There comes a time when we all have to come to terms with a more complex worldview than we were often raised with. We find out that some of the ideas we hold most dear are, in fact, more complicated than we have been led to believe or sometimes blatantly false. The so-called “Boston Massacre” was not actually an unprovoked attack on American colonists, but rather a riot that started from British soldiers attempting to defend themselves against an attack by a crowd of irate Bostonians. Though he was a great leader who helped change America by inspiring peaceful protests for civil rights, the late Martin Luther King Jr. was also very human and FBI wiretaps did confirm that he often struggled with infidelity. Thomas Edison was a brilliant and visionary man whose inventions have made life better for humanity, but in his zeal to promote his direct current electricity, he not only failed to properly compensate Nicola Tesla for Tesla’s work with Edison, but also conducted public demonstrations where he electrocuted animals (and a criminal) to discredit Tesla’s and Westinghouse’s alternating current electricity. Sometimes, we have to slaughter a sacred cow to see the truth. The polio vaccine is no exception.
The polio vaccine is one of America’s most cherished innovations. It’s pretty much up there with mom, apple pie and the American flag. Jonas Salk is one of the most celebrated figures of the twentieth century. Any attempt to point out any potential weaknesses are typically met with arguments that the polio vaccine has saved countless lives by preventing death and disability. The reality is that most of what you have heard about the polio vaccine is false.
You’ve heard that right after the introduction of polio vaccine, polio rates dropped dramatically and the vaccine was responsible for this decline. What do records from the 1950’s tell us about polio? Page LII of the Vital Statistics of the United States 1955 Volume I notes that: “…deaths from acute poliomyelitis fell below those for any year since 1947. While the drop was coincidental with the introduction of the poliomyelitis vaccine, very little of the decline can be attributed to its decline in 1955. This disease causes deaths among young adults as well as among children and the rates for almost every age group declined in 1955.” This report describes the polio vaccine is being only coincidental to the decline in polio rates.
Two vaccines emerged which both claimed to be able to defeat polio: the inactivated polio vaccine developed by Jonas Salk and the oral live-attenuated vaccine (frequently administered through sugar cubes) developed by Albert Sabin. Controversy existed among researchers over which one was effective and safe, however both were used in the United States throughout the twentieth century. In the 1970’s and 1980’s lawsuits were brought before U.S. government by individuals who claimed they had been infected with polio by the live oral polio vaccine campaign of 1962. In 1993, the federal district court of Maryland ruled that individuals had a legal right to sue the government for damages from the oral polio vaccine even though the 1962 oral polio vaccine (OPV) campaign had originally been considered above the law because it was deemed an extraordinary humanitarian effort. The claimants were awarded seven figure sums by the U.S. government. (The Coming Plague Laurie Garret 182. Please note, this is a very pro-vaccination book.) Vaccine acquired paralytic polio (VAPP) continued to persist through the end of the 20th century. According to the CDC, between 1980 and 1999 162 cases of paralytic polio were confirmed in the United States, 154 of which were VAPP. So while the OPV was supposedly lowering polio rates, it was actually adding to them.
But the OPV isn’t the only way to acquire paralytic polio. Throughout the twentieth century, provocative polio was a hotly debated phenomenon. Provocative polio is when polio is brought on (provoked) by a medical procedure. Tonsil/adenoid surgery was first implicated for polio provocation. In 1910 doctors observed that children who had throat surgery during a polio outbreak had an increased risk of contracting polio within the first 1-2 weeks after the operation. Physicians in the US Army and many leading health officials warned that it was better to hold off on tonsil surgery until after the polio season was over, though others said the risk was negligible.
One very well-documented medium for provocative polio turned out to be intramuscular injection, especially for vaccination with the diphtheria-tetanus-pertussis (DTP) shot. By 1952, leading health and medical organizations in the United States advised that vaccination with the DTP shot should wait until after the high season for polio was over. The problem of polio provocation persisted in third world countries where aid workers noticed children developing paralysis after receiving the DTP vaccine. In 1980, public health researchers noticed that several children had become paralyzed in the limb where they had recently received their DTP shot. (J.K. Martin described the the same occurrence in his 1949 study titled Local Paralysis in Children After Injections.) In an effort to combat polio provocation, researchers began examining the relationship between injections and polio. In 1998, Drs. Matthias Gromeier and Eckard Wimmer found that injury to tissue to during certain types of injections allowed the polio virus easy access to nerve channels, thereby increasing the likelihood of paralysis. The more recent HV Wyatt study from 2003 found that three-quarters of children with paralytic polio receive injections just before the onset of paralysis. So, what we have is an outbreak of a disease for which vaccination with injections was substantially responsible and we have attempted to fight it with more vaccine injections.
Ironically enough, a 2011 study from the Indian Journal of Public Health described a several cases of provocative polio brought on by vaccine injections. Because of the high rate of disability it has caused in some villages, they are now encouraging the use of the oral polio vaccine in hopes of preventing further cases of vaccine induced paralysis. Of course, the United States stopped the use of the OPV in 2000 because of the lingering problem of VAPP.
During the 1940’s, 1950’s and 1960’s some of the research on vaccines was conducted on prison inmates and the mentally ill. Even the beloved Dr. Jonas Salk co-authored a federally funded study in 1942 in which male prison inmates were injected with an experimental vaccine and then deliberately exposed to the flu virus several months later. http://www.washingtonpost.com/wp-dyn/content/article/2011/02/27/AR2011022700988.html pg.1 Mike Stobbe)
You have probably heard that because of the polio vaccine, parents no longer need to live in fear of their children coming home form school sick and then becoming seriously ill. Did you know you can still develop paralysis from enteroviruses like polio, despite the polio vaccine? Since polio is said to be eliminated from the United States, these types of enteroviruses are called non-polio enteroviruses. The CDC states that these viruses (often manifesting as cold-like illnesses in the summer and fall) often produce no symptoms or mild symptoms, but can cause serious infection and paralysis. Curiously enough, despite the fact that so-called non-polio enteroviruses can potentially cause the same serious effects as polio, there is no vaccine for them and in fact the CDC recommends hand washing and good hygiene to prevent transmission.
This brings up a lot of very interesting questions. How much testing was done to determine whether a case of paralysis was caused by polio vs. non-polio enteroviruses? Could non-polio enteroviruses have caused cases of paralysis in the pre-vaccine era? Could polio have persisted after the introduction of the vaccine, but was diagnosed as non-polio enteroviruses because doctors believed that it was impossible for a vaccinated individual to develop polio? (A sort of medical “blind spot”.)
And how about the charitable campaigns to stop polio in third world countries? How is the global polio eradication effort going?
The polio vaccine has had a very bad track record in third world countries. The April 23, 2010 edition of the Wall Street Journal describes how Bill Gates is having to rethink his stance on battling polio in Africa with vaccines. Mr. Gates gave $700 million dollars for a mass polio vaccination campaign in Nigeria. Despite the campaign, which included door-to-door vaccinators, polio still persists in Nigeria and in fact, half of the 1,600 cases of polio reported in 2009 happened in vaccinated individuals. The 1988-1989 outbreak of polio in the African country of Oman found that “a substantial proportion of fully vaccinated children had been involved in the chain of transmission.”
And last of all, I think it is only fitting to take a realistic look at Jonas Salk and see him as a person, not just a mythical hero. During the 1940’s, 1950’s and 1960’s research on vaccines was conducted on prison inmates and the mentally ill. There was a definite sense that it was acceptable to experiment on people who didn’t have full rights in society; they were sacrifices for the sake of progress and science. Like many of his contemporaries, Dr. Salk participated in human experimentation. He co-authored a federally funded study in 1942 in which mental patients were injected with an experimental vaccine and then deliberately exposed to the flu virus several months later. Most of the patients were unable to fully describe their symptoms or the procedure they were undergoing, which means that the research it yielded had serious flaws.
Salk himself was aware that there were potential dangers with polio vaccination and said “When you inoculate children with a polio vaccine, you don’t sleep well for two or three months.” His fears may have been well-founded. On April 24, 1955, polio broke out among children who had received a batch of Salk’s IPV that had been manufactured at Cutter Laboratories in California. Eleven children died as a result.
Salk was friends with Basil O’Connor, the president of the National Foundation for Infantile Paralysis (now the March of Dimes). O’Connor was known to be highly influential and the National Foundation for Infantile Paralysis did a great deal of politicking and lobbying for Salk’s polio vaccine. Salk himself acknowledged that his IPV would not have gained as much traction as it did had it not been for O’Connor and the National Foundation for Infantile Paralysis.
Accounts from his contemporaries paint a picture of a man who was very driven and ambitious, sometimes egotistical and unwilling to appreciate the efforts of his fellow researchers in developing the IPV.
It is ironic that many of the accusations leveled at Andrew Wakefield- a disregard for test subjects, flawed data, less than altruistic motivations- could be also apply to Jonas Salk.
If we look at the facts, a very different picture of the polio vaccine begins to emerge and we find medical technology with a lot of good press but poor results. While it’s difficult to let go of the story of the story we were raised with, slaughtering the sacred cow actually is to everyone’s benefit. If we start basing our health policies on the facts about polio and not what we want to believe, we can actually start to fight the disease far more effectively.
Update 11/14/14- Where are all the children in iron lungs? Surely the fact that we no longer see children in iron lungs must be proof of polio’s eradication? Sorry, but no. In fact, since the polio vaccine, cases of acute flaccid paralysis (AFP) have increased. India was certified polio-free, but it has some of the highest rates of AFP in the world now. AFP can cause paralysis which requires an oxygen tank (rather than an old iron lung). You’ve probably even seen children with oxygen tanks on occasion, I know I have. The United States has started seeing an increase in children with paralysis from enteroviruses as well.
Update 12/18/15 An excellent article on the many difficulties facing the polio eradication program can be found here: http://content.healthaffairs.org/content/28/4/1079.full This isn’t just a problem of funding or superstitious people who refuse the vaccine. This details the very real challenges with surveillance, the live polio vaccine- especially in HIV positive individuals and a number of other obstacles that we typically don’t hear about from the news media. I highly recommend it.
Update 7/9/16- Interesting fact: In the 1954 poliomyelitis vaccine field trial for the Salk IPV vaccine, a vaccine trial group, a saline placebo group and a control group who received neither the vaccine nor the placebo were all studied for polio rates. The vaccinated group experienced polio at a rate of 28 per 100,000, the placebo group experienced polio at a rate of 69 per 100,000 and the control group who received neither experienced polio at a rate of 46 per 100,000.- Basic Biostatistics: Statistics for Public Health Practice, Second Ed., B. Burt Gerstman, pg. 30. My hypothesis for why the control group fared better than the placebo group is that the placebo group may have experienced provocative polio.