Diane talks with The New Yorker's Susan Glasser.
Guest Host: Laura Knoy
For a certain generation of Americans, polio is a very scary word. Serious outbreaks of the disease began appearing in the U.S. in the late 1800s. President Franklin Roosevelt contracted polio in 1921. Over the next several decades, tens of thousands of Americans a year were debilitated by the poliomyelitis virus. In 1952, polio killed some 3,000 people in the U.S. and paralyzed many more. Then came Dr. Jonas Salk’s vaccine. Schoolchildren across the country were inoculated, saving untold Americans from contracting the disease. Today, because of aggressive public health efforts, polio has been nearly wiped out globally. We look at the history of polio and the ongoing battle to finally eradicate it worldwide.
- Dr. Charlotte Jacobs Professor of medicine at Stanford University; author of "Jonas Salk: A Life."
- David Oshinsky Pulitzer Prize-winning author of "Polio: An American Story"; director of the division of medical humanities at the NYU Langone Medical Center.
- Dr. Stephen Cochi Senior adviser to the director of the CDC's Global Immunization Division, Center for Global Health.
MS. LAURA KNOYThanks for joining us. I'm Laura Knoy of New Hampshire Public Radio sitting in for Diane Rehm. She'll be back next week. Polio used to be prevalent in the U.S. At its peak in 1952, more than 60,000 Americans contracted the virus, which often causes paralysis and sometimes death. But last year, there were fewer than 400 case worldwide.
MS. LAURA KNOYJoining me in the studio to talk about the history of polio and what it will take to eradicate it globally, David Oshinsky, author of "Polio: An American Story." From a studio in San Francisco, Dr. Charlotte Jacobs, author of "Jonas Salk: A Life." And from Atlanta, Dr. Stephen Cochi of the CDC's Center For Global Health. Welcome to all of you. Thank you for being here.
MR. DAVID OSHINSKYThank you.
DR. CHARLOTTE JACOBSThank you.
DR. STEPHEN COCHIThank you.
KNOYYou can join us, too. Call 1-800-433-8850, 1-800-433-8850. Send an email to email@example.com. You can find us on Facebook or Twitter as well. And David Oshinsky, let's just go back for a bit and remind us what it was like in this country when polio was prevalent, there's no vaccine, because it's easier for younger generations to forget just how terrifying this was.
OSHINSKYWell, I was a baby boom baby. I grew up in New York City after World War II and there was no vaccine. Polio came like the plague every summer without fail and the New York City newspapers had box scores, started around Memorial Day, of the number of children who had brought into the polio wards. And those numbers went up in July, higher in August and they'd peak around Labor Day and polio season would then end.
OSHINSKYBut during that period, hundreds -- and in New York City, even thousands of children would be paralyzed by polio. It's a very visual disease. You can walk into a restaurant and now know who has heart disease or cancer, but polio has leg braces. It has wheelchairs. It has crutches. And you knew how bad it was for these children. And we would come back in September, there'd be empty desks of children who had not survived the summer.
OSHINSKYMy parents actually used to take me up to the mountains. We didn't have much money, but they believed that if you got out of the city, erroneously, you could avoid polio. You couldn't. Polio was everywhere. There was no prevention. There was no cure. You couldn't go swimming. They closed beaches. The belief was that polio traveled through the water. You couldn't go bowling. Children had to stay out of crowds. Movie theaters were closed for us.
KNOYSounds like some kind of a, you know, nightmarish movie, David.
OSHINSKYIt was awful. My mother, I remember, would give me a polio test every couple of days. Could I touch my toes? Could I rest my chin on my chest? The slightest sore throat, muscle ache would bring an absolute panic. And this went on for months at a time and there was a sense that this dread was never going to go away.
KNOYWell, Dr. Jacobs, in your book about the inventor of the polio vaccine, Jonas Salk, you also describe New York City during the last century. I mean, babies literally being ripped from their mother's arms. Just, again, paint that picture for us of just how terrifying this was for people.
JACOBSWell, that was in 1916 and no one know, at that time, how polio was spread and so isolation was the treatment that was used, just as it had been in other types of epidemics. If people couldn't take care of their children at home and there was a case of polio, children were taken to local hospitals and they were there set in isolation so that a child may not see their parents, except through a door, perhaps, for months on end. It was a terrifying time.
KNOYWell, and David mentioned, you know, the leg braces and the wheelchairs. Dr. Jacobs, also the iron lung, that's a phrase from this terrible time in our history. Just remind us what those were because there's some heartbreaking pictures in your book.
JACOBSThat was terrible. If the polio virus -- once it gets into the bloodstream, it can spread into the brain. If it hits areas of the spinal cord, people can have one limb that's hanging useless or be paralyzed from the neck down. But if it got into the base of brain, someone could have the trouble swallowing saliva and be unable to breathe on their own, move their diaphragm and so they were place in an iron lung, which in a sense, breathed for them. Some children were confined to an iron lung for life. Others improved enough so that they could go home in what was called a rocking bed, which positioned them in order to allow them to breathe.
KNOYWow. So a little bit about the disease itself, please, Dr. Cochi. First of all, I was struck by what David said. Summer was polio season. How come?
COCHIYes. That's because this is a virus that tends to be spread most commonly during the summer time and that's when the peak of spread from person to person occurs.
KNOYWhy was that, though? Is it polio virus that particularly likes warm weather or?
COCHIWell, we don't understand exactly why the summer time is the favored time, but nonetheless, this is a virus that spreads from person to person, either through coughing and sneezing, close personal contact or since it inhabits -- infects and inhabits the gastrointestinal tract of people who are infected with the virus, it can spread by fecal oral route from person to person and it is a disease that has silent spread in the community. Only on average one out of every 200 people who are infected manifest the paralytic polio disease that's the hallmark of polio.
COCHISo there's silent transmission in the community occurring all the time.
KNOYSo it spreads from person to person in a variety of ways as you've described, Dr. Cochi. Do we know where it came from originally?
COCHIWe don't know where it came from, but we know that it has been with the human population for thousands of years. We have evidence of this, for example, from hieroglyphics, from the ancient Egyptian culture, so...
COCHIYes. So this is a disease that we've had to live and deal with throughout the millennia and it's only in the last 60 years that we've had a vaccine to prevent the disease.
KNOYWell, we'll definitely talk about the vaccine, what a huge, huge deal that was. It can't be overstated and then, ongoing efforts to eradicate the disease worldwide. But David Oshinsky, did you want to jump in on Dr. Cochi's point there?
OSHINSKYYeah, once the polio vaccines came into being, much of the research surrounding polio kind of ended so we really don't know why it's a summer disease. As the doctor mentioned, it is possible that certain viruses are more active in summer time in certain, like influenza, more active in cold weather. More boys got polio than girls. We don't know why. And it happened every year. And the theory then was that boys played harder than girls and therefore, when the polio virus was in their system, they were more likely to be paralyzed.
OSHINSKYFinally, and most importantly, in epidemic form, 30, 40,000 kids getting it a year, polio was a disease of the West and of the 20th century. The biggest polio epidemics occurred in the United States, in Canada, in Western Europe and the like and our belief is that polio may, in some sense, be a disease of cleanliness, that the more antiseptic we became as a society, the less likely infants were to have their parental antibodies and also to be exposed to polio at a very, very early age.
OSHINSKYSo what you find out in the United States are not only the number of polio cases rising in the '40 and '50s, but the age of the polio victim is also rising. The classic example, of course, being Franklin Roosevelt.
KNOYWow. Well, I want to talk with all of you about the vaccine that changed everything so dramatically. But also reminding our listeners that you can join us at 1-800-433-8850. Send an email to firstname.lastname@example.org. We're looking, this hour, at polio, efforts to eradicate it worldwide and we're looking back at some of the history around this disease. You can send an email to email@example.com. Find us on Facebook or Twitter or give us a call, 1-800-433-8850.
KNOYSo Dr. Jacobs, you were a girl when Dr. Jonas Salk's vaccine became available. You were, in fact, what was called a polio pioneer. Who were these kids and how did you become one?
JACOBSWell, the National Foundation For Infantile Paralysis, better known as the March of Dimes, in 1954 decided to test Jonas Salk's vaccine in a nationwide trial. And that included children in the 1st, 2nd and 3rd grade. They studied over a million children in their trial. They selected sites, specific sites, across the United States, usually areas with populations of 50 to 200,000. I lived in a small town in Kingsport, Tennessee, and actually our population wasn't that large so I don't know how we were selected.
JACOBSI was in the 2nd grade at that time and so I stood in line in the cafeteria and was one of the first children in the United States to get a polio vaccine. What we got in return for that was a red lollipop, a card that said we had had a vaccination and, most importantly, a button that called us a polio pioneer. So I think one of the things that's remarkable about that trial is that it was funded and carried out by volunteers. There's been nothing like that in the history of medicine and I doubt there ever will be again.
JACOBSNormally, trials now are carried out by large pharmaceutical houses or institutes. This was carried out by housewives and local high school principals. It was an amazing effort and all the funding came from the dimes that were donated. You couldn't even look at a dime, when I was a child, without feeling guilty if you didn't put it in a canister because we were all part of trying to prevent and cure this disease.
KNOYWow. Well, I think it's great that you still remember the color of the lollipop that you had there, Dr. Jacobs. It shows what a big moment it was. We will talk more about polio, the battle to eradicate it, past and present coming up on "The Diane Rehm Show." So stay with us.
KNOYWelcome back. I'm Laura Knoy sitting in for Diane Rehm. We're talking this hour about the history of polio eradication in this country and worldwide. You can join us if you'd like. The number is 1-800-433-8850. Send an email to firstname.lastname@example.org. Find us on Facebook or Twitter. Our guests are Dr. Charlotte Jacobs, professor of medicine at Stanford University, author of "Jonas Salk: A Life." Joining us from Atlanta, Dr. Stephen Cochi, senior adviser to the director of the CDC's Global Immunization Division. And with me in studio, David Oshinsky, Pulitzer Prize-winning author of "Polio: An American Story."
KNOYAnd David Oshinsky -- just following up on Dr. Jacob's great story, remembering being a polio pioneer, getting that shot and the red lollipop -- what do you remember about your polio vaccine?
OSHINSKYWell, what was most interesting at the time, I think, was that we're very big on informed consent today. In other words, people have to understand exactly what the experiment is about, what the risks are, the liabilities and the like.
KNOYYou get a sheet from the CDC every time...
KNOY...and so forth.
OSHINSKYYou bet. And in these days, basically, there was very little. When Jonas Salk did his first public testing, he basically did it at what was called the Pennsylvania Home for the Feeble-Minded. And he just simply got the head of the place just to let him test, which was extraordinary. And the consent form at that time, from the March of Dimes, was very, very shrewd. It didn't say, "I give my consent to have my child get a polio shot." It said, "I request that my child be part of this study." As if it was both an honor to do this, to end polio forever, and that you were getting into a study that would help you, personally, even though no one was certain whether the vaccine worked or, indeed, whether it was perfectly safe.
KNOYWell, that's the amazing thing, too, about this story is that nobody knew, but the risk, David, was so terrifying. And everybody had seen the empty desks at school, everybody had seen the children in the iron lungs, that people said, "It's worth the risk."
OSHINSKYExactly. You look, today, and people don't see polio in the United States. So they say, "Why should I take any risk in giving my kid a shot?" which I think is short-sighted and also very, very selfish. In those days, my mother just looked at 40,000 kids being paralyzed every year and it was a no-brainer. The risk versus reward was, get that shot.
KNOYWell, here's a Facebook comment from Sarah, who says, "I got polio in 1954, after the first two vaccinations." It began as a series of three. Sarah says, "I was paralyzed but, with lots of therapy, completely recovered in four years. Thank God and Dr. Salk and my parents for vaccinating me and for the therapy. Sarah, thank you for the story. And let's take a caller. Sue in Freeport, Texas. Hi, Sue. You're on "The Diane Rehm Show." Thanks for joining us.
SUEHi. Thank you for having me. My sisters and I, all four of us had polio. We were quite the celebrities in the summer of 1953. And it was just before they came out with the vaccine where we live, which is south of Houston. Two of my sisters spent a month or more in a hospital called Hedgecroft in Houston, where they treated polio victims. And my other sister spent a couple of weeks there.
KNOYAll four of you, Sue. That's some pretty bad luck in your family, huh?
SUEIt was. But, you know what? No, praise God, because everything -- none of us had any lasting effects. Who knew? I mean, but we all, after our experience and after the illness, we all were vaccinated, of course, but after the fact.
KNOYWell, thank you for calling, Sue. And to you, I think, Dr. Cochi, here we had that Facebook comment from Sarah and Sue saying "Thank goodness for this vaccine." But when Jonas Salk started presenting this the first time to the public, not everybody was universally excited. There were concerns about this vaccine. What were some of those, Dr. Cochi?
COCHIWell, I think, that for any vaccine or any health intervention, there are always a small number of doubters or people who would like to see the benefits of the vaccine in general use before they sign on and agree to use it for themselves or for their children. So that was the situation at that time, as it is today. But I think what David was describing was completely on target. During this period of time, in the 1950s, the magnitude of the concern, the fear of the polio virus was tremendous. And, as a result, the Salk field trial became by far the largest vaccine field trial ever in the history of the United States, with more than one million children involved and participating in that trial.
COCHII think that speaks to the issue of the communities being fearful, communities wanting a solution.
KNOYWell, and you write about this too, Dr. Jacobs, that, you know, some people really thought this was not the way to go. I think the influential radio broadcaster, Walter Winchell, right? You talk about how he took to the airwaves...
KNOY...warning parents. Yeah. Give us a little more there, please.
JACOBSWell, Walter Winchell, just as they were getting ready to start the major trial, went on the airwaves and said to be careful. That this could be a killer. He was really reflecting a major opposition that was going on within the scientific community. Jonas Salk made a polio vaccine using a killed, or he called it inactivated virus. That went against the basic tenet from all virologists that the only way to have life-term protection with a vaccine was to use a live, weakened virus. That was the case with smallpox, with yellow fever. And none of them really believed that his vaccine could prevent polio.
JACOBSThe second was that there was concern, within the scientific community, whether his inactivated or killed virus was really killed, or could there be a little bit of live virus left in that vaccine that would actually cause polio. There were concerns that it could cause kidney damage because he grew the polio virus on kidney cells. So that he was -- he was pretty much a lone scientist, with just a few others behind him, who advocated a killed virus vaccine.
KNOYWell, so here's a question for you then, Dr. Cochi. And then we'll go back to our listeners. Given the concerns by some in the anti-vaccine movement in this country today, could we potentially see serious diseases, like polio, reaching these epidemic proportions again?
COCHIWell, I don't -- no, I don't think that that's a possibility now. But, as has been pointed out by Charlotte, there's what's -- is no perfect vaccine against polio. Polio is kind of complicated in terms of protecting both the individual and the community. And so what has resulted from that is that we have two very good vaccines. We have the Salk vaccine, which provides ideal individual protection. But it doesn't provide good protection at all in terms of interrupting, stop -- and stopping the infection in the gastrointestinal tracts of people who are infected. And therefore it doesn't provide good community protection.
COCHIAs a result, the Sabin vaccine, which is orally administered and provides good immunity in the gastrointestinal tract, is an alternative to the Salk vaccine. But it has its own problems in that it doesn't work very well in the developing world, in tropical, developing countries. It has a poor immune response, in a relative sense, and requires many more doses. So we have this controversy that emerged back in the 1950s: Which vaccine is better, Salk vaccine or the Sabin vaccine? And what I'm trying to point out is neither one is perfect. And now we have a coming-together in the world where both vaccines are put into use to eliminate the last vestiges of polio in the world.
KNOYYeah. It is interesting. I'm glad you raised that point, Dr. Cochi. Because, David, these two men had sort of a scientific rivalry. Yet, as Dr. Cochi is explaining, you need both.
OSHINSKYIt's absolutely true. And I think they would both turn over in their graves if they realized they had to come together this way. They were both wonderful scientists. Albert Sabin basically was a scientist's scientist. In other words, he stayed in his lab. He stayed away from publicity. And he was very sharp elbowed. In other words, you got into his territory and there was going to be payback. Jonas Salk was a brilliant scientist. And he proved that you could raise high immunity levels with an inactivated vaccine. But he was also a celebrity scientist. The March of Dimes had brought him out. He was the knight in the white lab coat. He was getting the kind of publicity that scientists had really not gotten before.
OSHINSKYSo there was also an element of jealousy in this. These were two men, obviously both wanting to come out first. Salk got there first with a relatively good vaccine. And Sabin simply felt, in many ways, that he had to sabotage the work that Jonas Salk was doing. And that led to, I think, one of the ugliest rivalries. And I think it hurt Jonas Salk's reputation unfairly after that. Jonas Salk was seen as a sort of "Johnny One Note." He had this one vaccine that worked very well and that was it. In fact, that one vaccine saved tens of thousands of lives. It saved untold numbers of kids from being paralyzed. We owe Jonas Salk an enormous debt of gratitude. And I think that we also owe it to Albert Sabin.
OSHINSKYAnd I think the, you know, as was mentioned, the beauty of this is that these two men, who didn't get along, who didn't play nice, who were forced to share their research, will now have to have both of their vaccines in use to finally walk the end-mile and end polio.
KNOYWell, and I have to ask you about this, too, Dr. Jacobs. Because you write about not only the rivalry but how Jonas Salk kind of went back and forth on this celebrity-doctor image that he had.
JACOBSWell, first, I'd like to say I have a slightly different interpretation than David. Early on, Salk and Sabin were quite friendly to each other. Sabin took the role, kind of, of a mentor. And their -- the letters back and forth are always signed, "Best personal regards," asking about each other's families. At meetings, they stayed up late talking to each other. But what happened was that Jonas Salk saw -- really thought that he could make a vaccine quickly with this killed virus. And I don't think that he was really in rivalry at that point with Sabin. He just saw all these children being crippled every day. He didn't want to get lock-stepped behind all the weakened-vaccine, live-vaccine virus people.
JACOBSAnd so he actually had to do his initial testing in secret because he knew that he would be blocked by them. But I think, at that point in time, the rivalry wasn't about two men. The rivalry was really about the principle behind the vaccine. And Salk, by his work, challenged that basic tenet, that principle that -- as one epidemiologist from the CDC said -- they held with religious fervor. Now, after Salk's vaccine came out and Albert Sabin was still working on his vaccine, and it finally got licensed in the early '60s and eventually replaced the Salk vaccine, then things heated up. And I think Salk, as David said, spent the rest of his life trying to get Sabin's vaccine de-licensed. But he never made negative comments about Sabin as a person.
JACOBSI could find only one person, in the hundreds I interviewed, who ever heard Salk say a negative word. Sabin, on the other hand, was ruthless. And he called Jonas Salk a kitchen chemist, saying, "Well, anybody could go into a kitchen and do what he did." Many people thought that he was probably behind the fact that Salk was never invited into the National Academy of Sciences, which is really pretty egregious. So that -- and he told a reporter, toward the end of his life, "I will be known, not as the person that made a polio vaccine, but the polio vaccine." So I think the kind of rivalry was, in a sense, later in life.
JACOBSBut Jonas Salk did tell a reporter once -- no, it was a friend that he told, "I hope my biographer will not portray us as two little Jewish boys from the Bronx fighting it out." Now, in regard to your other question, Jonas Salk did become an overnight celebrity. He had been made the icon for the polio vaccine. And he had kind of mixed feelings about that. He was an introvert. He was really quite a shy person. But he felt that the public had, through their dimes, supported all of his research and the trial and that he owed it to the public. So that he would do things such as give interviews with Parent Magazine. He tried to answer every single letter, as silly as some of them were -- like, prove that cats cause polio.
JACOBSHe really reached out to the public and, as David said, he became the people -- the public's scientist. He did that, I think, with a big heart. But many in the scientific community, in particular, thought he was trying to grab the limelight, that he pandered to the media. Perhaps there was a little bit of that. But I think...
KNOYA little professional jealousy there. Yeah. Dr. Jacobs...
KNOYI want to remind everybody that I'm Laura Knoy and you're listening to "The Diane Rehm Show." If you'd like to join us, call 1-800-433-8850. Send us an email to email@example.com. Follow us on Facebook. Send us a Tweet. Again, the number, 1-800-433-8850. And up next is Barbara from Iron Station, N.C. Hi, Barbara. You're on "The Diane Rehm Show." Thanks for calling in.
BARBARAThank you. My brother died of bulbar polio, which you never hear much about. That was, like, 64 years ago. And they say he caught it and died from it within 24 hours. They put him in an iron lung and he died five minutes after he got in there. And they thought it was caused because he worked cleaning the bottom of a swimming pool. Do you know anything about that particular polio and if that's really an established fact?
KNOYWow. And, Barbara, I'm sorry to hear about your brother. It's long time ago...
BARBARAYeah, me too.
KNOY...but that's hard. Yeah.
BARBARAHe was a good kid.
KNOYThank you for calling. Yeah. Can you tell us? Yeah.
JACOBSWell, the bulbar polio is what I was talking about before, when the polio virus gets into the base of the brain. And it affects the breathing centers and the ability to swallow. And before they had iron lungs, it was not uncommon for children who had bulbar polio to just die in their -- drown, essentially, in their own secretions within a very brief time after getting polio. So that it sounds like, unfortunately, he got into the iron lung a little too late. And that still wouldn't have helped his secretions, if they couldn't suction them out well enough.
KNOYWell, and Barbara, thank you for sharing that story. And you know, to you, Dr. Cochi, swimming pools were implicated often with polio. I've got an email from Deborah in McLean, Va., who says, "I have a clear memory from when I was a child in the early '50s in Brooklyn of being warned: It's polio season, so it's really important to wash your hands after you use the toilet." Deborah says, "I have never met anyone else who remembers such a warning. Was it common at the time?" Talk a little bit more, please, Dr. Cochi, about possible causes: pools, not washing your hands, and so forth.
COCHIWell, I think the issue of washing your hands is just a manifestation of the fact that, as I indicated earlier, one of the ways that this virus can spread from one person to another is through contamination -- through fecal-oral contamination. So that was, at the time, a very good recommendation. On the other hand, getting polio virus from swimming pools is a lot farther out there on the spectrum. I think the real issue is that in the summertime, which is the peak season when the virus spreads from person to person, you have a coming together of the community, of children in particular, who are enjoying the pool. But it's much more likely that they were getting the virus from...
KNOYLet me jump in on you there, Dr. Cochi, for a moment. I apologize. You're listening to "The Diane Rehm Show."
KNOYWelcome back. I'm Laura Knoy sitting in for Diane Rehm. This hour we're looking at the history of polio eradication in the U.S. and current efforts to eradicate it worldwide. Our guests are David Oshinsky, Pulitzer Prize winning author of "Polio: An American Story." Joining us from San Francisco, Dr. Charlotte Jacobs, professor of medicine at Stanford University and author of "Jonas Salk: A Life." And joining us from Atlanta is Dr. Stephen Cochi, senior advisor to the director of the CDC's Global Immunization Division.
KNOYYou can join us as well, 1-800-433-8850. Send email to firstname.lastname@example.org. And all of you, let's go right back to our listeners. David joins us from Syracuse, N.Y. Hi, David. You're on "The Diane Rehm Show." Welcome.
DAVIDJust mostly a comment. I'm 59 years old, was born in 1956, which was the year after the polio vaccine was, I believe, wildly -- became widely available after these tests. My mother grew up in rural Kentucky in the 1930s. And she'd seen a lot of, you know, children, her contemporaries, people she knew had polio and were impaired, you know, one degree or another. And probably people who died of it.
DAVIDShe and my father had decided not to have children until there was some control of polio. And that was basically 60 years ago this year and I was born the following year. So in some sense, this work put me on Earth. So, you know, this, that or indifferent.
KNOYSo thanks to Jonas Salk for that. Right, David?
DAVIDI guess so.
KNOYWell, thank you for calling in. And, again, David, it just gives you a sense of how scary this was for people. Here's a question for you, maybe, David and others. We have heard from so many people already this hour who were born in the 1950s at this momentous time of change. How long did it take from the introduction of that vaccine, in the mid-1950s, for polio to be eradicated in this country?
OSHINSKYThat's a good question. Salk's vaccine, which really became widely used after 1955, brought the numbers down significantly. And then in the mid-1960s the Sabin oral polio vaccine, which Sabin had amazingly tested in the Soviet Union, Became the vaccine of choice here in the United States. And the numbers then began to go down and down and down. And there were fewer than 100, and then 50 and 20. The one problem with the Sabin oral polio vaccine in the United States is that in an infinitesimally small number of cases you can get polio from that vaccine.
OSHINSKYThe virus will revert to virulence. So you could get the numbers way down, but you could never get them down to zero because of vaccine-induced polio. And that is one of the reasons that in the 1990s the United States and many other countries went back to a juiced-up version of the Salk inactivated polio vaccine. And that's the vaccine we use today. And we…
KNOYSo kids are still vaccinated against polio today?
OSHINSKYOh, that is correct. Absolutely. It's a vital vaccine. And we haven't had a case of sort of wild-virus-induced polio in the United States in decades. It's virtually gone here.
KNOYSo if it's virtually gone, David, why do people still need to be vaccinated?
OSHINSKYBecause there's something called herd immunity. And basically you have to keep vaccinating. A virus can only survive by finding new hosts. And the fewer people who are vaccinated, the easier it is for a virus to move around and find new hosts. If you can reach a certain point, say over 85 or 90 percent, then the virus has virtually no place to go. And that's where we are with polio today. The numbers are very, very high in terms of the numbers who have been vaccinated.
OSHINSKYNow, will we ever have a major polio epidemic again? I would seriously doubt it. But if we don't keep vaccinating the chances of a wild-virus polio circulating here and affecting children is very possible. It happened with measles. We saw it at Disneyland in 2014. There are clusters of unvaccinated children and that's where viruses grow and spread and kill.
KNOYAnd, Dr. Cochi, what other countries have recently celebrated being polio free?
COCHIWell, we are pleased to be able to report that we're now 12 months since the last recorded polio case on the entire continent of Africa. So we have reached a milestone that never in recorded history has occurred. And we are now down to only two countries in the world that are reporting polio, Pakistan and Afghanistan. And in the last six months only 20 cases of polio have occurred in the world. So we are closer than ever and on the verge of the disappearance of polio virus from the face of the Earth.
KNOYSo Afghanistan and Pakistan are the two outliers there?
KNOYDr. Cochi? Yeah, Charlotte Jacobs, go ahead, please.
JACOBSWell, one thing I wanted to make a point -- maybe Stephen could elaborate on it. In 2014, worldwide I think there were about 414 cases of polio. Fifty-five of those were actually from the oral polio vaccine. From that virus that had reverted to a more virulent form. So I believe the Global Poliomyelitis Eradication Initiative has a three-step plan in which to eventually revert the entire world to the, as David calls it, the juiced-up Salk vaccine. And that the total eradication of polio will also see the eradication of the oral vaccine.
KNOYWow. And who's leading the charge on that, Dr. Cochi? Is it the World Health Organization? Is it the United States? What is it?
COCHIYes. We have a coalition of four spear-heading partners led by the World Health Organization, UNICEF, CDC and Rotary International, which I hasten to add is the heart and soul of the Global Polio Eradication Initiative. And it has been in this game for -- ever since 1985. In recent years the Bill and Melinda Gates Foundation has joined the effort and has provided huge amounts of funding, as well as advocacy to complete the job of polio eradication.
KNOYYou know what jumps out at me from Dr. Cochi mentioning Rotary, David Oshinsky, is earlier in the show you mentioned what was incredible about this early effort is it was volunteers.
OSHINSKYIt still is.
KNOYThere's Rotary, right? Just community volunteers.
COCHIRotary is doing God's work and they've been doing it since the mid-1980s. And they have raised more than -- well more than a billion dollars. They bring people out into the field. They have vaccinators. This is their cause. In some ways they fly below the radar. We should be giving them more publicity and more thanks for the incredible work they do.
KNOYI did have one more question for you, Dr. Cochi, on contemporary issues, vaccinations. As David said, kids are still vaccinated for polio. Last year more than 100 children in the U.S. were stricken by what was called a strange polio-like illness. This was terrifying for people. Everybody said, hey, I thought we were done polio. Did doctors ever figure this out?
COCHIWell, it is a little bit of mystery still. And in large part because there are other causes of acute floppy paralysis, the kind of paralysis that the polio virus causes. And these are occurring all the time in communities and require a careful investigation to determine their origin. So in this instance there's no definitive answer to that particular question. But we are aware that, for example, other viruses that are in the same family of the polio virus are capable of causing a polio-like paralysis. Fortunately, that's very rare.
KNOYIf you want to join us, again the number is 1-800-433-8850. The email is email@example.com. You can find us on Facebook or Twitter if you'd like. Again, it's 1-800-433-8850. Here's an email from Judy, who says, "My housemate, who is 62, has had polio since age six. He is now suffering from post-polio syndrome. There are so few doctors today who understand polio and its later effects," Judy says. "Where can one get proper treatment for these disabling after effects?" Now, first of all, David, what is post-polio syndrome?
OSHINSKYWell, post-polio syndrome is basically when the body breaks down. In other words, when you have polio, you've had to use other muscle groups to compensate. And the body just sort of breaks down over time. It does not mean that the virus has come back. It does not mean you're getting polio a second time. The problem is that as years go by, polio survivors are dying out, people are forgetting about polio. Those who had polio had fewer doctors, as the woman mentioned, who remembers exactly what polio was like or the possibility of treating it.
OSHINSKYBut what I will say, that if she goes on the internet, many, many cities have post-polio syndrome clubs, phone numbers you can look at. And I have spoken to a number of these groups, including one in Warm Springs, Ga. So they do exist. The problem is there's very little research going on about it.
KNOYWell, and I have a…
JACOBSIf I can add just a little bit about that…
KNOYActually, Dr. Jacobs, hang on one sec because I do want to let people know that there's information at postpolio.org. So postpolio.org and I want to recognize a Facebook comment from Linda, too, who also asks about research on post-polio syndrome. So that's an important issue. Go ahead, Dr. Jacobs, yeah.
JACOBSWell, there are three theories as to why people get post-polio syndrome. One is actually that the nerves that have re-enervated or re-grown to allow the muscle strength to come back with time start to die out. So it's actually the exact same muscle groups that were affected before, although, as David said, they can get total body fatigue. The second theory is in fact that there is still some live polio left in their bodies, although no one has absolutely proven that. And the third is that they have some sort of autoimmune response to their original polio.
JACOBSThere are on the websites, I might just add, if they put post-polio syndrome clinical trials, there are several sites that list all the clinical trials throughout the world for polio -- post-polio syndrome and what the criteria for participating in those trials.
KNOYAll right. Well, that's some useful information for the several people who contacted us about post-polio syndrome. Let's go back to our callers. And Jeff joins us from Pittsburgh, Pa. Hi, Jeff. You're on "The Diane Rehm Show." Welcome.
JEFFGood morning. I want to just sort of reaffirm the previous caller's couple comments. The ability to get treatment is very difficult here, simply because, like you said, they haven't -- there aren't that many doctors. They haven't seen it. I've been physiatrists, I've been to neurologists, I've been to pretty much everybody under the sun and they really can't put a finger on and help me. I had polio in '52, 60 days in an isolation ward. Had a pretty normal life to 2002. I know where carbon fiber AFOs again. The one thing I would like to add as a comment, though, is that -- and this is a great conversation.
JEFFThe history of polio is fascinating and it's important. But I -- there's another dimension to it, which is that the disease is a point in time. The effects are a lifetime. There's something less than about a million survivors in the United States. I have not a clue what it is internationally, if you add the rest of the world up. But it is, there is a large group of people that are suffering the effects. And some of the treatment options, like braces, wheelchairs and things like that, are extremely expensive and, you know, outside the realm of affordability for many people.
KNOYWow, well, Jeff, I'm sorry to hear about your struggles. So another issue of post-polio syndrome, is that what you're saying? I mean, that's what you're experiencing?
JEFFYes, correct. And there is just this whole frustration, as there is with somebody that has an autoimmune disease. You know, trying to get somebody that really understands. I've been through so many doctors that do the traditional strength. You know, push your knees in, push your knees out, you know, hold your arms up (unintelligible) push them down, elbows to the side, that that doesn't tell a doctor what's really going on. Because your body can overcompensate. You can fire your nerve cells faster in order to replicate strength, but that doesn't indicate your underlying strength for things like walking, lifting and things like that.
KNOYAll right. Well, Jeff, I hope you can take advantage of some of the resources that our guests have mentioned, including postpolio.org. Thank you for calling in. I'm Laura Knoy and you're listening to "The Diane Rehm Show." Here's an email that came in from Barbara. I'll throw this to you, David. Barbara says, "Since roughly 2003, the research community has strongly leaned toward Guillain-Barre syndrome diagnosis for FDR." I'm not sure if I'm pronouncing that right, but -- so people always thought he had polio, now we're thinking differently?
OSHINSKYWell, I would not say the research community is leaning in that direction. There have been some articles written on it. I think the more important point is that FDR believed he had polio. His friends believed he had polio. His family believed he had polio. His doctors believed he had polio. The American public believed he had polio. And because of that, FDR, with this disability, formed the most successful charitable organization, philanthropic organization in history, the March of Dimes.
OSHINSKYIt raised a huge amount of money and it made two promises to the American people. We will rehabilitate as best we can every polio survivor, which they tried to do. And we will give you a vaccine. And indeed, they gave us two. So without Franklin Roosevelt being associated with polio, this battle would have been much slower and would not have saved the number of lives it did save. So I think to some degree that's a moot question.
KNOYYeah, what do you think, Dr. Jacobs? It is interesting. Maybe it doesn't matter if he had polio or not.
JACOBSWell, he doesn't have the clinical picture, as I understand it, of Guillain-Barre syndrome, which is called ascending paralysis. And the cause it not actually known, but usually people begin with numbness and weakness in their toes and feet and then it gradually moves up the body. And I don't -- David, correct me if I'm wrong, but I don't believe that was the picture of his paralysis. So I think he…
OSHINSKYThat is correct. It was not the picture of his paralysis. You're quite right, yeah.
KNOYGo ahead, Dr. Jacobs. Did you want to finish up there?
JACOBSOh, well, Guillain-Barre syndrome has been around for a long time. And actually there were a number of cases following the swine flu vaccine. But I agree with David, it probably is a moot point.
KNOYWell, and, Dr. Cochi, just to look again globally, you mentioned earlier, Afghanistan and Pakistan, the only two countries that still have concerns with polio. Is that correct?
COCHIThat's correct, yes.
KNOYSo what's it going to take to eradicate polio from those two countries? I imagine that's tricky. There's a lot of conflict on the ground and so forth.
COCHII think these are two of the most challenging countries in the world to once and for all stop the transmission of the polio virus. It's taking a monumental effort, but progress is being made. For example, one of the big problems in Pakistan, which is the number one country, currently, is that in the tribal areas of Pakistan controlled by the Taliban, there was -- there were nearly a half a million children who went for about two years without access to any polio vaccination or any vaccination at all.
COCHIAnd last summer, in the summer of 2014, the Pakistan army finally went into the tribal areas and the Taliban anti-government elements were dispersed and access to these children is now a daily undertaking. So this is one example of many extraordinary efforts that need to be made to once and for all wipe out the virus in Pakistan and in Afghanistan.
KNOYThat's Dr. Stephen Cochi with the CDC. Also with us Dr. Charlotte Jacobs of Stanford University, author of "Jonas Salk: A Life," and David Oshinsky, Pulitzer Prize winning author of "Polio: An American Story." Thank you all for being with us. I'm Laura Knoy sitting in for Diane Rehm. Thanks for listening.
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