This Podcast Will Kill You - Ep 7 Hit Me With Your Best (Polio) Shot

Episode Date: December 12, 2017

A scientific rivalry for the ages, a president with a closely kept secret, and a summertime with no pool time. What do all these things have in common? Well step right up and take a listen- today we're talking about polio, that virus that just won't quit. See omnystudio.com/listener for privacy information.

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This is a job for Indeed Sponsored Jobs. In 1992 in February, I was born in India in a town talk called Not Four. It's basically in the dead center of India, if you're trying to find it. In April of 1993, I was brought over to the states by airplane and was adapted into a family in St. Louis, Missouri, and I was raised there until I was 19. And then in 2011, I moved to Springfield, Illinois, for college. So somewhere between four and nine months of age while in India, I had polio. I also had tuberculosis as well where I was there. So we're not sure which one of those came first, but very likely one of them weakened my immune

system and made it so when I had the polio vaccine, my body was possibly not able to fight it off because the records do show that I did get the vaccine. The orphanage also has a history of not having the best medical records. So there is a chance that maybe I was out getting my diaper changed or getting fed. And, you know, when they came down in the row and inoculated every child that I, you know, just wasn't there. So I could have just not gotten it either. But no other children in orphans got polio, which leads us to think that I possibly got it from the vaccine. Growing up with polio, I don't remember having it as a child, like, as a baby per se.

But I remember growing up. I remember learning how to walk when I was younger. I had a walker. I went to Shriners Hospitals for Children in St. Louis, which is where I got my leg brace made. and my mom can tell you exactly what tiles I took my first steps on as a child. And since then, I've pretty much just been having preventative care, whether that be different braces. A couple of times I've broken my leg because my left leg is weaker or just different surgeries to help correct or prevent certain problems from occurring related to the polio.

And the main one as an adult that I've really run into is my official paralysis line is at T9 in my spine. and luckily it makes it just so my abdomen is weaker, but the actual paralysis is where my hip is and down. So as an adult, I've had issues with chronic UTIs and kidney infection secondary to the polio, and I've also had issues with arthritis in my joints, but otherwise not too terrible. At least for me, when you grow up as disabled and it's the only thing that you know, that's your normal. So it's not anything like, There was an accident and I knew what being able-bodied was versus being disabled. So I never had that, I guess, annoying factor there.

I just was like, oh, this is how I walk. This is how I do things. I just do things a little differently. An interview that we conducted with a girl named Grace, who, as you heard, came down with polio as a small child. And so we wanted to actually have something unusual, which was an actual firsthand account, instead of me just reading from a piece of paper, which is the norm. Which is also great, but we like that too. Yeah.

But even better when we can actually hear firsthand from somebody who experienced it. Yeah. So that was really fascinating. And also thank you again so much grace for that. Yes, we really appreciate it. And if you're just tuning in, this is this podcast will kill you. Welcome. I'm Aaron Welsh.

And I'm Aaron Oman Updike. It's great to have you here. Yeah, thanks. And in case you haven't gathered, this week we are doing polio. And let's jump right in. Yeah, let's do it. Oh, wait. Oh, wait.

It's quarantine time. Yes. My favorite time. Mine too. What are we drinking this week? This week we're drinking the sulk shot. Right? Salk shot and say okay.

It sounds like salt. I don't pronounce things well. What's in the sulk shot? It is. Rum, orange liqueur, and lime juice. Rimmed with tahine. Yep, and we rim the glass with tahine. We're going to post the full recipe on all the social media,

so you can get it there. But I do have to note that this was not a true quarantini for us. Something weird happened this week, you guys. First of all, we don't drink rum very often. No. Why did we choose to use rum for this? Okay, so the reason that I was pushing for rum is because FDR, the most famous person with polio, was possibly the United States biggest drinker of all of the presidents. He was a drinking president, that's for sure.

He truly was, and he loved to make cocktails, and rum was one of his favorite liquors to mix, but also he made the worst cocktails of all time. It has there, like there are people on record saying the present made the worst martini I have ever tasted. So. So our sock shot is not that bad actually. No. Except we don't know that for sure because when we tried to make it, it turned out that my bottle of rum was water. Yeah, that was bizarre. And I don't have a 16 year old living with me. So I don't know what's going on.

So yeah, if you make this actually, make it because we have no rum, we haven't actually tried it. Let us know how it tastes. I'm very curious. So if you guys could make it and send us a picture and let us know, that would be great. That would be great. Are you ready for this? I'd better be. So poliomyelitis, or polio, for short, is a disease that is caused by the polio virus. That's the first thing you might have learned. Okay. Check. Check. It's a virus. Polio virus is an RNA virus. So if you remember that viruses are basically just genetic material surrounded by protein, polio's genetic materials, RNA, and it's surrounded by a protein capsid.

Polioviruses are related to enteroviruses, which are super common viruses that often cause stomach illnesses, like vomiting sort of stomach flu type illnesses, and also can cause upper respiratory illnesses. And they're also in the same family as the virus that causes the common cold rhinoviruses. Interesting. Yeah. Polio viruses are physically capable of infecting other primates, but they are really a human-specific virus in general. Okay. Polio virus itself. So, for instance, would you find another primate in the wild that has poliovirus or just humans?

Right. No, you wouldn't. You only find humans naturally infected. We can infect animals in the lab that are other primates and also certain lines of mice that we've mutated. Okay. Anyways, there are three distinct serotypes of the polio virus. Polio virus, one, two, and three. Oh, that's easy to remember. I love it. I love it when it's easy. Keep it simple. These three serotypes are antigenically distinct. So antigens, again, are the outside proteins that are on the surface of the virus that our bodies use to find them. So these three serotypes are different enough that infection with one serotype of polio does not confer immunity to the other serotypes. And that's important in terms of both exposure and vaccine. Definitely. Big time, big time. Yeah, so the vaccines that are used are

trivalent vaccines. So they cover all three serotypes. Oh, like try, yeah, try valent. Try harder. Just kidding. So polio virus one is the most common. And something that's kind of cool is that Poliovirus 2 has actually been declared eradicated. So there's no wild circulating polio virus 2. Whoa, that's super cool. Yeah, it's pretty exciting. And do these guys, sorry if I'm jumping the gun, but do these guys differ in their virulence or infectivity? Great question. I actually couldn't find a lot of good information on that. Do you know the answer? Well, I know that they do, but I don't know which is more virulent or infectious. Yeah, so I know that polio virus type 1 is by far the most common. Okay. And then type 2, I think was the least common.

common. So that's the one that has now been eradicated. Okay. And these are geographically distinct. Like that is why they have type 1, 2, and 3. Yeah, they tend to be in different geographic areas. But poliovirus one was overall, like across the globe most common. Polio virus is transmitted fecal oral, just like cholera. So you have to actually ingest poopiness to get infected. There's a small chance that you can transmit it by coughing if you have an infection in your upper gastrointestinal tract, but it's pretty not very common. So you can imagine that that similar to cholera, the burden was historically and still tends to be heaviest in countries that have poor sanitation.

But another important thing about polio that makes it very different from something like cholera is that it's considered a disease of childhood. So it tends to affect children that are under the age of five. And the reason for this, besides the fact that children are constantly shoving poop-covered stuff in their mouths, is that infection with polio virus provides a lifetime immunity. only to the strain that you're infected with, but unlike some other diseases, immunity to polio is very long-lasting. And so when you talk about the infection prevalence being highest in children under the age of five, that is current or recent polio infection prevalences?

Historically as well. Historically as well, okay. Yeah, so it was always considered a disease of childhood. So people who were not that you couldn't get it when you were older, but you were probably exposed when you were very young. and then once you got infected, you had lifetime immunity. Right. So you could, in theory, be infected with other stereotypes, but if you lived in the same geographic region, there's probably, in most regions, aren't multiple strains circulating.

Okay. So about 75% of people who get infected with polio virus are totally asymptomatic. 75%. 75%. I saw estimates as high as 95, but I don't believe them. I believe the WHO and the CDC. Fair enough. Similar to cholera, though, these asymptomatic people,

can still shed virus in their stool, so they still could be infecting others. The incubation period is around 7 to 10 days, but actually can vary from 4 to as long as 35, which is crazy to me. That's such a huge range. Well, I read that it had something to do with the amount of time that it takes to make it up to the central nervous system. And so for very tall people, your incubation period would be longer. Oh, my God, are you serious? That's what I read somewhere. Oh, that's funny. Yeah. I never, I guess I didn't think about that because, this is only for symptomatic cases, obviously, the incubation period. Right.

Because incubation period, again, is the time from when you're infected to when you show symptoms. So most people don't really have an incubation period because they don't have symptoms. Yeah, 75%. Right. Interesting. That is interesting. So also similar to what we saw in cholera, people start shedding virus in their poop a few days before symptoms start.

And they continue to shed for at least one to two weeks, though I saw some estimates that they can shed for up to four to six weeks, which is a really long time. Yeah. So undoubtedly that's something that has made polio more difficult to control is how long you are shedding and this very high rate of asymptomatic cases as well. So 75% of people are asymptomatic. And then the other 25% of people who get infected, most of them end up with a relatively mild illness.

Fever, headache, sore throat, maybe some nausea, stomachache, vomiting, since this does infect your gastrointestinal tract, right, fecal oral. But you're here, Erin, and listeners to hear about poliomyelitis. Oh, yes. AKA polio. So poliomyelitis is the disease that happens in less than 1% of people who get infected with the polio virus, about 1 in 200 cases. This happens when the polio virus exits your gut and travels to your central nervous system.

where it attacks your motor neurons. Can I just throw something in here right now? Please do. The etymology of poliomyelitis? Well, I'm going to... Are you going to say it? Okay, sorry. No, you go, go, go.

Give it to me. I love it. Okay. It's from the Greek polios, meaning gray, and Muelos, I guess, meaning marrow, anditis, meaning inflammation. And so it refers to the... inflammation in the gray matter of the spinal cord, which causes the paralysis. Yeah, exactly. So myelitis is essentially an infection of the central nervous system. So you can get myelitis from

other things as well, but polio myelitis is myelitis caused by the poliovirus. Thanks for that. Sorry. No, don't be sorry. So sometimes the paralysis can be reversible, but often it is not. And of these paralytic cases, about 5 to 10% of them are fatal because the paralysis affects the diaphragm or intercostal muscles, which are the muscles in between your ribs that are responsible for respiration. So you can't breathe. And was there a treatment for those cases eventually? Oh, I believe you may have heard of it. The iron lung. Are you going to tell us a bit about the iron lung later? I'm not, no. Oh, dang. I mean, there's so much, polio has such a rich history that it is, I mean, it's a very important part. It's hard to pick and choose. Right. Basically,

the iron lung was a huge machine that was used to treat the patients whose diaphragm, who could no longer breathe because their muscles had become paralyzed. And so it breathes for them using like a pressurized and depressurized rhythm. And there are still people that are in iron lungs today. Yeah, there's actually a video that's been making the rounds on social media and we'll post it to our social media account as well in case you haven't seen it yet. That's about some of the last people that are still living today in an iron lung, because that's pretty interesting. Dinner shows up every night, whether you're prepared for it or not. And with Blue Apron, you won't need to panic order takeout again. Blue Apron meals are designed by chefs and arrive with pre-portioned ingredients so there's no

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now available in Canada, too. That's Q-U-I-N-C-E.com slash this podcast to get free shipping and 365-day returns. Quince.com slash this podcast. So most of the time in paralytic poliomyitis, it's some part of the spinal cord that's attacked. So you might lose function of a limb or you might lose function entirely in a region inferior to where the motor neurons were damaged. But the fatal cases are often because the virus infects the brain stem. And when you infect the brain stem, you can affect the cranial nerves, which again can affect breathing, swallowing, speaking. So yeah, basically the virus infiltrates and just destroys your motor neurons.

So it's really sad. That's horrible. And if that's not horrible enough. Oh, great. the idea of tiny babies losing function in their limbs. There's also post-polio syndrome, which is a combination of symptoms that include progressive muscle weakness, fatigue, and pain from joint degeneration that can happen in about 25 to 40 percent of poliomyelitis cases. And this happens 15 to 40 years after infection.

So just to go back, to relate this back to polio infection overall, of the cases that are actually symptomatic of polio, there is a very small proportion of them that actually get poliomyelitis. Correct. And of those, it's the 25 to 40 percent that you're talking about. Exactly. So 25 to 40 percent of people who end up with poliomyelitis, that neuron involvement, can go on to have post-polio syndrome. And this happens 15 to 40 years after infection.

So if you imagine you get polio as a baby, 15 to 40 years later, you can end up with these very, in some cases, very severe and debilitating muscle symptoms. And there isn't really anything to do to prevent it and there's not much that you can do to cure it. And from what I understand, it's not like the polio virus is still sitting there alive in your nervous system or anything like that. It's not like herpes virus, for example, like with chickenpox where it can reemerge as shingles. The best explanation that I've seen is that when polio attacks your motor neurons, it might not destroy all of your motor neurons. So you're left with a subset of functioning neurons. And then these neuronal cell bodies, because your neurons are basically a cell

body with fibers sticking out of it, then the cell bodies that are left will sprout new fibers to re-inervate the muscles that have previously lost function. But then over time, these cell bodies are essentially working way harder than a cell body would otherwise have to work. And so over time, they may weaken or end up dying themselves. Right. So it's like rapid aging of your motor neurons. Yeah. And so that's why you have this very late onset and it's a very progressive weakening of your muscles. From what I understand, it's not 100% sure that that's the explanation, but that's the best that people have been able to come up with. Yeah.

Things like the severity of the initial infection, the age at which you were infected, and the thing I found really interesting is how well you recovered all of the, affect whether or not you end up getting post-polio syndrome, the better your recovery, the more likely you end up with post-polio syndrome. Interesting. Yeah. And I think that's one of the things that helps support this hypothesis that if you recovered really well, then your neurons regenerated a lot and then they're really working over time.

Isn't that interesting? Yeah. I thought that was very, very cool. I mean, not cool. Very, it's a very interesting side effect of an infection with a virus like this. Mm-hmm. Particularly when it's no longer in your system. Right.

Yeah. Yeah. So I think that's everything about the biology. Any questions? Not yet. Good. But we'll see. So I guess then that means that it's time for me, right?

Yes. It seems like I always start off the history part by saying, oh, well, the first recorded instance of whatever disease was in Egypt. And today is going to be no different. Yeah. Yeah, there are illustrations dating from Egypt in 1400 BC that show people with withered limbs and a dropped foot, which is particularly characteristic of polio. Wow. So it's been around for millennia, but it's interesting because it really didn't start to reemerge or be noted in literature or in historical accounts of the day until the 17th century. and then it was more just like case by case or describing a disease overall.

It wasn't really in reference to epidemics. Huh. Interesting. So descriptions of matching clinical signs of polio show up in the 17th century. This is in contrast with many of the other diseases that we've talked about so far, all of which have kind of popped up an epidemic form at some point or another or multiple times, or at least like leprosy, have left enough of an impact that they've, are written about throughout history. One of the thoughts as to why polio wasn't an epidemic disease has to do with sanitation. Prior to wide-scale water treatment and sanitation measures,

children were probably exposed to polio at a very young age, experienced a minor infection, or the vast majority of them did, and then also recovered and had lifetime immunity. Obviously, there was a proportion of these individuals who became partially paralyzed as a result of infection. Or died. Right. But studies done in the 20th century prior to the introduction of the vaccine showed that the case fatality rate and case paralysis rate was highest in the very young, so like under a year. Okay. And then it dropped in young children, like under the age of five.

And then it rose in adolescents and adults. Okay. So like a check mark. Right. which is really interesting. Yeah. And this seems to suggest that the older you are when you first encounter polio, the more devastating it could be.

And the more likely you are to get post-polio syndrome. So that makes sense. It just probably, I actually know why that is. Because as a child, your nerves are really good at regenerating. And so the older you get, the less good they are at regenerating. That makes sense. Except that when you're a tiny baby infant, you have no immune system. And so you can't fight anything off.

So tiny babies are going to die. Little kids are going to be okay for the most part. And then as you get older, you're not going to be able to recover. Got that medical degree for something. Hey. Working on it. That's really interesting. It's only a matter of years.

Yeah. So these epidemics were probably able to occur in the 20th century as sanitation measures increased. Interesting. And the population of already. exposed people decreased so that polio could tear through an unexposed community. That is so fascinating. It's it's kind of like a disease of sanitation. Right. Unlike a disease that we see like with cholera where the lower the sanitation measures and it kind of goes. It's a middle ground right? Because you have to have good sanitation so that you're clean. If you if you have really,

really great sanitation, then you're not going to have fecal oral contact very often. But then if you have you have a little bit of sanitation so that not everyone is exposed, then you have more susceptible individuals that are older and then you can have these epidemics. That is so interesting. Wow. Yeah. It's the sporadic nature of the sanitation that really would lead to these epidemics. Oh, wow. That is so interesting. Well, in any case, the polio story really begins full force in the late 19th and early 20th centuries when polio began appearing in epidemic form in Scandinavian countries, in the U.S. and then on to Europe. Of course, people only care about it when it's in the Western Hemisphere.

So let me make one thing clear. The only reason that there's a polio vaccine and that it is almost eradicated is because this struck wealthy children in the United States. And then it was like people actually cared about it. It's a darn shame that they don't care as much about diseases that are not on their doorstep. Right. Like visual licheminesis.

visceral lesthminaeysis is what I just said visual yep it's not what I said it was also of course had global distribution but these are the countries where all of a sudden it was appearing in a more epidemic form right in the past when we've talked about epidemics or pandemics the numbers are staggeringly huge except in the case of leprosy with like 25% of people being infected or dying as a result of infection by comparison polio caused minor outbreaks initially Its first epidemic appearances in the U.S. in the 1890s through the 1910s resulted in a few hundred to a few thousand cases, of which about 10% died and 40 to 50% were paralyzed. So side note, yeah, these percentages correspond to reported cases. Okay.

The actual number of polio cases was probably a lot higher. Right. And the percentages of fatal or paralytic cases was probably a lot lower. Oh, because the number of cases were a lot higher. Right. Of course. Still, though, we're talking about a few thousand cases in a country of a couple hundred million people. How then did polio mobilize an entire country towards finding a way to stop it? Because they were white babies. That's true. Well, yeah, the answer lies and who was most impacted. And that was young, otherwise healthy children. In the early 20th century, no one yet knew how polio was transmitted. All they knew was that one summer day, your kid would go out to play. Come home in the evening, feverish and complaining of body aches, and be paralyzed or dead within days. Yeah.

And it really struck fear into the hearts of people across the United States. I mean, it would be terrifying. Of course. There's no denying that. The fear was palpable. Summer was synonymous with polio season. Everyone's pooping in the pool. Well, swimming pools were shut down.

So you had better poop before it was shut down. Children under the age of 16 were barred from. public places such as movie theaters in an attempt to limit disease transmission. Do not gather in groups, children. That's kind of the idea. The number of polio cases in a town was reported daily on the radio and in newspapers the way baseball or football scores were reported. Wow.

Interesting. It was a nation obsessed. Yeah. And as the years went on, it was clear that polio was on the rise. From the small beginnings of a few hundred cases at the turn of the century, 1916, for instance, saw 27,000 fatal cases. Oh, my God. In the eastern United States, the vast majority of which, of course, were children.

Wow. Okay, that's a really, that's a big number. It's a big number. Yeah. And remember how, I just had to throw this in here. Remember how cats were killed during outbreaks of plague? No. It happened with polio too.

Wait, literally how? I don't. Cats don't have the receptor that, that polio virus needs to infect. cells. Right, but they did not know that polio was even a virus back then. I know, but how were cats, what were cats dying of? No, no, no, no, no, I'm sorry. Oh, they were dying of humans. People were killing cats? Yeah. Because they thought they were getting, oh my God. 72,000 stray cats during in 1916 were rounded up and killed in New York City. Because people are stupid? I'm going to call them. Lacking the knowledge. Okay, ignorant. And acting out of fear.

Oh, yes. Poor kitty cats. I mean, the number of theories as to what caused polio or how to treat it abounded. Oh, God. So George Washington Carver, the peanut man. Yeah. His idea was to treat polio with peanut oil. It's like today, like shove a walnut up your butt hole to cure your cancer.

That's not real. It's a very Gwyneth Paltrow type of treatment. Just have some lemon juice with some papyrus. with some paprika and cay and pepper little salt their problems Is that how she talked? That's my goop impression. I loved it.

Yeah. Okay. What was I saying? Oh yeah. Oh, so one unique thing that struck that stuck out to scientists from this epidemic was that the disease seemed to strike harder in relatively wealthy regions,

which enjoyed reliably, more or less, clean water and sanitation systems. And this was completely, completely unlike what had been seen in the past and was a large part of why the movement to halt polio gained so much momentum. Perhaps the most famous polio victim was FDR, like I already said, Franklin Delano Roosevelt, who was the 32nd President of the United States. In the summer of 1921, the then-year-old spent several days at the family home on an island off the coast of Maine, where he filled his time with extensive physical activity. He was like sailing and running and like

racing his kids and swimming in the freezing waters. And then one evening, a strange feeling came over him. He felt chilled, feverish, with numbness and deep muscle aches. He began to have trouble walking and the paralysis spread up to his chest and down even to his fingers. He had trouble writing. The diagnosis of polio did not come for several days, in part because he was of an unusual age to be afflicted. Yeah, that's quite old. But he grew up probably completely like, I isolated. Yeah. Yeah. By the time that he was actually diagnosed with polio, he had lost much of the function of his legs, which he would never fully regain. Newspapers, of course, ate this story up, and he was ridiculed by his political rivals as being physically unfit for office of any kind,

and he responded by initiating a massive campaign, which lasted throughout his life, to hide his disability from public view. He had intricate leg braces designed and was very careful not to be photographed in a wheelchair, but the truth was that he would never again be able to stand on his own unaided. Wow. FDR coming down with polio was honestly probably the best thing that could have happened for polio. To polio. Yeah. Or rather to the children who suffer from polio. Right. Right. Do you know whose face is on the dime? Oh, is it FDR? It is. That was a guess. Do you know, why it's there? Because he's a 10-cent and good guy. That was a bad. Nope. I don't know. Rewind. Just kidding. No, it's okay. I'll tell you. Please. Okay. From the time of his infection to

his death, FDR campaigned and helped raise funds for polio organizations. His first endeavor was to purchase Warm Springs, which was a retreat in Georgia whose natural mineral hot springs were advertises having curative benefits. So he spent so much time at Warm Springs, rebuilding the area, rehabilitating different cabins and stuff, and also providing a lot of treatment free of charge for polio patients. So it did do some good. And there was also he created something called the Warm Springs Foundation, which was used to raise money for polio patients. Cool. And the other huge thing that he did was to create the National Foundation for Infantile Paralysis in 1938. Infantile paralysis is what a lot of people called polio back then.

Okay. And this was an attempt to depoliticize the fundraising of money for polio victims and research. Fundraising had been going on, but it was mostly in the name of the Warm Springs Foundation. And the biggest fundraising events were on Roosevelt's birthday, which didn't exactly encourage donation from the Republicans, who was the opposing political party. The first action of the National Foundation for Infantile Paralysis, gets a mouthful. was to ask people to mail dimes directly to the White House. In a stunt they called the March of Dimes. To mail dimes?

Mail dimes. That's funny. And it was surprisingly enormously successful. Wow. People sent so many dimes that counting them individually was impossible. The dimes had to be shoveled onto a scale to be weighed. Oh my gosh. Yeah.

Wow. In total, over 2.7 million dimes were sent to the White House. Do you know how many dollars that is? $270,000. Thanks. And so because of this, the enormous success of this stunt, the National Foundation for Infantile Paralysis, eventually became the March of Dimes, which still exists today. And to honor Roosevelt's contribution to the cause, his face was put on the dime in 1946 after his death. That's really interesting. I never knew that story.

The impressive amount of money raised by the March of Dimes was used for two primary reasons. Treatment and care for those afflicted by polio and scientific research to develop a vaccine for its prevention. Cool. Yeah, it was, I mean, it was a really well-funded organization for a while. The early 20th century was riddled with amazing medical advancements that resulted in the reduction or elimination of many diseases through the development of vaccines or antibiotics. Polio then must have seemed like some kind of cruel joke because early research on a polio vaccine was wildly unsuccessful. Really? Yeah, and early trials in the 1930s led to several children, dozens, I think, because. becoming paralyzed or dying.

With the vaccine trials? Yeah. That sucks. As a result, scientists began to steer their research more towards treatments and away from vaccines. Uh-oh. A couple of hurdles stood in the way of a successful polio vaccine. With the smallpox and yellow fever vaccines, which had already been successfully developed

and deployed, there was only one strain of virus for the vaccine. So creating the vaccine was pretty straightforward. With polio, researchers didn't know at the time how many strains there were, and it wasn't until 1951 that the final number was in, which, as you mentioned, was three. That meant that an effective vaccine would have to contain all three types of the virus. The other issue was how to grow enough virus to make vaccines. Previous research had indicated that the virus could only be grown in nervous tissue, which was all but impossible to grow inside a lab at the time.

Then a man named John Enders tested this conventional belief by inoculating other tissue, skin, muscle, kidney with the poliovirus, and it grew. Right, because it actually infects your gut, and it can actually, I didn't mention this, but it can infect your spleen and your liver. It can actually infect a whole bunch of your tissues, but obviously they wouldn't have known that then because the only symptoms you really see or associate with poliomyelitis are the nervous symptoms. Well, he did know that.

Like he did know, he said, well, it infects your gut, so it's got to be able to exist in other tissues. Okay. Smart guy, Ender. Well, this incredible breakthrough would be the, only polio-related development to earn a Nobel Prize. It revolutionized cell culture in the lab. That's really cool.

This finding, along with the discovery of the three strains, meant that the groundwork was laid for vaccine development. The March of Dimes began to essentially funnel money into the development of a vaccine. An enormous number of scientists were involved in this process. So let's meet the two men whose names you've probably heard linked to polio before. Jonas Salk and Albert Sabin. These two were similar in many ways. Both men were of Eastern European descent.

Both were Jewish and both faced substantial obstacles because of this. However, Sabin was older, more established, and respected in the scientific community, more concerned with earning the respect and praise of his peers, his fellow researchers. Salk, on the other hand, was young, relatively young, a novice when it came to polio research and seemed to be more interested in the celebrity spotlight over the scientific one and was dismissive of others' contributions to the development of the vaccine, according to some of his lab members. He would put his name in front of theirs.

Oh, that's not cool, bro. I know. I really wanted there to be a hero in this story, and they both kind of seem to have their own personal issues. I can be a hero. Maybe. That was good. Anyone who works long hours knows the routine. Wash, sanitize, repeat.

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Well, yeah, okay. So what issue do you want to take up in arms? I don't feel strongly enough about anything. Okay. Maybe later. Okay. Just a thought. Get back to me on that. I will. So the feud between Salk and SABN simmered quietly with SABN passive-aggressively disparaging the work of Salk, but the two kept a polite front until 1953. The previous year, 1952, had seen the highest number of polio cases in the U.S. so far, with more than 57,000 cases overall, 21,000 of them paralytic, and 3,000 fatal. Oh, my gosh. Yeah.

So the urgency and pressure to create a vaccine was never high. higher. And when Jonas Salk announced in 1953 that he had come up with the vaccine that he had successfully tested on polio-afflicted and mentally disabled children, I might add. Oh, God. Always. Always. The U.S. celebrated. Salk became a celebrity overnight, appearing on TV to tell his story, but to also caution viewers that more testing needed to be done. In response, Sabin publicly declared himself to be, quote, anti-Salk, saying that the killed virus vaccine that Salk had developed was not enough to ensure lasting immunity and applied that it was downright dangerous. He emphasized that the only way to eliminate polio was through a live virus vaccine,

which coincidentally was what he was working on at the time. Of course. Sabin's hesitation did have some legitimacy. Salk's vaccine was in no way perfect. Despite Sabin and others' protestations, this vaccine was the closest thing yet to a prevention for polio and plans were drawn up for a countrywide experiment. Can you remind me what year this is? So this is in 1953, okay. When he announced, hey, I have a vaccine that is close to being ready. But it was still under trials at this point. It was still under trials. And so in 1954, the testing to validate this vaccine was going to happen. And it was going to be the biggest public health experiment in U.S. history to date. Whoa. So over the course of 1954, over 1.5,000, over 1.5,000,

million children would take part. 1.3 million? 1.3 million? Wow. With some of them receiving the vaccine. Oh no. And others receiving a placebo and others just being observed without receiving any sort of injection. In April 195, the results of the trial were in.

The vaccine was, quote, safe, effective, and potent. Thank goodness. Because like 1.3 million children, just like, ooh. Oh, boy. I mean, they do trials before they go to trials, but still. I mean, back then it was a little more iffy. I'm sure it was. Yeah, I'm sure it was. Definitely. Well, they did the trials just on kids who had no choice in the matter.

Exactly. It was estimated that this vaccine conferred protection to 60 to 90% of those vaccinated. Bells were rung. There was actual rejoicing in the streets. Wow. Seriously, children around the world could now be protected against polio. Cool. It was a huge, huge development. Yeah, that's a major deal. And Salk was a god of science in the eyes of the public.

especially after going on TV to answer the question, quote, who owns the patent on this vaccine? With, quote, well, the people, I would say. There is no patent. Can you patent the sun? Change my mind. I don't want a rivalry. I want to be a gut of science. So, yeah, I mean, that was a nice sentiment.

Yeah. Right? So with no patent on the vaccine, drug companies were free to make and sell the vaccine. Okay. You would think that the road was free and clear for all kids to be free from the fear of polio. Not so fast. Of course never. One problem was with administering it.

The U.S. government, headed at the time by Dwight Eisenhower, didn't want to administer the vaccine at public schools, fearing that it would seem too much like socialized medicine. Oh, God. So they consciously chose not to plan on how to get the vaccine to kids, how to ensure that there was enough vaccine being produced, and instead just leaving it up to the drug companies and to the parents. Oh, my lordy, lordy. Some of whom the parents could not afford to pay for the vaccine. Right.

But, you know, this was during the time of the Cold War, and so any sort of whiff of socialism was really like... It was communism. Exactly. Oh, dear, America. Another problem was that some drug companies had better safety checks than others. Of course. One drug company, Cutter Laboratories,

in San Francisco didn't check its product well enough, and they failed to disclose some of their findings, which show that there were live virus particles in the vaccine. Great. Cool. Over 200 people contracted polio from that vaccine with most severely paralyzed and 11 dying. This is a really great way of, like, how to convince people to not do vaccines by doing it this way. Oh, it was a fiasco for sure.

And it really also soured public opinion of the Salk vaccine, which was helped along by Sabin, whose live virus vaccine was finally ready to test. Just in time. Since the U.S. was not at all keen on the idea of another wide-scale vaccine trial, Sabin brought his vaccine to the Soviet Union, where in 1959, the Russians tested, never wanting to be outdone by the U.S., 10 million children. Successfully. Thank goodness.

That was funny. The Sabin live virus vaccine eventually displaced the Salk killed virus vaccine across the globe. It certainly had its advantages. The Sabin vaccine, which was a live virus, was a weakened virus, I should say. It was cheaper. Since it was an oral vaccine, whereas the Salk vaccine is injected, you did not need a trained medical professional to administer it. It was thought to be more effective and protect you for longer.

And it also apparently had a broader. protection. Recently, also this is a really cool thing, recently vaccinated individuals would shed attenuated viral particles for several days, which could then be picked up by unvaccinated individuals resulting in passive vaccination. I love that. I mean, very cool. That is very awesome. That was a huge bonus. It was a major bonus. You don't have to necessarily vaccinate everyone. Great if you can, but if you can't, they're probably going to indirectly vaccinate their family members because this is transmitted fecal oral and you're shedding this attenuated weekend virus in your poop. Yep.

Yeah. I love it. It's very, I mean, it's genius. Yeah. But, yep. There was one glaring fault of the Sabin vaccine. I'd say there might be two, but they're very related. Yeah.

Because it was a live virus vaccine, some of those given the vaccine would develop paralytic polio, three and 100 million doses, which is a really small number. but still very problematic. In several countries where wild polio had been completely wiped out, there were still a few dozen cases each year as all a direct result of the Sabin vaccine. You know, I actually saw numbers that were much higher than that. I'm sure that they are. One in 750,000 doses administered will result in vaccine-associated paralytic poliomyelitis.

Wow. Yeah. And that's if you're fully immunocompetent. Oh, right. But if you have any sort of... If you are immunocompromised, like in our interview with Grace, she talked about having TV. If you're immunocompromised, you are three to six thousand times more likely to end up getting vaccine-associated paralytic poliomyelitis than a person who's immunocompetent. Holy moly. I know.

So it's not an insignificant fear. No. Well, and seeing this in, I think the early 80s, Salk's son wrote who was a doctor. wrote an article calling for the switch back to the safer killed virus vaccine. In response, Sabin said, direct quote, he doesn't know what he's talking about. His work is completely out of focus, distorted, erroneous information, just to chip off the old block. Real piece of work Sabin was. This is the problem with toxic masculinity egos.

Well, toxic masculinity, but also scientific rivalries. Oh, my gosh. I know. But I mean, you got to be able to see both sides, man. Oh, yeah. It's, it's, there are pros and cons to both of these vaccines. I'll talk more about it, too, when we talk about the state of polio today. Yeah.

Yeah. So the craziest thing, though, is that Salk wrote that. Jonas Salk's son wrote that in the early 80s. And no one listened to it. No, no one listened to it. The live virus vaccine would continue to be used for another 20 years in the U.S. until the CDC finally called for a return to the Salk vaccine in 2000. which is what is used today.

Do you know what you were vaccinated with? Because I called my mom to ask. I have no idea. At that point in time, the recommendations were kind of do whichever one you and your doctor think is best. So I called my mom to ask. I was like, do you remember? I got the oral one. Oh, wow.

Yeah. I'm okay. So you're, yeah. So polio, like smallpox, is another of the diseases that the World Health Organization targeted for eradication. In 1988, the goal for eradication was announced to be the year 2000. But clearly there are still cases around. So, Erin, where do we stand today? Polio today, the good news is that polio is very close to being eradicated.

That is good news. So you mentioned it was 1988 that the World Health Organization decided that that was going to be their new goal. In 1985, the Pan American Health Organization, which is an organization we never talk about on this show. But it's also, it's an organization like the World Health Organization, but it's just for the America's in South America and Central America. They made it their goal in 1985 to eradicate polio from the Western Hemisphere by 1990. And they came super close. So in 1991, that was when the last case of wild polio virus transmission was recorded in Peru.

And in 1994, the America's region of the World Health Organization's region, so the Americas were classified as polio-free. Wow. Yeah, in 1994, it's been a long time. Yeah. It was four years late, later than they wanted. But hey, it's not so bad. I mean better late than never? Better late than never.

And again, in 1988 is when the WHO made it its goal to eradicate polio. They definitely haven't done it. It's 2017. Polio still exists. How many cases have there been, like, list this year or last year? Great question. Great question. So they have made major progress.

In 1988, when they made it their goal, there were 300,000. 150,000 cases estimated of poliomyelitis. That is neural and involvement. Wow. In 2016, 37. Wow. Yeah. The WHO estimates that 16 million people have been saved from paralysis.

16 million. Wow. I know. I know every episode we're always like, oh, the WHO, they're so amazing. But, you know, it's true. They're not a perfect organization by any means, but they really try hard. They've done great things. So, 1994, the Americas were declared polio-free.

In 2000, the Western Pacific region, which is Western Asia, Pacific Islands, and Australia were declared polio-free. In 2002, the European region. And in 2014, and this one's very exciting, the Southeast Asia region was declared polio-free. Wow. So India was one of the places that was very, very difficult to implement polio eradication campaign because it's a massive country. It's so densely populated. There are so many parts that are remote and underdeveloped and underserved, but they did it. That's incredible.

2011 was the last case of wild polio in India. That's so cool. Yeah. Well, and so just to bring it back to smallpox and the eradication campaign there, smallpox, the vaccination record is a scar on your arm. Right. And so it's very visible, whereas with polio, you need multiple courses for one. and two, it's not visible. And so the records have to be really well kept.

It just is overwhelmingly a lot more difficult. It's a very, very difficult and logistically challenging campaign to undertake. And we talked already about how the oral polio vaccine, OPEV, was and still is kind of the vaccine of choice for the eradication campaign. It's super cheap. I think I saw it cost 14 cents per administration. and it can be administered by anybody. So literally anyone can be trained as a volunteer. You just squeeze a dropper full.

Something I thought was really cool is that included in the oral polio vaccine is vitamin A. Because vitamin A deficiency is a major cause of mortality in children under five in a lot of countries. So the WHO estimates that they, by including vitamin A in the oral polio vaccine, they estimate that 1.5 million childhood deaths have been prevented. Holy cow. Right? That's amazing. I know. Fan girling over here. I know. And so we talked about one of the biggest risk factors by of using the oral polio vaccine is that this vaccine associated paralytic polio. There's another aspect of it. We've talked about the benefits, but there's another thing that actually makes this a dangerous vaccine to use and that's the exact flip side of the fact that you get this passive immunization of your

household members. This exact same property is what allows for outbreaks of what is called circulating vaccine-derived polio virus. This has happened in Pakistan, Nigeria, and Laos, Democratic Republic of Laos. This, what is called CV-D-P-V, that's too many acronyms. Whoa. The vaccine-derived polio virus. that is circulating, can evolve to become more virulent and more like its wild type progenitor, which is fascinating and scary and scary and insane. And so this type of paralysis that's associated with the vaccine-derived poliovirus is clinically indistinguishable from that that you would get from a wild poliovirus.

You can tell by laboratory analysis so we know when outbreaks are going on what is, which is causing it. So they are trying to move away from the use of OPV now that the risk of these side effects are essentially outweighing the risk of infection by wild type poliovirus in the majority of countries. We also are seeing a push towards using a mono or bivalent OPV instead of a trivalent OPV. Are they safer or what's the... Well, in the case of poliovirus 2, there basically is no wild circulating PV2. Right.

But we do see outbreaks of vaccine-derived PVVV. to happening. From the oral vaccine. Right. So if they moved away, so it would either be moving towards a killed virus vaccine, the objective vaccine, or it would be moving towards a bivalent or monovalent. Oral vaccine. Yeah.

And so what they're actually doing is both. So the W.HO is phasing out the use of the oral polio vaccine. They're using mono or bivalent where wild polio virus one or three are. circulating very commonly. Okay. But then they're phasing it out and they're trying to bring in the injected vaccine. But again, this is much more difficult and expensive to administer in a lot of countries. Did you find anywhere that actually indicated that the Salk killed virus vaccine conferred shorter than lifetime immunity to Sabin? Great question. I haven't found anything that indicates that it confers a shorter immunity. What happens is that the IPV

the injected or the inactivated poliovirus vaccine does not confer mucosal immunity. So the immunity that you get by taking the oral vaccine directly affects your cells in your gut. Because that is the root. That is the root of administration and that is the normal route of transmission. Okay. So from what I could gather, and I haven't read every paper on this, so this is me conjecturizing based on my knowledge, the antibodies that your gut uses are IGA in general, which are different than the antibodies that circulate in your blood. So the antibodies that you make when you get injected with the

inactivated poliovirus vaccine are not the same ones that your body would make. You'll make both types, but you'll make more of the kind if you get the oral polio vaccine. So what can happen is that you could potentially still get infected. You're less likely to end up with paralytic paralysis, so you're protected, but you can still transmit and pass the polio virus to other people if you don't have the oral polio vaccine, if that makes sense. So in a country, like for example, in Norway, they have only ever used the IPV. They've never used the OPV. But they have really great sanitation.

So they're not having this problem where if everyone is vaccinated with the IPV, then every individual is protected. and what you're not necessarily stopping is the transmission to other people that have not been vaccinated. Does that make sense? Yes. And so, yeah, so that's one of the biggest differences that I found between the two of them. Both of them are effective, but in slightly different ways. And like we said already, administration of, say, one dose of the IPV and one dose of the OPV,

like administration of both of them is actually very great. So it doesn't have to be all OPV or all IPV. can be some combination, but in areas where there is absolutely no circulating wild polio, you're better off with the IPV because the side effects are far less and the risk of a future outbreak is lower as well. Cool. So economic modeling way back in the 80s predicted that polio eradication would save 40 to 50 billion U.S. dollars between 1988 and 2035.

Which is why the global campaign started? I would assume so, yes, because everything's about money. But what's interesting is that it's predicted to cost $7 billion between just 2013 and 2019 to keep this eradication effort going. Right, because of the surveillance. Surveillance is super expensive. We're going to have to switch to the inactivated virus vaccine, which is more expensive. There's just a ton of costs involved in it. So I've heard a lot of critiques, and we talked about before how this eradication effort really was spearheaded and started because it was,

white children in wealthy countries who were being affected. Not only, obviously, but they were being affected. Because they were affected is how it became worked on. So there are critiques that say, you know, this eradication effort itself is there's a lot of money going to it that could be spent on other diseases. Such as? Well, I mean, you could think of it as diseases that we think of as even more neglected than polio like neglected tropical diseases intestinal helmets luschmeniasis

malayas chagas do a plug for that one but there's i i'm not i don't know the economics of this to be honest all that well and so this is my personal aran olman updex opinion it doesn't have to be the opinion of this podcast will kill you unless you agree okay i feel like number one polio still sucks it's still a terrible virus and so in my mind mind any kid who doesn't have to get it in any country, that's a worthwhile endeavor. That's the first thing I feel like. And the second thing is that what's really cool about this polio eradication effort is that it has taken so many individuals being mobilized and the development and implementation of infrastructure that now exists in so many countries that once you have a system of infrastructure

or like that up and running for vaccination for polio, there's not that many steps away from being able to vaccinate for MMR, D-TAP, hepatitis A, all of these other things. MMR is MMSLUMMS and Rubella. Oh, yeah. D-TAP is diphtheria, tetanus, and accellular pertussus. Sorry. Okay. Obviously, it's been easier to do polio because it's an oral vaccine, but still you're having

the switchover and you're still doing, there is so much surveillance that happens for polio. You can also train people to do surveillance for things like cholera and influenza, but what I think is even more exciting is you can train people then to identify outbreaks of new viruses like Marburg or NEPA, which I hope we'll talk about someday. So what's exciting to me is that getting this initial setup is often one of the biggest barriers to controlling any disease. So if nothing else, this global eradication campaign has put a lot of boots on the ground in helping to develop the infrastructure that we would need to be able to do even more great public health work in the future. Right. I agree. Yeah, I feel like if you are an economically minded person,

which is going to be the people who actually make these decisions, unfortunately, that the infrastructure is already set up. A lot of the cost is already invested and that it wouldn't be that much additional effort to do some of these other global campaigns. Right. Granted, the money just needs to keep coming, which is the second other biggest hurdle that every disease and public health campaign has to deal with. But, you know, polio is a, it's a mostly happy ending. It's, you know, we've really, really decreased. Did we even say the three countries that it still exists in? I don't think so. It's Afghanistan, Pakistan, and Nigeria. I think you might have said it, but I don't remember if I did. Polio is almost gone and that's great. Right. I mean, you and I didn't have to endure

closed swimming pools. That would have been, well, only for poop, but not for polio poop. Oh, okay. And, uh, yeah, so. So I don't even think we need to ask the question of how scared you need to be for this episode. It's not a big threat of bioterrorism. No. You know, recognize that it still happens, but you have probably been vaccinated. You've definitely been vaccinated. If you've ever gone to school, you've been vaccinated. Well, sources time. Yep. Let's do it. I read a couple of books to get my information. The first is called polio, an American story. It is by David Oshinsky. And it is a really great look at polio in the United States, sort of the drive to create this vaccine, and concentrates a lot on FDR, Sabin, Salk, basically what I talked about today.

Cool. Another great one, which had a better overview of the history, and it's a general book. It's called Viruses Plagues in History by Michael Oldstone. And finally, I want to put in a plug for a book called Small Steps, the year I got polio, and it's by a woman named Peg Carrot, I think is how you say her name. And I did not read this, but it was recommended to us by Grace. And it's supposed to be a great firsthand account, like a memoir of this girl experience with polio and when she contracted it at the age of 13, I believe. Oh, that sounds really interesting.

So that's all I got. I want to give a shout out to the polio global eradication initiative, which is funded by not only the WHO, even though we talked about them most today. It's also funded by UNICEF, Rotary International, the CDC, and the Bill and Melinda Gates Foundation, as well as, of course, all the governments in the countries that they operate. And finally, this review called Impact of Inactivated Polio Virus Vaccine on Mucosal Immunity, Implications for the Polio Eradication Endgame by Edward Parker at all in expert review of vaccines published in 2015. You know, my citations are always so much more boring than yours to read. Oh my gosh, I just fell asleep. I know. I almost did too.

Sorry. No offense. Eddie Parker. I'm sure that they're chock full of good information. It's a really, it is actually a very interesting article to read. But you got to like the articles things, I guess. The books are more accessible. I want to give a huge shout out to Grace, who was so awesome in letting us interview her and sharing her story with us.

And also to Bloodmobile, as peruge, who provided all the music for this episode. Yep. Thank you so much. Thank you, Grace, so much for talking with us. It was amazing and awesome. And I hope all of you listeners enjoyed it. Rate review and subscribe. Please, please, please.

Follow us on social media. Yep. And wash your hands. You have filthy animals. Running my small business was like playing basketball five on one, and I was the one. Now, QuickBooks gives me access to a team of AI agents and trusted experts for the assists I need. Nothing but, Nick. Outdo it with Intuit QuickBooks.

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