Why Does Polio Exist

Polio Still Exists? About two months after you were born your parents took you to the pediatrician for your set of “two month shots” (Crosta). Your doctor handed them a list of vaccinations he was going to administer to you and they looked over it carefully. They were curious to see exactly what diseases might have infected you without the doctor’s care. On the lengthy list in their hands a few names of the vaccinations puzzle your parents, a small amount intrigue them, but only one vaccination thoroughly shocks them. Full of concern, they question the doctor about the alarming vaccination: the Inactive Polio Vaccine (IPV). “We thought polio did not exist anymore. Isn’t it gone and no longer a problem?” The doctor begins to explain to your parents that polio is still a very real problem for infants.
He states how polio is actually prevalent all over the globe and medical professionals continue to administer vaccinations to prevent it, though a great portion of people do not realize it is still a problem. With this information your parents sign all the forms and you received the first installment of the vaccination against poliomyelitis. Like the doctor said though, polio is still an issue across the globe, and an ever smaller fragment of the population knows the effects of this disease. What
exactly is polio, why is it a continuing issue and, importantly, who erased polio as a household name with the vaccination that counters the crippling disease in infants all over the world to this day?
Poliomyelitis, more commonly known as polio, is considered a viral disease, which means that a microorganism virus causes this widely infectious disease. This virus affects the nerves, particularly those in the extremities, to cause partial or even full paralysis. Direct contact with another person, contact with phlegm left from another person, or even contact with contaminated fecal matter can spread the virus from person to person (“Poliomyeltits”). In the past, there were not strict health laws in effect to protect against unsanitary conditions in public places, such as swimming areas and parks, which led to the rapid spread of the virus. “The virus usually enters the environment in the feces of someone who is infected. In areas with poor sanitation, the virus easily spreads through the fecal-oral route, via contaminated water or food. In addition, direct contact with a person infected with the virus can cause polio” (Crosta). Once infected, the virus passes through the intestinal system where the lymph nodes absorb it. It can take up to 35 days to show infected viral symptoms, if there are any at all (“Poliomyelitis”).
No one knows for sure when polio first appeared, but there are cases that can date back thousands of years ago to ancient Egypt ("The Progress of Nations 1999 - A Priceless Legacy”). On the Salk Institute for Biological Studies polio information website, it states that “[t]he English physician Michael Underwood provided the first clinical description of the disease in 1789, when he referred to polio as “a debility of the lower extremities.” The work of physicians Jakob Heine in 1840 and Karl Oskar in 1890 led to it being known as Heine-Medin disease. The disease was later called infantile paralysis, based on its propensity to affect children” (“History: Polio Today”).
The polio disease infection process starts with subclinical symptoms. These symptoms are similar to those symptoms that people associate with a common illness, such as a cold or the flu. Symptoms of a subclinical infection only last about seventy two hours, and they include: headaches, sore or red throat, vomiting, slight fever, and a general discomfort or uneasiness. After exposure to subclinical poliomyelitis, clinical poliomyelitis may develop. Clinical poliomyelitis directly affects the brain and spinal cord, causing problems with motion. This most extreme stage of polio can either be paralytic, meaning spinal cord function paralysis, or nonparalytic (Crosta). President Franklin D. Roosevelt happened to contract the paralytic form.
FDR is best known for his four elected terms of presidency, even though his last term ended three months after it began. FDR suffered from polio, starting when he was only 39 years old, before he ran for presidential office. He contracted the disease while swimming in a public area, which had likely been contaminated on accident. He felt its crippling effects throughout his political career, but it did not stop him. He started with the assistance of braces and then progressed to a wheelchair as the polio continued its course. FDR only mentioned his disease once in public:
Seventeen years after contracting polio, FDR gave a speech at a joint session of Congress while sitting in his wheelchair, addressing those gathered, he admitted "I hope that you will pardon me for this unusual posture of sitting down during the presentation of what I want to say, but...it makes it a lot easier for me not to have to carry about ten pounds of steel around on the bottom of my legs." This was his only public mention of his disability (“Franklin Delano Roosevelt”).
Roosevelt did not believe his disease to be a hindrance, only a hurdle in his career progression. His dedication to his job and his desire to overcome his obstacles is inspiring, but what he formed with that dedication and desire is truly admirable.
The National Foundation for Infantile Paralysis (NFIP) started 76 years ago at the hand of FDR (“Franklin Delano Roosevelt”).
Established in 1938, the NFIP had the goal of curing infantile poliomyelitis, starting with the soldiers who contracted the disease. It gave the program a “war-effort cause” which in turn many Americans supported. After the war, funding to the NFIP increased. With the inflow of funding, the NFIP put that money directly into patient aid and medical research; however the patient aid funds were completely exhausted during the epidemic in 1949. The NFIP provided funding to many people working to find a cure, including biologist Jonas Salk
(Rose).
Jonas Salk, recognized by the Academy of Achievement through an interview and a biographical page on their website, was a New York City native who strived for excellence in everything he did. His immigrant parents encouraged their son into working to achieve his education, something they could not do themselves. As the first member of his family to attend college, Salk intended to study law, but wavered to medical science soon thereafter. During his time at the New York University medical school, Salk studied the virus that caused influenza, and looked at killing the infectious piece of the virus while allowing the virus to maintain its immunity. Salk successfully killed the active part of the virus and was able to derive a form for a flu vaccine using the weakened virus to immunize whoever received the vaccine. Salk saw a definite potential in this method (“Jonas Salk Biography”).
In 1947, the University of Pittsburgh offered Salk an appointment for a research position. Upon his acceptance of the appointment, the National Foundation for Infantile Paralysis started funding his research to find a cure for poliomyelitis. Salk knew that once a patient contracted the disease, it would be near impossible to be rid of it. He sought a vaccination to prevent the disease from becoming infectious in the first place. He strongly opposed using a live virus so as to not risk the potential for the virus to mutate and actually infect the individual. Salk realized this great opportunity to work with the University on his experimental method and eagerly devoted the next eight years of his life to finding a vaccination for the deadly disease. On April 12, 1955, Jonas Salk became a hero (“Jonas Salk Biography”).
In 2005, the Smithsonian Institute published an online article entitled “Conquering Polio” concerning the research processes Salk used to create his vaccination. Written by Jeffrey Kluger, the article details the following information to emphasize the humanitarianism in part of the researchers. The first research Salk completed confirmed his suspicions that using a small dose of the disease could cause immunity against it. He used different diseases to make sure that the process could be universal. Due to the fact that polio affected children the most, Salk studied three children with the three forms of polio very carefully. He used them to study the effects of his vaccination against their forms of the disease. He had a backup plan in case something went awry with the children, but nothing did. His research concluded that his vaccinations raised antibody levels in the children. However, it was not enough to cure the already infected kids. Salk asked for forty children housed in the D.T. Watson Home for Crippled Children in Pennsylvania to participate in a study, including a seventeen year old boy named Bill Kirkpatrick (Kluger).
Bill was in a stage that required leg braces at all times, and his name was first on the list to donate his blood to research. While Bill examined the needles required for the blood samples, Salk calmly stated “’ [h]ope [the other children are] not afraid of them,’ he said in a whisper. Bill smiled, and Salk looked inquiringly at the needles. ‘OK if we proceed’” (Kluger). This made Bill view himself as a hero, and allowed Salk to easily take the remaining samples from the other children without stress from them. Salk thanked Bill for his help in front of the other children, as a role model. Bill noted that he was not doing the research to help himself, but instead for his two nephews. He did not want them to go through what he had to as a polio victim. That emotion allowed the other thirty nine children to proceed; giving Salk the samples he needed (Kluger).
Salk did not complete all of the research on his own. He had a team dedicated to the vaccination as much as he was. Elise Ward was in charge of keeping the sample cells alive and growing. She also had to monitor the antibodies in the samples, making sure there were enough to kill the virus but still keep the cell alive. Ward kept the lab functioning properly and established a routine to maximize the productivity of the research. It was she who discovered that the samples were clear of the virus one morning. It was she who alerted the research team. It was she who first saw Jonas Salk’s miracle vaccination work (Kluger).
This inspiration led Salk and his team to replicate the results over and over, until NFIP gave the approval to start a human trial of 1.8 million children in 44 states. The test spanned two seasons and the results came in in the fall. Thomas Francis was in charge of interpreting the results. After he had sifted through the paperwork and numbers, he was set to describe the results to the public. On April 12, 1955, Francis cleared his throat at the University of Michigan, in front of reporters, medical professionals, dignitaries, and Salk’s own family. On April 12, 1955, Francis described the research conducted over the past year. On April 12, 1955, Francis told of how they administered and monitored the vaccination. On April 12, 1955, with 54,000 medical professionals across the country staring at the television broadcasting Francis’ speech, Thomas Francis stated “The vaccine works.” On April 12, 1955, Jonas Salk became a hero (Kluger).
One year after the vaccination’s public release, medical professionals across the country administered Salk’s vaccination; the polio total in the United States fell to half of its previous value. Two years after the release the number fell again by a factor of two thirds. The number stabilized at that point, only to increase a little after the negligence to follow up with the third installment of the vaccination. By 1961, the poliovirus was only present in a little over 1,000 children. Polio was no longer a threat in America (Kluger).
There have been other attempts to perfect the vaccination, but each has its own risk factors. Salk’s vaccination is still the preferred method to this day. Many countries declared polio “eradicated,” however there are still countries that face the epidemic. The World Health Organization, WHO, decided to administer a risky form of the vaccination that Albert Sabin developed in 1961.
Sabin 's vaccine was deemed the better of the two. It was found to confer longer-lasting immunity, so that repeated boosters were not necessary, and acted quickly, immunity being achieved in a matter of days. Taken orally (on a sugar cube or in a drink), the vaccine could be administered more readily than the Salk vaccine, which had to be injected. Most importantly, the Sabin vaccine offered the prospect of passive vaccination because it caused an active infection of the bowel that resulted in the excretion of live-attenuated virus. Thus, through fecal matter and sewage the Sabin vaccine could help to protect those who had not been vaccinated. (Blume and Geesink)
Sabin’s vaccination makes the administration process easier, and has a more effective rate for success. However, Sabin’s vaccination uses a live virus. In the event that the vaccination did not work properly, the live virus would surface, mutate, and cause a more dangerous strain of polio to infect the individual. Such occurrences marked the end of administering Sabin’s vaccination, until the WHO resurfaced it. Salk’s vaccination eradicates polio wherever health professionals use it. On the other hand, in countries that still administer Sabin’s vaccination the poliovirus still exists. The WHO decided that the reward of using Sabin’s vaccination strongly outweighs the risk it poses, and they work to administer it all across the globe to those who need it. Small rumors plague the spread of the vaccination, but after the WHO dispels them, the vaccination should be able to take full effect all over the world. The spread of the polio vaccination could not occur without proper funding. Such funding comes from humanitarian organizations, such as that of the Bill and Melinda Gates Foundation.
When someone mentions the name “Bill Gates” most people simply envision dollar signs. So many people know Bill Gates for his fortune in the technology industry, but sometimes forget he and his wife, Melinda, are great humanitarians as well. The Gates’ charity group, the Bill and Melinda Gates Foundation, released a one hundred million dollar grant to help the spread of the vaccination to places that did not have the funding or cultural stability to care properly for infected victims. The Gates Foundation helped reduced the world wide polio count to less than 250 people in 2012. The best measure of the success of the impact of the Gates Foundation is when India announced polio eradication in 2012. India, with its high population density and less than sanitary conditions, was a challenge to overcome in the polio distribution. The Gates Foundation heavily funded this venture, and it paid off. Polio eradication is a high priority of the Gates Foundation, and they use a very risky strategy (Kahn). “The foundation has a unique ability to contribute to polio eradication by taking big risks and by making nontraditional investments that can lead to valuable program improvements” ("Polio: What We Do - Strategy Overview"). The foundation works for the effort to find innovative ways to make the process an easier one. It is definitely a financial struggle that threatens the end of polio, but day by day it is getting closer to the end.
As of October 2013, the United Sates publicly announced the movement to vaccinate children in Syria. A reporter from the New York Times, Rick Gladstone, covered statements from the United Nations concerning Syria and America’s decisions. In the midst of governmental conflicts, there are at least twenty children currently paralyzed, most likely in effect of polio. “Dr. Bruce Aylward, the assistant director general for polio and emergencies at the World Health Organization…said officials at the agency were taking no chances and assuming that the 20 paralyzed children in Deir al-Zour were polio victims” (Gladstone). This panicked the UN into the idea that polio could resurface. Though the UN is in fear of this renewed war, they are unsure of how to proceed with the vaccination process. The hostile conditions in Syria lead to a question as to where the disease originated and how the infected could have spread the disease to the children. It also brings the effort to stifle any disease spread to a standstill, in fear of the safety of the humanitarian workers trying to help the children. This does not insinuate that polio is still a huge problem; however it is consistently posing a threat to people in culture specific areas (Gladstone).
Overall, polio would still be a very prevalent and threatening disease without Jonas Salk. He dedicated his life to the research of the medical problems in the world. When Salk was looking at how the vaccination would distribute, he did not patent his method. Salk elected to pass up what could amount to billions of dollars in profit, simply to keep the price of the vaccination at a level that any economic status could easily afford. Salk is a hero in the medical world for this one move, but he went even further with his humanitarianism. In 1963, Salk established the Salk Institute of Biological Studies with the hopes of preforming more life changing research. He even had the time to publish books on medical research so as to further enable future researchers. Salk continued research until the day he died. He passed away on June 23, 1995, spending his last years of life searching for a cure for AIDS (“Jonas Salk Biography”). Salk left his research in a place that someone can pick it up in the future. He left behind a legacy and an undeniable inspiration for others.
As stated in an article from the History Channel’s website by Barbara Marazani, Salk’s dedication and the end of polio even required the NFIP to switch focus and work instead for “a number of public health issues surrounding maternal and prenatal care, including the prevention of rubella and improving treatment and care for premature babies” (Marazani). This was something that was adaptable from the NFIP goals. The NFIP was such a leading organization its patrons hated to see it no longer in use. In 1979, the NFIP shifted goals and names to become what we know as the March of Dimes. It is substantial to see that an organization such as the NFIP was so effective that it had to work to find something new to prevent (Rose).
When your parents signed for you to receive the IPV, you became one of the billions to be immune to poliomyelitis. Your immune system has fought against a weakened and killed poliovirus. In effect, you have conquered polio through a simple three step shot you cannot even remember receiving. It is hard to think about the last time you heard of someone with polio. The global count of infected individuals is still above zero, making it a continued effort to rid the world completely. In retrospect, polio is a disease that is easily overlooked. It will continue to be overlooked because of the effort of many. Franklin D. Roosevelt, the National Foundation for Infantile Paralysis, Jonas Salk, Elise Ward, Albert Sabin, Bill and Melinda Gates, and countless more have aided in this fight. The aid will continue and serve as an inspiration to those who work to endeavor upon future medical research and discoveries.

Works Cited
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