Category Archives: Polio

Choose Science

Posted on November 1, 2025 | 1 comment

 “If you want to save your child from polio, you can pray or you can inoculate.  Choose science.”  — Carl Sagan, The Demon-Haunted World

Far be it for me to provide scientific illiterates like Donald Trump and Robert F. Kennedy, Jr. with an appreciation of vaccine science.  For them and their admirers, political commitments preclude an understanding of the human immune system, how vaccines work, and how scientists go about creating them and demonstrating their safety and efficacy.  So let’s take a different approach.  Let’s try to cultivate an appreciation of vaccine science that is strictly historical and begins with the Revolutionary War.  In this way, perhaps, vaccine skeptics can edge toward an appreciation of the foundational role of vaccination and its precursor, inoculation, to American greatness in the pre-Trump era.

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Dear Anti-Vaxxers:

Did you know that at the outset of the Revolutionary War,  inoculation against smallpox – the insertion of  pus from the scabs and pustules of smallpox sufferers into arms of healthy soldiers to induce typically mild attacks of smallpox – was a crucial instrument of strategic advantage for British and Continental forces alike?  When inoculated British troops came into contact with healthy Continental soldiers and noncombatants, that is, the latter frequently contracted smallpox in its unattenuated, occasionally lethal form.  The only defense against disablement-by-smallpox, it turned out, was inoculation, since inoculated soldiers and civilians, after recovery, were immunized against smallpox in both its deadly and attenuated forms.

Did you know that when George Washington realized that overcoming smallpox was crucial to winning the War of  Independence, he indeed mandated the inoculation of the entire Continental Army?   His order of 5 February 1777 also sent a clear message to all 13 colonies:  American governments – local, state, and national – were obligated to “protect public health by providing broad access to inoculation.”[1]

Did you know that when Benjamin Waterhouse began shipping  Edward Jenner’s smallpox vaccine to America in 1800, George Washington, John Adams, and Thomas Jefferson hailed it as the greatest discovery of modern medicine?  When Jefferson became president in 1801, he pledged to introduce the vaccine to the American public because “it will be a great service indeed rendered to human nature to strike off the catalogue of its evils so great a one as the smallpox.”

Did you know that Jefferson’s successor, James Madison, signed into law in 1813 “An Act to Encourage Vaccination”?  And did you know that among its provisions was the requirement that the U.S. postal service “carry mail containing vaccine materials free of charge.”[2]

Did you know that during the Civil War, Union and Confederate Armies were so desperate to vaccinate their troops against smallpox that they had their doctors cooperate in harvesting “vaccine matter” from the lymph of heathy children and infants, especially the offspring of the formerly enslaved?[3]

Did you know that when the Civil War ended, doctors from North and South joined forces to achieve a better understanding of smallpox vaccination methods?[4]  They believed an epidemiological understanding of effective vaccination was a shared mission in the service of the re-united nation.

Did you know that in 1893 New York State legislators passed a law requiring public schools to deny enrollment to any child who could not present proof of vaccination, and that the law was extended to private and parochial schools via the Jones-Tallett amendment of 1915?[5]  And did you know that the legislators’ commitment to vaccination for all children was reaffirmed a half century later, when Title XIX of the Social Security Act of 1965 mandated “the right of every American child to receive comprehensive pediatric care, including vaccinations.”[6]

Two 13-year-old classmates exposed to the same strain of smallpox at the same time in their classroom in Leicester, England in 1901. One was vaccinated against smallpox in infancy. The other was not.

Did you know that throughout the 19th century, diphtheria was “the dreaded killer that stalked young children”?[7]   It was an  upper-respiratory inflammation of such severity that it gave rise to a  “pseudomembrane” that covered the pharynx and larynx and led to death by  asphyxiation.    Then, in the early 1890s, Emile Roux and his team at the Pasteur Institute discovered that horses not only withstood repeated inoculation with live diphtheria bacteria, but their blood, purified into an injectable serum, both restored infected children (and adults) to health and provided healthy kids with short-term immunity.  No sooner did the serum become commercially available in 1895 than the U.S. death rate among hospitalized diphtheria patients was cut in half  – an astonishing fact for the time.  By 1913, when the “Shick test” permitted on-the-spot testing for diphtheria, public health nurses and doctors discovered that 30% of NYC school children tested positive for the disease.  Injections of serum saved the vast majority and immunized their healthy classmates.  New York’s program of diphtheria immunization was copied by municipalities throughout the country. In the early 1930s, diphtheria serum gave way to a long-lasting toxoid vaccine, and in the 1940s, given in combination with pertussis and tetanus vaccines (DBT), diphtheria, “the plague among children” (Noah Webster), became a horror of the past.

A ghostly Skeleton, representing diphtheria, reaches out to strangle a sick child. Watercolor by Richard Tennant Cooper (1885–1957), commissioned by Henry S. Wellcome c. 1912 and now in the Wellcome Collection

Did you know that in Jacobson v. Massachusetts, a landmark decision of 1905, the U.S. Supreme Court affirmed the constitutionality of compulsory vaccination laws? And then, in 1922, in Zucht v. King, the Court stated that “no constitutional right was infringed by excluding unvaccinated children from school.”  The decision was written by Louis Brandeis.[8]

Did you know that in 1909 the U.S. Army made typhoid vaccination compulsory for all soldiers, and the requirement reduced the typhoid rate among troops from 243 per 100,000 in 1909 to 4.4 per 100,000 in three years?[9]  When America entered WWI in 1917, troops sailing to France had to be vaccinated.  Those who had not received their shots stateside received them on arriving at their camps.  Vaccination was not negotiable.  The obligation to live and fight for the nation trumped the freedom to contract typhoid, suffer, and possibly die.

Did you know that in the mid-1950s, when Cold War tensions peaked, mass polio vaccination was such a global imperative that it brought together the United States and Soviet Union?   In 1956, with the KGB in tow, two leading Russian virologists journeyed to Albert Sabin’s laboratory in Cincinnati Children’s Hospital, while Sabin in turn flew to Moscow to continue the brainstorming.  The short-term result was mass trials that confirmed with finality the safety and efficacy of the Sabin vaccine, while bringing its benefits to 10 million Russian school children and several million young Russian adults.[10]  The long-term result was the Global Polio Eradication Initiative that began in 1988 and eradicated polio transmission everywhere in the world except Afghanistan and Pakistan.

Did you know that following the development of a freeze-dried smallpox vaccine by Soviet scientists in 1958, Soviet Deputy Health Minister Viktor  Zhdanov and American public health epidemiologist Donald Henderson jointly waged a 10-year international campaign to raise enough money to make the vaccine available world-wide?[11]  The result of their campaign, in partnership with WHO, was the elimination of smallpox by 1977.[12]

Did you know that in 1963 a severe outbreak of rubella (German measles) led the U.S. Congress to approve the “Early and Periodic Screening, Diagnosis, and Treatment” amendments to Title XIX of the Social Security Act of 1965?  The amendments mandated the right of every American child to comprehensive pediatric care, including vaccinations.[13]

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Now, in 2025, a segment of the population has reclaimed the mindset of antebellum America, when the Founding Fathers’ belief that medical progress safeguarded democracy gave way to something far less enlightened: the belief that everyone can be his or her own doctor.  Sadly, what the historian Joseph Kett termed the Dark Age of American medicine[14] has been revived among those newly skeptical of vaccination, and especially resistant to compulsory vaccination of children.  In its place, they proffer a contemporary variant of the anti-elitist cry of the Jacksonian era:  Every man his own doctor; every man his own remedies.  Transposed to the early 20th century, the Jacksonian cry resurfaced as resistance to smallpox vaccination.  To the anti-vaxxers of the time, the vaccine that, in its inoculatory form, helped win the Revolutionary War, was state-sanctioned trespassing on a person’s body.[15]  Now, in the wake of the coronavirus pandemic of 2020, the body has been politicized yet again.

In the case of President Donald Trump and Secretary of Health and Human Services Robert Kennedy, Jr., scientific ignorance of breathtaking proportions carries the prescientific regression back to ancient times.  When Plague, in the form of coronavirus, returned to America in 2020, legions of Trump followers followed the lead of a president whose understanding of viral infection followed the Galenic belief that whole-body states require whole-body remedies.  Disinfectants like Chlorox, he announced to the nation, kill microbes when we wipe our countertops with it.  Why then, he mused, can’t we destroy the coronavirus by injecting bleach into our veins?  What bleach does to healthy tissue, blood chemistry, and internal organs – these are questions an inquiring 8th grader might ask her teacher.  But they could not occur to a medieval physician or a boastfully ignorant President.  In Trump-world, as I observed elsewhere,[16] “there is no possibility of weighing the pros and cons of specific treatments for specific ailments (read: different types of infection, local and systemic).  The concept of immunological specificity is literally unthinkable.”  As to ingestion of hydroxychloroquine tablets, another touted Trump remedy for coronavirus, “More Deaths, No Benefit” begins the VA Virus Study reporting on Trump’s preferred Covid-19 treatment put forth by Trump.[17]

Trump’s HSS Secretary, Robert Kennedy, Jr. would not be among the inquiring 8th graders.  When coronavirus reached America, Trump at least followed a medieval script.  Kennedy Jr., encased in two decades of anti-vaccine claptrap, did not need a script. He simply absorbed coronavirus into an ongoing narrative of fabrication, misinformation, and bizarre conspiracy theories calculated to scare people away from vaccination.

As HHS Secretary, Kennedy Jr.’s mission has been to complexify access to coronavirus vaccines.  Most recently, he directed the CDC to rescind its recommendation of Covid-19 vaccination for pregnant women and healthy young children.  The triumph of scientists in creating safe genetic RNA vaccines could not dislodge the medieval mindset and paranoid delusions that have long been his stock in trade.  No, Mr. Secretary, Covid-19 was not engineered to attack Caucasians and African Americans while sparing Ashkenazi Jews and the Chinese.  No, Covid-19 vaccines were not created to effect governmental control via implanted microchips.  No, vaccines do not cause autism.  No, Wi-Fi is not linked to cancer.  No, anti-depressants do not lead to school shootings.  No, pharmaceutical firms are not conspiring to poison children to make money.

During the Black Death, 14th-century Flagellants roamed the streets of continental Europe, whipping themselves in a frenzy of self-mutilation that left them lacerated if not dead.  Their goal was to placate a wrathful God who had breathed down, literally, the poisonous vapors of Plague.  What they did, in fact, was leave behind an infectious stew of blood, tissue, and entrails that brought Plague to local villagers.   Kennedy, Jr. speaks out and showers listeners with verbal effluvia that induces them to forego vaccination and other scientifically grounded safeguards against disease.   Health-wise, he is a Flagellant,  spewing forth misinformation that puts listeners and their children at heightened risk for Covid-19 and  a cluster of infectious diseases long vanquished by vaccine science.

Does Kennedy, Jr. really believe that everything we have learned about the human immune system since the late 18th century is bogus, and that children who once died from smallpox, cholera, yellow fever, diphtheria, pertussis, typhoid, typhus, tetanus, and polio are still dying in droves, now from the vaccines they receive to protect them?   Does he believe the increase in life expectancy in the U.S. from 47 in 1900 to 77 in 2021 has nothing to do with vaccination?   Does he believe that the elimination of smallpox and polio from North America has nothing to do with vaccination?   Does he believe it a fluke of nature that the last yellow fever epidemic in America was in 1905, and that typhoid fever and diphtheria now victimize only unvaccinated American travelers who contract them abroad?

The fact that we have a President comfortably at home in the Galenic world, and an HSS Secretary whose web of delusional beliefs land him in the nether region of the Twilight Zone doesn’t mean the rest of us must follow suit.   We are citizens of the 21st century and entitled to reap the life-sustaining benefits of 250 years of sustained medical progress – progress that has taken us to the doorstep of epical advances in disease prevention, management, and cure wrought by genetic medicine.[18]   My urgent plea is carpe tuum tempus – seize the era in which you live.   Seize the knowledge that medical science has provided.  In a word:  Get all your vaccines and make doubly sure your children get theirs.  Do your part to Make America Sane Again.

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[1] Andrew M. Wehrman, The Contagion of Liberty:  The Politics of Smallpox in the American Revolution.  Baltimore (Johns Hopkins Univ. Press, 2022), p. 220.

[2] Dan Liebowitz, “Smallpox Vaccination: An Early Start of Modern Medicine in America, ” J. Community Hosp. Intern. Med. Perspect., 7:61-63, 2017 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5463674).

[3] Jim Downs, Maladies of Empire:  How Colonialism, Slavery, and War Transformed Medicine  (Cambridge:  Harvard Univ. Press,  2021), pp. 143-145.

[4] Ibid., p. 150.

[5] James Colgrove, Epidemic City: The Politics of Public Health in New York (NY:  Russell Sage Foundation, 2011), pp. 185-187.

[6] Louis Galambos, with Jane Eliot Sewell, Networks of Innovation:  Vaccine Development at Merck, Sharp & Dohme, and Mulford, 1895-1995 (Cambridge:  Cambridge Univ. Press, 1995), pp. 106-107.

[7] Judith Sealander, The Failed Century of the Child:  Governing America’s Young in the Twentieth Century (Cambridge: Cambridge Univ. Press, 2003), p. 326.

[8] Colgrove, op. cit., pp. 170, 190.

[9] Carol R. Byerly, Mosquito Warrior:  Yellow Fever, Public Health, and the Forgotten Career of General William C. Gorgas (Tuscaloosa: Univ. Alabama Press, 2024), p, 226.

[10] For elaboration, see Paul E. Stepansky, “Vaccinating Across Enemy Lines,”  Medicine, Health, & History, 16 April 2021 (https://adoseofhistory.com/2021/04/16/vaccinating-across-enemy-lines).

[12] Peter J. Hotez, “Vaccine Diplomacy:  Historical Perspective and Future Directions,” PLoS Neglected Trop. Dis. 8:e380810.1371, 2014; Peter J. Hotez, “Russian-United States Vaccine Science: Preserving the Legacy,” PLoS Neglected Trop. Dis., 11:e0005320,2017.

[13] Galombo & Sewell, op. cit., pp. 106-107.

[14] Joseph F. Kett, The Formation of the American Medical Profession:  The Role of Institutions, 1780-1860 (New Haven: Yale Univ. Press, 1968), p. vii.  I invoke the Jacksonian Dark Age of American medicine in  a different context in  Paul E. Stepansky, Psychoanalysis at the Margins (NY:  Other Press, 2009), pp. 283-285.

[15] Nadav Davidovitch, “Negotiating Dissent:  Homeopathy and Anti-Vaccinationism At the Turn of the Twentieth Century,” in Robert D. Johnston, ed., The Politics of Healing: Histories of Alternative Medicine in Twentieth-Century Medicine (New York:  Routledge, 2004), pp. 23-24.

[16] Paul E. Stepansky, “Covid-19 and Trump’s Medieval Turn of Mind,”  Medicine, Health, and History, 19 August 2020  (https://adoseofhistory.com/?s=Trump%27s+Medieval+turn)

[17]  Marilyn Marchone, “More deaths, no benefit from malaria drug in VA virus study,”  AP News, 21 April 2020 (https://apnews.com/article/malaria-donald-trump-us-news-ap-top-news-virus-outbreak-a5077c7227b8eb8b0dc23423c0bbe2b2).

[18] For a masterful introduction to the history of genetic medicine, including the discovery and applications of CRISPR gene editing, the development of RNA genetic vaccines for Covid-19, and the frontier of genetically engineered disease management, see Walter Issacson, Code Breaker:  Jennifer Doudna , Gene Editing, and the Future of the Human Race (NY:  Simon & Schuster, 2017).   No less illuminating is Doudna’s own account of her pathway to CRISPR research and evolving understanding of the therapeutic potential of CRISPR-based gene editing, Jennifer A. Doudna & Samuel H. Sternberg, A Crack in Creation:  Gene Editing and the Unthinkable Power to Control Evolution,  esp. chs. 1 & 2  (Boston:  Houghton Mifflin Harcourt, 2017).  Far more limited in scope but very worthwhile in illustrating contemporary genetic diagnosis and treatment is Am Amgis Ashley, The Genome Odyssey:   Medical Mysteries and the Incredible Quest to Solve Them (Milwaukee:  Porchlight, 2021).

Copyright © 2025 by Paul E. Stepansky. All rights reserved.  The author kindly requests that educators using his blog essays in their courses and seminars let him know via info[at]keynote-books.com.

 

 

 

 

 

 

 

 

 

 

 

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Posted in and Covid-19, Antebellum Medicine, Antivaccinationism, Civil War Medicine, Covid-19, Diphtheria, General, Genetic medicine, horse antitoxin, Medieval Medicine, Polio, Smallpox, Trump, Typhoid fever

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Vaccinating Across Enemy Lines

Posted on April 16, 2021 | 4 comments

There are periods in American history when scientific progress is in sync with governmental resolve to exploit that progress.  This was the case in the early 1960s, when advances in vaccine development were matched by the Kennedy Administration’s efforts to vaccinate the nation and improve the public’s health.  And the American public wholeheartedly supported both the emerging generation of vaccines and the government’s resolve to place them in the hands – or rather arms – of as many Americans as possible. The Vaccination Assistance Act of 1962 grew out of this three-pronged synchrony.[1]

Between 1963 and 1965, a severe outbreak of rubella (German measles) lent support to those urging Congress to approve title XIX (of the Medicaid provision) of the Social Security Act of 1965.  And Congress rose to the task, passing into law the “Early and Periodic Screening, Diagnosis, and Treatment” amendments to Title XIX.  The latter affirmed the right of every American child to receive comprehensive pediatric care, including vaccination.

The timing was auspicious.  In 1963, Merck, Sharp & Dohme began shipping its live-virus measles vaccine, trademarked Rubeovax, which had to be administered with standardized immune globulin (Gammagee). In 1967 MSD combined the measles vaccine with smallpox vaccine as Dryvax, and then, a year later, released a more attenuated live measles vaccine (Attenuvax) that did not require coadministration of immune globulin.[2]   MSD marketing reminded parents that mumps, long regarded as a benign childhood illness, was now associated with adult sterility.  It too bowed to science and responsible parenting, with its incident among American children falling 98% between 1968 and 1985.

Crowd waiting for 1962 oral polio vaccination
Creator: CDC/Mr. Stafford Sm

America’s commitment to vaccination was born of the triumphs of American medicine during WWII and came to fruition in the early 1950s, just as Cold War fears of nuclear war gripped the nation and pervaded everyday life.  Grade school nuclear attack drills, “duck and cover” animations, basement fallout shelters with cabinets filled with canned food – I remember all too well these scary artifacts of a 1950s childhood. Competition with the Soviet Union suffused all manner of scientific, technological, public health-related, and athletic endeavor. The Soviets leapt ahead in the space race with the launching of Sputnik in 1957.  The U.S. retained an enormous advantage on the ground with the size and destructive power of its nuclear arsenal.

Less well known is that, in the matter of mass polio vaccination, countries in the Eastern Bloc – Hungary, Czechoslovakia, Poland – led the way. Hungary’s intensive annual vaccination campaigns, launched in 1957 with Salk vaccine imported from the U.S. and Sabin vaccine imported from the U.S.S.R. in 1959, was the prototype for the World Health Organization’s (WHO) global strategy of polio eradication.  Czechoslovakia became the first nation to eradicate polio in 1959; Hungary followed in 1963.[3]  

It is tempting to absorb the narrative of polio eradication into Cold War politics, especially the rhetoric of the vaccination campaigns that mobilized the public. Throughout the Eastern Bloc, mass vaccination was an aspect of pro-natalist policies seeking to increase live births, healthy children, and, a bit down the road, productive workers. Eradication of polio, in the idiom of the time, subserved the reproduction of labor. In the U.S., the strategic implications of mass vaccination were framed differently.  During the late 50s and early 60s, one in five American applicants for military service was found medically unfit.  Increasing vaccination rates was a cost-effective way of rendering more young men fit to serve their nation.[4]   

But there is a larger story that subsumes these Cold War rationales, and it is a story, surprisingly, of scientific cooperation across the Iron Curtain.  Amid escalating Cold War tensions, the United States and Soviet Union undertook a joint initiative, largely clandestine, to develop, test, and manufacture life-saving vaccines.  The story begins in 1956, when the U.S. State Department and Soviet Ministry of Foreign Affairs jointly facilitated collaboration between Albert Sabin and two leading Soviet virologists, Mikhail Chumakov and Anatoli Smorodintsev.  Their shared goal was the manufacture of Sabin’s oral polio vaccine on a scale sufficient for large-scale testing in the Soviet Union. With a KGB operative in tow, the Russians travelled to Sabin’s laboratory in the Cincinnati Children’s Hospital, and Sabin in turn flew to Moscow to continue the brainstorming.  

Two years later, shipments of Sabin’s polio virus strains, packed in dry ice, arrived in the Soviet Union, and shortly thereafter, with the blessing of post-Stalin Kremlin leadership, the mass trials began.  The Sabin vaccine was given to 10 million Russian school children, followed by millions of young adults.  A WHO observer, the American virologist Dorothy Horstmann, attested to the safety of the trials and the validity of their findings. It has long since stopped polio transmission everywhere in the world except Afghanistan and Pakistan.   

No sooner was the Sabin live-virus vaccine licensed than Soviet scientists developed a unique process for preserving smallpox vaccine in harsh environments.  With freeze-dried vaccine now available, Viktor Zhdanov, a Soviet virologist and Deputy Minister of Health, boldly proposed to the 1958 meeting of the World Health Assembly, WHO’s governing body, the feasibility of global smallpox eradication.  After the meeting, he did not wait patiently for the WHO to act: he led campaigns both to produce smallpox vaccine and to solicit donations from around the world.[5]  His American colleague-in-arms in promoting freeze-dried vaccine was the public health physician and epidemiologist Donald Henderson, who led a 10-year international vaccination campaign that eliminated smallpox by 1977.[6] 

What can we learn from our Cold War predecessors?  The lesson is self-evident: we learn from them that science in the service of public health can be an enclave of consensus, what Dora Vargha, the historian of Cold War epidemics, terms a “safe space,” among ideological combatants with the military resources to destroy one another. The Cold War is long gone, so the safe space of which Vargha writes is no longer between geopolitical rivals with fingers on nuclear triggers.

But America in 2021 is no longer a cohesive national community.  Rather, we inhabit a fractured national landscape that erupts, with demoralizing frequency, into a sociopolitical battle zone. The geopolitical war zone is gone, but Cold War-type tensions play out in the present. Right-wing extremists, anti- science Evangelicals, purveyors of a Trump-like notion of insular “greatness” – these overlapping segments of the population increasingly pit themselves against the rest of us:  most Democrats, liberals, immigrants, refugees,  defenders of the social welfare state that took shape after the Second World War.  Their refusal to receive Covid-19 vaccination is absorbed into a web of breezy rhetoric:  that they’ll be okay, that the virus isn’t so bad, that the vaccines aren’t safe, that they come to us from Big Government, which always gets it wrong.  Any and all of the above.  In fact, the scientific illiterati are led by their anger, and the anger shields them from relevant knowledge – of previous pandemics, of the nature of a virus, of the human immune system, of the role of antibodies in protecting us from invading antigens, of the action of vaccines on blood chemistry – that would lead them to sequester their beliefs and get vaccinated.   

When the last wave of antivaccinationism washed across these shores in the early 1980s, it was led by social activists who misappropriated vaccination in support of their cause.  Second-wave feminists saw vaccination as part of the patriarchal structure of American medicine, and urged women to be skeptical about vaccinating their children, citing the possibility of reactions to measles vaccine among children allergic to eggs.  It was a classic instance of throwing out the baby with the bathwater which, in this case, meant putting the children at risk because the bathwater reeked of male hubris.  Not to be left out of the antiscientific fray, environmentalists, in an act of stupefying illogic, deemed vaccines an environmental pollutant – and one, according to writers such as Harris Coulter, associated with psychiatric illness.[7]                                

Matters are now much worse.  Antivaccinationism is no longer aligned, however misguidedly, with a worthy social cause.  Rather, it has been absorbed into this far-reaching skepticism about government which, according to many right-wing commentators and their minions, intrudes in our lives, manipulates us, constrains our freedom of choice, and uses our tax dollars to fund liberal causes.

Even in the absence of outright hostility, there is a prideful indifference to vaccination, partly because it is a directive from Big Government, acting in conformity with the directive of what is, after all, Big Pharmaceutical Science.  But we have always needed Big Government and Big Science to devise solutions to Big Problems, such as a global pandemic that has already claimed over 560,000 American lives.  Without American Big Government, in cooperation with British Big Government, overseeing the manufacture and distribution of penicillin among collaborating pharmaceutical firms, the miracle drug would not have been available in time for D-Day.  Big government made it happen.   A decade later, the need for international cooperation transcended the bonds of wartime allies.  It penetrated the Iron Curtain in the wake of global polio and smallpox epidemics that began in 1952 and continued throughout the decade.  

The last thing we need now is a reprise on that era’s McCarthyism, when anyone was tainted, if not blacklisted, by mere accusation of contact with communists or communism. That is, we do not need a nation in which, for part of the population, anything bearing the stamp of Big Government is suspected of being a deception that infringes on some Trumpian-Hobbesian notion of “freedom” in a state of (market-driven) nature.  

If you want to make America “great” again, then start by making Americans healthy again.  Throughout the 1960s, the imperative of vaccination overcame the anxieties of American and Soviet officials given to eying one another warily atop growing nuclear stockpiles. They brought the scientists together, and the result was the mass testing that led to the eradication of polio.  Then America rallied around the Soviet creation of freeze-dried smallpox vaccine, and largely funded the manufacture and distribution that resulted in the eradication of smallpox. 

Now things are better.  We live in an era in which science enables us to alter the course of a global pandemic.  It is time for antivaccinationists to embrace the science, indeed, to celebrate the science and the gifted scientists whose grasp of it enabled them to create safe and effective Covid-19 vaccines in astonishingly little time.  You’ve got to get your vaccine.  It’s the only way. 

[1] Elena Comis, Vaccine Nation: America’s Changing Relationship with Immunization  (Chicago: University of Chicago Press, 2014), 20.

[2] Louis Galambos, with Jane Eliot Sewell, Networks of Innovation: Vaccine Development at Merck, Sharp & Dohme, and Mulford, 1895-1995.Cambridge:  Cambridge University Press, 1995, 96-98, 196-107.

[3] Dora Vargha, “Between East and West: Polio Vaccination Across the Iron Curtain in Cold War Hungary,” Butt. Hist. Med., 88:319-345, 2014; Dora Vargha, “Vaccination and the Communist State,” in The Politics of Vaccination (online pub date: March 2017).

[4] Comis, Vaccine Nation, 27.

[5] Manela E. “A Pox on Your Narrative: Writing Disease Control into Cold War History,” Diplomatic History, 34:299-323, 2010.

[6] Peter J. Hotez, “Vaccine Diplomacy:  Historical Perspective and Future Directions,” PLoS Neglected Trop. Dis. 8:e380810.1371, 2014; Peter J. Hotez, “Russian-United States Vaccine Science: Preserving the Legacy,” PLoS Neglected Trop. Dis., 11:e0005320,2017.

[7] The feminist and environmentalist antivaccination movements of the 1980s are reviewed at length, in Comis, Vaccine Nation, chapter 5 & 6.

Copyright © 2021 by Paul E. Stepansky.  All rights reserved. The author kindly requests that educators using his blog essays in courses and seminars let him know via info[at]keynote-books.com.

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Posted in Antivaccinationism, Cold War medicine, Covid-19, General, Polio

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The Costs of Medical Progress

Posted on July 30, 2012 | Leave a comment

When historians of medicine introduce students to the transformation of acute, life-threatening, often terminal illness into long-term, manageable, chronic illness – a major aspect of 20th-century medicine – they immediately turn to diabetes.  There is Diabetes B.I. (diabetes before insulin) and diabetes in the Common Era, i.e., Diabetes A.I. (diabetes after insulin).  Before Frederick Banting, who knew next to nothing about the complex pathophysiology of diabetes, isolated insulin in his Toronto laboratory in 1922, juvenile diabetes was a death sentence; its young victims were consigned to starvation diets and early deaths.  Now, in the Common Era, young diabetics grow into mature diabetics and type II diabetics live to become old diabetics.  Life-long management of what has become a chronic disease will take them through a dizzying array of testing supplies, meters, pumps, and short- and long-term insulins.  It will also put them at risk for the onerous sequelae of long-term diabetes:  kidney failure, neuropathy, retinopathy, and amputation of lower extremities.  Of course all the associated conditions of adult diabetes can be managed more or less well, with their own technologically driven treatments (e.g., hemodialysis for kidney failure) and long-term medications.

The chronicity of diabetes is both a blessing and curse.  Chris Feudtner, the author of the outstanding study of its transformation, characterizes it as a “cyclical transmuted disease” that no longer has a stable “natural” history. “Defying any simple synopsis,” he writes, “the metamorphosis of diabetes wrought by insulin, like a Greek myth of rebirth turned ironic and macabre, has led patients to fates both blessed and baleful.”[1]  He simply means that what he terms the “miraculous therapy” of insulin only prolongs life at the expense of serious long-term problems that did not exist, that could not exist, before the availability of insulin.  So depending on the patient, insulin signifies a partial victory or a foredoomed victory, but even in the best of cases, to borrow the title of Feudtner’s book, a victory that is “bittersweet.”

It is the same story whenever new technologies and new medications override an otherwise grim prognosis.  Beginning in the early 1930s, we put polio patients (many of whom were kids) with paralyzed intercostal muscles of the diaphragm into the newly invented Iron Lung.[2]  The machine’s electrically driven blowers created negative pressure inside the tank that made the kids breathe.  They could relax and stop struggling for air, though they required intensive, around-the-clock nursing care.[3]  Many survived but spent months or years, occasionally even lifetimes, in Iron Lungs.  Most regained enough lung capacity to leave their steel tombs (or were they nurturing wombs?) and graduated to a panoply of mechanical polio aids: wheelchairs, braces, and crutches galore.  An industry of rehab facilities (like FDR’s fabled Warm Springs Resort in Georgia) sprouted up to help patients regain as much function as possible.

Beginning in 1941, the National Foundation for Infantile Paralysis (NFIP), founded by FDR and his friend Basil O’Connor in 1937, footed the bill for the manufacture of Iron Lungs and then distributed them via regional centers to communities where they were needed.   The Lungs, it turned out, were foundation-affordable devices, and it was unseemly, even Un-American, to worry about the cost of hospitalization and nursing care for the predominantly young, middle-class white patients who temporarily resided in them, still less about the costs of post-Iron Lung mechanical appliances and rehab personnel that helped get them back on their feet.[4]  To be sure, African American polio victims were unwelcome at tony resort-like facilities like Warm Springs, but the NFIP, awash in largesse, made a grant of $161,350 to Tuskegee Institute’s Hospital so that it could build and equip its own 35-bed “infantile paralysis center for Negroes.”[5]

Things got financially dicey for the NFIP only when Iron Lung success stories, disseminated through print media, led to overuse.  Parents read the stories and implored doctors to give their stricken children the benefit of this life-saving invention – even when their children had a form of polio (usually bulbar polio) in the face of which the mechanical marvel was useless.  And what pediatrician, moved by the desperation of loving parents beholding a child gasping for breath, would deny them the small peace afforded by use of the machine and the around-the-clock nursing care it entailed?

The cost of medical progress is rarely the cost of this or that technology for this or that disease.  No, the cost corresponds to cascading “chronicities” that pull multiple technologies and treatment regimens into one gigantic flow.  We see this development clearly in the development and refinement of hemodialysis for kidney failure.  Dialysis machines only became life-extenders in 1960, when Belding Scribner, working at the University of Washington Medical School, perfected the design of a surgically implanted Teflon cannula and  shunt through which the machine’s tubing could be attached, week after week, month after month, year after year.  But throughout the 60s, dialysis machines were in such short supply that treatment had to be rationed:  Local medical societies and medical centers formed “Who Shall Live” committees to decide who would receive dialysis and who not.  Public uproar followed, fanned by the newly formed National Association of Patients on Hemodialysis, most of whose members, be it noted, were white, educated, professional men.

In 1972, Congress responded to the pressure and decided to fund all treatment for end-stage renal disease (ESRD) through Section 2991 of the Social Security Act.  Dialysis, after all, was envisioned as long-term treatment for only a handful of appropriate patients, and in 1973 only 10,000 people received the treatment at a government cost of $229 million.  But things did not go as planned.  In 1990, the 10,000 had grown to 150,000 and their treatment cost the government $3 billion.  And in 2011, the 150,000 had grown to 400,000 people and drained the Social Security Fund of $20 billion.

What happened?  Medical progress happened.  Dialysis technology was not static; it was refined and became available to sicker, more debilitated patients who encompassed an ever-broadening socioeconomic swath of the population with ESRD.  Improved cardiac care, drawing on its own innovative technologies, enabled cardiac patients to live long enough to go into kidney failure and receive dialysis.  Ditto for diabetes, where improved long-term management extended the diabetic lifespan to the stage of kidney failure and dialysis.  The result:  Dialysis became mainstream and its costs  spiraled onward and upward.  A second booster engine propelled dialysis-related healthcare costs still higher, as ESRD patients now lived long enough to become cardiac patients and/or insulin-dependent diabetics, with the costs attendant to managing those chronic conditions.

With the shift to chronic disease, the historian Charles Rosenberg has observed, “we no longer die of old age but of a chronic disease that has been managed for years or decades and runs its course.”[6] To which I add a critical proviso:  Chronic disease rarely runs its course in glorious pathophysiological isolation.  All but inevitably, it pulls other chronic diseases into the running.  Newly emergent chronic disease is collateral damage attendant to chronic disease long-established and well-managed.  Chronicities cluster; discrete treatment technologies leach together; medication needs multiply.

This claim does not minimize the inordinate impact – physical, emotional, and financial – of a single disease.  Look at AIDS/HIV, a “single” entity that brings into its orbit all the derivative illnesses associated with “wasting disease.”  But the larger historical dynamic is at work even with AIDS.  If you live with the retrovirus, you are at much greater risk of contracting TB, since the very immune cells destroyed by the virus enable the body to fight the TB bacterium.  So we behold a resurgence of TB, especially in developing nations, because of HIV infection.[7]  And because AIDS/HIV is increasingly a chronic condition, we need to treat disproportionate numbers of HIV-infected patients for TB.  They have become AIDS/HIV patients and TB patients.  Worldwide, TB is the leading cause of death among persons with HIV infection.

Here in microcosm is one aspect of our health care crisis.  Viewed historically, it is a crisis of success that corresponds to a superabundance of long-term multi-disease management tools and ever-increasing clinical skill in devising and implementing complicated multidrug regimens.  We cannot escape the crisis brought on by these developments, nor should we want to.  The crisis, after all, is the financial result of a century and a half of life-extending medical progress.  We cannot go backwards.  How then do we go forward?  The key rests in the qualifier one aspect.  American health care is organismic; it is  a huge octopus with specialized tentacles that simultaneously sustain and toxify different levels of the system.  To remediate the financial crisis we must range across these levels in search of more radical systemic solutions.

[1]C. Feudtner, Bittersweet: Diabetes, Insulin, and the Transformation of Illness (Chapel Hill: University of North Carolina Press, 2003), p. 36.

[2] My remarks on the development and impact of the Iron Lung and homodialysis, respectively, lean on D. J. Rothman, Beginnings Count: The Technological Imperative in American Health Care (NY: Oxford University Press, 1997). For an unsettling account of the historical circumstances and market forces that have undermined the promise of dialysis in America, see Robin Fields, “’God help you. You’re on dialysis’,” The Atlantic, 306:82-92, December, 2010. The article is online at   http://www.theatlantic.com/magazine/archive/2010/12/-8220-god-help-you-you-39-re-on-dialysis-8221/8308/.

[3] L. M. Dunphy, “’The Steel Cocoon’: Tales of the Nurses and Patients of the Iron Lung, 1929-1955,” Nursing History Review, 9:3-33, 2001.

[4] D. J. Wilson, “Braces, Wheelchairs, and Iron Lungs: The Paralyzed Body and the Machinery of Rehabilitation in the Polio Epidemics,” Journal of Medical Humanities, 26:173-190, 2005.

[5] See S. E. Mawdsley, “’Dancing on Eggs’: Charles H. Bynum, Racial Politics, and the National Foundation for Infantile Paralysis, 1938-1954,” Bull. Hist. Med., 84:217-247, 2010.

[6] C. Rosenberg, “The Art of Medicine: Managed Fear,” Lancet, 373:802-803, 2009.  Quoted at p. 803.

[7] F. Ryan, The Forgotten Plague: How the Battle Against Tuberculosis was Won and Lost  (Boston:  Little, Brown, 1992), pp. 395-398, 401, 417.

Copyright © 2012 by Paul E. Stepansky.  All rights reserved.

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Posted in AIDS/HIV, Diabetes, Health Care Reform, Medical Technology, Old & New, Polio, TB

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