Dora Vargha
University of Exeter

When not portrayed as a heroic struggle for the betterment of mankind, polio vaccine development has mostly been told as a story of bitter rivalry between Salk and Sabin. It has also been recounted as a particular “American Story”, with the March of Dimes, the National Foundation for Infantile Paralysis with the occasional mention of the Sabin trials in the Soviet Union. Historical narratives of polio have rarely crossed national borders, even though polio is undisputedly seen as a global health issue today.

But if we step outside of the national boundaries and shift our perspective from an American view, another story of polio unfolds. It reveals that polio as a global health issue is not a recent phenomenon, but one that reaches back to the late 1940s and early 1950s. It sheds light on a global network of scientists and public health officials, who set in motion global vaccine trials in the 1950s and 60s. Against a backdrop of Cold War tensions and the remnants of the colonial world, the personal networks of researchers intertwined with the emergence of the World Health Organization (WHO) in the development of live poliovirus vaccines. The international agency capitalized on the network of scientists to become a coordinating, validating and standardizing entity, while researchers used the WHO to establish further ties, get access to cutting-edge technology, or to free vaccines in public health emergencies.

While global cooperation in polio research, prevention, and treatment reached its climax in the late 1950s, an international exchange of knowledge and specimens was present from the outset. The WHO expressed interest in international research on polio from the very beginning of its existence. Based on the proposal of the French delegation, which emphasized that polio should be studied in international collaboration of virologists, epidemiologists, and clinical experts, the First World Health Assembly passed a resolution in 1948 to investigate the disease and base its report on international conferences. What is more, the WHO also explicitly claimed a role in coordinating polio field trials and mass vaccination methods. A report of the Executive Board stated that preventive measures “will generally need testing in different circumstances. Normally such field work will be undertaken by individual national services and institutions. However, there is a place for co-ordination of the design of such studies, and for a comparison of the results achieved in the different countries.”[1]

This interest in international collaboration was warranted by the fact that polio was increasingly becoming “a world problem”. The particularities of polio also resonated with the postwar era in powerful ways. It was a relatively new disease, surrounded by scientific uncertainties, attacked children in societies recovering from the demographic shock of WWII, caused disability, threatening the modernist postwar projects, and it was not a disease of poverty – it afflicted upper and middle class as much as the poor.

Conducting polio vaccine research, scientists stood in the crux of national agendas of security and population politics, international cooperation framed by the perceived universality of children and the neutrality of science and professional rivalries and collaborations. Neurologist William Ritchie Russell of Oxford remarked in the British Medical Journal that “Virologists represent a group of scientists who have a close international understanding with each other, and for whom all must have a great admiration. After Dr. Enders’s great discovery, however, they seemed to be forced into positions they were unable to cope with. Tremendous political and national decisions had now come to depend on their advice. Every line of action involved some risk, yet action had to be taken.”[2] One would have to search for a more apt description of a reluctant internationalist. Yet these virologists, moving between continents and across political dividing lines embarked on a truly global scientific project, and their rivalries were fraught with Cold War politics and were played out on a global scale.

Live virus vaccines had been in use for more than 100 years in the case of smallpox and for over 20 years in the case of yellow fever. The concept, therefore, was not new, and many thought that a live vaccine would be more effective than the killed one to begin with, in that it would work quicker and would probably provide a more lasting protection since it followed the pattern of a natural infection. Most importantly, those vaccinated would get the attenuated virus back to the environment through their stool, creating a chance to immunize the others indirectly. The challenge of the live, attenuated polio vaccine was to find a strain of virus that would not cause paralysis, but would provide immunity nonetheless. This method took considerably more time than Salk’s of finding a way to kill the virus and preserve it.

In the 1950s, Hilary Koprowski, Albert Sabin, and Herald Cox took on live polio vaccine development. Koprowski was born in Warsaw and left Poland in 1939 after the Nazi occupation. From working with the Rockefeller Foundation in Brazil on yellow fever, he landed at the Lederle Laboratories in the United States, where he started to work on the live polio vaccine. Albert Sabin, the most well-known of the three, was of Russian descent, and worked on the polio vaccine at the University of Cincinnati. H.R. Cox, an American scientist, became head of the Virus and Rickettsial Research Department at Lederle Laboratories in 1946 and, for a while, worked with Koprowski there.

Koprowski was the first researcher to conduct experiments with live poliovirus vaccine. In 1947, he was his own first experimental subject; three years later he moved on to experiment on mentally disabled children in a state institution in New York’s Hudson Valley. In light of the Nuremberg Code of 1947, this was an ethically dubious experiment at the very least, even by contemporary standards. Koprowski received much criticism, but reservations about his methods softened as time went on, and his experiment on “volunteers” became represented as a brave first step in the development of a new and successful vaccine.

In 1956, a new opportunity presented itself for Koprowski to test his vaccine, this time in Belfast, Northern Ireland. Koprowski, therefore, also became the first to take his vaccine abroad. The trial, however, turned out to be a disappointment for Koprowski’s Irish colleagues: the strain used by Koprowski was proven to be unsuitable as a vaccine, turning virulent in the volunteers’ bodies. It was thus deemed unsafe. George Dick and David Dane, the researchers in Belfast became a strong critical voice of live vaccine trials from then on.

Beginning in 1958, international live poliovirus trials accelerated, thanks to a report published by the WHO. This was the same year that a severe polio epidemic outbreak in Singapore gave the first opportunity for a trial of Sabin’s vaccine. The WHO’s Second Expert Committee Report on Poliomyelitis gave its support for trials.

This was the green light live-virus researchers had been waiting for. Proponents of live vaccine field trials trumpeted the report’s recommendations that a large-scale trial of attenuated vaccine should be attempted in the face of an emerging epidemic, and in a place where polio was endemic. Sabin agreed to the trial on the condition that adequate laboratory control could be assured.

In early 1958, Koprowski conducted a mass-vaccination trial in the Ruzizi Valley in Belgian Congo. In 1955, the opportunity of the trial came up in personal conversations during Koprowski’s participation in a rabies conference organized by the WHO in Kenya. Koprowski’s vaccine was later tested on large-scale in his native Poland, Finland and Yugoslavia.

That same year, Albert Sabin started field trials in the Soviet Union in cooperation with Mikhail Chumakov, Karina Voroshilova, and Anatoli Smorodintsev. The perhaps best-known cooperation in the Cold War began when Sabin and Chumakov met on the latter’s visit to the US, where he was part of a medical mission studying the Salk vaccination. Further trials were organized with the Sabin strains in Czechoslovakia, Hungary, and Mexico. Czechoslovak public health leadership sought Sabin’s assistance in organizing a trial through the WHO, while Hungarian virologists became involved in a study trip to the USSR, although both countries built on long standing ties and scientific collaboration. These three Eastern European trials later became reference points in the international evaluation of live polio vaccines.

Lederle Laboratories conducted field trials of their own in 1959 with vaccine developed by Herald Cox in Colombia, Nicaragua, and Costa Rica. The mass-immunization campaigns in the latter two countries produced disappointing results, as the number of polio cases did not fall significantly after vaccination. However, a controlled trial in Minnesota with the same vaccine reported great results.

In a way, a major reason for the global trials was very similar to what Adriana Petryna claims of a later period: to find populations that are not saturated with previous vaccines and medications, and which are expected to be compliant in participation. Similarly, the payoff for participating societies would be access to vaccination in epidemic crises – trials as public health measures. However, two further reasons for the trials arose that were particular to polio: first, there was serious concern with the safety of the vaccine. Attenuated virus strains could turn virulent, causing disease instead of curbing it. Second, since live vaccines entered and worked in the alimentary tract, some feared that enteroviruses, which follow a similar route, could compromise the effectiveness of the vaccines. This was a particular problem in tropical areas. Third, health ministries, public health offices and agencies and researchers were also receptive to the trials for what the live vaccine had to offer. As the work of Marcos Cueto, Randall Packard, and Erez Manela show, eradication was the big thing in the 1950s and 1960s.

Unsurprisingly, then, the possibility of eradicating polio appeared as one of the main reasons for the need of live virus vaccines over the inactivated one. Governments of countries like Hungary, after a bloody revolution were lured by the prospect of success. Another very attractive feature of the live vaccine was its technical advantages (oral administration vs. injection) and that “the low cost of the attenuated vaccine would probably bring it within reach of every public health service”, as the Pan American Sanitary Organization pointed out in 1958.

The global effort to put a stop to polio epidemics created a community of scientists who transcended Cold War barriers and defied the Manichean world order. Scientists and national public-health authorities shared results of field trials from all over the world with three different live virus vaccines, along with updates on vaccine use and epidemiological data in the pages of major scientific journals and at international conferences.

The success of the new vaccines ignited a scientific euphoria, strengthening the sense that science, as putatively objective and universal, could serve as a tool to stop the Cold War and unite humanity in a common bond. At the Fifth International Poliomyelitis Conference in 1960 in Copenhagen, Basil O’Connor (president of the American National Foundation for Infantile Paralysis) celebrated the achievements of the cooperation in his opening speech:

This is a council, not of war, but of victory. Together we have successfully created weapons against a common enemy that bring within our reach a triumph for all mankind, the coming elimination of epidemic-paralytic poliomyelitis. We meet now to compare notes on what we have created, to report our experiences and help each other in reaching decisions on the most effective use of those weapons. Your very presence here, from the East, from the West, is proof to the world that in your high calling, in search for the truth that frees man from disease, there is no cold war.[3]

This feeling of unity marked the end of a decade when other domains of public health were hindered by Cold War tensions. For much of the 1950s, the Soviet Union, along with Eastern European countries, left the WHO as a sign of protest against the agency’s politics. Since the founding document of the WHO did not permit the unjoining of the agency, the Eastern European countries were termed inactive. The U.S.S.R. returned to the international agency in 1957 with Bulgaria, Albania, Poland, and Romania. Other states rejoined later, with Hungary being one of the last countries in the Eastern Bloc in 1963.

However, persisting concerns over safety brought to light underlying Cold War tensions. Cold War stereotypes and possibility of biological warfare saturated scientific research and the evaluation of trials. Russian virologists feared that the Sabin trials were part of a devious American scheme to destroy Soviet youth and Americans distrusted Russian scientific results.

In fact not everyone shared the excitement over an international project. U.S. health officials did not uniformaly accept vaccine testing on foreign ground. In a congressional hearing on polio vaccines in 1961, Alexander Langmuir, chief epidemiologist of the Department of Health, Education and Welfare and founder of the Epidemic Intelligence Service, found it important to note that “… it is not as though they [Koprowski, Sabin and Cox] went elsewhere to test. They went to the place to test that would give the best tests, but all of the questions were started and worked on in this country before any overseas activity.”[4] In a scientific race between the East and West, the fact that such an important vaccine was first widely tested and produced outside the United States needed explanation. In a Cold War over science, it was crucial to claim American ownership in vaccine development.

The live vaccine trials were by no means uncontested by the scientific community. The trials did, however, come to play an enormous role in setting the stage for regional and global polio eradication programs. Fragmented and varied in success as they were, the trials, conducted by three different researchers on four continents, were seen as one single enterprise. National governments, public health authorities, the World Health Organization and individual researchers drew on the trials to make decisions about prophylactic measures, directions of research, and international policies.

Dr. Dora Vargha is lecturer in medical humanities at the University of Exeter. Her book, Polio Across the Iron Curtain, was recently published with Cambridge University Press and is available in Open Access.

 

[1] “The Co-Ordinating Role of Who in Poliomyelitis Research,” in Executive Board (Geneva: World Health Organization, 1954).

[2] W. Ritchie Russell, “Development of Live Polio Vaccine,” British Medical Journal 2, no. 5194 (1960).

[3] Basil O’Connor, “The Setting for Scientific Research in the Last Half of the Twentieth Century,” in Fifth International Poliomyelitis Conference, ed. International Poliomyelitis Congress (Copenahgen, Denmark1960).

[4] Subcommittee on Health and Safety of the Committee on Interstate and Foreign Commerce, Polio Vaccines, First session on developments with respect to the manufacture of live virus polio vaccine and results of utilization of killed virus polio vaccine, March 16 1961.p.108.