David Oshinsky’s Polio: An American Story is a really interesting read and I highly recommend it, especially for those interested in the history of medicine and global health.
Rather than give a full review, I’ll just bullet point a few thoughts I had while reading and some of the themes that resonated with me most.
- Polio : 20th century America :: Cholera : 19th century Europe. Its presentation was terrifyingly quick – minor symptoms one day, paralysis the next; mercurial – no one knew where it came from, leading to isolated summers; visceral, with permanently crippled (white) children – but hardly the most deadly or problematic disease of the time, in terms of total morbidity and mortality
- The National Foundation of Infant Paralysis, or NFIP (which posterity will know best through the March of Dimes), was a remarkable organization. It completely upended the philanthropic regime of the day, by asking everyday people to give what they could – a dime, a dollar, whatever. It also used the influence of the radio and prominent public figures (e.g., actor Edie Cantor, Franklin Delano Roosevelt) to drive attention and monetary support to the disease – things that sound trivially obvious now but were novel then
- Tying together the two bullets above: in 1954, NFIP absorbed $66.9 million of the $140 million given to health charities in America – an amazing amount when considering the number of polio cases that same year: 100,000. The other organizations were upset about this, finding it unfair and a poor allocation of resources. The argument continues in a similar vein today; $1 billion is spent on polio eradication each year, which siphons critical resources (not just money, but also technical, human capital, and supply chain, to name a few) away from the prevention and treatment of other diseases and social ills that cause a much higher burden
- Oshinsky does his part to dispel the Great Man Theory of Scientific Discovery in this book, highlighting the dozens of scientists and researchers who were involved in the hunt for a workable vaccine, including Albert Sabin (who developed the live oral vaccine that did the heavy lifting in ridding most of the world of polo); Isabel Morgan (had she not taken maternity leave and left the lab, she very well could have developed the first workable vaccine against polio); and Hilary Koprowski* (who tested a live oral polio vaccine on humans years before Sabin did). It seems that Jonas Salk’s most useful skills were his pliability and his sense of urgency – both of which NFIP liked
- Hear this famous quote from Salk before? “There is no patent. Could you patent the sun?” Turns out, NFIP looked into it, decided that, like the sun, it would be unable to legally patent its vaccine (prior art). Salk was being more literal than moral**
- The rollout of the Salk and Sabin vaccines in America goes a long way towards showing why other massive public health campaigns are so hard; Salk/Sabin had much that future campaigns would not: an ample supply of physicians and nurses (who have comfortable enough lives to be able to volunteer their time and expertise freely for “the cause”); across-the-board literacy and “medical sensitization” (i.e., people used to interacting with the medical system); a society that viewed new science and technology positively, and thus willing to take a chance
- Polio inadvertently gave us one of the first cases of machine-assisted artificially-lengthened life: Fred Snite., Jr., a young man struck with polio in 1936, lived in an iron lung for 18 years, a time during which he married, had kids, and attended his alma mater’s football games with regularity
*Koprowski’s name would come up in the 1990s, as accusations mounted that his live OPV trials in Belgian Congo in the 1950s caused Simian Immunodeficiency Virus (SIV) to spillover into humans; in other words, that he caused HIV and, subsequently, the deaths of tens of millions of people. This was shown, again and again, to be inaccurate.
**Decades later, Salk would create an AIDS vaccine, and, as Oshinsky put it, “there was no talk of giving it to the world as a gift – no illusions about patenting the sun.” Salk co-founded a company, the Immune Response Corporation, and assigned the rights to it, then profited immensely when the company went public. The vaccine didn’t work.