David Oshinsky’s Polio: An American Story is a richer and more complex book than Kluger’s. Oshinsky’s position on the mythmaking? “I am trying to stay away from it,” he said in a recent conversation.
Salk emerges here as a complex scientist. He was an outsider, Oshinsky writes. “Salk was marooned out there in Pittsburgh, fiddling with an old-fashioned killed-virus vaccine and doing the dog’s work that his betters refused to do.” Yet he was close to the National Foundation for Infantile Paralysis and to O’Connor. He was meticulous in his science. “It was a game of trial and error, testing and tinkering, and few knew it better than Jonas Salk.” He was confident about his work but aware of its dangers. “ ‘When you inoculate children with a polio vaccine,’ he said later, ‘you don’t sleep well for two or three months.’” He was sensible and accommodating, yet he could be insensitive and egotistic, especially when dealing with his laboratory team. “Once the goal was reached, the group would split apart amidst charges that Salk had not appreciated, much less acknowledged, the collaborative nature of his success.” He shied away from the media yet craved publicity. “One of his greatest gifts was a knack for putting himself forward in a manner that made him seem genuinely indifferent to his fame, a reluctant celebrity, embarrassed by the accolades, oblivious to the rewards.”
All this Oshinsky unfolds in the context of the National Foundation’s politicking and lobbying, and of the larger politics of the day. In the end, Oshinsky’s Salk emerges as someone we care to know something about, most notably his left-wing leaning early in life (which Oshinsky learned about from FBI files), his apolitical stance in midlife, and his mystical tendencies in old age. Yet Oshinsky’s account has problems of its own. Although early concerns about Salk’s vaccine were scientifically motivated, those at the end of the 1950s were broadly social. An immunity gap among different social and economic classes had developed; Oshinsky knows this but gives the subject only two pages.
In 1959, epidemiologists reported findings on the pattern of the disease. These suggested a shift in incidence according to age, geography, and race. By 1960, less than one-third of the population under 40 years of age had received the full course of three doses of the Salk vaccine plus a booster. Most of those who had were white and from the middle and upper economic classes. The disease raged on in urban areas among African Americans and Puerto Ricans and in certain rural locales among Native Americans and members of isolated religious groups.
The gap had to do with access to vaccination. Pediatricians were not well compensated. “This was the one thing they could do which was a guaranteed reasonable flow of cash,” explained Henderson. The physicians resisted losing that cash; they argued for a vaccine that required their professional training.
Late in 1960, at the mid-winter clinical session of the American Medical Association, the surgeon general of the United States presided over a symposium on the state of polio immunization. E. Russell Alexander, chief of the surveillance section at the Communicable Disease Center, said, “The residual pattern of disease represents a measure of our failures to apply vaccine completely enough.” A. D. Langmuir, chief of the epidemiological branch at the center, said, “[P]olio seems far from being eradicated. The dreamed-for goal has not been achieved. In fact, many students of the problem question that eradication of poliomyelitis infection with inactivated vaccine is a scientifically tenable concept.” One of the main concerns was that the Salk vaccine did not prevent infection in the gut and thus did not break the chain of transmission.
Beginning in January 1962, pediatricians in two Arizona counties, Maricopa and Pima, containing the state’s largest cities, Phoenix and Tucson, conducted separate but similar voluntary mass immunizations using Sabin’s vaccine. “Previous programs in the county, using the Salk vaccine, had failed to bring polio immunization to a satisfactory level,” they reported a year later in the Journal of the American Medical Association. The program was called SOS (Sabin Oral Sundays). More than 700,000 people were immunized–75 percent of the total population in both counties. The vaccine was given at the cost of 25 cents, for those who could pay. It was given to population groups that were socially, racially, and culturally diverse, on Indian reservations and military posts and in urban and rural areas. The program became a model for subsequent U.S. mass-immunization programs. By the mid-1960s, Sabin’s vaccine was the only one in use in the United States. It was the Sabin vaccine that closed the immunity gap and effectively put an end to polio in the States.
Yet Sabin’s vaccine, too, has a problem. Attenuated live virus can mutate back into a virulent form. This has happened in a small number of cases. In the United States, therefore, after the decades in which the Sabin vaccine extinguished polio, the Salk vaccine is, ironically, once again preferred for immunizations. But the Sabin vaccine, cheap and easy to administer, is still the one used in the current campaign to eradicate polio worldwide. This campaign has extinguished the disease in the rest of the Western Hemisphere and in Europe, and almost entirely in Asia, though recent flare-ups in central Africa remain ominous.
Angela Matysiak is completing her PhD at George Washington University, in history of science, and is writing a biography of Albert Sabin.