What Can the History of Polio Teach Us About the Coronavirus Pandemic?
Neither the COVID-19 pandemic nor the 1918 influenza pandemic are the only public health crises to have taken massive tolls on the United States during the last century. To learn lessons about widespread disease — especially about the development of and need to trust in vaccines — we don’t even need to look back 100 years. Instead, we can consider the experience that took place just a few generations ago: the experience of our nation’s fight to stop the spread of poliomyelitis, or polio. What can this fight — a war that was won despite mistakes that bred lingering distrust — with polio teach us during the ongoing COVID-19 crisis and efforts to distribute vaccines?
Polio’s Dark History Led to Scientific Breakthroughs
Poliomyelitis and the novel coronavirus are both viruses, of course, but there are some interesting similarities in the ways society dealt with — and, in the case of the coronavirus, continues to deal with — both of them. In comparing the two viruses, it’s important to start with the history of polio.
In the 1940s, poliomyelitis had been appearing seasonally, typically during late summer months eventually deemed "polio season." Across the United States, and seemingly without warning, children were becoming paralyzed after contracting the disease. Cities and towns alike came to a standstill, with public officials shutting down public pools, closing theaters and bringing education and summer programs to a halt. Little was known about the virus, only that it mysteriously flared during the warmest days of the year. Everyone was told to avoid drains and unscreened windows, to go out in public as little as possible and to avoid crowds. According to NPR, the panic was so widespread that insurance companies even started selling polio insurance to parents of newborns.
An April 2020 Discover article titled "The Deadly Polio Epidemic and Why It Matters for Coronavirus" describes the threatening conditions surrounding polio — responses that sound as if they’d fit into a dystopian film world: "Health workers in New York City would physically remove children from their homes or playgrounds if they suspected they might be infected. Kids, who seemed to be targeted by the disease, were taken from their families and isolated in sanitariums."
Whereas COVID-19 has become a disease affecting people of all ages — however differently in terms of symptoms, mortality rates and treatment options — polio primarily affected young children. But adults were affected by polio, too. President Franklin D. Roosevelt was a foremost example of an adult who experienced polio’s hallmark paralysis later in life, but infections in children were much more common. Entire hospital wards were set up with iron lungs — large, tank-sized ventilators that stimulated breathing using negative pressure — to counteract polio’s lung-paralyzing effects and manage the increasing numbers of patients experiencing the disease.
Developing the Polio Vaccine
In 1952, confirmed polio cases in the United States peaked at 57,879, with 3,145 deaths. But in 2019, the World Health Organization reported fewer than 100 cases of polio in the world. How did this happen? Jonas Salk and his team at the University of Pittsburgh engaged in a vaccine research and deployment campaign that we can learn from today. In the 1950s, there was no Operation Warp Speed. Developing a response to poliomyelitis fell largely on the private sector, spurred by a new entity called the National Foundation for Infantile Paralysis founded by Roosevelt in 1938. It exists to this day as the March of Dimes and in the early 1950s became "the primary funding source for Salk’s vaccine trials."
Salk had begun developing what would become his successful polio vaccine in 1948 after being named the head of the University of Pittsburgh’s research laboratory and being awarded a grant to study the virus. The physician set to work on an inactivated vaccine — one that used dead strains of poliovirus to create immunity once injected into people’s bloodstreams. After formulating a promising vaccine candidate in 1950, he then began testing it on his own family members and on former polio patients. On the evening of March 25, 1953, Salk revealed his findings on a CBS national radio program.
Salk’s announcement about successful results meant his vaccine received approval for clinical trials. Throughout 1954, the new polio vaccine was tested on over 1,800,000 children between the ages of 6 and 9 who became known as "Polio Pioneers." Over 1,000,000 children were "observed controls," but 623,972 children were injected with either the vaccine or a placebo — the largest medical study ever conducted at the time. On April 12, 1955, the results of the vaccine-efficacy study were announced by the Poliomyelitis Vaccine Evaluation Center at the University of Michigan's School of Public Health. The vaccine, it was reported, was "safe, effective, and potent" — up to 90% effective in preventing paralytic polio infection. But this good news only lasted so long.
It Wasn't All Successful — but Can We Learn From the Failures?
In 1955, the government licensed several companies to start producing vaccines within hours of the University of Michigan’s declaration. Speed was a primary focus, just as it has been during the race to develop the COVID-19 vaccines. The very next day, a campaign for production of the polio vaccine had begun.
But within just a few days, there were reports of children who developed polio and even paralysis after getting the vaccine. As described in "Covid-19 vaccine safety and the public trust: lessons from Paul Meier and polio," vaccinations continued for weeks due to minimal federal oversight and political pressure. The United States Surgeon General halted vaccinations on May 6, 1955, but not before 40,000 people developed vaccine-induced polio. Companies that manufactured the vaccine — which Salk left unpatented in an effort to make the cure available quickly — didn’t follow the researcher’s inactivation method properly. As a result, 200,000 people received vaccines containing live poliovirus.
The story of Salk’s polio vaccine serves as a "cautionary tale" for developers working to ensure the safety of COVID-19 vaccines. Speed is important today, too. Scientists are in a rush to develop vaccines. Governments are in a rush to deliver those vaccines — which can easily degrade — across long distances to medical facilities. And many people are in a rush to get vaccinated. But at what cost?
Thankfully, we have yet to see vaccine-induced COVID-19 or severe consequences other than extremely rare anaphylactic reactions. But that says nothing about potential long-term implications of vaccines that were developed and given emergency authorizations over the course of just several months. In addition to potentially harmful health effects that fast-tracked vaccines could cause, lingering suspicion about vaccines endures — suspicion that developed in the 1950s. Drs. Porismita Borah, Sterling M. McPherson and Erica Weintraub Austin of Washington State University explain that "safety concerns, lack of transparency from the scientific community, lack of trust in the government and the desire to wait until a longer track record of safety can be established" all contributed to public mistrust of the polio vaccine. Similar concerns persist today regarding the COVID-19 vaccines.
What lessons can we learn from the tragically flawed initial polio vaccinations for today’s effort to inoculate the world against COVID-19? These key takeaways can help us understand:
- Independent experts should be empowered to review original data produced from the many ongoing COVID-19 vaccine trials around the world.
- In the United States, the Food and Drug Administration (FDA) must exercise oversight of manufacturing processes. That’s a challenge, given that many millions of doses are manufactured overseas. The FDA has also proposed eliminating inspections of manufacturing plants before authorizing vaccines on an emergency basis, which could have disastrous consequences.
- Rigorous and mandatory tracking of side effects must continue throughout the vaccination campaigns nationwide, especially because so many trials were fast-tracked and researchers were unable to gather much information related to potential side effects.
- The National Vaccine Program Office within the United States Department of Health and Human Services that was created under the National Childhood Vaccine Injury Act of 1986 but dismantled in 2019 should be reinstated.
Will these types of measures be enough to engender the public trust necessary to encourage broad willingness and desire to be vaccinated against COVID-19? The tragedies of 1955’s polio vaccination program linger today in the form of distrust of public health pronouncements by the government, especially on the heels of admittedly rushed — or, from a different perspective "fast-tracked" — process.
Overcoming Mistrust in Vaccines Involves Massive Public Campaigns
The good news is that the number of Americans who oppose vaccines is a relatively small — albeit vocal — minority. Vaccination rates among young and school-aged children for diseases like measles, mumps and rubella are, despite pockets of opposition, generally high at around 92%, according to the Centers for Disease Control and Prevention (CDC). Furthermore, in December of 2020 the Pew Research Center reported that 60% of Americans reported they’d probably or definitely get the coronavirus vaccine.
On the other hand, there are troubling signs about the broader population’s willingness to voluntarily get vaccinated. In the 2019 to 2020 flu season, for example, one study discussed in an article from The Atlantic titled "How to Build Trust in the Vaccines" found that only 48% of adults, 64% of children and 70% of seniors were vaccinated for influenza, which kills hundreds of thousands of people annually around the world. What’s more is that the 60% rate from the Pew Research Center’s findings isn’t enough to reach the herd immunity necessary to end the coronavirus pandemic.
Getting the vaccination rates for COVID-19 up even higher in the face of rampant political division and public disharmony will take intentional efforts to combat distrust. Options to do so include the following:
- Government officials could initiate public campaigns focused less on trying to correct vaccine-related mythology and more on the actual risks of COVID-19.
- Once campaign plans were in place, the next step would involve empowering the right person to deliver that message. One example of a trusted messenger in the United States today is Dr. Anthony Fauci — Americans are more than twice as likely to trust him than distrust him, according to analytics firm YouGov. Particularly during a period of transition between political administrations following the 2020 elections, voices of non-partisan public health professionals like Dr. Fauci should be amplified.
- On a more local level, trusted family doctors should be equipped and empowered to explain the benefits of vaccination, to encourage inoculation and to provide public health information within their local communities. (There’s no denying that, at a time when resources are stretched thin, asking family physicians to do more is asking quite a bit.)
- We must accept that government spokespersons are not necessarily trusted voices and expect local public health officials to partner with trusted non-government entities, such as churches, schools, community groups, businesses — and, yes, even celebrities and influencers unique to specific communities — to promote vaccinations.
With intentional and persistent investments in science, communication and trust-building, COVID-19 can be beaten just as the war against polio was ultimately won, despite some dark and fearsome battles. Time will tell just how well the lessons of polio have been learned, but they ultimately can give us hope for success in the fight against COVID-19.