Get Well Soon

by Jennifer Wright

  It was this foundation that helped fund Jonas Salk’s research for a polio vaccine.

  Jonas Salk is often remembered as the closest you can come to a secular saint in U.S. history, but he started life as a regular kid growing up in New York. Salk was born in 1914 in New York City, after his family moved to the United States from Russia to avoid persecution for their Jewish faith. That was only two years before polio epidemics would make their entrance in America; 2,343 people would die of polio in New York in 1916. Salk did not care about this problem because he was two. All you care about at age two is whether or not you can eat paste. However, Salk’s mother, Dora, was very concerned about the outbreak and responded by fastidiously cleaning the apartment, making everyone remove their shoes before entering, and isolating Jonas from other children. Certainly, the fear of polio was something that influenced his upbringing, as did the threat of influenza, because the Spanish flu broke out when Jonas was four. His early life would be defined by fear of disease.

  No wonder he wanted to be a doctor. Salk was something of a wunderkind and was accepted to the City College of New York at age fifteen. By age nineteen he was studying for his medical degree at the New York University (NYU) School of Medicine. He chose NYU in large part because it didn’t discriminate against Jews—unlike, for instance, Yale, where the dean decreed that no more than five Jews would be accepted out of all applicants per year. (Jews had it slightly better than Irish Catholics—only two of them were allowed admittance.) Salk loved medical school and excelled in his studies. He recalled: “At the end of my first year of medical school, I received an opportunity to spend a year in research and teaching biochemistry. At the end of that year I was told I could, if I wished, switch and get a PhD in biochemistry but my preference was to stay with medicine. And I believe all this was linked to my original ambition, or desire, which was to be of some help to humankind.”20

  During his final year in medical school, Salk would meet his mentor, Dr. Thomas Francis, who was attempting to create a flu vaccine. Salk was exceedingly enthusiastic about this project; Dr. Francis would later note, “Dr. Salk is a member of the Jewish race but has, I believe, a very great capacity to get on with people.”21

  It may seem I am hanging a lot of Salk’s story on his Jewishness, but it did have a considerable influence. By the early twentieth century society had stopped burning Jews to try to eradicate the bubonic plague, but it was still extremely anti-Semitic, and not just in Germany. Just as FDR’s life would help alter society’s perception of people with disabilities, Salk’s would play a role in the United States becoming slightly more tolerant.

  However, his legacy is not completely spotless. By 1942 Dr. Francis had become head of the Department of Epidemiology at the University of Michigan. He asked Salk to work in his lab because thousands of soldiers were dying of influenza and they desperately needed a vaccine. That is a noble goal. Unfortunately, it led to an extreme lapse of ethical judgment on Salk’s part (which is the first thing antivaccine websites will tell you about his career). Salk participated in a study that injected institutionalized mental patients with an experimental flu vaccine without their consent. Many of them were senile and barely able to describe their symptoms. That behavior was so stupid and evil. If it makes you hate Jonas Salk, that’s fine! By any modern-day ethical standard, Salk’s conduct was appalling. By the standards of the time, it was controversial; you already know from the lobotomy chapter how badly mental patients were treated in the United States during the 1940s. Exploiting people who are already ill, and in need of help, compassion, and respect, is something that should upset people.

  If you want to say you do not care for Salk and skip ahead to the other people involved in this story, that is fine. There are many! Skim right to the Eisenhower stuff! However, I am inclined to believe that the good Salk did in his life outweighs this lapse.

  It is easier for me to continue liking Salk because his influenza vaccine worked. Francis and Salk developed the flu vaccine in 1938, though it’s modified every year because flu strains change annually. They got lucky. If their vaccine had not worked and if the patients had died, Salk and Francis would be monsters. If it did not work and they had screamed, “It works if I say it works!” then they would be Walter Jackson Freeman II.

  Feel free to start using Walter Jackson Freeman II as an insult directed toward people you hate. Almost no one will get the reference, but if I am in the room we’ll high-five and it will be awesome.

  Salk was celebrated for his work on the flu vaccine, and by 1947 he turned his attention to polio. The NFIP funded a lab, and Salk began researching the disease.

  He began working on a killed virus vaccine. There are both live and killed virus vaccines. The purpose of all vaccines is to expose the body to a weaker version of a disease, which will cause the body to create antibodies to fight that disease. Vaccines in general act like training wheels for your immune system. Live virus vaccines expose the body to a weakened form of a virus. It’s like the way people used to scratch their arms and then rub fluids or pustules from those with smallpox into the cut in order to contract a milder version of the disease, except now the process is much safer. In order to weaken those diseases today, we do not just crush up sick people’s pustules; we generally use processes like breeding the virus in animal—generally chicken—embryos. After a virus has grown in a few embryos, it adapts to become very good at growing in chicken embryos. However, as it does so, it forgets how to grow in humans. So a human patient is injected with the chicken-embryo form of the virus. Your body sees it but kills it easily because it’s a weak pathetic version of a virus that can’t replicate effectively in a human. But now your immune system recognizes that virus, knows how to kill it, and can kill the full-strength virus if you’re ever exposed to it again. The downside to a live virus vaccine is that in extremely rare cases, the chicken-embryo virus can mutate into a more virulent or hostile strain of the disease inside you. Mutation, it must be noted, is incredibly, statistically insignificantly unlikely, and even if it did occur, you still wouldn’t become autistic or experience the other negative outcomes antivaccine proponents try to peddle.

  Live virus vaccines are effective, but Salk wanted to develop a killed virus vaccine. A killed virus vaccine entirely inactivates a virus. Scientists can do that in a few ways, such as exposing the virus to extreme heat or formaldehyde. Therefore, some vaccines contain an extremely diluted amount of formaldehyde, which sounds scary, as formaldehyde in large doses is linked to cancer. However, formaldehyde also occurs naturally in your body and helps you metabolize food. The amount you would find in a vaccine is not even close to the amount that would be dangerous to humans. For some comparison, if this sort of thing interests you, there is a smaller trace amount of formaldehyde in a vaccine than you would find in an apple. (A vaccine contains at most 0.1 milligrams, while your average apple contains 6 milligrams.)22

  An inactivated virus can’t replicate inside you at all. And amazingly, the immune system still recognizes this inactivated virus as a danger and mounts a response against it. That’s great! The downside is that the body doesn’t get quite as good at fighting the virus. If you think of training your body to fight against a significantly weaker opponent with a live virus vaccine, killed virus vaccines are like training your body to fight against a dummy. Killed virus vaccines tend to provide a shorter period of immunity than live virus vaccines, which means, at least at first, that they require booster shots every few years.

  In short, live virus vaccines work better on the first try, which is an advantage if you are in an area where people can’t or won’t come in for yearly booster shots. Killed virus vaccines are a tiny bit safer but require follow-ups.

  While Salk was trying to produce a killed virus vaccine, his rival Albert Sabin, who was also funded by the NFIP to develop a polio vaccine, was trying to produce a live virus vaccine. The two would become bitter rivals, with Sabin referring to Salk as merely “a kitchen chemist.”23
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  If the two were in a race, Salk won. On March 26, 1953, Salk announced on CBS radio that “it has also been shown that the amount of antibody induced by vaccination compares favorably with that which develops after natural infection.” Which meant his vaccine was working.24

  The American people heard Salk’s announcement. Oh, they heard him. The Pittsburgh Sun-Telegraph declared: “This is not only a triumph for American medical research. It is also a triumph for every one of us who has given to the March of Dimes, which made the research possible. The dimes that we gave have produced a dividend of 1,000,000 percent or so in heart-warming experience in shared good.”25

  The only thing left to do was test the vaccine on human volunteers. In a nationwide trial of this experimental vaccine in 1954, American parents volunteered 1.8 million of their children to serve as test subjects; about 600,000 would ultimately be given either the placebo or the experimental polio vaccine. Approximately 325,000 adults—the largest group of volunteers ever assembled in the United States during peacetime—gathered to help administer the tests.26 Time magazine reported: “Dr. Salk’s laboratories could not produce more than a fraction of the hundreds of gallons of vaccine needed for such a massive trial. So it is being made according to his specifications on a nonprofit basis by five pharmaceutical houses—Parke, Davis & Co. in Detroit, Pitman-Moore and Eli Lilly & Co. in Indianapolis, Wyeth Inc. in Philadelphia, the Cutter Laboratories in Berkeley, Calif.”27 On a nonprofit basis. This is such a selfless moment in human history that it feels like one of those chapters in a science fiction series where there’s a brief period of “utopia” before everyone becomes reptiles or is eaten by alien overlords.

  On April 13, 1955, the New York Times ran a headline joyfully yelling in all caps: “SALK POLIO VACCINE PROVES SUCCESS; MILLIONS WILL BE IMMUNIZED SOON; CITY SCHOOLS BEGIN SHOTS APRIL 25.” The article declared, “The world learned today that its hopes for finding an effective weapon against crippling polio had at last been realized.”28

  As you might expect, this was a huge deal for Salk. That same day he was asked by the CBS newsman Edward R. Murrow whether he was planning to patent the vaccine (and thereby make millions). When Murrow asked the researcher who owned the patent, Salk famously replied, “Well, the people, I would say. There is no patent. Could you patent the sun?”29

  He gave the formula away for free.

  If Salk had patented his vaccine, he would have made, depending upon how you interpret patent law, between 2.5 billion and 7 billion dollars.30 Can you imagine how many Wu-Tang albums he could have kept from the public with that money? So whenever you feel cynical about whether the human race is made up of selfish jerks, remember that Jonas Salk sacrificed billions of dollars because he hoped it would prevent more children around the world from losing the ability to walk.

  Full disclosure: I would have patented that vaccine and not felt guilty about it for a second. I suspect I would have used the money to do dumb stuff I thought was awesome like start an F. Scott Fitzgerald theme park. I assume everyone else would also do that. (Why doesn’t a theme park devoted to books exist? It would be so much fun! Just a thought. Just what I’d do.)

  Salk, however, seemed to realize that the American people, more than anyone else, were the true owners of the vaccine. After all, hadn’t they danced for it, and raised money for it, and volunteered in large numbers, all to create it? Both the NFIP and the University of Pittsburgh had looked into patenting the vaccine, which Salk had no interest in doing. Now, there are many people who say that Salk couldn’t have patented the vaccine even if he had wanted to because it incorporated prior medical techniques. However, the polio vaccine was viewed as such a miracle that Salk could probably have burned down the White House and everyone would have been fine with it. Very few Americans would have objected to him becoming a billionaire in exchange for the lives he saved. Many people were in fact outraged that Salk didn’t benefit monetarily, and wrote to the president suggesting that the government give Salk “big money” and/or “lots of cash!”31 This is one of the few times in history when people adamantly wished for someone who was not themselves to get an enormous payday. Salk did, in fact, get lots of cash. He received so many monetary gifts that an assistant at his lab said, “Paper money [went] into one bin, checks into another, and metal coins into a third.”32 He received free cars, which he donated to charities.

  He also earned acclaim that no money could buy. Publications across the country celebrated him, with articles like the one in Newsweek declaring the polio vaccine “A Quiet Young Man’s Magnificent Victory.” Movie studios wanted to share his life story; Salk suggested that it would be better for them to wait until he was dead.

  President Dwight D. Eisenhower met with Salk in the White House Rose Garden on April 22, 1955. There Eisenhower promised to give Salk’s vaccine to “every country that welcomed the knowledge, including the Soviet Union.” (The Soviet Union! During the Cold War!) He declared Salk a “benefactor to mankind.”33 Before handing Salk a special citation, honoring his achievement, Eisenhower said:

  When I think of the countless thousands of American parents and grandparents who are hereafter to be spared the agonizing fears of the annual epidemic of poliomyelitis, when I think of all the agony that these people will be spared seeing their loved ones suffering in bed, I must say to you I have no words in which adequately to express the thanks of myself and all the people I know—all 164 million Americans, to say nothing of all the people in the world that will profit from your discovery. I am very, very happy to hand this to you.34

  Salk gave a self-deprecating response claiming that it had really been a group effort.

  Now that the vaccine existed, the next challenge was how to distribute it to everyone.

  On May 21, 1955, President Eisenhower declared that the polio vaccine was currently being screened and would be released within a few days. He explained the vaccination programs that would be in place for children:

  Since April 12 the National Foundation for Infantile Paralysis has been furnishing free vaccine for children in the first and second grades, and for children in the third grade who participated in the field tests of vaccine last year. [Millions of] children have been vaccinated—including one of my grandchildren, a first grader. This free vaccination program is the initial method for getting the vaccine to our children. No vaccine is now being distributed in any other way …

  To assure that no child is denied vaccination by reason of its cost, some states and localities may operate mass free public vaccination programs for all children. Other States may provide free vaccination only for children whose parents are unable to pay, through clinics, schools and preschool programs, or by furnishing free vaccine to private physicians. In those States, a portion of the State allocation of vaccine will flow into normal drug distribution channels for the exclusive use of children in the priority age brackets—to be administered by family doctors.

  To assist the States in providing free vaccinations, I have recommended that the Congress enact legislation making $28 million available to the States for the purchase of vaccine. This legislation is now being considered by the appropriate Committees of the Congress and I urge its immediate adoption.35

  It is notable that a famous Republican war hero president was desperately urging the American people to make free medical treatment available to its citizens. Do you like to discuss politics? If so, this fact may be useful to you someday.

  By encouraging the community to be vaccinated—and trying to limit the expense of doing so—Eisenhower wasn’t just providing peace of mind to millions of families. He was also increasing herd immunity among the population. The herd immunity theory, which shows up as early as 1900 in the Lancet, is the premise that outbreaks of diseases like polio “arose because of the accrual of a critical number of susceptible individuals in populations and that epidemics could be delayed or averted by maintaining numbers of susceptible individuals below this critical density (i.e, by maintaining the prop
ortion of immune above some threshold).”36 Basically, if a large majority of the population is immunized, even if you are a fool who refuses to vaccinate your children, it is still unlikely they will contract measles or mumps or polio because most of the rest of society is vaccinated. To which you might say, “Jennifer, I love being a murderous idiot. Why should I vaccinate my children if they probably won’t get a disease anyway, because everyone else cares about their children’s health and vaccinated them accordingly?” Well, herd immunity works for most diseases only if about 80 to 90 percent of the population is vaccinated. With some diseases, like measles, a 95 percent vaccination rate is necessary. So if enough people decide that their yoga teacher is really onto something and they are not going to immunize their kids, because they are going to feed them a whole bunch of grapes instead, then the number of immunized people drops beneath the percentage necessary for herd immunity to be effective. That sounds ridiculous because clearly most people vaccinate their kids, right?

  Well, Zimbabwe now has a higher immunization rate for one-year-olds against measles (around 95 percent) than the United States does. So do 112 other countries, according to the World Health Organization (WHO).37 We are down to a 91 percent vaccination rate for measles, which, according to the WHO, makes us much more vulnerable to outbreaks. That is why, for instance, there was an outbreak at Disneyland in 2014. This is very bad news for people in the United States who are especially vulnerable to diseases, including those with compromised immune systems or babies who are too young to be vaccinated.