If this was 1950, parents all over the state would be losing sleep over this week’s polio infection in New York’s Rockland County. The poliomyelitis epidemic that hit the state in June-October 1916 killed 6000 during those six months and left some 24,000 people paralyzed. In New York City alone, 2400 people died of the disease during the 1916 outbreak—with children under the age of five (always the most vulnerable to the disease) comprising 80% of the mortalities. And that was merely one among many periodic polio outbreaks that surged through the country before the Salk vaccine was introduced in 1955.
Today, more children are vaccinated for polio than they are for any other disease, with 92% of school-age children receiving at least three doses by the age of 24 months. While the 20th-century polio outbreaks killed far fewer kids each year than accidents or cancer, the danger that one’s child might end up immobilized in an “iron lung” or dying as their breathing muscles succumbed to paralysis cast a shadow over summer holidays for many parents. Their dread was exacerbated by the fate of many survivors, as an average of 35,000 people were left disabled by the illness every year. Like Covid-19, there is no cure for poliomyelitis so public health officials focused on preventive measures, and until the controversial campaign of nurse Sister Kenny, “treatment” often consisted of immobilizing children in splints.
Once the Salk vaccine was established and perfected, deaths and paralysis quickly dropped. And as the potential consequences of not vaccinating one’s children for poliomyelitis are so devastating, states soon began to mandate the vaccine for children in public schools. Still, like most vaccines, the Salk faced a variety of challenges. The best-known is the notorious Cutter Laboratories incident in 1954, in which 200,000 children in midwestern and western states received the vaccine with a still-active virus. Some 40,000 were infected; 200 were left with some form of paralysis, and 10 died of the disease. To prevent similar (or worse) tragedies, the federal government created the Division of Biologics Standards to provide more stringent oversight of manufacturing processes and vaccine purity (the Division later became part of the FDA’s Center for Biologics Evaluation and Research (CBER)).
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The launch of the Salk vaccine also had to contend with the usual reactions to a new vaccine. Although there was no opportunity to blame a “deep state”—the March of Dimes was the main force behind the original polio vaccination program—the prospect of a population being injected with a new and unfamiliar drug inevitably makes many people fearful. As schools started to get their ducks in a row for a full-scale launch in April 1954, national media figure and radio announcer Walter Winchell (who had misinterpreted data from the vaccine trials) told millions of listeners that the new vaccine “May be a killer… The U.S. Public Health Service tested ten batches… found that seven contained live, not dead, polio virus. It killed several monkeys …”
Child receives Sabin polio vaccine (orally administered; often administered on sugar cubes).
The trusted broadcaster frightened many parents into refusing permission, but as with previous vaccine/inoculation scares the public ultimately realized that the disease was infinitely more frightening than a vaccine that could help to prevent it. By 1961, 53% of the US population had received the vaccine. There were 1312 cases and 90 recorded deaths that year. Six years later, in 1967, the number of cases and deaths fell to 41 and 16 respectively; in the 1980s there was just one death on record, and the last poliomyelitis case originating in the US occurred in 1979 (see Our World in Data). In fact, the vaccine is so robust that even when mandatory vaccinations were halted by a regulation-averse government between 1986 and 1991, polio failed to make a comeback even as cases of measles, mumps, and rubella enjoyed a strong resurgence.
Interestingly, the case that emerged in New York this week originated with a patient who had been vaccinated in a country that uses the Sabin vaccine, which was only briefly used in the US when the Cutter infection event made people regard the Salk with suspicion. The Salk is made from an inactivated virus, while the Sabin vaccine uses a weakened but live form of the virus. The CDC’s sequencing determined that the infection was transmitted via a revertant (mutated) Sabin poliovirus.
Outside the US, the WHO considers both formulas to be safe and effective, but prefers the Sabin as it is administered orally (some elderly Americans still recall receiving the vaccine on sugar cubes in the 1950s), which makes it much easier to administer in mass vaccination programs. However, the New York case illustrates the caveat about the oral vaccine: communities with low vaccination rates give the virus just enough “breathing room” to survive. As it is slowly transmitted from one unvaccinated child to another, the virus mutates and can eventually hit on a form that causes paralysis just like the “wild” polio virus. This probably sounds hauntingly familiar to most nurses, but it may be heartening to keep in mind that since the formation of the Global Polio Initiative in 1988, polio cases worldwide have plummeted by 99%.
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