Poupard went to work in Koprowski’s polio lab. He inoculated rabbits, nursed HeLa cells used for testing stool samples for the polio virus, and occasionally descended the wrought-iron stairs to retrieve a test tube of polio virus from a communal walk-in freezer in the back of the building. The freezer was kept at –94 degrees Fahrenheit. Poupard would don a big blue parka, enter the freezer, open the door of the wire mesh cage into Koprowski’s section, brush the frost off a Magic Marker label on a rack of test tubes, grab a test tube, and get out of the freezer as quickly as humanly possible. (Also resident in the cage were hundreds of stool samples from trials of polio vaccine that Koprowski had run in the Belgian Congo in the late 1950s, kept in small Dixie-like paper cups. They were eventually burned in the Wistar’s courtyard incinerator.)
But mainly Poupard was on deck for the regular phone calls that came from the nursery for premature babies at Philadelphia General Hospital. When the lab phone rang and it was a nurse reporting that a new preemie was available at the hospital—the baby had to weigh at least two pounds, Poupard recalls, or it was deemed too vulnerable for the trial that was under way—he would retrieve a tiny, frozen test tube with a black rubber stopper, run it under cold water until the frozen vaccine it contained melted into a bright yellow liquid, and stick it in his pocket along with an empty test tube and a lancet wrapped in sterile packaging. (A lancet is a two-sided scalpel blade used for making small incisions.)
Then he would shed his white lab coat, descend the Wistar’s broad front steps, turn right, and head down Thirty-sixth Street, passing the giant Hospital of the University of Pennsylvania on his left before the street dead-ended half a block farther on, in a T junction at a pedestrian path called Hamilton Walk. There he confronted a big, thick, black wall. It separated two worlds.
The wall marked the edge of the University of Pennsylvania campus. On the near side was the prestigious university hospital. On the other was Philadelphia General Hospital—PGH—the charity hospital for the city’s poor, nicknamed “Old Blockley” after the family that once owned the land on which it stood. The City of Philadelphia had bought that land in 1832. There it built an insane asylum, a poorhouse, and the hospital that would become PGH.
In the 1880s the famous Canadian physician William Osler, then chair of clinical medicine at Penn, used to troop through the PGH wards followed by a gaggle of medical students, demonstrating patient examination at the bedside—a novel departure in those days from classroom-based medical education. Osler reigned over autopsies in a special “autopsy house” at the edge of the grounds backing on the big black wall.
In 1920 the insane asylum and the poorhouse were moved, leaving just the hospital that became PGH. It was enormous, comprising more than two dozen buildings—most of them big brick structures—and occupying twenty-six acres. Funded almost entirely by the city, PGH had a mandate to serve city workers: policemen, firefighters, and other city employees had their own ward. But the huge majority of Old Blockley’s patients were poor people with nowhere else to go. Most of them were black: African Americans made up three quarters of the hospital’s walk-in cases in 1955.3
Black people felt welcome there because, relying as it did on city funding, PGH had been obligated to establish a clear nondiscrimination policy.4 African American women especially liked the place and traveled there from all over the city, ignoring their neighborhood hospitals. Unlike at other hospitals, no questions were asked about finances when patients arrived, and half of patients were treated for free. Every patient was respectfully addressed as “Mrs.” or “Mr.” And on the obstetrics wards single women giving birth rarely had to fend off prying, judgmental questions. The same went for the one in seven women on these wards who was seriously ill from a botched back-alley abortion.5
A new obstetrics building opened in 1955 to help cope with the 37 percent increase in births at PGH during the 1950s. It was followed the next year by two new nurseries—one for full-term infants and the other for premature babies. The number of bassinets in the latter soon grew from thirty-eight to sixty-two. The obstetrics patients were overwhelmingly African American: 94 percent of the nearly five thousand births at PGH in 1960 were to black women.6
PGH was an ambitious place in the early 1960s: a ten-year report published late in 1961 boasted of new buildings, renovation of obsolete facilities, and the “beginning of the hospital’s recognition as a major research center.”7 In 1955 the hospital had launched the PGH Research Fund to get its staff more actively engaged in research. With its heavy patient load and physicians from the city’s medical schools under contract to provide patient care, it was “ideally suited” for research, the 1961 report went on, noting that, if several major grant applications came through, PGH would vault into the “major leagues” of research institutions.8
Koprowski had already taken advantage of the pro-research agenda at PGH. Paul György, an eminent nutritionist who had discovered several of the B vitamins and who was head of pediatrics at Old Blockley, opened the door there to the Wistar’s chief, giving him and his researchers permission to use the babies in the hospital’s premature infant nursery. Beginning in January 1959—when he was still bent on beating Sabin in the race to license a live polio vaccine—and continuing through June 1961, Koprowski, Plotkin, and other Wistar researchers, working in some cases with doctors from PGH and Philadelphia’s Department of Child and Maternal Welfare, fed Koprowski’s then–monkey cell–based polio vaccine to scores of premature babies weighing as little as 1.75 pounds.9
It is unlikely that the researchers sought parental permission for these experimental vaccinations, according to Plotkin.10 In the papers that were published reporting on the trials, they do not mention doing so. They do thank György for making the nursery and its babies available and the PGH nursing staff and two physicians who were not authors of the papers for their assistance and cooperation.11,12
The scientists were seeking to understand, they wrote in one of the papers that resulted, why some newborns resisted intestinal infection with live polio vaccines—infection that was necessary for the vaccine to successfully generate protective antibodies. They were also examining how antibodies that the babies received from their mothers while in the womb influenced their responses to vaccination.
In their first study, begun in 1959, the scientists found that 92 percent of the babies became infected with the vaccine virus. But only 59 percent responded to the infection by producing protective antibodies, and their responses were “distinctly” weaker than those of babies that were even two or three months old.13
Nonetheless, the takeaway from that trial, Plotkin recalled in a 2015 interview, was that having 60 percent of premature newborns even somewhat protected from polio was considerably better than having none of them protected.14 While viral infections were rare in preemies, the authors conceded in one of the papers, unusually severe infections in these babies “assuredly do occur.”15
Three years later their calculus hadn’t changed. With naturally occurring poliovirus still circulating—988 Americans were paralyzed by polio in 1961—they felt that vaccinating newborns, including preemies, was a priority.16 Admittedly, maternal antibodies that lingered in the babies’ systems for the first six months of life could make vaccination less successful by eliminating the vaccine virus before it could prompt an immune response that would generate the baby’s own antibodies. But the trade-off was this, Plotkin said in 2015: if the babies weren’t vaccinated while they were a captive population in the nursery, the chance to vaccinate them could be gone for good.
So it was that, armed with the new Koprowski polio vaccine made with Hayflick’s human diploid cells, the Wistar researchers began vaccinating dozens of full-term and premature newborns. The preemies they found were at PGH, where pediatrics chairman György was still in charge.
Poupard was hired to vaccinate the preemies and to take their blood. Their stays in the hospital would last for wee
ks—far longer than full-term babies stayed—and would, if their mothers cooperated, be followed by checkups in the outpatient clinic for several months, allowing for follow-up blood draws to measure antibody responses to the vaccine.
When Poupard first arrived in PGH’s premature infant nursery, he immediately appreciated what he was up against. Guarding the nursery like a mother bear was the head nurse, a skinny woman in her fifties whose starched white cap perched upon gray hair often done up in a bun. She never cracked a smile. She took one look at the nineteen-year-old Poupard and without uttering a word made it clear that she was offering him access to her babies—she always called them “my babies”—only under duress.
“She would stand there while you washed your hands to her specifications and while you gowned,” Poupard recalled in a 2014 interview.17 “Then she would bring the baby.” Poupard would pour the tiny tube of yellow vaccine down the baby’s throat. Then, still under the head nurse’s killing stare, he would uncork the empty test tube and unwrap the lancet.
With the baby lying on a table or being held by someone else, Poupard would cut an incision of about one quarter inch in the soft flesh of the baby’s heel. He would quickly set down the lancet, grab the test tube, and begin repeatedly scraping the edge of its mouth along the length of the incision, collecting every drop of blood he could squeeze out. He needed at least one milliliter of blood in order for the baby’s antibody levels to be tested. That’s about one tenth of a teaspoon, but with a three-pound baby, this is easier said than done. At first the baby would inevitably be crying. This boosted its circulation, so that the cut would bleed. But problems arose if the baby, as often happened, then went to sleep. At that point blood flow from the wound would slow and then stop.
“The last thing you wanted to happen is the baby goes to sleep, ’cause then they won’t bleed,” Poupard recalled. So he would wait until the head nurse turned her head and then flick the baby behind its knees “to cause as much pain as I could to the poor little kid to wake them up.” Some babies would keep sleeping anyway, and he would get back to the lab without enough blood. But he succeeded often enough.
Poupard asked himself many times, as he walked on his errands between the Wistar and PGH, passing through a gap in the big black wall that separated it from the university, why Koprowski would be putting an experimental polio vaccine in premature babies. But he was a kid with a high school education, and the orders were from the godlike man himself. If Koprowski wanted it done, there must be a good reason. Poupard proceeded without ambivalence.
His work wasn’t confined to PGH. The Wistar researchers were preparing data for a first-of-its-kind meeting to be held in Geneva that July, where experts convened by the World Health Organization were going to examine the potential of Hayflick’s human diploid cells for vaccine production and make recommendations to WHO’s director general. Immunization data would be important for the experts to have in hand, and the more of it the better.
So that spring of 1962 Poupard also drove his pea green 1956 Impala with a “med tech” parking sticker on the windshield to Clinton Farms, to collect pre- and postvaccination blood from full-term babies. He was also sent to a third destination, three miles down Woodland Avenue, a streetcar-clogged commercial artery that ran from the university to southwest Philadelphia. There, in Hayflick’s old childhood neighborhood, he visited a brand-new, redbrick building: St. Vincent’s Hospital for Women and Children.
The hospital was run and financed by the Archdiocese of Philadelphia. It had begun as a Catholic home for “unfortunate infants” in 1858 and been expanded to include a maternity home in 1885. But that huge, rambling Victorian building was torn down in 1959. People called the new replacement St. Vincent’s Home for Unwed Mothers, although this was not its official name. One four-story wing had dorm-style rooms for the pregnant girls and women who kept it at or near capacity. The other wing was a three-story, twenty-two-bed maternity hospital where they gave birth.18
In an era when pregnant girls and women often disappeared suddenly from their communities only to return months later with tales of European sojourns or visits to sick aunts, the Home for Unwed Mothers hosted around sixty girls and women on any given day.19 They came from every kind of situation. There was a rape victim who was perhaps twelve or thirteen years old; a stunning flight attendant who arrived by taxi in a pink Chanel suit with a pink pillbox hat; and the underage daughter of a hugely prominent Catholic politician, who quietly arranged with the archbishop to have his daughter admitted under an assumed name.
Under the watchful eyes of the black-habited Medical Mission Sisters who staffed the home and hospital, the young women went to school, did their homework, took crafts classes, grumbled about the endlessly recycled maternity clothes, went to Mass, and took their prenatal vitamins. They looked forward to their weekly escape from the home on Sundays, when they were allowed to walk up Woodland Avenue to buy soap and toothpaste and shampoo. They talked one another out of running away—rumor had it that they would wind up in jail if they did.
Many knew that they would never hold, or even see, their babies: girls and women putting their babies up for adoption would learn only the sex of their child, so that they could bestow a name on the baby.20
St. Vincent’s Hospital was, like Clinton Farms, an attractive spot for the Wistar researchers because of the follow-up that it allowed. In addition to the newborn nursery, there was a sixty-cot nursery for older babies, some of whom lingered in the hospital for months while the Catholic Children’s Bureau looked for foster homes or adoptive parents. In 1962, the hospital was beyond overflowing, with an average of eighty-four babies on any given night.21 If infants reached one year of age, they were transferred to St. Vincent’s Home for Children, which stood back to back with the Home for Unwed Mothers, on Greenway Avenue, the next street over. (The Home for Children too will play a role in this story.)
Sister Mary Jacob, a thirty-five-year-old Medical Mission Sister with a ski-jump nose and a mischievous smile, was in charge of St. Vincent’s Hospital several years earlier, when Koprowski’s Wistar scientists first sought to vaccinate newborns there with their boss’s monkey cell–propagated live polio vaccine. It was 1959 and she was worried, she told them, about the safety of the live vaccine. She had recently read comments from the surgeon general saying that it wasn’t ready to be licensed.22 So she was declining their request.
She also had a contract to keep, she wrote to her boss, Archbishop John Cardinal O’Hara, Philadelphia’s top prelate, after the Wistar scientists appealed her decision to him. “Every child admitted to our care has the written consent of his parent for ‘vaccination or any necessary operation.’” That covered only “normal” procedures, not experimental ones, she argued.23
The seventy-one-year-old archbishop, a former president of the University of Notre Dame who was known to answer his own doorbell (“How else can I meet the poor?” he once asked),24 agreed with Sister Mary Jacob and said so in his reply to her.
“If I am acting in loco parentis for the children at Saint Vincent’s I have qualms of conscience about the use of the children for the testing of remedies and procedures,” O’Hara wrote to the young nun. “My mind is not entirely free from the prejudice that our research teams want these infants because they are always available in quantity and under conditions which permit [a] wide variety of controls.”25
Early in 1960 Koprowski tried again, writing directly to O’Hara, urging him to permit a trial of his monkey cell–propagated vaccine. “Our interest in vaccinating the infants . . . at St. Vincent’s Hospital would be primarily to protect them,” he wrote, noting that some 25 million people in various trials had by then been vaccinated with experimental live polio vaccines. In babies at Philadelphia General Hospital, he added, “it has been proved that such vaccination provides longlasting—probably lifelong—immunity.” He would be happy to come and discuss the matter in person with the archbishop.
26
Koprowski was at his manipulative best in this letter; he could not accurately have described “longlasting” or “lifelong” immunity in babies that had been vaccinated only one year earlier.
O’Hara turned to Sister Mary Jacob for her opinion.
“This type of study should not be conducted without the specific written permission of each parent,” she persisted. “Since this is not possible under the present circumstances, we do not think it is advisable to recommend this study.”27
“My dear sister,” O’Hara replied to the thirty-five-year-old nun late in March 1960. “I am deeply grateful for your letter. . . . Since you do not recommend the project of Dr. Koprowski, I am writing to tell him it is not authorized.”28
O’Hara died six months later in August 1960. He was replaced by John Joseph Krol. One year later, in late summer 1961, the U.S. government licensed Sabin’s live polio vaccine. Perhaps because this legitimized live vaccines, or perhaps because Krol was a staunch conservative and a defender of hierarchical authority, by the spring of 1962 Wistar researchers had gained access to St. Vincent’s Hospital; the fetal-cell–produced experimental polio vaccine was being given to the infants there; and Poupard was drawing their blood to measure their antibody responses. (At St. Vincent’s Hospital and Clinton Farms it was nurses who administered the vaccines, pouring the yellow fluid into the babies’ mouths. At PGH Poupard did this because, he recalls, the researchers didn’t trust the head nurse to vaccinate the babies.)29
By July 5, 1962, polio vaccines made using Hayflick’s human cells had been fed by the Wistar team to 132 premature and full-term infants ranging from just born to several months of age. Plotkin, Norton, and another Wistar virologist and veterinarian, Richard Carp, reported on the vaccinations in a working paper they submitted on that date to the experts meeting in Geneva at the World Health Organization.
The Vaccine Race Page 16