Daniel and Kelly’s Extraordinary Universe - How was the polio vaccine developed?

Episode Date: October 30, 2025

Daniel and Kelly talk about the development of the polio vaccine.See omnystudio.com/listener for privacy information.

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Okay, on to the show. Quick disclaimer here. This episode is about polio and touches on issues related to death and suicide. In a past episode, we talked about what I consider to be one of humanity's most incredible achievements, the eradication of smallpox. Let's keep the good vibes going and talk about another massive win for humanity, how science eradicated wild polio in the United States and many other nations around the world. Towards the middle of the 20th century, for reasons we don't totally understand. cases of severe polio in the United States started to rise.

In 1948, over 27,000 kids got polio, which was three times more than the prior year. In 1949, there were 42,000 cases, and by 1952, there were 57,000 cases, which included 21,000 cases of paralysis and 3,000 deaths. Initially, polio symptoms are pretty similar to cold symptoms. So for thousands of parents, Every time their child came down with cold-like symptoms, they had to wonder, is this polio?

But today, no parent in the United States goes to bed wondering if cold-like symptoms are actually polio. Two polio vaccines developed in the United States paved the way to eradicating wild polio from most of the world. Today, we're going to talk about the development of these amazing vaccines. We'll also talk about how polio vaccine testing played a role in the current high, standards we set for things like informed consent, vaccine trials, and industry standards for vaccine manufacturing and testing. And now feels like a great time to remind everyone to get their yearly flu vaccine. If you have questions about vaccines, please ask your doctor. Welcome to Daniel and Kelly's Extraordinary Universe.

Hi, I'm Daniel. I'm a particle physicist and I'm very grateful to biologists and to doctors. Hello, I'm Kelly Weiner-Smith. I study parasites and space. And I am so excited that I knew pretty much nothing about polio because I haven't had to worry about it. Yeah, exactly. Blissful ignorance. Beautiful thing. So, Kelly, my question for you today has to do with vaccines. And my question is, are you afraid of shots? Or can you take like a big hunk and needle in the arm without flinching? So when I am going to answer your question. Just it's going to be a tortuous path to get there. Are we going to start with fish guts?

No, we're going to start with organic chemistry. Okay. That's the other place Kelly's story start. Yeah. I'd say it's way worse than fish guts. But give me a dump truck full of fish guts before an O-KEM class any day. Wow, that's fire. All right.

So you're in O-KEM. So I'm in O-KM. I took it over the summer. and I was taking it with my friends. We were the benzene ring. There were six of us. There's six carbons in a benzene ring. And at the end of each week, there'd be an exam.

And we would stay up all night, sitting for the exam. But every exam that I passed, I would reward myself by getting a piercing. Oh. And I was pretty well pierced by the end of that summer. And so the lesson I'm trying to convey here, or the point I'm trying to convey here, is I'm not super worried about needles. And so I can handle shots. It's not a big deal in my opinion. I've had bigger needles passed through my face.

So it's not so bad. What about you? Well, you anticipated my next question because I was going to say, you don't look like you have a lot of piercings. And so was that just a phase and you let them close? Or are they piercings of a less visible nature? I let them close. I think at some point I was trying to, like, get a job where I thought they wouldn't be appreciated. And some of them were just kind of like, you know, I decided I didn't actually look as good with the nose ring as I thought.

And then I had the Traegis, which is like the spot right underneath your lip. Oh, man. The metal back kept rubbing my teeth. And I was like, oh, I don't like that feeling. But, you know, I kept my eyebrow ring for a while. But mostly it was a lot of piercings in my ear. But my ear is weird. This is way more information than anyone needs.

My ear is weird and would grow around my piercings. Oh, my gosh. And so that was like less attractive and hard to get them out at some point. So I was like, all right. Maybe the space of my life is done. But it might come back. Who knows? Well, I'm not afraid of shots.

It's just not a big deal to me. I mean, obviously, they hurt, but I don't flinch or whatever. But my daughter is terrified of shots. I mean, she understands the concept, obviously, and she's into it. But she, like, sometimes faints when she gets a shot. But she's also really interested in piercing. And so I've been with her multiple times when she has passed out after getting a piercing. Oh, wow.

And so it's just, you know, something you have to know. Make sure she's sitting down. Yeah. I think the weirdest piercing I ever got was the eyebrow piercing because they like pinch your eyebrow and then this person went up from the bottom up with the needle before they put the ring in so you could see the like needle like going up and you could like see it was right in front of your eye

and I was like oh that's that's maybe a little disconcerting. All right. Well, we're not here to talk about Kelly punching holes in her body. We're here to talk about saving lives with vaccines. So Kelly, tell us. why you decided to talk about the polio vaccine? So I'm kind of interested in stories about people who infect themselves with parasites on purpose. This is just sort of like a weird thing that I'm interested in learning about.

And I had heard that everyone who made a polio vaccine tested it on themselves first. And so I bought an audiobook, Polio, an American story by David Oshinsky. And the story about the development of the vaccine was so fascinating. I was like, you know what? I'm going to read this book again. I'm going to take 44 pages of nests. notes, and I'm going to share the highlights with the DKEU audience. And just to make sure that I was getting the story right, I also read Splendid Solution, Jonas Sok in the Quest of Polio by Jeffrey

Kruger. So both great stories about how polio was developed. I love reading stories about how science happens or how progress is made because it's hard for us to put ourselves in the minds of people who didn't understand, you know, the early universe or didn't have a solution or didn't know if there was a solution to vaccinations for polio. And I think it's so. important to bring us back to those moments and understand what they were fighting against, the challenges there. Remember when Sean Carroll was on the podcast and he said, it's so important to read the original papers because they didn't know the answers and you can see them trying to work it out. And I think that process is so important to illuminate and so fun and so

inspiring, right, because it shows you how to make discoveries. Well, yeah, and another lesson that the polio story is going to teach us that we're going to return to at the end of the episode is that none of our listeners are going to be surprised to learn that scientists are humans and we make mistakes. And there is also some unethical decisions along the way. And so we're going to get to one of my pet peeves, which is when people act like because a scientist said so, you don't have any right to ask follow-up questions. And I saw a lot of this during COVID. A lot of, you know, people posting on their Facebook page like, the science is settled. Yeah, the science is settled. The good thing about science is you don't have to believe in it. It's just true or whatever.

And I'm like, oh, man, but like there's different levels of evidence to support. claims. And I think you should be very willing to answer questions about what you did and how confident you are. And the polio story has a lot of ups and downs and reveals some errors made along the way. Well, before we share that whole story, we were wondering what people already knew about the polio vaccine. So Kelly went out there and asked folks, what did they know about the development of the polio vaccine? So think about it for a moment. What is your understanding of the development of the polio vaccine. Here's what's in the minds of our listeners. Medically, I don't know the development of the polio vaccine, only that it worked, and that it

was a big deal. I mean, millions suffered from a debilitating disease, and it essentially ended that. I mean, think about the advantages that you've just created for society. I don't know. Vaccines are incredible. Yes, I remember vaccination day in kindergarten, 1979. I'm older than you. Except now you claim you're 100. I'm still 28, lies, I'm in my 50s. Well, I know that it was very welcome, and that Jonas Salk, I don't know, synthesized it, whatever you call it, and that he gave way any rights to it so that people can get it cheaply. So, all in all a good story.

My mother's from England when my grandfather was diagnosed with polio, my grandparents were told it would likely kill him, but were given the option to try an experimental vaccine. and he took it and lived with Justice Leight Limp to show for it. I think it was developed in the late 1940s. It worked, and all children in the U.S. were and still are required to get the polio vaccine to attend school. I know the polio vaccine helped the world tremendously. I think that's all I know.

I was so knowledgeable about the polio vaccine, especially considering that it probably saved my life and a whole lot of other people's lives. I know that the most commonly used polio vaccine is inactivated. Polio vaccine, which means it contains dead polio virus. There's also an oral vaccine, which contains weakened polio virus, but you still have the risk of catching polio from it, as far as I know. So it's a vaccine against polio. Boom, that's it.

Podcast done. I know there was a huge campaign in Brazil to eradicate polio, and it was a great success. The most memorable thing I remember about this campaign was a mascot called Zegocinia, something like Joseph Droplet, which is famous up to this day. Well, all I know is that I got it when I was a little kid, and since then I've never owned a polo shirt at all, so it must have worked pretty well. The idea for the vaccine came about when Louis Pasteur was hanging out with those milkmaids. I know that smart people get the polio vaccine.

Kelly, so you heard these answers after you did your deep research dive. You have like 50 pages of notes here for one hour episode. I'll talk fast. The listeners have sort of the same impression you did before you did all your research. Well, some of them knew a lot more, to be honest. So one of the listeners mentioned that there's a killed virus version of the vaccine and a live virus version of the vaccine. I didn't realize there were multiple versions of the vaccine. I was excited to hear the story.

about Brazil. But I think the only thing I knew about this vaccine was that it worked, and I didn't have to know about polio because it worked so well. And I think I had heard that Jonas Sock gave his vaccine away for free, and he has been sort of lionized for that. Had you heard that too? Yeah, I have heard that story. Yeah. I hope that's true. Yeah, it's more complicated. Uh-oh. No, we're going to get to it. And so that reveals that this podcast secretly is actually just a project to give me and Kelly excuses to do deep dives and research and stuff we always wanted to know about. Yeah, I don't think that should be a secret. I think our excitement about the universe is, you know, that's part of why I love researching for this podcast. There is so much really cool stuff to learn. But today we're talking about not the whole universe, just polios to tell us. What is polio? How does it work? It's not a prion. It's not a bacteria. Is it a virus? It is a virus. And it's a virus that you can get either through droplets in the air, like if someone's

sneezes or coughs, or through the, we've talked about the fecal oral route before, the the butt-to-mouth route. I don't like talking about the fecal oral route. That is a very delicate opinion for someone who lives with a microbiologist who studies poop. I know. And we just did a freezer clean out last weekend. Oh, no. And boy, there was a corner of that freezer I did not want to touch.

Yeah. No, were there feces in the corner? I didn't get a definitive answer. I got to, like, you don't really want to open that bag kind of an answer. Oh, my gosh. Anyway, so polio is a virus and it lives in fluid, bodily fluids. Does that mean that, like, it can't live outside of water if it, like, landed on a surface and it dried up the polio and it break apart or something, it needs those droplets? Well, so because it's fecal oral, oral, that means that, like, you know, so if you wipe your rear end and then you touch a surface, the virus can stay alive on that surface for a while.

And then if somebody else comes by and they touch the same surface and then they put their finger. fingers in their mouth, then they can get it that way. So it can survive in the environment. I like the way you made that indirect. It's like fecal table oral. Like, that's a nice intermediary there. I appreciate that. Thank you. It is nice if there's a step in between. But, uh, all right. So it can come in through the mouth of the nose. And then where does it go in the body? So it can go to your gut and start replicating in your gut. It can go to your lymph nodes and start replicating in your lymph nodes. And for a lot of people, actually, they get pretty lucky. And this.

replication sort of stops there. Your immune system gets it under control. Some people don't even realize they have polio. Really? And that's actually the majority of people don't realize they have polio. Like, they don't have bad symptoms. So it might be that a lot of people have had polio and didn't know it? 80 years ago, yes.

Yeah. But yeah. In the past, yeah. But not now. Wow. Fascinating. And so for that small subset of people who are super unlucky, the virus keeps replicating and gets into the bloodstream. And then once it gets into the bloodstream, it moves to the nerves.

And it can kill some nerves. And so a lot of times it will kill nerves that go to your legs or your arms. And so you'll wake up and discover you can't use an appendage. Or sometimes you'll wake up and discover you can't use multiple appendages. It's that sudden that you just like go to sleep, being able to walk and you wake up paralyzed? Yeah. So when Franklin Delano Roosevelt got it, he went to bed feeling kind of like he had the cold or like a flu. And then the next morning his legs started to feel kind of numbed and like he couldn't really use it.

and then on the way to the bathroom, he fell over and was paralyzed. So it's pretty quick. Oh, my God, that is terrifying. I know, I know. But even more terrifying is that it can go after a part of your brainstem that controls the muscles that are important for breathing. Oh. And so the way you breathe is, you know, you have a diaphragm that goes up and down,

and as it goes up and down, it changes the pressure in your lungs and pulls air into your lungs and pushes the air out of your lungs. So when your diaphragm isn't working, you can't breathe. Breathing's kind of important, right? Yeah, this is a major cause of death from the disease. Oh, no. And if you caught it fast enough, you could get put in an iron lung. And the iron lung, it has a change in pressure inside that sort of does the job of the diaphragm.

And so it breathes for you, but it means you have no control over your breathing, which makes it hard to talk. It makes it hard to eat because you're just on the timer of the iron lung. And some people could stay in the iron lung for a little while, and they got better and they'd get out. They got better, meaning you can recover control of your body. your nerves? Yeah. So I think in some cases, your nerves will, like, grow back or, you know, your body will sort of rewire things. But that's not always the case. Plenty of people were paralyzed for their entire lives. And some people have stayed in an iron lung for their entire life. For their entire life. Wow. Yeah. Yeah. I mean, I've seen pictures of these things. It's basically,

like, a head sticking out of a wall, right? And the rest of your body's just, like, inside this tube. Yes. And that's, you just live like that? Yeah, right? And if, like, you know, if your nose is It's itchy. You can't scratch it. Like Mary Roach had this story where she, in her most recent book, Irreplaceable You, which highly recommend. And you should check out our episode with Mary Roach. Anyway, she got in an iron lung to see what it was like. And she said like the second you get in there, you want to scratch your face, but you can't because you can't get your hands out of the tube that you're in. And she said that she was in there for like five minutes and it felt like hours. And it was like a very, very uncomfortable experience. And she wanted to get out, like, right away. Are there people who spent, like, decades in those things? Yes. Oh, my gosh. Wow. Yeah.

And so, as we've discussed, this happened pretty quickly. And so, and a lot of times the symptoms started as sort of like a cold or a flu, and often it would hit kids. And so can you imagine, like, when your kids in first grade, all the times that they came home with cold or flu-like symptoms, and every time that happened, having to worry, like, oh, my gosh, is this polio? Like, my kids were constantly snotty for, like, kindergarten, first grade, second. grade, I'd like just never would have slept for those years. Me either. I mean, I'm a worrier. So anything that goes wrong, I'm like, uh-oh, is this the end? Is it all coming, crashing down? And so to have a real reason to worry every time your kid gets a cold, yeah, I would be like checking on them in the middle of the night every

hour, though I guess there's nothing you can do, right? I mean, is there something you can do if they catch it? Is there an intervention or something? No, there wasn't like a medication or anything like that. You know, the best you can do is make sure that you're at the hospital if your kiddo is going to need the iron lung so you can get them in there right away. Oh, my God. Yeah, it was, and one of the weird things about this illness is that, you know, we know that this illness has been running through the human population for a really long time, but most

of the time it didn't produce really bad symptoms. But then in the 1940s and into the 1950s, suddenly a lot more cases of paralytic polio started happening. Wow. And we kind of stopped studying polio after we got a vaccine, so we don't really understand why this is the case. But in 1948, there were almost 28,000 kids who got polio, which was three times more than the prior year. Oh, boy. And in 1949, it was 42,000 cases.

And in 1952, it was 57,000 cases. Yikes. 21,000 of those kids got paralyzed and 3,000 of them died. Wow. So, I mean, to be fair, we're not talking millions of deaths. But still, like, you know, 21,000 kids being paralyzed is nothing to sneeze at if it's, you know, happening for one year in the United States. Yeah. And it made a big impact on that generation. I think anybody who knows people from that generation has met somebody impacted by polio. My teacher in fifth grade walked with crutches and didn't have complete use of his legs because he had polio as a kid.

Wow. I have never met anyone who has shared a polio story with me. I think we're moving far enough away from when the vaccine was developed that it's rarer. and rarer to hear those stories, but certainly it was common in the 50s. Didn't Mitch McConnell have polio? I mean, I think he's, like, 500 years old, yeah. Yeah, Mitch McConnell is a polio survivor. Wow. His upper left leg was paralyzed. Huh.

Well, he was one of the lucky ones who made it through. So do we understand now why this started to ramp up? Was there some mutation in the virus or a change in the environmental situation? As far as I know, we don't know. We kind of, we felt like we licked polio, and so we moved on to other things, which Makes sense, but it would still be interesting to know and interesting to understand because, you know, there could be other viruses that might mutate that we should be like keeping an eye on if we understood why this happened. Are there silly conspiracies based on like random correlations? Like, that's when rock and roll started to spread across the country or something. There were a lot of crazy conspiracy theories about how polio was transmitted. For example, a lot of people thought it had to do with cats.

So thousands of cats in New York City got killed. I know. So there were. You know, there were plenty of conspiracy theories, but to be honest, I didn't look too much into why. I didn't look for conspiracy theories. They're so easy to find most of the time. All right. And so at this point, we have vaccines already for other diseases, right? So it must have been, like, on the radar. Like, let's get a vaccine for polio.

Yeah. And so our early research into polio unfortunately set us on kind of the wrong track. So there was a guy named Simon Flexner at the Rockefeller Institute, and he was trying to infect Rhesus monkeys to understand how, the virus is transmitted, but one of the hard things about studying human diseases in other animals is that sometimes it works different in those animals. And so in the rhesus monkeys, the way you got them infected was you swabbed their nasal passage. And essentially you were sending the virus like really close to the nervous system. And so the rhesus monkeys got polio, but if you put it in their mouth and had them swallow it, they didn't. And so there was this idea

that the only way polio could get to people is if it went directly into the nervous system and that you couldn't get it by ingesting it. And that's bad for a couple of reasons. So one, it's throwing off your understanding of how the disease is actually transmitted, which means public health measures are harder to create. And the other thing is it suggests that the virus is never passing through the bloodstream. And that is your best chance at hitting it with your immune system. So if you're going to have a vaccine, it's probably going to create a virus.

antibodies that will be in your bloodstream. And if the virus is never in the bloodstream, how's your body going to attack it? All right. So naive question, your immune system is only in the blood? Or is that where most of it is? Or what? Your immune system is in lots of places. But my understanding is that the strongest part of the immune system and the part of the immune system that gets activated by vaccines tends to be in the blood. Yeah. And since we're doing an immune system primer, what is an antibody exactly? Is it one of these crazy white blood cells that you see on those videos like searching around and killing bacteria? Ah, no, not quite.

So your immune system makes an antibody when it encounters a pathogen for the first time. And what the antibody does, it's like a protein, and it binds to the pathogen. And one of the things that it does is it keeps the pathogen from, for example, getting into a cell. So this could keep polio from getting into a nervous system cell because it's essentially like blocking it from doing anything that it wants. Another thing that it does is it flags the pathogens so that those white. White blood cells can then find it. So it essentially is like, white blood cells, over here, I've got something.

And so you make antibodies that are specific to different kinds of pathogens. So if your body encounters the polio virus, it will create antibodies that remember the polio virus. And so the next time you encounter polio, your immune system is ready to attack it right off of the bat. And you say remember, and that makes me think of like, you know, I remember somebody's face and I have no idea how that works inside the brain. How does it work for the immune system? Is it like it builds some protein which latches on to the something on the surface of that thing? I'm totally guessing here. How does it work?

Yeah, so I think the amount of antibodies that you have for a specific pathogen does kind of go down over time. And like you may have had the experience where you go to get a booster vaccine. And so sometimes your body does seem to sort of forget if it hasn't seen something for a while. And so you're essentially just reminding your immune system like, hey, this is a bad thing. You should be prepared. And it's not like it always has loads of antibodies for all pathogens it could possibly encounter. But there's some of them in there. And then the number of them can be rapidly increased if the pathogen is encountered again.

I see. And so you're saying remember and forget. It's sort of like anthropomorphizing our immune system. Really, it's like, do you have a bunch of antibodies for this or do you not? Absolutely. Yep. That's right. Cool.

All right. And so it's a big challenge to develop a vaccine for something if it doesn't go through the blood, if it just bypasses our major defense system. So what does that mean about developing a vaccine? What else can we do? Well, so it turns out that Simon Flexner, because he had studied rhesus monkeys, he thought it never went through the blood,

but he was wrong. He was wrong. He was wrong. And he was wrong because he was studying monkeys, and polio is different in rhesus monkeys than it is in humans. In those monkeys, it can only get in through the nose if you put it really close to the nervous system.

But in humans, we can get. it through our mouth. And then it goes into our stomach and into our lymph nodes. And then it goes into our blood before it goes to the nerves. So you do have a shot. But for a long time, we were all sort of thrown off track by this research that didn't quite get it right because the animal model set us on the wrong track. All right. So bad news for the rhesus monkeys, but good news for humans. So eventually good news when we figure it out. When we figure it out. Yeah. All right. So let's take a break. When we come back, we'll hear more of the saga of how we developed a polio vaccines. The twists, the turns.

the ups, the downs. Get your popcorn and get some tissues because it's going to get emotional. Here we go. Hey, I'm Cal Penn, and on my new podcast, Here We Go again. We'll take today's trends and headlines and ask, why does history keep repeating itself?

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Adia knows she's a cult leader. Well, Dakota, luckily it's I'm not afraid of a scary story week on the OK Storytime podcast, so you'll find out soon. This person writes, My neighbor has been blasting music every day and doing dirt rituals, and now my ceiling is collapsing. I try to report them, but things keep getting weirder. I think they may be part of a couple.

cults? Hold up, Sophia. A real-life cult? And what is a dirt ritual? No clue. But according to this person, contractors are tearing down the patio to find out what's going on with her ceiling and her neighbors are not happy. Well, she needs to report them ASAP. She did. And now they've been confronting her in really creepy ways all the time. So do we find out if this person survives their neighborhood cult or not? To hear the explosive finale, listen to the OK Storytime podcast on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. All right, we're back and we're telling a story of how we develop the polio vaccine. Kelly, what is the next step in this story?

Well, you know, like so many scientific endeavors, the next step is get the money because it's expensive to do science. And the story for how the vaccine got funded starts with Franklin Delano Roosevelt, who in 1921 at the age of 39 got polio himself and his legs were paralyzed. Right. In 1924, he hears that this person went to these nice warm springs. And by going in the warm springs and moving his body around in the springs, he was able to walk again. And FDR was like, whoa, what? That's great.

I'm going to go. And so he goes and he falls in love with the place. feels like actually he can move a little bit better in the warm strings. That might have been a placebo effect. But also it's just sort of nice to have a lot of your body supported by the water and the warm water probably felt pretty good. Hot tubs are fun. They sure are. Yes. And so he decides, you know what? I love this place. I'm going to buy it. Wait, I'm going to buy it. I'm going to buy it. Yes. He came from a rich family, so he was like, I'm going to buy it. I'm not just enjoying the hot tubs. I'm in the hot tub business now. Wow. Cool.

Yeah. And so he buys it, but he buys it and tries to make it a place. where lots of polio folks can go. Okay. And so he will sometimes even charge people less if they have polio and they want to come to the warm springs, but they can't afford to. And that's great, but he's having trouble making money. One, because he's giving people all these discounts. And two, because it turns out people who don't have polio are worried about getting

into the water with people who do have polio because we don't know how it's transmitted. And so this place is financially going down the tubes. Come soaking hot disease water doesn't really work, it turns out. Yeah, right. Yes, that's right. You know, for these patients, the polio had passed through their body. They were so paralyzed, but they almost certainly weren't shedding virus anymore. Right. So it probably was safe. But, you know, stigma being what it is. People were staying away. Nobody wants to slip into polio soup anyway. Yeah. Yeah, that's right. So in 1928, FDR becomes New York governor. And in 1932, FDR becomes New York governor. And in 1932, he becomes pregnant. Pregnant. Oh, my God. In 1932, he becomes... What an accomplishment. Yeah, that's right. That's right.

Who knew? Polio was the key. Anyway, all right. So in 1932, he becomes president. And he no longer has time to run Warm Springs. And so his work colleague, Basil O'Connor, takes over. And he's trying to figure out how he's going to take this financial disaster and turn it around. And he essentially starts a campaign that's sort of focused on FDR.

where he says, hey, let's start to raise money for polio by having, like, big gala balls, and eventually he brings in famous actors and actresses to try to raise money. And this becomes the National Foundation for Infantile Paralysis, which ultimately becomes the March of Dimes, which I think a lot of people have heard of.

Yeah. And this is why FDR's face is on the dime. Oh. Because this, yeah, this became, like, a super popular thing. Cool. Okay. Well, they raised loads of money. A lot of their money was spent on, helping to care for people who were paralyzed. And so they offered a lot of support for polio

victims. But they also saved a bunch of money for research. And so this is how the research is going to get funded. So if you're out there and you're a disease and you're listening, it's a bad idea to infect a white guy who becomes really important because those are the diseases that get attention. I wish that that were otherwise. But no, you're right. And in fact, there's a pretty good argument that you could make that polio in particular was getting a lot of attention because it tended to hit the middle class. And so there was this idea that maybe because the middle class were living in like super sanitary environments, they were more susceptible to polio. But it was, this was a disease of like upper middle class white people. And that is probably

part of why it got so much attention. Yeah. Unfortunately, folks in government need like a personal connection to some kind of experience before they take action sometimes. It's too bad. Anyway, it's good news that there was a lot of research money towards developing. being a vaccine. It's a bummer that FDR had to get polio for that to happen. But then how did that research effort kick off? All right. Well, so first they had to decide what kind of vaccines they wanted to fund. And it turned out there were two competing camps that both felt very strongly. And the competing camps were live attenuated virus. So you essentially get a wimpy version of the virus and inject that into people. Or a killed virus where you kill the virus before you

injected into people, but you make sure that you haven't like totally destroyed it. You need your immune system to still recognize it. Okay. And did we have working examples of both in other diseases? Yes. The live attenuated virus was pretty common at the time. And it was thought that that was the best way to make vaccines. But Jonas Sock early in his career is going to get experience working on a killed version of the influenza virus. And he's one of the people who helps develop the first flu virus and that kind of convinces him that killed viruses are the way to go. But there's a couple problems. So the live virus people argue that a killed virus will never stimulate the immune system as well. And so you might get weaker immunity or immunity that fails more quickly. And they're

concerned that it's going to be really hard to be sure you've always killed all of the virus. Like if you, you know, you've got a batch of virus that is alive and then usually, what happened is they put formalin of formaldehyde in there. How can you be sure that it got to every single virus particle? How can you be sure you're not going to give people polio? Oh, my God. Imagine injecting polio into some kid. That would be terrible.

Yeah, hang on. We're going to get there. Oh, no. Oh, no. Yeah, I know. It's a sad story. And so the problem with the live attenuated virus is that viruses mutate. And so a virus that has been made sort of wimpy over time can mutate and go back to being

really bad. And when you make a live attenuated virus, people shed that virus and it gets into the environment. And so anywhere people are defecating, you've now got this polio virus in the environment and you can't really control where it goes and what it does. Yanks, both of these seem like bad ideas now, Kelly, you got me almost over to the anti-vax community. I'm terrified. No, okay. The lesson at the end is going to be that we have really good protocols for killing viruses now. And it's been going well for like 50 or 60 years. So there have been no mistakes as far as I know. All right.

So what were some of the early tests? How did they go? Okay. So one of the early trials is called the Park Brody vaccine. And this is named after the two scientists who worked on it. And this was around 1934. And they essentially infect monkeys with polio, grind up their nervous tissue, and add a little bit of formulin, hoping the formalin will kill the virus. And they first give it to 20 monkeys.

And the monkeys make antibodies to polio, which suggests it works. And then they try the vaccine off. on themselves, and it goes pretty well. They gave the vaccine to themselves. They did give the vaccine to themselves. They were pretty confident. Wow. Okay. And then they give it to 12 kids, and it goes okay.

Okay. And so they say, hey, we've got a safe polio vaccine, and they start scaling things up really quickly because everybody really wants a polio vaccine, right? And so as soon as there's, like, evidence that you've got something that works, people start scaling up. But the problem is it wasn't really safe, and it might not. have been protecting against polio. So, but before they scaled up, they must have had some evidence that it was working.

Was the evidence just that it was creating antibodies in the humans? And that doesn't mean necessarily that it's protecting against polio. Having antibodies isn't enough? One of the lessons we're going to learn from this is that there hadn't been enough basic research before they started making the vaccine. And it turns out there's three types of polio, not just one. And so you can protect against one type, but someone can still die or get paralyzed by some of the other types.

I see. And so they didn't have complete protection. And then the other problem was we didn't know at the time that there's a lot of people who will have very strong immune system reactions to monkey nervous tissue. And so some of the nervous system cells were still in the vaccine and people had like massive abscesses and their whole body would be inflamed and kids were getting super sick from this vaccine. And it was because of the monkey cells. At the same time, this guy, Comer, is making a little bit of.

another vaccine, but this one is a live virus vaccine with the wimpy version of the virus. This was in 1935. He also vaccinates himself. He vaccinates his two kids. Oh, my gosh. And so he must have been confident. And then he vaccinates 23 other kids. Whose kids are these kids?

Right. So sometimes... Trick or treat. Jab. Jab. Well, you know, if somebody confidently told me I can protect your kid from polio, there's some chance I'd be like, oh. Like, I wouldn't want my kid to be the first one. in line. Yeah.

But I can imagine why he was able to find 23 kids. Well, it's a terrible decision to make, like, do you maybe take this vaccine that protects your kids, or do you not take it? And then they're still risking their lives, right? There's risks either way. Yeah, there absolutely are. But he then goes on to vaccinate 10,000 kids. Wow.

So a pretty big trial, and at least a dozen kids get paralytic polio from his vaccine and nine of them die. Oh, my gosh. Yeah. And so there's a scientific conference where the Park Brody vassie. vaccine and the Comer vaccine are discussed, and it's a bunch of polio scientists. And at the end, essentially, Comer gets accused of murder by one of the other scientists. And he says, gentlemen, this is one time I wish the floor would open up and swallow me. Oh, my God. He must have felt

terrible. He felt horrible. And Brody dies at age 36 or something of a heart attack. There's some argument that maybe it was, he brought the heart attack on, you know, purposefully. But anyway, a really horrible episode for everyone involved. And the lesson they end up taking away from this is that we need a lot more basic research. And these guys are all acting in good faith, right? Maybe they rushed a little bit. Maybe they got unlucky,

but they were trying to do good, right? Yeah. And, you know, I think that Homer, who tested the vaccine on his kids, he must have thought he had the solution. Yeah. Or he didn't like his kids. Wow.

One or the other. I was trying to say these people are not monsters. They're not villains. But you're like, Maybe he hates his children. No, I'm just joking. They're not monsters. Like, they really, no doubt part of them was thinking, I will be a really big deal if I

solve this polio thing, right? I can't imagine that that wasn't on their minds. But I do genuinely believe the fact that they tested it on themselves first, they tested it on their kids, that they really, they were trying to save lives. I think their intentions were good, but they rushed into it and they didn't realize how little we knew, I think. Well, it's a tragedy either way. It is.

So then we did it by. a basic research to understand polio and the immune system better. How did that help shape the next step in the vaccine story? Yeah, so the next thing that we wanted to do was work on figuring out how many types of polio there are. So it became clear to us that that is a question we didn't really have a good answer to. And this is where Jonas Salk comes in. So I think a lot of people have heard of Salk. He's a fairly famous scientist. His family were Jewish immigrants from Russia who moved to New York City. Yay, scientists as immigrants. Yay. Yay. Oh, there's a lot of stories of scientists as immigrants here that, like, we have a lot of immigrants to thank for protection against polio.

It's almost like we should be welcoming smart, hardworking people into our country, especially if they bring expertise and want to help us. Yeah, you know, I think you and I try to not be political on the show very often. I don't think that's political. I don't think that's political. It's just common sense. I am 100% behind you. Yes, I agree. This is a small subset of the many immigrants who have made our country better.

So as we mentioned, Sok had some experience working on the flu vaccine, which was a killed virus vaccine. He did that at the University of Michigan with an advisor who were going to hear about later, Thomas Francis Jr. But then he starts his own lab at the University of Pittsburgh. And when he's at the University of Pittsburgh, he meets a representative for the National Foundation for Infantile Paralysis. This is the funding agency we were talking about before. And they're like, hey, look, you're starting up a lab. You clearly need a lot of equipment and some extra space. if we gave you a bunch of money to try to figure out how many types of polio virus there

are? And he was like, I need money. I'm in. And so he starts typing polio. And he works on this for two years from 49 to 51. And he confirms that there are three types. The first type is the most common and it's the most likely to lead to paralysis. The second type tends to lead to asymptomatic cases, but sometimes it can still paralyze the unlucky. And type three is the most rare, but it's also the most likely to go after your brain stem and put you in an iron lung or kill you. Oh, boy. Yeah. So you want protection from all three of those. I certainly do. Yes. Okay, so around this time, there are some other really exciting advances, one of them being that we figure out how to grow the virus in monkey kidney cells in dishes

rather than nervous system cells. And so now we're in a position where if we need to grow up this virus to make vaccines, we don't have to be doing it in monkey nervous systems anymore, and we don't have to worry about that horrible reaction the first set of kids had to monkey nervous system tissue. All right, that's good news. That is good news. And then a woman named Dorothy Horseman while doing some experiments realizes, hey, actually, polio does have a phase where it goes through the blood. At this point, we knew that sometimes it gets in through the stomach, and she figures out that

sometimes it goes through the blood on the way to the nervous tissue. And she's like, hey, that's good news. We might be able to make a vaccine. This is promising. But then she stopped working on that question. But now it's in the air that you could go after it in the blood. Okay. So in 1951, Stalk starts growing the virus in the lab.

And he has to pick the three strains that he wants to use. So he knows that there's lots of different, like even if it's just type one, there's still different kinds of strains. And some of them are worse than the others. And so what he does is he puts the polio virus. into kidney cells. He gently rocks it in an incubator with nutrients. He gently rocks it. Well, not like, you know, not like with a foot on a bassinet. Yeah, exactly. I'm sure he had a piece of equipment that was, you know, moving it around on a tray. He's whispering sweet nothings to it as it grows. That's like, come on, babies, we got this. Okay. There is something

kind of macab about growing them up just so you can kill them and then kill all their brethren, right? But all right, anyway, go ahead. So you grow up all these polio vaccines in these monkey kidney cells. You're growing up all these polio viruses, right? I got to say I don't feel bad for them. So then you filtrate out as much as you can to make sure you're just left with viruses. And viruses are really tiny. So it's pretty easy to filter them out.

But remember, some nervous system cells got through the last time. So you've got to be careful. And now he tries to kill the viruses with formaldehyde. Formaldehyde is a super nasty chemical, and it's hard to, do because you need to be absolutely sure that every time you do this procedure, you kill all of the virus. Any free-living virus can really cause some trouble because one of the types that he picks is a super virulent strain called the Mahoney virus.

And he picks it because it would be really good to have resistance against this particular strain. It's very common. It's very lethal. So he decides to go with it. But you've got to be sure you kill it. And so they worked really hard on this procedure. And one of the things you've got to be worried about.

is if at any point your vial sits for too long, stuff can sort of accumulate at the bottom and form like clumps, and virus particles in the middle of that clump can stay alive and kill things. And so at this point, he's using what seems like an established procedure. You take the virus, you mix it with formaldehyde,

you have a killed version of the virus. There's no innovation yet, right? That's 100% right. That's a really good observation, and that is going to continue throughout a lot of this story. Salk didn't really do anything 100% new. He was taking procedures that other people had used and he was the first one to sort of put them together and get it right. That's important. Other people had not established a protocol that definitely killed all the virus every time. But Salk manages to do that. Wow. Interesting. Yes. And so he eventually gets something that's worth trying and he tries it on monkeys and it goes well. And after the break, let's talk about how he starts his human testing.

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Okay, we're back and we're talking about the development of the polio vaccine. And so far, Salk has discovered there are three kinds of polio virus. He's grown them up whispering sweet nothings as he incubates them in monkey kidney cells and then he's mixed them with formaldehyde to kill them. And you said this was successful in monkeys. But we've seen that before, right? Yep, we've seen that before. And so it's important to note that at this stage, Salk also injects his vaccine into himself and his children because he's confident that it's going to work.

But then he goes on to find a larger community that he can test it on. And here I feel a little bit uncomfortable. So he found the D.T. Watson home for crippled children. Crippled is the word they were using at the time. He also reaches out to the person running the Pope School for Mental Defectives. Wow. Really, you know, from today, That is a pretty insulting name for the facility,

but it was basically children who had some intellectual disabilities who were getting cared for there. And there was this general feeling in the community that this was a good population. So there was a sort of condescending attitude that this is some way they can contribute to society by essentially being these guinea pigs and the implication there being that they weren't contributing

in any way otherwise, which upsets me. Or that there's somehow less vassending. because if something goes wrong, it's not as big a deal or something? Exactly. Yes. Right. Also, you know, they are in one place and will stay in one place for a long time so you can go back and test them and you know who they're interacting with. So there's a lot of things you can control with this population. So for better or worse, he gets permission to work with both of those communities. Now, the D.T. Wantson Home for Crippled Children, most of those children who are disabled are disabled because of polio. And so what he does is he figures out by looking at antibodies in their blood what kind of polio they encountered. And then he gives them a shot of the same type of polio that he killed in his lab. And he thinks this should be a pretty safe way to test things because if I didn't kill all the virus, it's not going to be bad for them because their immune system is going to be able to respond. And I can see if they start making even more antibodies when I give them the vaccine. So they shouldn't get hurt, but they'll give us some information about whether or not we're stimulating the immune system.

All right. So they have like natural immunity already because they've been exposed to the disease itself. That's right. Okay. And how did that go? That went great, actually. And it went so great that they moved on to the other community. And when they moved on to the other community, this time, they, you know, these kids had no expected immunity to polio.

They didn't have polio. You could check that with blood tests initially. And they are not sick after they get the vaccine. And they start making antibodies. And those antibody levels stay good for months. And these are some really good results. So he's super excited. Do you think, by the way, that they got parintal approval?

to test it on these kids? Do you think the parents were like, yeah, go ahead and test it on my kid and I put in the institution? Or do you think they sort of did it without asking the parents? So in the interest of time, we skipped another vaccine story where Hillary Kopposki did not get good parental consent. And the Lancet even jokes about his use of the word, quote unquote, volunteer. Oh, no. And so there are some questions about consent that are raised earlier in the vaccine story. And so Salk had this on his mind.

He contacted a lawyer to make sure he had insurance to cover him in case he got sued. And he worked with the state to come up with parental consent forms that were very clear about all this stuff. Yeah. So some lessons were learned there, which is good. And so he goes to write up his results to publish them in the Journal of the American Medical Association. But word gets out before his article is published that there is a polio vaccine that could start saving kids before the next polio season. Oh my gosh. And so Salk is freaking out because everybody is like, oh, you got to give us the vaccine. And he's like, no, I'm not ready yet. This was like a small scale study. This is not

ready for large scale distribution. And we learned a lesson from earlier rapid scale ups that we need to be careful. Yes, exactly. Right. And so he goes on a radio show and essentially tells the nation, look, we don't have a vaccine yet. We have some good results. But like, I don't think we're going to have something for the next polio season. So we're working on it. But, but now the ball is rolling, right? And the National Foundation that's paid for his research is like, we need to do a massive national trial. And Sox sort of gets pulled along. And so they give the protocol for making this vaccine to some drug companies. And they say, okay, start making this vaccine. Wow. And now this debate starts about how do you design this nationwide experiment that's about to happen? And the big debate is

about whether you want observed controls or double blind injected controls. So here's the difference. For the observed controls, they wanted to open enrollment to second graders. And any second grader who wanted the shot could get it. And then they would compare polio rates in the second graders who got the shots to first and third graders. So similarly aged kids who were probably engaging in the same activities and then compare how much those two groups got polio. And I guess it's an issue there because there could be a bias because people are selecting, right? And it would be some confounding factor with that selection. Yes, exactly. There's a concern that the higher income families whose risk is a little bit higher might be more likely to enroll their kids in the trial. And low income populations were less likely to get paralytic polio. Again, for reasons we don't totally understand. But those two confounding factors made this experimental design not ideal. And so there were people who were pushing for signing up a bunch of kids who want the vaccine and giving half of them the vaccine and half of them the placebo. All right. So the first plan was observed controls, but this is the other plan, the double-blind study. Yeah. And Salk is pretty hard against this initially because he believes his vaccine works, and it's not ethical to randomly not vaccinate a bunch of kids whose parents want them to get the vaccine. And in the human way that we often find imperfect solutions to our problems, what they ended up doing was in some places they use observed controls. And in other places, they used this double-blind placebo situation.

So you end up with both kinds of data. And this lab at the University of Michigan collects and analyzes all the data. It was a massive record-keeping fiasco because you couldn't let the doctors or the kids know, who was getting placebo and who was getting the actual virus. Because, like, if you give a doctor a vial and you say this has the actual vaccine, they're going to vaccinate their family, like they're humans, you know, and maybe they're not going to give anyone the placebo. And so you have to actually make sure nobody knows.

And then someone's job was to track down every kid that died that was part of the study and figure out, did they die of polio or could they have died of something else? So very depressing. And this is before computerized record. So this is like literally a lot of paperwork and scraps of paper and oh my gosh. It was a massive, massive undertaking. So Thomas Francis Jr., who was Sox advisor, was the one who undertook this work. And it was like, you know, years of what his lab did.

was crunching these data. But right before this vaccine trial was about to roll out and they were about to start, you know, giving the kids the vaccines, some of the monkeys and some of the labs where they're testing the vaccine to make sure it's safe, get polio. Oh. And it looks like it was just one monkey, maybe two,

that actually got polio. And the system of checks worked, right? So they did say, okay, there's some monkeys that got polio. We need to pull those vaccine lots. There was something wrong with them. but it gets out. And this celebrity gossip show has a host

named Walter Winchell and he announces that 7 out of 10 tested batches contain live virus. It's been killing monkeys. He starts a rumor that coffins for kids

are being made and distributed around the world in advance of the release of the Salk vaccine. Sorry, not around the world, around the United States. But, you know,

a lot of what he said wasn't wrong. There were monkeys dying of the vaccine. But that had been our way of catching a mistake in the vaccine process. But the word was out. And it's estimated that 150,000 children were pulled from the trial due to this broadcast. And in response to the monkey incident, they now have a protocol where companies have to submit 11 consecutive lots of

the vaccine that they made. And every single one needs to pass testing before any are cleared for use. So if in a batch of 11, one monkey dies, then all of that has to get thrown out. and you've got to start again. Good. Yeah, they're trying to be extra super careful about it. So the vaccine trial happens. It's like the biggest vaccine trial in the history of the United States at the time. And it turns out if you look at the data where we had that placebo, like the best quality data, the vaccine is 80 to 90% effective against paralytic polio.

It's 60 to 70% effective against type 1 and 90% or more effective against type 2 and 3. Wow. That is amazing. That's incredible. Yeah, that's incredible. And so the vaccine starts getting made in massive quantities. Six different drug companies start making it. And this is where we have a problem.

So it was announced that, like, hey, look, we're probably not going to have enough vaccine for the oncoming polio season. We'll have it for the year after. But parents really wanted it, right? And so companies started scaling up production and some mistakes were made. And this is where I can imagine. There could be some anti-vaxxers today that remember stories that their grandparents told them because there was a company called Cutter Labs from Berkeley, California, that had some batches of vaccine where not all the virus had been killed.

Oh, no. And so as these cases start getting reported, Cutter vaccine gets completely taken off the shelves. They actually stop all vaccines for a while until they can re-look at all of the different drug companies to make sure everything is okay. Cutter never ends up making more vaccine. The rest of the companies are given permission to go ahead. But now there's much stronger controls for what kind of test the vaccines need to pass before they can go public. And in the last 50, maybe even 60 or 70 years, this problem has not happened again. So now that we've got these appropriate controls in place, we're good.

And this is when the government started stepping in. So you probably couldn't get a vaccine. trial run by a foundation that isn't government run again. And so this is part of how like the CDC and the National Institute of Health sort of grew in response to this situation. Wow. So let's real quick get to, so Calk sort of famously said something to the effect of you can't patent the sun. I won't patent this vaccine. But as you pointed out, Daniel, he actually hadn't produced any new procedures. He was very clever about taking preexisting procedures in being like absolutely anal retentive in creating a protocol that was fail-safe,

but he actually probably could not have patented his vaccine anyway because there were no new novel procedures. And he did talk to patent lawyers, and they were like, yeah, you're right, this probably isn't patentable. So it's not just that he was like a really great guy, although he was a really great guy, I think, but it also was just that like there wasn't really anything to patent there. But at the same time, there was a competing vaccine.

So Sabin is a scientist who was born in Poland, in 1906. He ends up at the University of Cincinnati. He's also getting funded by the National Foundation. And he makes a vaccine with virus that he has run through animals multiple times until the virus is super weak. And he does this with all three strains. But the National Foundation just finished doing this national trial for the Salk vaccine. They're not going to do it again for a new vaccine when they've got one that works. And so he goes to Moscow. And he and he And the Soviet Union in 1959, they're like, this vaccine looks good. We like it.

We're going to vaccinate 10 million kids. Wow. And so they vaccinate 10 million kids. And they essentially say, you have to show up at the school on this day or the factory on this day. And they all get vaccinated. They decide that actually went pretty well. And so they now decide they're going to vaccinate everybody who's under 20 years old. So 77 million people get vaccinated.

Oh, my gosh. And so the Sabin vaccine starts making its way back to the United States. And this is after, you know, the cutter incident where people are like, oh, maybe the Salk vaccine isn't safe anymore. And that starts to be on people's mind. And SABN sort of capitalizes on this fear. And SABN and Salk didn't like each other at all. They were definitely like, not necessarily racing, but definitely competing. And the SABN vaccine ends up becoming a lot more popular.

And eventually at some point, people stop getting the Salk vaccine and they get the SABN vaccine instead. Oh, wow. Both of these vaccines contributed in bringing the levels of polio down massively. But a problem with the Sabin vaccine, which we mentioned earlier, is that that vaccine is a live virus. And even though it's a weak version of the virus, there are parts of the world where when people get polio, what they're getting is this version that's in the vaccine. The Sabin vaccine causes polio in one out of a million doses. So this is the problem with having a live vaccine. And so at some point, the United States said, look, we have so little polio, but for one out of a million people who get this polio vaccine, there's a chance they're going to get polio, we're going to switch back to the Salk vaccine. So after doing the Sabin vaccine for a while, we switch back to Salk. And now everybody gets the killed virus version, which has been safe for 60 years. So some parts of the world still have polio like Pakistan, but we are incredibly lucky in the United States to not have to worry about it.

As we mentioned at the beginning of the show, you know, I get frustrated when I hear this quote, the good thing about science is that it's true whether or not you believe it. And it's like such a condescending attitude to give to people when there have been mistakes in the past, right? And I still think we have a right to say, hey, you know, if your kid wants to go to public school or if you want to be a health worker, you have to get these vaccines. I think we have a right to like mandate that kind of stuff. But I also feel like we have this massive responsibility to be super open and transparent about like what we're doing and how we made these decisions because we've made mistakes in the past. And I think it's reasonable for people to like want to be convinced and to, you know, and for you to need to make a good argument for it. Not that I think all the anti-vaxxers are anti-vax because they are familiar with this history, you know, the like 5G from a vaccine is kind of crazy.

But anyway, I think these things are complicated. What do you think? Yeah, I think it's important that we share the process that people understand how scientists come to these decisions and also that science informs policy but doesn't dictate it. Like the questions of how do you develop a vaccine and the questions of should we inject this into children are different questions. What is science and what is policy? And I do think that it's important that people out there are educated in how science works so they understand where these decisions come from. Because, yeah, nobody wants to be told this is a true. truth and that's not the truth and we can't explain it to you shut up um that's not the way it should work

if science is by the people for the people and of the people and that's one reason why i think it's great we do these episodes to show people how we learn this stuff and what we know what we don't know we got to be honest about all of that because that's what's going to convince people it's the process that people should trust not any individual answer or result um and so we're going to include people in that process absolutely yep amen and also hooray i never had to worry about my kids getting polio. Yeah, me either. How terrifying. Yep. And so, as I said, the top of the program, like, I am so grateful to scientists and to doctors and to everybody who's made our lives so much better and safer. Agreed. Thank you. All right. And thanks to everybody

out there who's interested in learning about how the scientific process works, how peer review works, how discoveries are made, how we develop some of these life-saving vaccines and the things we learned along the way. And thanks to Kelly, as always, for your patented research deep dive. And thank you to The Extraordinaries for giving me the opportunity to read loads of stuff about topics I find fascinating. And apologies to anybody who heard the phrase fecal oral while you were having breakfast. All right, thanks, everyone. Tune in next time. Heart Radio. We would love to hear from you. We really would. We want to know what questions you have about this extraordinary universe. We want to know your thoughts on recent shows,

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