Vol. 89 May 1, 2013 Science, Personalities, and Politics of the Polio Vaccines

hub_2Dr. Hilary Koprowski, the creator of the live polio vaccine, died last month at age 96. What? I thought Dr. Albert Sabin developed that vaccine.

At a physicians’ educational meeting last month, Dr. Larry Pickering of the CDC and the University of Georgia recounted the headline-grabbing, fearsome, panic-causing polio epidemic of 1952-53 and gave us some insight into the sometimes dramatic duel between Dr. Sabin (with his oral live virus vaccine) and Dr. Salk (with his injectable killed vaccine) in everyone’s urgent efforts to stop the spread of the disease. I read Dr. Koprowski’s obituary the next week.

Dr. Koprowski was a Polish immigrant, earned his MD at the University of Warsaw, and helped develop a yellow fever vaccine with the Rockefeller Foundation. That success led him to the idea of using the same process to develop an attenuated live virus vaccine for polio. He was working for the Lederele pharmaceutical company in Pearl River, NJ at the time, and so was some times dismissed as a “commercial scientist”. He was described as a loner who was most comfortable in the lab, never sought public attention, but occasionally referred to himself as the “developer of the Sabin polio vaccine” .

Koprowski first tested the safety of the vaccine by having himself and his family sip a grey slurry of the seventh pass of the virus through the brains of Swiss albino mice in 1948 (1). When none of them got polio, he then tested its efficacy by administering it, at the facility’s request, to 20 retarded residents of Letchworth Village, NY  in 1950. All showed excellent development of antibodies against polio. Dr. Koprowski sent a sample of his vaccine to Dr. Albert Sabin.

Dr. Albert Sabin, also a Polish immigrant and a Rockefeller grantee, received his MD from New York University and developed his live virus vaccine from Dr. Koprowski’s sample using monkey kidney tissue at Cincinnati’s Children Hospital. After testing vaccine safety on himself and his family, he gave it to institutionalized children in a Ohio reformatory in 1954. All developed antibodies, and none got polio.

Meanwhile Dr. Jonas Salk, also a graduate of New York University School of Medicine, received a grant from the National Foundation for Infantile Paralysis to study the three types of polio virus at the University of Pittsburgh. The grant allowed Dr. Sabin to finally establish his own lab after several years of difficulty due to the traditional “academic jewish quotas” of the time. When he succeeded in developing a killed-virus vaccine, he successfully tested it in 1953 in 43 children at the D.T. Watson Home for retarded and feeble-minded children in Pittsburgh.

In 1938 Basil O’Conner, CEO of the National Foundation and a former law partner of Franklin D. Roosevelt (the most famous polio victim in the world), had started a fund-raising effort called the March of Dimes which in its first year literally inundated the White House with coins and letters. When Salk’s vaccine proved efficacious in 1953 Basil O’Conner successfully urged the U.S. government to launch a field trial of his grantee’s vaccine. That “field trial” eventually distributed vaccine to 1.8 million children with the help of 20,000 physicians, 64,000 school personnel, and 220,000 other volunteers. (Now THAT’S a “field trial”.) The success of the trial was announced on April 12, 1955 in a Waldorf Astoria Hotel press conference and radio broadcast supported by a $250,000 grant from Eli Lilly and Company, and Salk became a superstar. Salk, himself, valued his privacy, abhorred the resulting publicity, and refused any effort to patent the vaccine.

Basil O’Connor was much more energetic in promoting the use of the Salk vaccine and a fearful public embraced it. An adversarial situation soon developed between Salk and Sabin as each pushed the government in Congressional committee hearings to use their vaccine. Sabin became “openly hostile to Salk” and would provide immediate “specific critiques of his presentations at scientific meetings”. Basil responded in the newspapers by saying in 1955, “Those who would prevent its [Salk vaccine] use must be prepared to be haunted for life by the crippled bodies of little children who could have been saved from paralysis had they been permitted to receive the Salk vaccine.”

The oral live virus vaccine was used to immunize over 100 million Russian children between 1955 and 1961, but it’s first U.S. trial was in 1961 on 180,000 school children in Cincinnati, Ohio. The live virus vaccine reproduces itself in the intestines of those vaccinated and spread of the attenuated virus from those vaccinated can protect others in the community. This was an advantage in endemic, poorly developed countries, but caused the U.S. to stop using the Sabin vaccine for fear of secondary spread.

The polio vaccine we give today is a 1988 refinement of an injectable killed-virus for all 3 types of polio and is 100% protective after three injections in the first year of life and a booster at 6 yrs.

All three physicians went on to develop or lead separate, stellar research organizations bearing their name and  continuing their superb work.

In 2007 Dr. Hilary Koprowski was awarded  the annual Albert B. Sabin Gold Medal given by the Sabin Vaccine Institute.

Relevance today?
1. Even in science, what you know is important, but WHO you know can be also.
2. Yesterdays “field trial” is today’s mass immunization campaign, and NOBODY tests drugs or vaccines, whether from mice brains or monkey kidneys, on themselves and their family members anymore!
3. The history of testing vaccines and drugs on impaired or incarcerated populations reminds us again of the necessity for “informed consent”.
4. As more academic institutions seek joint contracts with big pharma to replace reduced NIH support of research (MGH and Sanofi, AztraZenenca, etc.) accusations of being a “commercial scientist” seem moot.
5. Some immigrants can be very smart, focussed, and hard-working, and they can contribute immensely to our country’s health and wealth.
6. Science keeps gathering data and testing hypotheses, so we should not be surprised when its recommendations change.

References:  1. NY Times, April 21, 2013, pg.18

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