Every year, more children died. Survivors often endured crippling injuries. Some had paralyzed limbs. Others went blind. They were victims of a virus–an unseen killer without a cure.
The world is battling the 21st century’s deadliest virus. In the 20th century, there were several viral pandemics. Yet in the developed world most have forgotten the one that spread fear and death for decades. Poliomyelitis––polio––was never cured. It was virtually eradicated by a vaccine. Yet there are places where polio remains a threat. So long as it endures, the unvaccinated are at risk––no matter where they live.
Polio Panic
Polio almost always struck during the summer. Swimming pools, summer camps, and family holidays stopped being fun diversions. They instead became sources for disease transmission. The virus was never as deadly as 1918’s Spanish flu pandemic, and more children died from cancer or car crashes than polio. What made polio a truly terrifying virus is that no one knew where it would strike. Nearly every year, there was a major epidemic somewhere in North America. An average of 35,000 children were paralyzed annually. By the 1950s, polls showed parents feared polio more than almost anything else. The only thing that scared them more was nuclear war.
A 3,500-year old Egyptian stone carving might be the oldest image of a polio survivor. It shows a priest with a withered foot and a walking stick––hallmarks of the disease. Polio was first described by Michael Underwood in 1789. Just over 50 years later, Jakob Heine recognized polio as a medical condition. Cases were rare until the cusp of the 20th century. It flourished, ironically, because of the modern world’s new found obsession with cleanliness.
As the World Health Organization explains, polio “is a highly infectious viral disease, which mainly affects young children. The virus is transmitted by person-to-person spread mainly through the fecal-oral route or, less frequently, by a common vehicle (e.g., contaminated water or food) and multiplies in the intestine, from where it can invade the nervous system and can cause paralysis. Initial symptoms of polio include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs. In a small proportion of cases, the disease causes paralysis, which is often permanent. There is no cure for polio…”
Babies who contracted polio were usually asymptomatic. Unharmed, they developed lifetime immunity. As living spaces became cleaner and babies more confined, they had fewer opportunities to contract polio. The older the victim, the more likely they were to become paralyzed or even die. The WHO notes that “one in 200 infections leads to irreversible paralysis. Among those paralyzed, 5% to 10% die when their breathing muscles become immobilized.” In the early part of the 20th century, the mortality rate was much higher.
In 1894, the United States endured its first major polio outbreak. Some 132 cases were identified in Vermont. In 1916, there were over 27,000 cases in New York City. Over 6,000 died––a truly gruesome mortality rate.
In 1921, Franklin Delano Roosevelt fell overboard while vacationing in New Brunswick, Canada. Nearly paralyzed by the frigid waters of the Bay of Fundy, he felt sore the next day. It took some time and two different doctors before Dr. Robert Lovett was able to provide an accurate diagnosis. FDR had polio. He was 39 and skeptical––back then the disease was commonly called infantile paralysis. When he became president a dozen years later, he did his best to conceal the extent of his own disability while becoming a tireless champion for its cure. In 1938, he and his former law partner, Basil O’Connor, co-founded the National Foundation for Infantile Paralysis. Later renamed the March of Dimes Foundation, the organization used celebrities like Mickey Rooney and legions of children to raise money for a vaccine. Over $20 million was raised in 1940 alone.
Vaccine: Victims and Victory
The events of 1935 offer a cautionary tale to anyone dreaming of a miracle COVID-19 vaccine. That year New York University’s Maurice Brodie, M.D., and Temple University John Kolmer, M.D., tested their polio vaccines. Brodie’s relied on a killed polio virus while Kolmer used an attenuated, or weaker, poliovirus vaccine. Thousands of children were volunteered by their worried parents. None developed immunity. Instead, nine died while dozens were left permanently paralyzed. It would take twenty years before a safe, effective vaccine found widespread use.
Soon after Roosevelt died in 1945, his successor Harry S. Truman gave a speech echoed by presidents and prime ministers promising action against polio: “The fight against infantile paralysis cannot be a local war. It must be nationwide. It must be total war in every city, town and village throughout the land. For only with a united front can we ever hope to win any war.”
In 1948, Thomas Weller and Frederic Robbins were the first to grow live polio virus in living cells by culturing it in samples of human skin and muscle. Just a few years later, Dr. Jonas Salk developed an injectable vaccine that used an inactive, killed vaccine. Following its widespread adoption in 1955 and the “live” oral vaccine developed by Dr. Albert Sabin six years later, polio incidents declined dramatically.
As reported by the Center for Disease Control and Prevention in the United States, “During 1951-1954, an average of 16,316 paralytic polio cases and 1879 deaths from polio were reported each year.” By 1962, it had dropped to fewer than 1000 cases. That decade the numbers continued to decline –– dropping to below 100. As the CDC notes, “In 1994, every dollar spent to administer oral poliovirus vaccine saved $3.40 in direct medical costs and $2.74 in indirect societal costs. The last documented indigenous transmission of wild poliovirus in the United States occurred in 1979. Since then, reported cases have been either vaccine-associated or imported. As of 1991, polio caused by wild-type viruses has been eliminated from the Western Hemisphere.”
These amazing achievements had an unfortunate side effect. Because polio was no longer seen as a threat in places like the United States and the United Kingdom, its impact on less developed nations was ignored. In 1988, that began to change. At the time, some 125 countries endured regular polio outbreaks. Across the world over 350,000 people were paralyzed. That year an unprecedented public-private partnership sought to change that. Organizations including the CDC, WHO, Rotary International, and UNICEF set a goal of 400 million vaccinations worldwide. Joined later by the Bill and Melinda Gates Foundation, the effort largely succeeded. The number of cases worldwide dropped by over 99%. The oral vaccine has been a blessing to worldwide eradication. Administering it requires far less training than giving shots––often volunteers deliver the oral vaccine. WHO estimates that since 1988, over 16 million people have been saved from paralysis.
These global efforts have had benefits beyond polio eradication. For example, Vitamin A supplements have been given to children receiving the vaccine. Because this boosts immunity, WHO estimates it has averted over 1.5 million deaths. In the 21st century, the number of countries experiencing polio outbreaks has dwindled to three. Unfortunately, the border regions between Afghanistan and Pakistan along with Northern Nigeria are among the most challenging places on the planet for healthcare workers. Yet because the three strains of wild poliovirus will die if they can’t find a human host, completely eliminating the disease is possible. In order for this to happen, every child on the planet must be vaccinated against polio. Unfortunately the eradication of this 20th century scourge has been delayed by one from the 21st. During the COVID-19 outbreak, polio eradication has been put on hold.
Written by John Bankston
References
- The immunological basis for Immunization series: module six: poliomyelitis
- World Health Organization: Poliomyelitis Overview
- World Health Organization. Poliomyelitis Key Facts
- The Story of Polio
- Achievements in Public Health, 1900-1999 Impact of Vaccines Universally Recommended for Children — United States, 1990-1998
- Ten facts on polio eradication