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US Has Been Down This Vaccine Rollout Road Before

US Has Been Down This Vaccine Rollout Road Before

Thursday, 7 January, 2021 - 06:00

If you’re a person of a certain age, you most likely have a vague memory of being vaccinated for polio. Your mother took you to the doctor’s office, where you rolled up your sleeve and bravely let him administer a shot. You tried not to cry.


Getting a polio vaccination was a big deal in the mid-1950s. The poliovirus was a scourge that could inflict paralysis or death, and it mainly affected children. Parents were so terrified of polio that many wouldn’t allow their children to play outside in the summer, when the virus was most virulent. In 1952, 57,000 people in the US were infected; 21,000 were paralyzed and 3,145 died. Is it any wonder that our memory of polio’s eradication is one of an untrammeled triumph?


But it wasn’t, at least not entirely. Just as the US is now struggling to distribute Covid-19 vaccines, so did the nation struggle in the mid-1950s to distribute the polio vaccine developed by Jonas Salk. There were shortages, mistakes and self-inflicted impediments. In some ways, the parallels are striking. To delve into the history of the polio vaccine is to realize that it has lessons for the here and now.


Dwight D. Eisenhower was president in 1955, when the Salk vaccine was declared “safe, effective, and potent.” Salk, the head of the Virus Research Laboratory at the University of Pittsburgh School of Medicine, had been working on a polio vaccine since the late 1940s, funded primarily by the National Foundation for Infantile Paralysis. By 1952, his vaccine was far enough along that he injected it in himself, his wife and his three sons. Two years later, that same foundation — which mainly oversaw the vaccine’s development and raised money through its famous March of Dimes campaign — funded an enormous trial in which almost 1.5 million children received either the vaccine or a placebo. It also lined up six companies to make the vaccine. On April 12, 1955, the trial was declared a success by the Poliomyelitis Vaccine Evaluation Center, a monitoring group at the University of Michigan.


Only the last step involved the federal government, which had to approve the vaccine.


As David M. Oshinsky notes in his book “Polio: An American Story,” although Eisenhower was a political moderate, his secretary of Health, Education and Welfare, Oveta Culp Hobby, was a fierce conservative from Texas. To her way of thinking, federal involvement in a polio vaccine was a step toward “socialized medicine.”


Thus, even after it became clear that the Salk vaccine was likely to be effective, Hobby made no distribution plans; indeed, the day after the April 12 announcement, she appeared before a congressional committee and said flatly that the federal government should not be involved. Oshinsky wrote:


Neither the president nor his advisors viewed the distribution of polio vaccine as a legitimate government function. At a time when the very hint of federal intervention raised angry cries of “socialized medicine,” they fully expected the process to remain in private hands, with the vaccine going from the manufacturer to the wholesaler to the druggist to the local doctor, who would inoculate the child three times in three paid office visits. As one administration official put it, “an allocation program for the Salk vaccine would constitute an undesirable precedent.”


The result was nothing short of a crisis. People had been led to expect that millions of doses would be available on Day One. They weren’t. Instead, there were shortages. The companies manufacturing the vaccine more than doubled the price they had been paid by the foundation just months earlier, raising accusations of price-gouging. As it became clear that summer was going to arrive with few children vaccinated, parents were up in arms.


There was one other big problem. Just weeks after the rollout of the vaccine, children who had been recently inoculated started coming down with polio. It turned out that one of the manufacturers, Cutter Laboratories, based in Berkeley, California, was making batches that somehow contained live virus instead of the killed-virus that Salk’s vaccine required. Cutter’s mistake was causing the polio outbreak.


The remaining batches of the Cutter vaccine were pulled, but the consequences were enormous. On the one hand, many parents put off getting their children vaccinated — even though the other five companies were making perfectly safe vaccines. The result? “More than 28,000 cases were reported that year [1955] and most of those could have been avoided,” Oshinsky wrote.


On the other hand, the Cutter incident forced the government’s hand. It simply could not sit back and allow private industry to manage a national vaccine program. The National Institutes of Health became much more involved in vaccine testing — and its budget more than tripled. And while the federal government still wasn’t willing to take over the distribution itself, it did begin to fund the states’ efforts. The truth is, though, that shortages remained an issue until an oral vaccine, developed by Albert Sabin, became widely available in the late 1950s.


One difference between then and now is that Americans were far more trusting of large institutions, including government, than they are today. A similar incident now would have devastating consequences, not only to the people who got Covid-19 as a result of taking a contaminated vaccine but also in giving anti-vaccine proponents a powerful talking point. That we haven’t had such a disaster is a testament to the pharmaceutical companies and the government health bureaucracy, both of which have insisted on standard protocols in the face of Trump’s anger that they weren’t moving fast enough.


But just as the Eisenhower administration failed to plan for distributing the polio vaccine, so has the Trump administration largely failed to plan for the Covid-19 virus — despite having a year to do so. The results have been exactly what the polio experience should have taught us. Expectations of a huge early rollout have been dashed. Shortages have been prevalent. Pharmaceutical companies have said they have doses ready but haven’t been told by the federal government where to send them. States have to fend for themselves. Disputes have erupted about how to allocate the vaccine that is available — something that also happened in the 1950s.


“A plan that took the whole nation into account would have been a more effective way to approach it,” Josh Michaud of the Kaiser Family Foundation told Business Insider. Well, yes. We don’t have a Covid-19 equivalent of the National Foundation for Infantile Paralysis, and it’s probably just as well; a foundation with that kind of power would likely cause tremendous suspicion today. As was true in the 1950s, the only entity capable of putting together a distribution plan for the nation is the federal government. That is a lesson that remains relevant today.


The combination of incompetence and indifference of the Trump administration in dealing with the pandemic is sadly well known by now. President-elect Joe Biden has vowed to do better, starting with getting the vaccine to more people more quickly. Let’s hope someone passes him a primer on the polio vaccine. It will help.


Bloomberg


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