MEDICINE

It Works

The big news came in three words:

"The vaccine works."

That was how the University of Michigan started off its terse summary of the verdict on the Salk polio vaccine. The reading of the report itself took longer, and the setting in the university's Rickham auditorium was elaborate. Under the klieg lights set up for TV and newsreel cameras, surrounded by microphones and 150 reporters, sat the unquestioned hero of the occasion: Dr. Jonas Edward Salk, 40, the determined, youthful-looking virologist who for five years had battled in his University of Pittsburgh laboratory to lick polio. Next to him sat the University of Michigan's Dr. Thomas Francis Jr., 54, one of the U.S.'s most eminent epidemiologists, who had been chosen by the National Foundation for Infantile Paralysis to evaluate last year's nationwide tests of the Salk vaccine. For an hour and a half, Dr. Francis read his report in an even, matter-of-fact tone. The gist:

P: The vaccine is up to 90% effective.

P: The vaccine causes a minimum of undesirable side effects--all, apparently, minor.

P: Results were most favorable from the areas where conditions were best for accurate appraisal.

Dr. Francis stopped when he finished telling what had been done. Dr. Salk, who rose to a standing ovation from 500 usually undemonstrative scientists, took a peek into the future: the vaccine, he suggested, might be made almost 100% effective. This does not mean that polio will be suddenly abolished. But it could mean that as vaccination becomes universal for children, whole generations will grow up free of the paralysis that has condemned so many to enfeebled limbs or iron lungs, eventually, polio can become as rare as smallpox--which U.S. doctors now rarey get a chance to identify.

The test vaccine was given in 127 areas, deliberately picked because they had had a high polio-attack rate for several years. This was to make sure that there ivould be enough cases for the epidemiologists and their statistical machines. No fewer than 1,830,000 children were studied in the trials (440,000 were inoculated with the vaccine, 210,000 got a dummy substance, 1,180,000 were merely observed as "controls").

Among these children, there were only 1,013 cases reported as polio (in the U.S. as a whole there were 38,000 cases in 1954).

Six big U.S. pharmaceutical firms* are now producing Salk vaccine or hurrying to get into production. The vaccine works on a principle that has already provided protection against such traditional plagues as smallpox and yellow fever. When they attack human beings or other mammals, most viruses stimulate the invaded system to manufacture tiny protein particles called antibodies. If the system under assault does not have enough of these antibodies or cannot manufacture them fast enough, the victim may die or, with polio, suffer permanent crippling.

Polio virus is unusual in that there are three main types. All can cause paralysis, but one type causes more than the others combined. Within each type there are many different strains. The Salk vaccine is made by taking a representative strain of each type and growing it--till it reaches many times its original strength--in a broth made with snips of monkey kidney. (To keep production going, 4,000 monkeys a month are flown in from India and the Philippines.) Then the virus in each deadly brew is killed with formaldehyde. Strangely, although the virus particles now lose their power to multiply or to cause disease, they keep their power to stimulate a higher animal to produce antibodies. Because in the Salk formula the virus types are mixed, the Salk vaccine is really three vaccines in one, effective against all known polio strains.

Never before in history had a medical development been big, instantaneous news over a large part of the world. Ironically, poliomyelitis has always been a relatively uncommon disease with a comparatively low death rate.** Polio is actually less of a public-health problem than rheumatic fever and some forms of cancer which single out the young. But, largely because of its long-term crippling effects, no disease except cancer has been so widely feared in the last three decades. With polio's dramatic defeat, as the Detroit Free Press wrote, "The prayers and hopes of millions . . . in all parts of the world were answered."

President Dwight Eisenhower ordered the State Department to transmit information on the Salk vaccine and its effectiveness to 75 nations through U.S. Ambassadors, and the World Health Organization planned to duplicate this effort. Actually, relatively few countries have facilities to make the vaccine; only a few areas in the world have a serious polio problem, for clinical polio is a disease that goes with high standards of hygiene and sanitation. Highest recent incidence abroad: Canada, New Zealand, Scandinavia. The six firms making the vaccine are selling it at cost to the National Foundation for Infantile Paralysis, but will otherwise sell for normal profit, an average $1.50 per shot.

And what of the Infantile Paralysis Foundation itself, with its 250 headquarters personnel and 3,100 chapters spread all across the U.S.? Dr. Salk suggested that medical science should turn its biggest guns next on mental illness. To help science do this, an organization like the foundation would come in handy.

* Cutter Laboratories, Berkeley, Calif.; Eli Lilly Co. and Pitman-Moore, Indianapolis; Parke, Davis & Co., Detroit; Sharp & Dohme and Wyeth Laboratories, Inc., Philadelphia.

** Polio death rate is 1 per 100,000; rheumatic heart disease, 13; leukemia, 6.1. This file is automatically generated by a robot program, so viewer discretion is required.