The February 4, 2015, front page of the Pittsburgh Post-Gazette, the city where Jonas E. Salk developed and refined the polio vaccine, exclaimed, “Despite Objections, Vaccinations Urged.” 1 Sixty years after his remarkable breakthrough, many Americans are following a troubling trend to delay or reject childhood immunizations , largely led by a generation that neither witnessed cases of measles , mumps , or rubella (i.e., whooping cough ) nor trembled in fear each summer as polio epidemics raged, leaving illness, death , or disability in their wake. What prompted this headline? For several months, two dozen National Hockey League athletes, including Pittsburgh Penguin’s player Sidney Crosby , contracted mumps . Nothing symbolized this situation more than this all-star center appearing before news cameras with swollen neck glands that prior December. A month earlier, a media storm had erupted over a measles outbreak at California’s Disneyland affecting numerous unvaccinated children . 2
Decisions to avoid, or at least postpone, immunizations can prove catastrophic, affecting more than a few high-profile, professional athletes and some children on holiday. On July 2, 2015, the USA Today reported that a hospitalized woman, in Clallam County, Washington , had contracted measles and died of pneumonia , a common complication from this highly contagious disease. She had become infected from another patient who had been diagnosed with it. Because she had been at this medical facility to receive “medications that suppressed her immune system,” her illness and death were tragically coincidental. This article attributed her death to a resurgence of measles . 3 Children’s parents, for a variety of reasons, had chosen not to have them inoculated. In an era when such childhood diseases have been largely eliminated, such scenes appeared surreal. How do we explain these parents’ actions?
Newspaper commentators at the time summoned the past in general and poliomyelitis in particular to shed light on this phenomenon. David Oshinsky , director of Medical Humanities at New York University and Pulitzer Prize winner for his 2005 book, Polio: An American Story, wrote “The Last Epidemic” in the October 18, 2014, edition of Wall Street Journal . The development of the polio vaccine signaled the pinnacle of the golden age of medicine . Kathleen Parker a Washington Post columnist, in early February of 2015, struck a sardonic tone, “Seeking a Vaccine for Ignorance,” for her nationally syndicated article. Its subtitle read, “How Would Salk Be Treated If He Tried to Introduce His Polio Vaccine Today?” 4 Why did these writers invoke Jonas Salk ? As medical historian James Colgrove states it, “The nationwide testing and subsequent licensing of Jonas Salk’s polio vaccine were watershed events in the history of vaccination in America, bringing the value of the practice to the forefront of popular culture to an extent unequaled before or since.”
This study reconsiders the “mythology that surrounds [that] vaccine’s development.” It reveals a complex experience. The discovery of the polio vaccine represented a remarkable breakthrough for medical science in its own right, marking the death of a dreaded childhood disease. But it was more than this. It also signaled the largest medical experiment using American schoolchildren. Furthermore, the public school system operated as an extension of the medical laboratory, supplying tens of thousands of young human subjects , thousands of trained educators to conduct it, and a medicalized environment. And it became the site of the first mass immunization of children. Finally, it supports the argument that “the fight against polio changed vaccination programs.” 5
Medical science certainly improved the lives of millions of human beings through discoveries that prevented diseases as well as treatments and cures for other illnesses. Nevertheless, it possessed a dark side: Test subjects faced risk. Advancements in vaccines and sera, through most of the twentieth century, relegated them to what scholars term “vulnerable populations ;” that is, groups that have traditionally been exploited in scientific experiments. Race and social class often characterized them. African Americans have been exploited for medical experiments from the antebellum period through the 1970s; like them, poor and working-class subjects rarely knew they were even participants. Other historians have relied on the term “captive populations ” to encompass military troops , prison inmates, and school students. Because of their institutionalization, they seldom, if ever, had an opportunity to volunteer . Countless examples exist. 6
However, children have universally served as research subjects. For example, Albert Neisser , a German professor of dermatology and venereology, inoculated four children and three adolescents with syphilis in 1892. In the USA, physician M. Hines Roberts performed spinal punctures on “423 African-American infants from the newborn service of Atlanta’s Grady Hospital ,” publishing his findings in 1925. Finally, the American medical profession in 1940 hailed children as “‘little medical heroes’ … [who] had done so much to advance medical knowledge.” 7
This leads to Jonas Salk’s trials with the polio vaccine. Historian Jane S. Smith points out that Salk, while at the University of Pittsburgh , wrote to Harry Weaver , research director at the National Foundation for Infantile Paralysis (the parent organization for the March of Dimes ) speculating about human tests as early as June 1950, before the poliovirus typing program had been completed. Using ultraviolet light to inactivate the virus , Salk suggested trying it on “‘Hydrocephalics and other similar unfortunates’” residing at local institutions by transferring them to Pittsburgh’s Municipal Hospital to keep “‘them under isolation and under very close supervision.’” He felt confident that he would easily “‘obtain permission’” to use them. He also floated the idea of injecting “‘inmates of prisons who might volunteer for such studies.’” Weaver balked at this audacious plan.
Salk’s dream was Weaver’s nightmare–taking helpless children, wards of the state, isolating them in Municipal Hospital, injecting them with an unproved vaccine, and exposing them to live poliovirus, even in an attenuated form. Although Salk’s proposal was not far from standard experimental procedures in 1950, Weaver knew better than to think the public would regard the test of any polio vaccine as a routine experiment.
Such premature testing could have resulted in a “medical atrocity.” As Smith concludes, like other scientists, “[s]ecure in his conviction of his careful work, his good intentions, and the infallibility of his laboratory results, Salk never even imagined such a response.” 8
Medical researchers reflected the ethical context of their times. Although some general guidelines existed at different periods and in various countries, decisions remained at the sole discretion of the experimenter. Or, they chose to simply ignore them. No enforceable guidelines or regulatory bodies, public or private, domestic or international, existed.
Moreover, and completely overlooked, education played a significant role in the ultimate eradication of infantile paralysis . Fear of this disease certainly drove parents to submit their children to a nationwide trial, based at local elementary school buildings. However, the long-standing medicalization of American society as well as the concomitant development of school health programs acted as effective and influential instruments of persuasion. For decades, the media had touted breakthroughs, building a largely trusted medical culture by the 1950s. The public education system, meanwhile, developed a medical infrastructure to accommodate the largest experiment involving children ever attempted. Coupled with National Foundation director Basil O’Connor’s keen use of mid-twentieth-century mass media, it assured public consensus and a high level of efficiency. 9
Additionally, the public school system proved to be an indispensable instrument in the eradication of polio in the USA and as a means to facilitate mass immunizations , yet the histories of education, medicine, and public heal...