How thousands of first- and second-graders saved the world from a deadly disease
Although Jonas Salk has gone down in history for helping rid the world (almost) of polio, his revolutionary vaccine wouldn't have been possible without the world’s largest clinical trial – and the bravery of thousands of kids.
Exactly 67 years ago, in 1955, a group of scientists and reporters gathered at the University of Michigan and waited with bated breath for Dr. Thomas Francis Jr., director of the school’s Poliomyelitis Vaccine Evaluation Center, to approach the podium. The group had gathered to hear the news that seemingly everyone in the country had been anticipating for the past two years – whether the vaccine for poliomyelitis, developed by Francis’s former student Jonas Salk, was effective in preventing the disease.
Polio, at that point, had become a household name. As the highly contagious virus swept through the United States, cities closed their schools, movie theaters, swimming pools, and even churches to stop the spread. For most, polio presented as a mild illness, and was usually completely asymptomatic – but for an unlucky few, the virus took hold of the central nervous system and caused permanent paralysis of muscles in the legs, arms, and even people’s diaphragms, rendering the person unable to walk and breathe. It wasn’t uncommon to hear reports of people – mostly children – who fell sick with a flu-like virus and then, just days later, were relegated to spend the rest of their lives in an iron lung.
For two years, researchers had been testing a vaccine that would hopefully be able to stop the spread of the virus and prevent the 45,000 infections each year that were keeping the nation in a chokehold. At the podium, Francis greeted the crowd and then proceeded to change the course of human history: The vaccine, he reported, was “safe, effective, and potent.” Widespread vaccination could begin in just a few weeks. The nightmare was over.
The road to success
Jonas Salk, a medical researcher and virologist who developed the vaccine with his own research team, would rightfully go down in history as the man who eradicated polio. (Today, wild poliovirus circulates in just two countries, Afghanistan and Pakistan – with only 140 cases reported in 2020.) But many people today forget that the widespread vaccination campaign that effectively ended wild polio across the globe would have never been possible without the human clinical trials that preceded it.
As with the COVID-19 vaccine, skepticism and misinformation around the polio vaccine abounded. But even more pervasive than the skepticism was fear. The consequences of polio had arguably never been more visible.
The road to human clinical trials – and the resulting vaccine – was a long one. In 1938, President Franklin Delano Roosevelt launched the National Foundation for Infantile Paralysis in order to raise funding for research and development of a polio vaccine. (Today, we know this organization as the March of Dimes.) A polio survivor himself, Roosevelt elevated awareness and prevention into the national spotlight, even more so than it had been previously. Raising funds for a safe and effective polio vaccine became a cornerstone of his presidency – and the funds raked in by his foundation went primarily to Salk to fund his research.
The Trials Begin
Salk’s vaccine, which included an inactivated (killed) polio virus, was promising – but now the researchers needed test subjects to make global vaccination a possibility. Because the aim of the vaccine was to prevent paralytic polio, researchers decided that they had to test the vaccine in the population that was most vulnerable to paralysis – young children. And, because the rate of paralysis was so low even among children, the team required many children to collect enough data. Francis, who led the trial to evaluate Salk’s vaccine, began the process of recruiting more than one million school-aged children between the ages of six and nine in 272 counties that had the highest incidence of the disease. The participants were nicknamed the “Polio Pioneers.”
Double-blind, placebo-based trials were considered the “gold standard” of epidemiological research back in Francis's day - and they remain the best approach we have today. These rigorous scientific studies are designed with two participant groups in mind. One group, called the test group, receives the experimental treatment (such as a vaccine); the other group, called the control, receives an inactive treatment known as a placebo. The researchers then compare the effects of the active treatment against the effects of the placebo, and every researcher is “blinded” as to which participants receive what treatment. That way, the results aren’t tainted by any possible biases.
But the study was controversial in that only some of the individual field trials at the county and state levels had a placebo group. Researchers described this as a “calculated risk,” meaning that while there were risks involved in giving the vaccine to a large number of children, the bigger risk was the potential paralysis or death that could come with being infected by polio. In all, just 200,000 children across the US received a placebo treatment, while an additional 725,000 children acted as observational controls – in other words, researchers monitored them for signs of infection, but did not give them any treatment.
As with the COVID-19 vaccine, skepticism and misinformation around the polio vaccine abounded. But even more pervasive than the skepticism was fear. President Roosevelt, who had made many public and televised appearances in a wheelchair, served as a perpetual reminder of the consequences of polio, as an infection at age 39 had rendered him permanently unable to walk. The consequences of polio had arguably never been more visible, and parents signed up their children in droves to participate in the study and offer them protection.
The Polio Pioneer Legacy
In a little less than a year, roughly half a million children received a dose of Salk’s polio vaccine. While plenty of children were hesitant to get the shot, many former participants still remember the fear surrounding the disease. One former participant, a Polio Pioneer named Debbie LaCrosse, writes of her experience: “There was no discussion, no listing of pros and cons. No amount of concern over possible side effects or other unknowns associated with a new vaccine could compare to the terrifying threat of polio.” For their participation, each kid received a certificate – and sometimes a pin – with the words “Polio Pioneer” emblazoned across the front.
When Francis announced the results of the trial on April 12, 1955, people did more than just breathe a sigh of relief – they openly celebrated, ringing church bells and flooding into the streets to embrace. Salk, who had become the face of the vaccine at that point, was instantly hailed as a national hero – and teachers around the country had their students to write him ‘thank you’ notes for his years of diligent work.
But while Salk went on to win national acclaim – even accepting the Presidential Medal of Freedom for his work on the polio vaccine in 1977 – his success was due in no small part to the children (and their parents) who took a risk in order to advance medical science. And that risk paid off: By the early 1960s, the yearly cases of polio in the United States had gone down to just 910. Where before the vaccine polio had caused around 15,000 cases of paralysis each year, only ten cases of paralysis were recorded in the entire country throughout the 1970s. And in 1979, the virus that once shuttered entire towns was declared officially eradicated in this country. Thanks to the efforts of these brave pioneers, the nation – along with the majority of the world – remains free of polio even today.
How We Can Return to Normal Life in the COVID-19 Era
A crowded baseball stadium is the epitome of "getting back to normal."
I was asked recently when life might return to normal. The question is simple but the answer is complex, with many knowns, lots of known unknowns, and some unknown unknowns. But I'll give it my best shot.
To get the fatality rate down to flu-like levels would require that we cut Covid-19 fatalities down by a factor of 5.
Since I'm human (and thus want my life back), I might be biased toward optimism.
Here's one way to think about it: Is there another infection that causes sickness and death at levels that we tolerate? The answer, of course, is 'yes': influenza.
According to the Centers for Disease Control, from 2010 to 2019, an average of 30 million Americans had the flu each year, leading to an annual average of 37,000 deaths. This works out to an infection-fatality rate, or IFR, of 0.12 percent. We've tolerated that level of illness death from influenza for a century.
Before going on, let's get one thing out of the way: Back in March, Covid-19 wasn't, as some maintained, "like the flu," and it still isn't. Since then, the U.S. has had 3.9 million confirmed Covid-19 cases and 140,000 deaths, for an IFR of 3.6 percent. Taking all the cases — including asymptomatic patients and those with minimal symptoms who were never tested for Covid-19 — into account, the real IFR is probably 0.6 percent, or roughly 5 times that of the flu.
Nonetheless, even a partly effective vaccine, combined with moderately effective medications, could bring Covid-19 numbers down to a tolerable, flu-like, threshold. It's a goal that seems within our reach.
Chronic mask-wearing and physical distancing are not my idea of normal, nor, I would venture to guess, would most other Americans consider these desirable states in which to live. We need both now to achieve some semblance of normalcy, but they're decidedly not normal life. My notion of normal: daily life with no or minimal mask wearing, open restaurants and bars, ballparks with fans, and theaters with audiences.
My projection for when we might get there: perhaps a year from now.
To get the fatality rate down to flu-like levels would require that we cut Covid-19 fatalities down by a factor of 5, via some combination of fewer symptomatic cases and a lower chance that a symptomatic patient will go on to die. How might that happen?
First, we have to make some impact on young people – getting them to follow the public health directives at higher rates than they are currently. The main reason we need to push younger people to stay safe is that they can spread Covid-19 to vulnerable people (those who are older, with underlying health problems). But, once the most vulnerable are protected (through the deployment of some combination of effective medications and a vaccine), the fact that some young people aren't acting safely – or maybe won't take a vaccine themselves – wouldn't cause so much concern. The key is whether the people at highest risk for bad outcomes are protected.
Then there's the vaccine. The first principle: We don't need a 100 percent-effective vaccine injected into 320 million deltoid muscles (in the U.S. alone). Thank God, since it's fanciful to believe that we can have a vaccine that's 100 percent effective, universally available by next summer, and that each and every American agrees to be vaccinated.
How are we doing in our vaccine journey? We've been having some banner days lately, with recent optimistic reports from several of the vaccine companies. In one report, the leading candidate vaccine, the one effort being led by Oxford University, led to both antibodies and a cellular immune response, a very helpful belt-and-suspenders approach that increases the probability of long-lasting immunity. This good news comes on the heels of the positive news regarding the American vaccine being made by Moderna earlier in July.
While every article about vaccines sounds the obligatory cautionary notes, to date we've checked every box on the path to a safe and effective vaccine. We might not get there, but most experts are now predicting an FDA-approvable vaccine (more than 50 percent effective with no show-stopping side effects) by early 2021.
It is true that we don't know how long immunity will last, but that can be a problem to solve later. In this area, time is our friend. If we can get to an effective vaccine that lasts for a year or two, over time we should be able to discover strategies (more vaccine boosters, new and better medications) to address the possibility of waning immunity.
All things considered, I'm going to put my nickel down on the following optimistic scenario: we'll have one, and likely several, vaccines that have been proven to be more than 50 percent effective and safe by January, 2021.
If only that were the finish line.
Once we vaccinate a large fraction of high-risk patients, having a moderate number of unvaccinated people running around won't pose as much threat.
The investments in manufacturing and distribution should pay off, but it's still inconceivable that we'll be able to get vaccines to 300 million people in three to six months. For the 2009 Swine Flu, we managed to vaccinate about 1 in 4 Americans over six months.
So we'll need to prioritize. First in line will likely be the 55 million Americans over 65, and the six to eight million patient-facing healthcare workers. (How to sort priorities among people under 65 with "chronic diseases" will be a toughie.) Vaccinating 80-100 million vulnerable people, plus clinicians, might be achievable by mid-21.
If we can protect vulnerable people with an effective vaccine (with the less vulnerable waiting their turn over a subsequent 6-12 month period), that may be enough to do the trick. (Of course, vulnerable people may also be least likely to develop immunity in response to a vaccine. That could be an Achilles' heel – time will tell.)
Why might that be enough? Once we vaccinate a large fraction of high-risk patients, having a moderate number of unvaccinated people running around won't pose as much threat. Since they're at lower risk, they have a lower chance of getting sick and dying than those who received the vaccine first.
We're likely to have better meds by then, too. Since March, we've discovered two moderately effective medications for Covid-19 — remdesivir and dexamethasone. It seems likely that we'll find others by next summer, perhaps even a treatment that prevents patients from getting ill in the first place. There are many such therapies, ranging from zinc to convalescent plasma, currently being studied.
Moreover, we know that hospitals that are not overrun with Covid-19 have lower mortality rates. If we've gotten a fairly effective vaccine into most high-risk people, the hospitals are unlikely to be overwhelmed – another factor that may help lower the mortality rate to flu-like levels.
All of these factors – vaccination of most vulnerable people, one or two additional effective medications, hospitals and ICU's that aren't overwhelmed – could easily combine to bring the toll of Covid-19 down to something that resembles that of the flu. Then, we should be able to return to normal life.
Whatever the reason, if enough people refuse the vaccine, all bets are off.
What do I worry about? There's the growing anti-vaxxer movement, for one. On top of that, it seems that many Americans worry that a vaccine discovered in record speed won't be safe, or that the FDA approval process will have been corrupted by political influences. Whatever the reason, if enough people refuse the vaccine, all bets are off.
Assuming only high-risk people do get vaccinated, there will still be cases of Covid-19, maybe even mini-outbreaks, well into 2021 and likely 2022. Obviously, that's not ideal, and we should hope for a vaccine that results in the complete eradication of Covid-19. But the point is that, even with flu-like levels of illness and death, we should still be able to achieve "normal."
Hope is not a strategy, as the saying goes. But it is hope, which is more than we've had for a while.
Will the Pandemic Propel STEM Experts to Political Power?
The White House rising out of a Petri dish.
If your car won't run, you head to a mechanic. If your faucet leaks, you contact a plumber. But what do you do if your politics are broken? You call a… lawyer.
"Scientists have been more engaged with politics over the past three years amid a consistent sidelining of science and expertise, and now the pandemic has crystalized things even more."
That's been the American way since the beginning. Thousands of members of the House and Senate have been attorneys, along with nearly two dozen U.S. presidents from John Adams to Abraham Lincoln to Barack Obama. But a band of STEM professionals is changing the equation. They're hoping anger over the coronavirus pandemic will turn their expertise into a political superpower that propels more of them into office.
"This could be a turning point, part of an acceleration of something that's already happening," said Nancy Goroff, a New York chemistry professor who's running for a House seat in Long Island and will apparently be the first female scientist with a Ph.D. in Congress. "Scientists have been more engaged with politics over the past three years amid a consistent sidelining of science and expertise, and now the pandemic has crystalized things even more."
Professionals in the science, technology, engineering and medicine (STEM) fields don't have an easy task, however. To succeed, they must find ways to engage with voters instead of their usual target audiences — colleagues, patients and students. And they'll need to beat back a long-standing political tradition that has made federal and state politics a domain of attorneys and businesspeople, not nurses and biologists.
In the 2017-2018 Congress, more members of Congress said they'd worked as radio talk show hosts (seven) and as car dealership owners (six) than scientists (three — a physicist, a microbiologist, and a chemist), according to a 2018 report from the Congressional Research Service. There were more bankers (18) than physicians (14), more management consultants (18) than engineers (11), and more former judges (15) than dentists (4), nurses (2), veterinarians (3), pharmacists (1) and psychologists (3) combined.
In 2018, a "STEM wave" brought nine members with STEM backgrounds into office. But those with initials like PhD, MD and RN after their names are still far outnumbered by Esq. and MBA types.
Why the gap? Astrophysicist Rush Holt Jr., who served from 1999-2015 as a House representative from New Jersey, thinks he knows. "I have this very strong belief, based on 16 years in Congress and a long, intense public life, that the problem is not with science or the scientists," said. "It has to do with the fact that the public just doesn't pay attention to science. It never occurs to them that they have any role in the matter."
But Holt, former chief executive of the American Association for the Advancement of Science, believes change is on the way. "It's likely that the pandemic will affect people's attitudes," former congressman Holt said, "and lead them to think that they need more scientific thinking in policy-making and legislating." Holt's father was a U.S. senator from West Virginia, so he grew up with a political education. But how can scientists and medical professionals succeed if they have no background in the art of wooing voters?
That's where an organization called 314 Action comes in. Named after the first three digits of pi, 314 Action declares itself to be the "pro-science resistance" and says it's trained more than 1,400 scientists to run for public office.
In 2018, 9 out of 13 House and Senate candidates endorsed by the group won their races. In 2020, 314 Action is endorsing 12 candidates for the House (including an engineer), four for the Senate (including an astronaut) and one for governor (a mathematician in Kansas). It expects to spend $10 million-$20 million to support campaigns this year.
"Physicians, scientists and engineers are problem-solvers," said Shaughnessy Naughton, a Pennsylvania chemist who founded 314 Action after an unsuccessful bid for Congress. "They're willing to dive into issues, and their skills would benefit policy decisions that extend way beyond their scientific fields of expertise."
Like many political organizations, 314 Action focuses on teaching potential candidate how to make it in politics, aiming to help them drop habits that fail to bridge the gap between scientists and civilians. "Their first impulse is not to tell a story," public speaking coach Chris Jahnke told the public radio show "Marketplace" in 2018. "They would rather start with a stat." In a training session, Jahnke aimed to teach them to do both effectively.
"It just comes down to being able to speak about general principles in regular English, and to always have the science intertwined with basic human values," said Rep. Kim Schrier, a Washington state pediatrician who won election to Congress in 2018.
She believes her experience on the job has helped her make connections with voters. In a chat with parents about vaccines for their child, for example, she knows not to directly jump into an arcane discussion of case-control studies.
The best alternative, she said, is to "talk about how hard it is to be a parent making these decisions, feeling scared and worried. Then say that you've looked at the data and the research, and point out that pediatricians would never do anything to hurt children because we want to do everything that is good for them. When you speak heart to heart, it gets across the message and the credibility of medicine and science."
The pandemic "will hopefully awaken people and trigger a change that puts science, medicine and public health on a pedestal where science is revered and not dismissed as elitist."
Communication skills will be especially important if the pandemic spurs more Americans to focus on politics and the records of incumbents in regard to matters like public health and climate change. Thousands of candidates will have to address the nation's coronavirus response, and a survey commissioned by 314 Action suggests that voters may be receptive to those with STEM backgrounds. The poll, of 1,002 likely voters in early April 2020, found that 41%-46% of those surveyed said they'd be "much more favorable" toward candidates who were doctors, nurses, scientists and public health professionals. Those numbers were the highest in the survey compared to just 9% for lawyers.
The pandemic "will hopefully awaken people and trigger a change that puts science, medicine and public health on a pedestal where science is revered and not dismissed as elitist," Dr. Schrier said. "It will come from a recognition that what's going to get us out of this bind are scientists, vaccine development and the hard work of the people in public health on the ground."
[This article was originally published on June 8th, 2020 as part of a standalone magazine called GOOD10: The Pandemic Issue. Produced as a partnership among LeapsMag, The Aspen Institute, and GOOD, the magazine is available for free online.]