, Dwight D. Eisenhower Presidential Library
• Conquering Polio, Smithsonian Magazine, April 2005

Jonas Salk
File:Wisdom-cover1.jpg Magazine photo by Yousuf Karsh, 1956
Born	Jonas Edward Salk (1914-10-28)October 28, 1914 New York, New York
Died	June 23, 1995(1995-06-23) (aged 80) La Jolla, California, United States
Residence	New York, New York Pittsburgh, Pennsylvania La Jolla, California
Nationality	American
Fields	Medical research, virology and epidemiology
Institutions	University of Pittsburgh Salk Institute
Alma mater	City College of New York New York University
Doctoral advisor	Thomas Francis, Jr.
Known for	First polio vaccine
Notable awards	Lasker Award (1956)
Spouse	Donna Lindsay (m. 1939–1968) «start: (1939)–end+1: (1969)»"Marriage: Donna Lindsay to Jonas Salk" Location: (linkback:http://en-wiki.pop.wn.com/index.php/Jonas_Salk), Françoise Gilot (m. 1970–1995) «start: (1970)–end+1: (1996)»"Marriage: Françoise Gilot to Jonas Salk" Location: (linkback:http://en-wiki.pop.wn.com/index.php/Jonas_Salk)
Signature

Jonas Edward Salk (October 28, 1914 – June 23, 1995) was an American medical researcher and virologist, best known for his discovery and development of the first safe and effective polio vaccine. He was born in New York City to parents from Ashkenazi Jewish Russian immigrant families. Although they did not have much formal education, his parents were determined to see their children succeed. While attending New York University School of Medicine, Jonas stood out from his peers not just because of his academic prowess, but because he chose to do medical research instead of becoming a physician.

Until 1955, when the Salk vaccine was introduced, polio was considered the most frightening public health problem of the post-war United States. Annual epidemics were increasingly devastating. The 1952 epidemic was the worst outbreak in the nation's history. Of nearly 58,000 cases reported that year, 3,145 people died and 21,269 were left with mild to disabling paralysis,^[1] with most of its victims being children. The "public reaction was to a plague", said historian William O'Neill. "Citizens of urban areas were to be terrified every summer when this frightful visitor returned." According to a 2009 PBS documentary, "Apart from the atomic bomb, America's greatest fear was polio."^[2] As a result, scientists were in a frantic race to find a way to prevent or cure the disease. U.S. president Franklin D. Roosevelt was the world's most recognized victim of the disease and founded the organization that would fund the development of a vaccine.

In 1947, Salk accepted an appointment to the University of Pittsburgh School of Medicine. In 1948, he undertook a project funded by the National Foundation for Infantile Paralysis to determine the number of different types of polio virus. Salk saw an opportunity to extend this project towards developing a vaccine against polio, and, together with the skilled research team he assembled, devoted himself to this work for the next seven years. The field trial set up to test the Salk vaccine was, according to O'Neill, "the most elaborate program of its kind in history, involving 20,000 physicians and public health officers, 64,000 school personnel, and 220,000 volunteers." Over 1,800,000 school children took part in the trial.^[3] When news of the vaccine's success was made public on April 12, 1955, Salk was hailed as a "miracle worker", and the day "almost became a national holiday." His sole focus had been to develop a safe and effective vaccine as rapidly as possible, with no interest in personal profit. When he was asked in a televised interview who owned the patent to the vaccine, Salk replied: "There is no patent. Could you patent the sun?"^[4]

In 1960, he founded the Salk Institute for Biological Studies in La Jolla, California, which is today a center for medical and scientific research. He continued to conduct research and publish books, including Man Unfolding (1972), The Survival of the Wisest (1973), World Population and Human Values: A New Reality (1981), and Anatomy of Reality: Merging of Intuition and Reason (1983). Salk's last years were spent searching for a vaccine against HIV.

Early days[link]

Jonas Salk was born in New York City on October 28, 1914. His parents, Daniel and Dora Salk, were from Russian-Jewish immigrant families, and did not receive extensive formal education. According to historian David Oshinsky, Salk grew up in the "Jewish immigrant culture" of New York. He had two younger brothers, Herman and Lee, a child psychologist.^[5][6] The family moved from East Harlem to the Bronx, with some time spent in Queens.

Education[link]

High school[link]

When he was 13, Salk entered Townsend Harris High School, a public school for intellectually gifted students. Named after the founder of City College of New York (CCNY), it was, wrote Oshinsky, "a launching pad for the talented sons of immigrant parents who lacked the money—and pedigree—to attend a top private school." In high school "he was known as a perfectionist...who read everything he could lay his hands on", according to one of his fellow students.^[7] Students had to cram a four-year curriculum into just three years. As a result, most dropped out or flunked out, despite the school's motto "study, study, study." Of the students who graduated, however, most would have the grades to enroll in CCNY, noted for being a highly competitive college.^[8]:96

College[link]

Salk enrolled in City College of New York from which he earned a Bachelor of Science degree in 1934. Oshinsky writes that "for working-class immigrant families, City College represented the apex of public higher education. Getting in was tough but tuition was free. Competition was intense, but the rules were fairly applied. No one got an advantage based on an accident of birth."^[8]

At his mother's urging, he put aside aspirations of becoming a lawyer, and instead concentrated on classes necessary for admission to medical school. However, according to Oshinsky, the facilities at City College were "barely second rate." There were no research laboratories. The library was inadequate. The faculty contained few noted scholars. "What made the place special", he writes, "was the student body that had fought so hard to get there . . . driven by their parents. . . From these ranks, of the 1930s and 1940s, emerged a wealth of intellectual talent, including more Nobel Prize winners—eight—and PhD recipients than any other public college except the University of California at Berkeley." Salk entered City College at the age of 15, a "common age for a freshman who had skipped multiple grades along the way."^[8]:98

As a child, Salk did not show any interest in medicine or science in general. He says in an interview with the Academy of Achievement^[9] "As a child I was not interested in science. I was merely interested in things human, the human side of nature, if you like, and I continue to be interested in that."

Medical school[link]

According to Oshinsky, NYU based its modest reputation on famous alumni, such as Walter Reed, who helped conquer yellow fever. Tuition was "comparatively low, better still, it did not discriminate against Jews, ... while most of the surrounding medical schools—Cornell, Columbia, University of Pennsylvania, and Yale—had rigid quotas in place." Yale, for example, accepted 76 applicants, in 1935, out of a pool of 501. Although 200 of the applicants were Jewish, only five got in.^[8]:98

During his years at the New York University School of Medicine he stood out from his peers, according to Bookchin, "not just because of his continued academic prowess—he was Alpha Omega Alpha, the Phi Beta Kappa Society of medical education—but because he had decided he did not want to practice medicine." Instead, he became absorbed in research, even taking a year off to study biochemistry. He later focused more of his studies on bacteriology which had replaced medicine as his primary interest. He said his desire was to help humankind in general rather than single patients.^[7] And as Oshinsky writes, "it was the laboratory work, in particular, that gave new direction to his life."^[8]

According to Salk: "My intention was to go to medical school, and then become a medical scientist. I did not intend to practice medicine, although in medical school, and in my internship, I did all the things that were necessary to qualify me in that regard. I had opportunities along the way to drop the idea of medicine and go into science. At one point at the end of my first year of medical school, I received an opportunity to spend a year in research and teaching in biochemistry, which I did. And at the end of that year, I was told that I could, if I wished, switch and get a Ph.D. in biochemistry but my preference was to stay with medicine. And, I believe that this is all linked to my original ambition, or desire, which was to be of some help to humankind, so to speak, in a larger sense than just on a one-to-one basis."^[10]

Post-graduate research[link]

In 1941, during his postgraduate work in virology he chose a two-month elective to work in the laboratory of Dr. Thomas Francis at the University of Michigan. Francis had recently joined the faculty of the medical school after working for the Rockefeller Foundation, where he had discovered the Type B influenza virus. According to Bookchin, "the two month stint in Francis's lab was Salk's first introduction to the world of virology—and he was hooked."^[7]:25 Since then originates the first controversy (the second one relates in revealing SV40 in the rhesus monkey kidney cells used for multiplying poliomyelitis virus for vaccines in 1960^{[11][12][13][14]}) in Salk's career: Francis and other researchers, one of whom was Salk, deliberately infected patients at several Michigan mental hospitals with the influenza virus by spraying the virus into their nasal cavities.^[15]

After graduating from medical school he began his residency at New York's Mount Sinai Hospital, where he again worked in Francis's laboratory. Few hospitals in Manhattan had the status of Mount Sinai, particularly among the city's Jews. Oshinsky interviewed a friend of Salk's, who said, "to intern there was like playing ball for the New York Yankees ... only the top men from the nation's medical schools dared apply. Out of 250 who sought the opportunity, only a dozen were chosen."^[8]

According to Oshinsky, "Salk quickly made his mark." Although focused mainly on research, "he showed tremendous skills as a clinician and a surgeon." But it was "his leadership as president of the house staff of interns and residents at Mount Sinai that best defined him to his peers." The key issue for many of them in 1939, for example, was not the fate of the hospital, but rather the future of Europe after Nazi Germany's invasion of Poland. In one instance, "several interns responded by wearing badges to signify support for the Allies", but the hospital's director told them to remove them lest they upset some of the patients.

The interns then took the matter to Salk, where he said that "everyone should wear the badge as an act of solidarity." One intern recalled, "Jonas was a very staunch guy. He never took a backward step on that issue or any other issue of principle between us and the hospital." The hospital administrators backed off and there was no further interference from the director.^[8]

Research career[link]

At the end of his residency, Salk began applying for permanent research positions, but he discovered that many of the jobs he desired were closed to him due to Jewish quotas, which, according to Bookchin, "prevailed in so much of the medical research establishment." Nor could he apply at Mount Sinai as their policy prevented hiring their own interns. As a last resort, he contacted Dr. Francis for help. But Francis had left New York University a year earlier after accepting an offer to direct the University of Michigan's School of Public Health.

However, "Francis did not let him down," writes Bookchin. "He secured extra grant money and offered Salk a job" working on an army-commissioned project in Michigan to develop an influenza vaccine. He and Francis eventually perfected a vaccine that was soon widely used at army bases, where "Salk had been responsible for discovering and isolating one of the flu strains that was included in the final vaccine.^[7]:26

By 1947, Salk decided to find an institution where he could direct his own laboratory. After three institutions turned him down, he received an offer from William McEllroy, the dean of the University of Pittsburgh School of Medicine, which included a promise that he would run his own lab. He accepted, and in the fall of that year left Michigan and relocated to Pennsylvania. But the promise was not quite what he expected. After Salk arrived at Pittsburgh, "he discovered that he had been relegated to cramped, unequipped quarters in the basement of the old Municipal Hospital", writes Bookchin. As time went on, however, he began securing grants from the Mellon family and was able to build a working virology laboratory, where he continued his research on flu vaccines.^[7]

Salk's work on influenza viruses has been associated with ethical controversy. The Associated Press reported that Salk authored a research paper, describing a federally-funded study that began in 1942. Salk injected patients in a state insane asylum in Ypsilanti, Michigan with an experimental influenza vaccine, then exposed them to influenza virus months later to check the vaccine's efficacy. It is questionable at best whether any of these patients could have understood what was being done to them, or why.^[16]

He was later approached by the director of research at the National Foundation for Infantile Paralysis and asked if he would like to participate on the foundation's polio project, which had earlier been established by President Franklin D. Roosevelt, at the time thought to be a victim of polio himself. He quickly accepted the offer saying he "would be happy to work on this important project."^[7]

In 1956, Wisdom magazine ran a cover story about Salk, summarizing some of the reasoning behind his desire to do research:

There are two types of medical specialists. There are those who fight disease day and night, who assist mankind in times of despair and agony and who preside over the awesome events of life and death. Others work in the quiet detachment of the laboratory; their names are often unknown to the general public, but their research may have momentous consequences.^[17]

Joining the fight against polio[link]

The worst disease of the postwar era[link]

Polio was a medical oddity that baffled researchers for years. It was first recorded in 1835 and grew steadily more prevalent. It took a long time to learn that the virus was transmitted by fecal matter and secretions of the nose and throat. It entered the victim orally, established itself in the intestines, and then traveled to the brain or spinal cord.^[18]

At the start of the 20th century, during the 1914 and 1919 polio epidemics in the U.S., physicians and nurses made house-to-house searches to identify all infected persons. Children suspected of being infected were taken to hospitals and the child's family was quarantined until they were no longer potentially infectious, even if it meant they could not go to their child's funeral if the child died in the hospital.^[19]

There are many famous polio victims, most of whom were able to overcome their disabilities, while others were less fortunate: Itzhak Perlman, one of the world's finest violinists, was permanently disabled at age four, and still plays sitting down; actor Donald Sutherland; writer Arthur C. Clarke; writer Robert Anton Wilson; actress Mia Farrow;^[20] singer-musician Neil Young; Olympic dressage rider Lis Hartel; actor Alan Alda; musician David Sanborn; singer Dinah Shore; singer Joni Mitchell; former Supreme Court Justice William O. Douglas; director Francis Ford Coppola; nuclear physicist J. Robert Oppenheimer; actor Lionel Barrymore;^[21] and Congressman James H. Scheuer.^[22]

March of Dimes poster circa 1952

According to American historian William O'Neill, "Paralytic poliomyelitis (its formal name) was, if not the most serious, easily the most frightening public health problem of the postwar era." He noted that the epidemics kept getting worse and its victims were usually children. By 1952 it was killing more of them than any other communicable disease. In the twenty states that reported the disease back in 1916, there were 27,363 cases. New York alone had 9,023 cases of which 2,448 (28%) resulted in death, and a larger number in paralysis.^[18]:136 However, polio did not gain national attention until 1921, when Franklin D. Roosevelt, former vice presidential candidate and soon to be governor of New York, came down with a paralytic illness, at the time diagnosed as polio.^[23] At the age of 39, Roosevelt was left with severe paralysis and spent most of his presidency in a wheelchair.

Subsequently, as more states began recording instances of the disease, the numbers of victims grew larger. Nearly 58,000 cases of polio were reported in 1952, with 3,145 people dying and 21,269 left with mild to disabling paralysis.^[1] In some parts of the country, concern assumed almost the dimensions of panic. According to Olson, "parents kept children home from school, avoided parks and swimming pools, and played only in small groups with the closest of friends."^[23] Cases usually increased during the summer when children were home from school. "The public reaction was to a plague", noted O'Neill. "Citizens of urban areas were to be terrified every summer when this frightful visitor returned."^[18] As a result, Olson points out, "scientists were in a frantic race to find a cure."^[23]

The fight begins[link]

President Franklin D. Roosevelt meeting with Basil O'Connor

Oshinsky writes that as "headlines screamed, 'Polio Scourge,' 'Polio Panic,' and 'Polio's Deadly Path,'" parents "faced a dilemma" and a feeling of personal helplessness in the midst of an "apparently runaway epidemic." Their "postwar culture was being turned upside down" as polio became the "crack in the fantasy" of a suburban home "bursting with children." Parents began to see that there would be an alternative, however: "Since worry did no good and quarantine seemed fruitless, parents might best protect their children by helping others to discover a vaccine against polio, and, perhaps, even a cure." The public soon realized that this kind of research demanded "big money" and an "army of devoted volunteers,"^[8]:85-87 but Salk was determined to make it over this barrier.

The fight against polio did not really get under way until 1938 when the National Foundation for Infantile Paralysis was born. Basil O'Connor, the former law partner of President Roosevelt, the US' most famous polio victim, headed it. That same year, the first March of Dimes fundraising program was set up, with radio networks offering free 30-second slots for promotion. Listeners were asked to send in a dime and the White House received 2,680,000 letters within days.

As the fear of polio increased each year, funds to combat it increased from $1.8 million to $67 million by 1955. Research continued during those years, but, writes O'Neill, "everything scientists believed about polio at first was wrong, leading them down many blind alleys... furthermore, most researchers were experimenting with highly dangerous live vaccines. In one test six children were killed and three left crippled."^[18]

"This was the situation when young Jonas Salk, a medical doctor in charge of a virology laboratory at the University of Pittsburgh, decided to use the safer killed virus", writes O'Neill. Despite a general lack of enthusiasm for this approach, O'Connor backed Salk handsomely. After successful tests on laboratory animals, it next had to be tested on human beings. "Who would take the risk?" author Dennis Denenberg asked. "Dr. Jonas Salk did ... along with his wife and children, who also allowed themselves to be human guinea pigs."^[24] In November, 1953, at a conference in New York's Waldorf-Astoria Hotel, he said, "I will be personally responsible for the vaccine." He announced that his wife and three sons had been among the first volunteers to be inoculated with his vaccine.^[25]

Salk in 1955 at the University of Pittsburgh

It was critical that he develop the trust of the US public for his experiments and mass tests that would become necessary. An associate of his noted, "That boy really suffers when he sees a paralytic case. You look at him and you see him thinking, 'My God, this can be prevented'."^[26] An article in Wisdom notes that at one point "he even thought of giving up virus research":

But as he was sitting in a park and watching children play, he realized how important his work was. He saw that there were thousands of children and adults who would never walk again and whose bodies would be paralyzed. He realized his awesome responsibility, and so he continued his task with renewed vigor.^[17]

As a result of his preliminary results in 1954, "when polio was destroying more American children than any other communicable disease, Salk's vaccine was ready for field testing."^[18]

Field trials

The field trial set up to test the vaccine developed by Salk and his research team was, according to O'Neill, "the most elaborate program of its kind in history, involving 20,000 physicians and public health officers, 64,000 school personnel, and 220,000 volunteers",^[18] with over 1,800,000 school children participating in the trial.^[3] A 1954 Gallup poll showed that more Americans knew about the polio field trials than could give the full name of the US President. According to medical author Paul Offit, "more Americans had participated in the funding, development, and testing of the polio vaccine than had participated in the nomination and election of the president."^[27]:54 At least one hundred million people had contributed to the March of Dimes, and seven million had donated their time and labor as well.^[18] They included fund-raisers, committee workers, and volunteers at clinics and record centers.

Doris Fleischer, a disability historian, noted that O'Connor was willing to take whatever risks necessary to serve the purposes of the foundation. She writes, "When O'Connor realized that success seemed imminent, he allowed the foundation to go into debt to finance the final research required to develop the Salk vaccine. His 'passionate' devotion to this task became almost 'obsessive' when his daughter, a mother of five, told him that she had contracted the illness, saying, 'I've gotten some of your polio.' "^[28]

With the hopes of the world upon him, "Salk worked sixteen hours a day, seven days a week, for years...", wrote Denenberg.^[24] It had been, Salk later described, "two and a half years of drudgery and hard work."^[7]:44 The results of the tests were eventually deemed successful and, O'Neill wrote, "Salk had justified Basil O'Connor's faith."^[18]

The research by Salk was not without controversy. Esther Lederberg's research with lambda phage and plasmids was well known and used by Salk. However, Dr. Esther Lederberg felt that Salk needed detailed records to ensure that his vaccine was as effective as claimed.^[29]

Discovering a vaccine[link]

Newspaper headlines about polio vaccine tests (13 April 1955).

Test results announced[link]

On April 12, 1955, Dr. Thomas Francis, Jr., of the University of Michigan, the monitor of the test results, "declared the vaccine to be safe and effective." The announcement was made at the University of Michigan, exactly 10 years to the day after the death of President Roosevelt. Five hundred people, including 150 press, radio, and television reporters, filled the room; 16 television and newsreel cameras stood on a long platform at the back; and 54,000 physicians, sitting in movie theaters across the country, watched the broadcast on closed-circuit television. Eli Lilly and Company paid $250,000 to broadcast the event. Americans turned on their radios to hear the details, department stores set up loudspeakers, and judges suspended trials so that everyone in the courtroom could hear. Europeans listened on the Voice of America. Paul Offit writes about the event:

Shopkeeper expresses a nation's gratitude for Dr. Salk's discovery (13 April 1955).

"The presentation was numbing, but the results were clear: the vaccine worked. Inside the auditorium Americans tearfully and joyfully embraced the results. By the time Thomas Francis stepped down from the podium, church bells were ringing across the country, factories were observing moments of silence, synagogues and churches were holding prayer meetings, and parents and teachers were weeping. One shopkeeper painted a sign on his window: Thank you, Dr. Salk. 'It was as if a war had ended', one observer recalled."^[27]:56

"The report", wrote The New York Times, "was a medical classic." Dr. Francis reported that the vaccinations had been 80 to 90 percent effective on the basis of results in eleven states. Overall, the vaccine was administered to over 440,000 children in forty-four states, three Canadian provinces and in Helsinki, Finland,^[3] and the final report required the evaluation of 144,000,000 separate items of information. After the announcement, when asked whether the effectiveness of the vaccine could be improved, Salk said, "Theoretically, the new 1955 vaccines and vaccination procedures may lead to 100 percent protection from paralysis of all those vaccinated."^[30]

The nation celebrates[link]

Dr. Jonas Salk receiving a Gold Medal from President Eisenhower (27 January 1956).

Within minutes of Francis's declaration that the vaccine was safe and effective, the news of the event was carried coast to coast by wire services and radio and television newscasts. According to Debbie Bookchin, "across the nation there were spontaneous celebrations... business came to a halt as the news spread. The mayor of New York City interrupted a city council meeting to announce the news, adding, 'I think we are all quite proud that Dr. Salk is a graduate of City College.'"^[7]:46 "By the next morning", writes Bookchin, "politicians around the country were falling over themselves trying to figure out ways they could congratulate Salk, with several suggesting special medals and honors be awarded.... In the Eisenhower White House, plans were already afoot to present Salk a special presidential medal designating him "a benefactor of mankind" in a Rose Garden ceremony.

It was also declared "a victory for the whole nation." Jonas Salk became "world famous overnight and was showered with awards", writes O'Neill. The governor of Pennsylvania had a medal struck, and the state legislature gave him a chaired professorship. However, New York City could not get him to accept a ticker tape parade. Instead New York created eight "Jonas Salk Scholarships" for future medical students. He received a Presidential Citation, the nation's first Congressional Medal for Distinguished Civilian Service, and a large number of honorary degrees and related honors.^[18]:138

According to O'Neill, "April 12th had almost become a national holiday: people observed moments of silence, rang bells, honked horns, blew factory whistles, fired salutes, kept their red lights red in brief periods of tribute, took the rest of the day off, closed their schools or convoked fervid assemblies therein, drank toasts, hugged children, attended church, smiled at strangers, and forgave enemies."^[18]:138

By July, movie studios were already fighting for the motion-picture rights to his film biography. Twentieth Century-Fox began writing a screenplay and Warner Brothers filed a claim to the title The Triumph of Dr. Jonas Salk shortly after the formal announcement of the vaccine.^[31]

Global acceptance and hope[link]

Six months before Salk's announcement, optimism and hope were so widespread that the Polio Fund in the U.S. had already contracted to purchase enough of the Salk vaccine to immunize 9,000,000 children and pregnant women the following year.^[32] And around the world, the official news prompted an immediate international rush to vaccinate. Medical historian Debbie Bookchin writes, "Israel had committed to the Salk vaccine just days before the final report was released, and now Canada, Sweden, Denmark, Norway, West Germany, the Netherlands, Switzerland, and Belgium all announced plans to either immediately begin polio immunization campaigns using Salk's vaccine or to gear up to quickly do so. "Overnight", she adds, "Salk had become an international hero and a household name. His vaccine was a modern medical miracle."^[7]:47 Because he was the first to prove that a killed-virus could prevent polio, medical historian Paul Offit wrote in 2007 that "for this observation alone, Salk should have been awarded the Nobel Prize.^[27] Virologist Isabel Morgan had earlier shown and published that a killed-virus could prevent polio, although she did not test her vaccines on humans. Morgan's work, nonetheless, was a key link in the chain of progress toward the killed-virus polio vaccine for humans later developed and tested by Salk.

By the summer of 1957, over two years later, 100 million doses had been distributed throughout the United States and "reported complications following their administration have been remarkably rare", noted the scientists at the International Polio Conference in Geneva. Scientists from other nations reported similar experiences: Denmark, for example, "reported only a few sporadic cases among the 2,500,000 ... who received the vaccine." Australia reported virtually no polio during her past summer season.^[33]

Other countries where the vaccine was not yet in use suffered continued epidemics, however. In 1957, Hungary, for example, reported a severe epidemic requiring emergency international assistance. By the first half of the year they had 713 reported cases and a death rate of 6.6%, and the peak infection months of summer were still ahead. Canada sent a shipment of vaccine to Hungary by a refrigerated plane, and Britain and Sweden sent iron lungs. A few years later, during a polio outbreak in Canada, "masked bandits" stole 75,000 Salk vaccine shots from a Montreal university research center.^[34]

Worldwide eradication successes[link]

By the end of 1990 it was estimated that 500,000 annual cases worldwide of paralysis as result of polio had been prevented due to immunization programs carried out by WHO, UNICEF, and many other organizations. In developing countries, estimates ran as high as 350,000 cases each year in 1988.^[35] As a result, in 2002, more than 500 million children were immunized in 93 countries,^[19]:112 and by December 2002, there were only 1,924 cases worldwide, with 1,599 of them in India. However, there were still six other countries where polio is suspected of being endemic: Afghanistan, Egypt, Niger, Nigeria, Pakistan, and Somalia.^[36] In 1991 transmission of polio was declared as "interrupted" in the Western hemisphere.

China

In 1993, China initiated a national immunization program with over 80 million children getting vaccinated in just 2 days; by the following year the country reported only 5 cases of polio.^[37]

Africa

In 2003, after an outbreak in Nigeria, international organizations spent $10 million to vaccinate 15 million children in Nigeria and neighboring countries.^[19]:112

Latin America

During the 1970s, Latin America had an estimated 15,000 paralysis cases with about 1,750 deaths each year from polio. By 1991, the last case of polio was reported in Latin America and the Caribbean, and polio has now been declared as fully eliminated from the region.^[38]

Remaining eradication efforts[link]

In 1988 numerous international medical organizations launched a campaign to eradicate polio globally, as was successfully done for smallpox. By 2003 polio had been eradicated in all but a few countries, among them Afghanistan, India, Nigeria, and Pakistan^[39] However, mullahs in northern Nigeria began to oppose the vaccination program, claiming that it was a plot to spread AIDS and sterility, and prevented any vaccination. Polio cases in Nigeria tripled over the next three years.^[39]

Environmental scientist Lester Brown speculates that Nigerian Muslims may have spread the disease to Muslims of other polio-free countries during their annual pilgrimage to Mecca, in Saudi Arabia. With these same fears, Saudi Arabian officials imposed polio vaccination requirement on certain visitors.

In Pakistan in 2007, there was violent opposition to vaccinations in the Northwest Frontier Province where a doctor and a health worker in the Polio Eradication Program were killed. Since then, the Taliban has blocked all vaccinations in the Swat Valley of Pakistan. As a result, Pakistan was the only country in 2010 to record an increase in cases of polio, according to the World Health Organisation, along with having the highest incidence of polio in the world.^[40]

In India, Microsoft co-founder Bill Gates is helping sponsor a campaign to eradicate polio, and whose Bill & Melinda Gates Foundation committed nearly $1 billion to health and development projects throughout India. As a result, the number of cases has dropped by over 50% since 2002.^[41]

New medical research projects urged[link]

Just two weeks after the vaccine was announced, Senator Hubert H. Humphrey (Democrat, Minnesota) urged President Dwight D. Eisenhower "to show the nation's gratitude to Dr. Jonas E. Salk for his new polio vaccine by 'loosening the purse-strings' on Federal medical research."^[42] Salk knew it would take time to verify his theories and improve the vaccine. "He still wants to find out a number of things about polio", wrote The New York Times that summer. Questions remained: "How long will the immunity last? Are there any children who cannot be immunized? What improvements can be made?" Beyond that, "he has far bigger goals—'more in the nature of dreams right now'—involving other diseases."^[26]

Over the next few years, while trying to perfect the polio vaccine, Salk had begun working unannounced, on a cure for cancer. A 1958 article in The New York Times confirmed "that he had been conducting experiments on cancer patients." The news was leaked after a Pittsburgh newspaper, the Sun-Telegraph, reported that he had been giving injections to children suffering from cancer. Salk stated afterwards, "It is true that we have been conducting experiments in many persons with a variety of cancer and cancer-like conditions ... but we have no treatment for cancer. Our studies are of a strictly exploratory nature..."^[43] In 1965, he also said "a vaccine for the common cold is a matter of time and of solving some technical problems."^[44]

Final conquest of polio and the Sabin vaccine controversy[link]

U.S. postage stamp, 1959

Years before the Salk vaccine was officially announced as safe, Dr. Albert Sabin had also joined in the search for a vaccine, using a live-virus, as opposed to Salk's killed-virus. Sabin, however, had been "openly hostile to Salk." Debbie Bookchin writes that he had been "perhaps accurately guessing that Salk was about to challenge him for ascendancy in the polio world." After one presentation that Salk made to a medical conference, "Sabin mounted a full-scale offensive, engaging in a piecemeal demolition of his presentation."^[7] However, the National Foundation "swiftly put its full weight behind Salk. Here, finally, was a polio researcher, they said, who had accomplished something."^[7]

By 1962 polio had almost become extinct, with only 910 cases reported that year—down from 37,476 in 1954. "It's a matter of principle", Salk said. "It is not a Salk versus Sabin controversy, a competition between two people... I had worked with influenza viruses, helping to establish the efficacy of a killed-virus vaccine... I demonstrated that it could be 100 percent effective if the quantity of virus in the vaccine was sufficient."^[45] That same year the state of New York Health Department recommended "that the Salk vaccine be given preference over the Sabin oral vaccine..."^[46]

On October 20, 1998, after eighteen years of using the Sabin vaccine, however, the federal government recommended that children use the Salk vaccine exclusively. Sabin's polio vaccine is no longer available in the United States.^[27]:127[47]

While OPV is not recommended by the CDC, its website explained that Sabin's OPV is more suited to areas where polio is endemic, because of "its advantages over IPV in providing intestinal immunity and providing secondary spread of the vaccine to unprotected contacts."^[48]

Looking back—Public confusion over which vaccine to use

In September 1962, public health officials in the U.S. and Canada faced a "major dilemma": whether or not to continue using the recently begun Sabin vaccine inoculations, until further studies were conducted, due to reports of polio cases among persons who had received it. The U.S. Surgeon General, Luther Terry, recommended a temporary halt due to sixteen cases of confirmed polio in adults. And "the Canadian Federal Health Department recommended against mass use of the [Sabin] oral vaccine pending further study of its effects." One of the unfortunate results caused by the controversy was that "many authorities have deplored the confusion that has been created in the public mind."^[49]

Due to the American Medical Association's (AMA) "obstructive tactics, however, which caused numerous delays", writes O'Neill, the AMA had called for mass vaccinations in early 1962 employing Sabin's vaccine rather than Salk's. However, writes O'Neill, "as live-virus was more dangerous, it caused an unknown number of polio cases... [but] the medical establishment seemed not to mind, having gotten its own way at last." But, concludes O'Neill, "polio was conquered all the same, even if not so quickly and safely as it might have been."^[18]:139

In 1980, Salk pointed out the renewed interest in his killed virus vaccine, particularly in developing countries. "The live virus vaccine is highly effective in developed countries ...", he said, "but in the developing countries, where polio is on the increase, the drawback is that the live virus fails to establish the infection that leads to immunity because of intestinal inhibitors in the population."^[45] Recent evidence of this was found in Iran, where a number of children receiving the oral vaccine became infected with polio, leading Iranian researchers to recommend using the killed virus in the future.^[50]

Basil O'Connor enters the controversy

Two months after the Salk vaccine was announced to the world, in 1955, Basil O'Connor found it necessary to respond to critics of the vaccine, especially Dr. Sabin. As the President of the National Foundation for Infantile Paralysis, he said, during a news conference before a Congressional group in Washington, that "criticism of the Salk vaccine program by Dr. Albert Sabin of the University of Cincinnati was 'old stuff'." According to The New York Times, "Dr. Sabin recommended at a hearing before a House Investigating subcommittee that Salk inoculations be suspended" until a safer preparation could be perfected.^[51] O'Connor responded in a prepared statement: (excerpt)

"He's been using it [criticism] for years. He used it in an attempt to stop the field trials of the Salk vaccine... The Salk vaccine is safe and effective and will protect children from paralytic polio to the extent of 60 to 90 percent... In the United States, Canada and Denmark, 7,675,000 children have actually received the Salk vaccine with no untoward results. There could be no better proof of its safety than this. No vaccine in the history of the world has ever had such a test for safety. Anyone who would seek to prevent its use for other than unanswerable scientific reasons would be acting neither as a scientist nor as a humanitarian....

"Those who would prevent its use must be prepared to be haunted for life by the crippled bodies of little children who could have been saved from paralysis had they been permitted to receive the Salk vaccine."^[51]

However, a year and a half after the Salk vaccine was introduced, a Sabin vaccine had still not yet been tested on humans. Sabin himself said, in October 1956, that "the Salk vaccine is still the only protection against polio available to the public." He was hoping to be able to start tests on humans by the end of the year or by 1957.^[52]

The Cutter incident[link]

In 1955 Cutter Laboratories was one of several companies licensed by the United States government to produce Salk's polio vaccine. In what came to be known as the Cutter Incident, a production error caused some lots of the Cutter vaccine to be tainted with live polio virus. It was one of the worst pharmaceutical disasters in U.S. history and caused several thousand children to be exposed to live polio virus, causing 56 cases of paralytic polio and 5 deaths.^[53]

10th anniversary ceremonies[link]

On April 12, 1965, leaders of the Senate and House presented Salk with a joint resolution expressing the nation's gratitude to him, his colleagues in the project and the March of Dimes, which helped to finance the work. President Lyndon B. Johnson called him to the White House to congratulate him personally. Dr. Luther Terry, Surgeon General of the United States said in a statement marking the anniversary that only 121 cases of polio were reported the previous year, as opposed to more than 28,000 ten years ago. "This represents an historic triumph of preventive medicine—unparalleled in history", Dr. Terry said.^[44]

30th anniversary—"Jonas Salk Day"[link]

On May 6, 1985, President Ronald Reagan proclaimed that day to be "Jonas Salk Day."

One of the greatest challenges to mankind always has been eradicating the presence of debilitating disease. Until just thirty years ago poliomyelitis occurred in the United States and throughout the world in epidemic proportions, striking tens of thousands and killing thousands in our own country each year. Dr. Jonas E. Salk changed all that. This year we observe the 30th anniversary of the licensing and manufacturing of the vaccine discovered by this great American. Even before another successful vaccine was discovered, Dr. Salk's discovery had reduced polio and its effects by 97 percent. Today, polio is not a familiar disease to younger Americans, and many have difficulty appreciating the magnitude of the disorder that the Salk vaccine virtually wiped from the face of the Earth.

Jonas E. Salk always had a passion for science. It was because of this that he finally chose medicine over law as his career goal. Even after his great discovery, he continued to undertake vital studies and medical research to benefit his fellow man. Under his vision and leadership, the Salk Institute for Biological Studies has been in the forefront of basic biological research, reaping further benefits for mankind and medical science.

In recognition of his tremendous contributions to society, particularly for his role in the epochal discovery of the first licensed vaccine for poliomyelitis, and in celebration of the thirtieth anniversary of its mass distribution, the Congress, by House Joint Resolution 258, has designated May 6, 1985, as "Dr. Jonas E. Salk Day" and authorized and requested the President to issue a proclamation in observance of this event. Now, Therefore, I, Ronald Reagan, President of the United States of America, do hereby proclaim May 6, 1985, as Dr. Jonas E. Salk Day. I urge the people of the United States to observe the day with appropriate tributes, ceremonies, and activities throughout the Nation and by paying honor, at all times, to this outstanding physician and to his life's work. In Witness Whereof, I have hereunto set my hand this sixth day of May, in the year of our Lord nineteen hundred and eighty-five, and of the Independence of the United States of America the two hundred and ninth.^[54]

Becoming a public figure[link]

Celebrity versus privacy[link]

With David Ben-Gurion in Jerusalem, 1959

Salk preferred not to have his career as a scientist affected by too much personal attention, as he had always tried to remain independent and private in his research and life. But this proved to be impossible. "Young man, a great tragedy has befallen you—you've lost your anonymity", the late television personality Ed Murrow said to Salk shortly after the onslaught of media attention.^[45] When Murrow asked him, "Who owns this patent?", Salk replied, "No one. Could you patent the sun?"^[55]

Author Jon Cohen noted that "Jonas Salk made scientists and journalists alike go goofy. As one of the only living scientists whose face was known the world over, Salk, in the public's eye, had a superstar aura. Airplane pilots would announce that he was on board, and passengers would burst into applause. Hotels routinely would upgrade him into their penthouse suites. A meal at a restaurant inevitably meant an interruption from an admirer... and scientists approached him with drop-jawed wonder, as though some of the stardust might rub off."^[56]

For the most part, however, Salk was "appalled at the demands on the public figure he has become and resentful of what he considers to be the invasion of his privacy", wrote The New York Times, a few months after his vaccine announcement.^[26] The Times article noted that "at 40, the once obscure scientist ... was lifted from his laboratory almost to the level of a folk hero." He received a Presidential citation, a score of awards, four honorary degrees, half a dozen foreign decorations, and letters from thousands of fellow citizens. His alma mater, City College of New York, gave him an honorary degree as Doctor of Laws. But "despite such very nice tributes", The New York Times wrote, "Salk is profoundly disturbed by the torrent of fame that has descended upon him.... He talks continually about getting out of the limelight and back to his laboratory... because of his genuine distaste for publicity, which he believes is inappropriate for a scientist."^[26]

During a 1980 interview, 25 years later, he said, "It's as if I've been a public property ever since, having to respond to external as well as internal impulses.... It's brought me enormous gratification, opened many opportunities, but at the same time placed many burdens on me. It altered my career, my relationships with colleagues; I am a public figure, no longer one of them."^[45]

Maintaining his individuality[link]

"If Salk the scientist sounds austere", wrote The New York Times, "Salk the man is a person of great warmth and tremendous enthusiasm. People who meet him generally like him." A Washington newspaper correspondent commented, "He could sell me the Brooklyn Bridge, and I never bought anything before." Award-winning geneticist Walter Nelson-Rees called him "a renaissance scientist: brilliant, sophisticated, driven... a fantastic creature."^[57]:127

He enjoys talking to people he likes, and "he likes a lot of people", wrote the Times. "He talks quickly, articulately, and often in complete paragraphs." And, notes the Times, "He has very little perceptible interest in the things that interest most people—such as making money." That belongs "in the category of mink coats and Cadillacs—unnecessary", he said.^[26]

Establishing the Salk Institute[link]

In the years after his discovery, many supporters, in particular the National Foundation, "helped him build his dream of a research complex for the investigation of biological phenomena 'from cell to society'." It was called the Salk Institute for Biological Studies and opened in 1963 in the San Diego neighborhood of La Jolla. Salk believed that the institution would help new and upcoming scientists along their careers as he said himself, "I thought how nice it would be if a place like this existed and I was invited to work there." This was something that Salk was deprived of early in his life, but due to his achievements, was able to provide for future scientists.

In 1966, Salk described his "ambitious plan for the creation of a kind of Socratic academy where the supposedly alienated two cultures of science and humanism will have a favorable atmosphere for cross-fertilization."^[58] Author and journalist Howard Taubman explained:

"Although he is distinctly future-oriented, Dr. Salk has not lost sight of the institute's immediate aim, which is the development and use of the new biology, called molecular and cellular biology, described as part physics, part chemistry and part biology. The broad-gauged purpose of this science is to understand man's life processes.

"There is talk here of the possibility, once the secret of how the cell is triggered to manufacture antibodies is discovered, that a single vaccine may be developed to protect a child against many common infectious diseases. There is speculation about the power to isolate and perhaps eliminate genetic errors that lead to birth defects.

"Dr. Salk, a creative man himself, hopes that the institute will do its share in probing the wisdom of nature and thus help enlarge the wisdom of man. For the ultimate purpose of science, humanism and the arts, in his judgment, is the freeing of each individual to cultivate his full creativity, in whichever direction it leads. . . As if to prepare for Socratic encounters such as these, the institute's architect, Louis Kahn, has installed blackboards in place of concrete facings on the walls along the walks."^[58]

The New York Times, in a 1980 article celebrating the 25th anniversary of the Salk vaccine, described the current workings at the facility:

"At the institute, a magnificent complex of laboratories and study units set on a bluff overlooking the Pacific, Dr. Salk holds the titles of founding director and resident fellow. His own laboratory group is concerned with the immunologic aspects of cancer and the mechanisms of autoimmune disease, such as multiple sclerosis, in which the immune system attacks the body's own tissues.^[45]

In an interview about his future hopes at the institute, he said, "In the end, what may have more significance is my creation of the institute and what will come out of it, because of its example as a place for excellence, a creative environment for creative minds."

Francis Crick, co-discoverer of the DNA molecule, was a leading professor at the institute until his death in 2004.

AIDS vaccine work[link]

Beginning in the mid 1980s, Salk also engaged in research to develop a vaccine for another, more recent plague, AIDS. To further this research, he co-founded The Immune Response Corporation with Kevin Kimberlin, to search for a vaccine, and patented Remune, an immune-based therapy.^[59] The AIDS vaccine project was discontinued in 2007, twelve years after Jonas Salk's death in 1995.

Although many advances have been made in treating AIDS, "the world still waited for the miracle vaccine the conqueror of polio had sought", wrote historian Alan Axelrod.^[60]:294

Salk's "biophilosophy"[link]

Jonas Salk during a 1988 Centers for Disease Control visit

In 1966, The New York Times referred to him as the "Father of Biophilosophy." According to Times journalist and author Howard Taubman, "he never forgets... there is a vast amount of darkness for man to penetrate. As a biologist, he believes that his science is on the frontier of tremendous new discoveries; and as a philosopher, he is convinced that humanists and artists have joined the scientists to achieve an understanding of man in all his physical, mental and spiritual complexity. Such interchanges might lead, he would hope, to a new and important school of thinkers he would designate as biophilosophers."^[58]

Salk describes his "biophilosophy" as the application of a "biological, evolutionary point of view to philosophical, cultural, social and psychological problems." He went into more detail in two of his books, Man's Unfolding, and The Survival of the Wisest. In an interview in 1980, he described his thoughts on the subject, including his feeling that a sharp rise and an expected leveling off in the human population would take place and eventually bring a change in human attitudes:

"I think of biological knowledge as providing useful analogies for understanding human nature.... People think of biology in terms of such practical matters as drugs, but its contribution to knowledge about living systems and ourselves will in the future be equally important.... In the past epoch, man was concerned with death, high mortality; his attitudes were antideath, antidisease", he says. "In the future, his attitudes will be expressed in terms of prolife and prohealth. The past was dominated by death control; in the future, birth control will be more important. These changes we're observing are part of a natural order and to be expected from our capacity to adapt. It's much more important to cooperate and collaborate. We are the co-authors with nature of our destiny."^[45]

His definition of a "bio-philosopher" is "Someone who draws upon the scriptures of nature, recognizing that we are the product of the process of evolution, and understands that we have become the process itself, through the emergence and evolution of our consciousness, our awareness, our capacity to imagine and anticipate the future, and to choose from among alternatives."^[61]

Personal life[link]

The day after his graduation from medical school, Salk married Donna Lindsay, a master's candidate at the New York College of Social Work. David Oshinsky writes that her father, Elmer Lindsay, "a wealthy Manhattan dentist, viewed Salk as a social inferior, several cuts below Donna's former suitors." Eventually, her father agreed to the marriage on two conditions: first, Salk must wait until he could be listed as an official M.D. on the wedding invitations, and second, he must improve his "rather pedestrian status" by giving himself a middle name."^[8]

They had three children: Peter, Darrell, and Jonathan Salk. In 1968, they divorced, and in 1970 Salk married Françoise Gilot, the former mistress of Pablo Picasso.

Jonas Salk died from heart failure at the age of 80 on June 23, 1995 in La Jolla^[62] and was buried at El Camino Memorial Park in San Diego.^[63]

Honors and recognition[link]

• 1955, one month after the vaccine announcement, he was honored by the Commonwealth of Pennsylvania, where he was given their "highest award for services" by Governor George M. Leader, Meritorious Service Medal, where the governor added,

"... in recognition of his 'historical medical' discovery... Dr. Salk's achievement is meritorious service of the highest magnitude and dimension for the commonwealth, the country and mankind." The governor, who had three children, said that "as a parent he was 'humbly thankful to Dr. Salk,' and as Governor, 'proud to pay him tribute'."^[64]

• 1955, City University of New York city creates the Salk Scholarship fund which it awards to multiple outstanding pre-med students each year
• 1956, awarded the Lasker Award;
• 1957, the Municipal Hospital building, where Salk conducted his polio research at the University of Pittsburgh, is renamed Jonas Salk Hall and is home to the University's School of Pharmacy and Dentistry.^[65]
• 1958, awarded the James D. Bruce Memorial Award;

Salk's bronze bust in the Polio Hall of Fame

• 1958, elected to the Polio Hall of Fame, which was dedicated in Warm Springs, Georgia;
• 1975, awarded the Jawaharlal Nehru Award and the Congressional Gold Medal;
• 1976, Jonas Salk received the Academy of Achievement's Golden Plate Award;
• 1976, named the Humanist of the Year by the American Humanist Association;
• 1977, awarded the Presidential Medal of Freedom from President Jimmy Carter, with the following statement accompanying the medal:

"Because of Doctor Jonas E. Salk, our country is free from the cruel epidemics of poliomyelitis that once struck almost yearly. Because of his tireless work, untold hundreds of thousands who might have been crippled are sound in body today. These are Doctor Salk's true honors, and there is no way to add to them. This Medal of Freedom can only express our gratitude, and our deepest thanks."

• 1996, The March of Dimes Foundation created an annual $250,000 cash "Prize" to outstanding biologists as a tribute to Salk^[66]
• 2006, the United States Postal Service issued a 63 cent Distinguished Americans series postage stamp in his honor.
• 2007, California Governor Arnold Schwarzenegger and First Lady Maria Shriver inducted Salk into the California Hall of Fame^[67]
• 2009, BBYO boys chapter chartered in his honor in Scottsdale, Arizona, Named "Jonas Salk AZA #2357"
• Schools in Mesa, Arizona; Spokane, Washington; Tulsa, Oklahoma; Bolingbrook, Illinois; Levittown, New York; Old Bridge, New Jersey; Merrillville, Indiana, and Sacramento, California, are named after him.

Documentary films[link]

• In early 2009, the American Public Broadcasting Service (PBS), aired its new documentary film, American Experience: The Polio Crusade.^[2] The documentary, available on DVD, can also be viewed online: PBS video, 1 hr.

• In the summer of 2009, the new film by Michael Moore, Capitalism: A Love Story , includes a segment about Salk. According to Moore's website, "One of the film's heroes is polio researcher Dr. Jonas Salk, who could have enriched himself by claiming patent rights to his vaccine. He gave it away for free. Saving millions from paralysis and death was reward enough."^[68]

• On April 12, 2010, to help celebrate the 55th anniversary of the Salk vaccine, a new 66-minute documentary, The Shot Felt 'Round the World', had its world premiere. Directed by Tjardus Greidanus^[69] and produced by Laura Davis,^[70] the documentary was conceived by Hollywood screenwriter and producer Carl Kurlander to bring "a fresh perspective on the era."^[71]

Salk's book publications[link]

• Man Unfolding (1972)
• Survival of the Wisest (1973)
• World Population and Human Values: A New Reality (1981)
• Anatomy of Reality: Merging of Intuition and Reason (1983)

See also[link]

• Lee Salk

References[link]