HEALTH CARE/Joan Retsinas

Polio: Lessons for Today

Today many Americans distrust science, government, and this country’s social mores. We hear the drumbeat of “No” to vaccinations, to government-sponsored anything, to the changing notions of “family” as gender and sexual orientation break new cultural ground.

For those distrusters, I recommend Polio: An American Story. In recounting the campaign to stop polio, historian David Oshinsky puts to rest some myths that need, once again, to be put to rest.

1) Soap conquers all, or sanitation will guard against disease. The truth is that while sanitation can ward off a host of diseases, it will not ward off all of them. Polio (like measles) is one. Polio has been endemic for centuries. (Egyptian drawings show children probably infected with the virus). Most people would have a fever, a headache, then recover. But in the United States starting in 1916, physicians noted spikes. Even at its height in the 1950s, more children died from accidents; but “infantile paralysis” galvanized the nation, leaving some children dead, with withered limbs, or encased in iron lungs.

Early on, people assumed that polio would respond to intense hygiene. Stores offered free DDT, so parents could spray their homes. Some people blamed slum-dwelling immigrants. Some towns issued quarantines, barring newcomers from entering. Yet the statistics belied those precautions: middle class children were contacting polio, more than their immigrant counterparts. Children in isolated communities were contacting polio. And “good” (middle-class) parenting, with careful hygiene and nutrition, seemed to make children more vulnerable.

2) Experts can find a cure for most diseases. Polio, like measles today, had no effective treatment. Warm packs may have comforted children, but did not stay the effects. Families waited and watched. The nation’s most famous polio patient, Franklin Roosevelt, almost died. Scientists had recently developed penicillin and streptomycin; but those miracle drugs did not cure polio.

To compound the misery, scientists understood little about the virus. Did it enter through the nose? The mouth? How many types were there? Did it enter the bloodstream? Why were children disproportionately affected, at least in the early years of the epidemics? Why more boys than girls? Why did some children recover quickly?

Initially the National Association for Infantile Paralysis funded basic research into this virus; but, as the toll of crippled and dead patients mounted, the National Association switched focus: the goal was a vaccine. Scientists had developed vaccines for yellow fever and influenza; polio would be next. Admittedly, vaccination introduces the disease into the body (the debate over killed versus live virus continued for years) – an idea that frightened parents; but the consequences of the disease frightened them more.

3) Religious, ethnic, and political “screens” for scientists matter. For polio researchers, the screens mattered. Both Jonas Salk and Albert Sabin were Jewish, the sons of Eastern European immigrants. Salk in particular faced entrenched anti-Semitism: most American medical schools had quotas, as did residency programs. When he was hired to head a department, scientists discussed his ethnicity. After World War II, the McCarthy-era vigilantism hung over Salk: his wife, a Smith-educated social worker, had endorsed “left-wing” causes, bringing the couple under the radar of J. Edgar Hoover, who, even when President Eisenhower feted Dr. Salk at the White House, sent a cautionary note to the President. In retrospect, this “screen” seems ridiculous.

Today some are erecting a “sexual orientation” screen. Consider Indiana: would parents living there want to reject physicians who were gay? Transgender? Would parents want to delay a scientific breakthrough because of this screen?

4) Government is inefficient; the private sector can best battle disease. without governmental encumbrances. Initially, with polio, the private sector emerged as the champion. The National Alliance for Infantile Paralysis, headed by President Roosevelt’s former law partner, raised millions of dollars, galvanized millions of volunteers. The Mothers’ March, the campaign for dimes (President Roosevelt is on today’s dimes), the local chapters – the National Alliance set the standard for philanthropy. And it eschewed government support. Indeed, its private sector moorings left it flexible to fund the projects it wanted, plus pay for patients’ iron lungs, crutches, hospital stays.

But when the time came to make, and distribute, a vaccine to millions of schoolchildren, the nation turned to the newly-formed Department of Health, Education and Welfare. The federal government had never assumed such a role. Not surprisingly, it trusted the private-sector drug companies to abide by the strict manufacturing protocols laid down by Drs. Salk et al. And, maybe not surprisingly for this first foray of government into oversight, government failed. One small California manufacturer did not follow protocols; but, without rigorous on-site inspections, nobody recognized the failure until the morbidity and mortality tolls spiked. (The first trial included children injected with a placebo, so that researchers could evaluate the worth and safety of the vaccine). After some children contacted a virulent form of polio, the company ceased production; key HEW officials resigned; and the trials stopped for a year, until HEW asserted itself as stringent overseer.

In short, we needed the government’s help to vanquish polio. Researchers from diverse backgrounds collaborated to “solve” polio, not by curing it, but by developing a vaccine to prevent it. And government spread that vaccine throughout the country. Today we see iron lungs only in museums.

As the nation faces a recurrence of not just measles, but whooping cough, the tale of polio bears remembering.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, May 15, 2015

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