Polio: An American Story

Historian David M. Oshinsky traces the rise and fall of polio in the United States, from its emergence as a terrifying epidemic in the early twentieth century through the development of two competing vaccines and the bitter rivalry between the scientists who created them. The book examines how a relatively uncommon disease became the most feared affliction of its era, mobilizing an unprecedented campaign of private philanthropy, public voluntarism, and medical research that reshaped American science, politics, and culture.

Oshinsky opens with the 1949 polio outbreak in San Angelo, a West Texas county seat of 50,000, where 420 cases, 84 permanent paralyses, and 28 deaths illustrated the panic polio inflicted on American communities. Although polio killed far fewer children than accidents or cancer, the National Foundation for Infantile Paralysis (NFIP), popularly known as the March of Dimes, turned it into the nation's most dreaded disease through relentless publicity that amplified fears about a disease striking randomly and leaving visible devastation.

The book traces polio's long history. For centuries, poliovirus circulated harmlessly in unsanitary conditions, producing mild childhood infections and lifelong immunity. As sanitation improved, children lost early exposure to the virus, creating a cruel paradox: Cleaner societies produced more vulnerable populations. Simon Flexner, director of the Rockefeller Institute in New York City, became the nation's foremost polio researcher but committed a fateful error, concluding that poliovirus entered through the nose rather than the digestive tract. This mistaken theory discouraged vaccine development for decades. The devastating 1916 epidemic claimed 27,000 American lives and revealed that affluent neighborhoods were struck as hard as crowded immigrant slums.

Oshinsky devotes considerable attention to Franklin Delano Roosevelt, whose 1921 bout with polio at age 39 transformed the nation's relationship with the disease. Roosevelt concealed his paralysis and purchased Warm Springs, Georgia, converting a struggling resort into a rehabilitation center. After his election as president in 1932, his law partner Basil O'Connor organized nationwide birthday balls raising over $1 million through small donations, replacing wealthy donors' philanthropy with mass middle-class participation. In 1938, Roosevelt announced the creation of the nonpartisan NFIP with O'Connor as director. Comedian Eddie Cantor suggested calling its fundraising arm the March of Dimes, and the White House mailroom was buried under 2.68 million dimes.

Roosevelt's death in April 1945 forced the foundation to reinvent itself. O'Connor fought off federated giving, the combined-charity model exemplified by United Way, insisting the March of Dimes must stand alone. The foundation pioneered poster children and the Mothers' March on Polio, a door-to-door canvass that became the largest annual charitable effort in the country, raising $250 million between 1951 and 1955. The foundation also spent $233 million on patient care between 1938 and 1955, covering medical bills for more than 80 percent of polio patients regardless of ability to pay. Australian bush nurse Sister Elizabeth Kenny challenged prevailing practice by advocating hot packs and exercise over immobilization, becoming an international celebrity in the process.

The book's central narrative follows Jonas Salk from a working-class Jewish immigrant family in New York City to the creation of the first successful polio vaccine. Salk entered New York University's medical school at 19, one of the few schools that did not impose quotas on Jewish applicants, and trained under virologist Thomas Francis Jr. at the University of Michigan, spending six years learning to inactivate viruses with formaldehyde for a killed-virus influenza vaccine during World War II. In 1947, Salk accepted a position at the University of Pittsburgh, arriving to find two bare basement rooms but gradually building a world-class laboratory with foundation grants.

Previous vaccine experiments in 1935 had ended in disaster when prematurely tested vaccines harmed children, but by the late 1940s, a series of breakthroughs made a safe vaccine feasible. In 1948, John Enders, Fred Robbins, and Tom Weller at the Children's Hospital of Boston grew poliovirus in non-nervous tissue cultures, enabling mass production of safe virus for a vaccine. The foundation's typing program confirmed three distinct types of poliovirus, meaning a successful vaccine must protect against all three. Dorothy Horstmann at Yale and David Bodian at Johns Hopkins discovered that poliovirus circulated briefly in the bloodstream before reaching the central nervous system, proving a vaccine could intercept the virus before it caused paralysis.

Oshinsky introduces three main competitors. Salk favored a killed-virus vaccine. Albert Sabin, a Polish-born émigré at the University of Cincinnati, championed a live-virus vaccine that would mimic natural infection and produce more durable immunity. Hilary Koprowski at the pharmaceutical company Lederle Laboratories had tested his own live-virus vaccine on institutionalized children in 1950. By 1952, Salk had begun human testing at two Pittsburgh-area institutions, producing promising results. The record-breaking 1952 polio season, with more than 57,000 cases, intensified pressure for a mass trial.

The 1954 field trials sparked fierce debate over design. O'Connor favored observed controls comparing vaccinated volunteers with unvaccinated classmates, while scientific advisors demanded rigorous double-blind trials with placebos. Francis agreed to direct the evaluation from the University of Michigan. Almost 1.5 million schoolchildren participated in the largest public health experiment in American history, supported by 20,000 physicians, 40,000 nurses, and 200,000 volunteers.

On April 12, 1955, the tenth anniversary of Roosevelt's death, Francis announced that the vaccine was 60 to 70 percent effective against the most common type of poliovirus and 90 percent or more effective against the other two types. National celebration erupted. Salk followed with a presentation claiming his improved vaccine could achieve near-total protection, angering colleagues who felt he was dismissing the trial that validated his work. He also failed to individually acknowledge his laboratory staff, causing lasting bitterness. That evening, on Edward R. Murrow's CBS program See It Now, Salk was asked who owned the patent. He replied, "Well, the people, I would say. There is no patent. Could you patent the sun?"

The euphoria collapsed within weeks when children vaccinated with lots from Cutter Laboratories developed polio. More than 200 cases were traced to contaminated lots, and 11 people died. Investigation revealed that virus particles had clumped during storage, shielding them from the formaldehyde meant to kill them. The licensing process was exposed as grossly inadequate. Secretary of Health, Education, and Welfare (HEW) Oveta Culp Hobby resigned. The National Institutes of Health (NIH) was reorganized, and the NIH budget swelled from $81 million to $400 million between 1955 and 1960.

The crisis opened the door for Sabin. Unable to conduct mass trials in the United States, he cultivated a relationship with Soviet scientists. In 1959, the Russians vaccinated 10 million children with his oral vaccine, administered by medicine dropper or wrapped in candy. Sabin's vaccine offered clear advantages: It was given by mouth, produced longer-lasting immunity, and could spread protection to unvaccinated populations through the shedding of weakened virus. In 1960, Surgeon General Leroy Burney approved Sabin's vaccine for trial manufacture while rejecting competing live-virus vaccines by Koprowski and Herald Cox, another researcher at Lederle Laboratories. HEW licensed Sabin's vaccine beginning in September 1961, and by 1963, it had supplanted the Salk vaccine.

Salk departed Pittsburgh in 1960 and established the Salk Institute for Biological Studies in La Jolla, California. The rivalry between Salk and Sabin persisted until both men died, Sabin in March 1993 and Salk in June 1995. Sabin won honors from the scientific establishment, including election to the National Academy of Sciences, while Salk remained beloved by the public. Studies showed Sabin's vaccine caused approximately one case of polio per million doses due to rare reversion to virulence. In 1996, the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices recommended a return to the killed-virus vaccine, and in 2000, the CDC endorsed full replacement of the Sabin vaccine in the United States, vindicating Salk's position decades after the debate began.

Oshinsky concludes by examining the estimated 400,000 American polio survivors, many of whom began experiencing Post-Polio Syndrome in the 1980s, a condition involving progressive muscle weakness caused by the degeneration of overtaxed nerve cells. He notes their role in the disability rights movement, including lobbying for the Americans with Disabilities Act of 1990. The global eradication campaign launched by the World Health Organization in 1987 has reduced cases dramatically but faces persistent obstacles. The conquest of polio, Oshinsky argues, remains one of the most significant triumphs in American medical history, driven by voluntarism, private philanthropy, and faith in the progress of science.