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Friday, January 16, 2015

Jonas Salk

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Jonas Salk
Dr Jonas Edward Salk (cropped).jpg
Jonas Salk at Copenhagen Airport (May 1959)
Born October 28, 1914
New York, New York
Died June 23, 1995 (aged 80)
La Jolla, California,
United States
Residence New York, New York
Pittsburgh, Pennsylvania
La Jolla, California
Nationality American
Fields Medical research,
virology and epidemiology
Institutions University of Pittsburgh
Salk Institute
University of Michigan
Alma mater City College of New York
New York University
University of Michigan
Doctoral advisor Thomas Francis, Jr.
Known for First polio vaccine
Notable awards Lasker Award (1956)
Spouse Donna Lindsay (m. 1939–68)
Françoise Gilot (m. 1970–95)
Signature

Jonas Edward Salk (/sɔːlk/; October 28, 1914 – June 23, 1995) was an American medical researcher and virologist. He discovered and developed the first successful inactivated polio vaccine. Born in New York City to Jewish parents, he attended New York University School of Medicine, later choosing to do medical research instead of becoming a practicing physician.

Until 1957, when the Salk vaccine was introduced, polio was considered one of the most frightening public health problems in the world. In the postwar United States, annual epidemics were increasingly devastating. The 1952 U.S. epidemic was the worst outbreak in the nation's history. Of nearly 58,000 cases reported that year, 3,145 people died and 21,269 were left with mild to disabling paralysis,[1] with most of its victims being children. The "public reaction was to a plague", said historian Bill O'Neal.[2] "Citizens of urban areas were to be terrified every summer when this frightful visitor returned." According to a 2009 PBS documentary, "Apart from the atomic bomb, America's greatest fear was polio."[3] As a result, scientists were in a frantic race to find a way to prevent or cure the disease. U.S. President Franklin D. Roosevelt was the world's most recognized victim of the disease and founded the organization, the March of Dimes Foundation, that would fund the development of a vaccine.

In 1947, Salk accepted an appointment to the University of Pittsburgh School of Medicine. In 1948, he undertook a project funded by the National Foundation for Infantile Paralysis to determine the number of different types of polio virus. Salk saw an opportunity to extend this project towards developing a vaccine against polio, and, together with the skilled research team he assembled, devoted himself to this work for the next seven years. The field trial set up to test the Salk vaccine was, according to O'Neill, "the most elaborate program of its kind in history, involving 20,000 physicians and public health officers, 64,000 school personnel, and 220,000 volunteers." Over 1,800,000 school children took part in the trial.[4] When news of the vaccine's success was made public on April 12, 1955, Salk was hailed as a "miracle worker" and the day almost became a national holiday. Around the world, an immediate rush to vaccinate began, with countries including Canada, Sweden, Denmark, Norway, West Germany, the Netherlands, Switzerland, and Belgium planning to begin polio immunization campaigns using Salk's vaccine.

His sole focus had been to develop a safe and effective vaccine as rapidly as possible, with no interest in personal profit. When asked who owned the patent to it, Salk said, "There is no patent. Could you patent the sun?"[5] In 1960, he founded the Salk Institute for Biological Studies in La Jolla, California, which is today a center for medical and scientific research. He continued to conduct research and publish books, including Man Unfolding (1972), The Survival of the Wisest (1973), World Population and Human Values: A New Reality (1981), and Anatomy of Reality: Merging of Intuition and Reason (1983). Salk's last years were spent searching for a vaccine against HIV. His personal papers are stored at the University of California, San Diego Library.[6]

Early days

Jonas Salk was born in New York City on October 28, 1914. His parents, Daniel and Dora (née Press) Salk, were Ashkenazi Jewish immigrants who had not received extensive formal education. According to historian David Oshinsky, Salk grew up in the "Jewish immigrant culture" of New York. He had two younger brothers, Herman and Lee, a child psychologist.[7][8] The family moved from East Harlem to the Bronx, with some time spent in Queens.

Education

High school

When he was 13, Salk entered Townsend Harris High School, a public school for intellectually gifted students. Named after the founder of City College of New York (CCNY), it was, said Oshinsky, "a launching pad for the talented sons of immigrant parents who lacked the money—and pedigree—to attend a top private school." In high school "he was known as a perfectionist . . . who read everything he could lay his hands on," according to one of his fellow students.[9] Students had to cram a four-year curriculum into just three years. As a result, most dropped out or flunked out, despite the school's motto "study, study, study." Of the students who graduated, however, most would have the grades to enroll in CCNY, noted for being a highly competitive college.[10]:96

College

Salk enrolled in CCNY from which he earned a Bachelor of Science degree in chemistry in 1934.[11] Oshinsky writes that "for working-class immigrant families, City College represented the apex of public higher education. Getting in was tough, but tuition was free. Competition was intense, but the rules were fairly applied. No one got an advantage based on an accident of birth."[10]

At his mother's urging, he put aside aspirations of becoming a lawyer, and instead concentrated on classes necessary for admission to medical school. However, according to Oshinsky, the facilities at City College were "barely second rate." There were no research laboratories; the library was inadequate. The faculty contained few noted scholars. "What made the place special," he writes, "was the student body that had fought so hard to get there ... driven by their parents... From these ranks, of the 1930s and 1940s, emerged a wealth of intellectual talent, including more Nobel Prize winners—eight—and PhD recipients than any other public college except the University of California at Berkeley." Salk entered CCNY at the age of 15, a "common age for a freshman who had skipped multiple grades along the way."[10]:98

As a child, Salk did not show any interest in medicine or science in general. He said in an interview with the Academy of Achievement,[12] "As a child I was not interested in science. I was merely interested in things human, the human side of nature, if you like, and I continue to be interested in that."

Medical school

After City College, Salk enrolled in New York University to study medicine. According to Oshinsky, NYU based its modest reputation on famous alumni, such as Walter Reed, who helped conquer yellow fever. Tuition was "comparatively low, better still, it did not discriminate against Jews, . . . while most of the surrounding medical schools—Cornell, Columbia, University of Pennsylvania, and Yale—had rigid quotas in place." Yale, for example, accepted 76 applicants, in 1935, out of a pool of 501. Although 200 of the applicants were Jewish, only five got in.[10]:98 During his years at New York University Medical School, Salk worked as a laboratory technician during the school year and as a camp counselor in the summer.[11]

During Salk's medical studies, he stood out from his peers, according to Bookchin, "not just because of his continued academic prowess—he was Alpha Omega Alpha, the Phi Beta Kappa Society of medical education—but because he had decided he did not want to practice medicine." Instead, he became absorbed in research, even taking a year off to study biochemistry. He later focused more of his studies on bacteriology which had replaced medicine as his primary interest. He said his desire was to help humankind in general rather than single patients.[9] "It was the laboratory work, in particular, that gave new direction to his life."[10]

According to Salk: "My intention was to go to medical school, and then become a medical scientist. I did not intend to practice medicine, although in medical school, and in my internship, I did all the things that were necessary to qualify me in that regard. I had opportunities along the way to drop the idea of medicine and go into science. At one point at the end of my first year of medical school, I received an opportunity to spend a year in research and teaching in biochemistry, which I did. And at the end of that year, I was told that I could, if I wished, switch and get a Ph.D. in biochemistry, but my preference was to stay with medicine. And, I believe that this is all linked to my original ambition, or desire, which was to be of some help to humankind, so to speak, in a larger sense than just on a one-to-one basis."[13]

Postgraduate research

In 1941, during his postgraduate work in virology, Salk chose a two-month elective to work in the laboratory of Dr. Thomas Francis at the University of Michigan. Francis had recently joined the faculty of the medical school after working for the Rockefeller Foundation, where he had discovered the type B influenza virus. According to Bookchin, "the two-month stint in Francis's lab was Salk's first introduction to the world of virology—and he was hooked."[9]:25 From that time originates the first controversy (the second one relates in revealing SV40 in the rhesus monkey kidney cells used for multiplying poliomyelitis virus for vaccines in 1960[14][15][16][17]) in Salk's career: Francis and other researchers, one of whom was Salk, deliberately infected patients at several Michigan mental hospitals with the influenza virus by spraying the virus into their nasal cavities.[18]

After graduating from medical school, Salk began his residency at New York's Mount Sinai Hospital, where he again worked in Francis's laboratory. Few hospitals in Manhattan had the status of Mount Sinai, particularly among the city's Jews. Oshinsky interviewed a friend of Salk's, who said, "to intern there was like playing ball for the New York Yankees ... only the top men from the nation's medical schools dared apply. Out of 250 who sought the opportunity, only a dozen were chosen."[10]

According to Oshinsky, "Salk quickly made his mark." Although focused mainly on research, "he showed tremendous skills as a clinician and a surgeon." But it was "his leadership as president of the house staff of interns and residents at Mount Sinai that best defined him to his peers." The key issue for many of them in 1939, for example, was not the fate of the hospital, but rather the future of Europe after Nazi Germany's invasion of Poland. In one instance, "several interns responded by wearing badges to signify support for the Allies," but the hospital's director told them to remove them lest they upset some of the patients. The interns then took the matter to Salk. Salk replied, "everyone should wear the badge as an act of solidarity." One intern recalled, "Jonas was a very staunch guy. He never took a backward step on that issue or any other issue of principle between us and the hospital."
The hospital administrators backed off and there was no further interference from the director.[10]

Research career

At the end of his residency, Salk began applying for permanent research positions, but he discovered that many of the jobs he desired were closed to him due to Jewish quotas, which, according to Bookchin, "prevailed in so much of the medical research establishment." Nor could he apply at Mount Sinai, as its policy prevented it from hiring its own interns. As a last resort, he contacted Dr. Francis for help, but Francis had left New York University a year earlier after accepting an offer to direct the University of Michigan's School of Public Health.

However, "Francis did not let him down," writes Bookchin. "He secured extra grant money and offered Salk a job" working on an army-commissioned project in Michigan to develop an influenza vaccine. He and Francis eventually perfected a vaccine that was soon widely used at army bases, where "Salk had been responsible for discovering and isolating one of the flu strains that was included in the final vaccine."[9]:26

By 1947, Salk decided to find an institution where he could direct his own laboratory. After three institutions turned him down, he received from William McEllroy, the dean of the University of Pittsburgh School of Medicine, an offer which included a promise that he would run his own lab. He accepted, and in the fall of that year, left Michigan and relocated to Pennsylvania. The promise, though, was not quite what he expected. After Salk arrived at Pittsburgh, "he discovered that he had been relegated to cramped, unequipped quarters in the basement of the old Municipal Hospital," writes Bookchin. As time went on, however, Salk began securing grants from the Mellon family and was able to build a working virology laboratory, where he continued his research on flu vaccines.[9]

Salk's work on influenza viruses has been associated with ethical controversy. The Associated Press reported that Salk authored a research paper describing a federally funded study that began in 1942. Salk injected patients in a state insane asylum in Ypsilanti, Michigan, with an experimental influenza vaccine, then exposed them to influenza virus months later to check the vaccine's efficacy. It is questionable at best whether any of these patients could have understood what was being done to them, or why.[19]

He was later approached by the director of research at the National Foundation for Infantile Paralysis and asked whether he would like to participate in the foundation's polio project which had earlier been established by President Franklin D. Roosevelt, at the time thought to be a victim of polio himself. Salk quickly accepted the offer, saying he "would be happy to work on this important project."[9]

In 1956, Wisdom magazine ran a cover story about Salk, summarizing some of the reasoning behind his desire to do research:

There are two types of medical specialists. There are those who fight disease day and night, who assist mankind in times of despair and agony and who preside over the awesome events of life and death. Others work in the quiet detachment of the laboratory; their names are often unknown to the general public, but their research may have momentous consequences.[20]

Polio research

Postwar era

Polio was a medical oddity that baffled researchers for years. It took a long time to learn that the virus was transmitted by fecal matter and secretions of the nose and throat. It entered the victim orally, established itself in the intestines, and then traveled to the brain or spinal cord.[2]

At the start of the 20th century, during the 1914 and 1919 polio epidemics in the U.S., physicians and nurses made house-to-house searches to identify all infected persons. Children suspected of being infected were taken to hospitals and a child's family was quarantined until that child was no longer potentially infectious, even if it meant the family could not go to their child's funeral if the child died in the hospital.[21]

Many famous people were polio victims; most were able to overcome their disabilities, while others were less fortunate. Itzhak Perlman, one of the world's finest violinists, was permanently disabled at age four, and still plays sitting down. Actor Donald Sutherland, President Roosevelt, writer Arthur C. Clarke, writer Robert Anton Wilson, actress Mia Farrow,[22] singer-musician Neil Young, Olympic dressage rider Lis Hartel, actor Alan Alda, musician David Sanborn, singer Dinah Shore, singer Joni Mitchell, former Supreme Court Justice William O. Douglas, director Francis Ford Coppola, nuclear physicist J. Robert Oppenheimer, actor Lionel Barrymore,[23] and Congressman James H. Scheuer were infected.[24]

According to American historian William O'Neill, "Paralytic poliomyelitis (its formal name) was, if not the most serious, easily the most frightening public health problem of the postwar era." He noted that the epidemics kept getting worse and its victims were usually children. By 1952, it was killing more of them than was any other communicable disease. In the 20 states that reported the disease back in 1916, 27,363 cases were counted. New York alone had 9,023 cases, of which 2,448 (28%) resulted in death, and a larger number in paralysis.[2]:136 However, polio did not gain national attention until 1921, when Franklin D. Roosevelt, former vice presidential candidate and soon to be governor of New York, came down with a paralytic illness, diagnosed at the time as polio.[25] At the age of 39, Roosevelt was left with severe paralysis and spent most of his presidency in a wheelchair.

Subsequently, as more states began recording instances of the disease, the numbers of victims grew larger. Nearly 58,000 cases of polio were reported in 1952, with 3,145 people dying and 21,269 left with mild to disabling paralysis.[1] In some parts of the country, concern assumed almost the dimensions of panic. According to Olson, "parents kept children home from school, avoided parks and swimming pools, and played only in small groups with the closest of friends."[25]

Cases usually increased during the summer when children were home from school. "The public reaction was to a plague," noted O'Neill. "Citizens of urban areas were to be terrified every summer when this frightful visitor returned."[2] As a result, Olson points out, "scientists were in a frantic race to find a cure."[25] The famous U.S. artist Andrew Wyeth created a painting in 1948 depicting his neighbor, Christina Olson, who was crippled with polio. The painting, Christina's World, is considered his most famous work.[26]

Initial work

Salk became ambitious for his own lab and was finally granted one at the University of Pittsburgh. However, he was disappointed. The lab they had given him was much smaller than he had hoped and the university forced him to conform to many rules which stunted his research as a beginning virologist.[27]

In 1948, Harry Weaver, the director of research at the National Foundation for Infantile Paralysis, which later became known as the March of Dimes, contacted Salk. He asked Salk to join the fight against polio and research/confirm how many polio types existed. At the time, scientists had discovered three; they wanted to know if there were any more types. Although this type of polio research would be repetitious, boring, and time-consuming, the foundation agreed to pay for additional space, equipment, and researchers. Once the research was finished, Salk would be able to keep the facilities and continue his previous work.

Because Salk desperately needed space, he joined the fight. For the first year, he gathered supplies and researchers. Dr. Julius Youngner, Byron Bennett, Dr. L. James Lewis, and secretary Lorraine Friedman joined Salk's team, as well.[28] Youngner remembers this period:
Jonas was swimming against the current. He was a young whippersnapper who came out of nowhere, and suddenly is taking on this responsibility, and not only that, but getting the support of Basil O’Connor, because Jonas convinced Basil O’Connor that we were going to do it.[3]

Preliminary results

President Franklin D. Roosevelt meeting with Basil O'Connor

Oshinsky writes that as "headlines screamed, 'Polio Scourge,' 'Polio Panic', and 'Polio's Deadly Path'," parents "faced a dilemma" and a feeling of personal helplessness in the midst of an "apparently runaway epidemic." Their "postwar culture was being turned upside down" as polio became the "crack in the fantasy" of a suburban home "bursting with children." Parents began to see that there would be an alternative, however: "Since worry did no good and quarantine seemed fruitless, parents might best protect their children by helping others to discover a vaccine against polio, and, perhaps, even a cure." The public soon realized that this kind of research demanded "big money" and an "army of devoted volunteers",[10]:85–87 but Salk was determined to make it over this barrier.

The fight against polio did not really get under way until 1938 when the National Foundation for Infantile Paralysis was born, headed by Basil O'Connor, the former law partner of President Roosevelt, the U.S.'s most famous polio victim. That same year, the first March of Dimes fundraising program was set up, with radio networks offering free 30-second slots for promotion. Listeners were asked to send in a dime and the White House received 2,680,000 letters within days.
Patients in iron lungs during 1952 epidemic

As the fear of polio increased each year, funds to combat it increased from $1.8 million to $67 million by 1955. Research continued during those years, but, writes O'Neill, "everything scientists believed about polio at first was wrong, leading them down many blind alleys . . . furthermore, most researchers were experimenting with highly dangerous 'live' vaccines. In one test, six children were killed and three left crippled."[2]

"This was the situation when young Jonas Salk, a medical doctor in charge of a virology laboratory at the University of Pittsburgh, decided to use the safer 'killed' virus," writes O'Neill. Despite a general lack of enthusiasm for this approach, O'Connor backed Salk handsomely. After successful tests on laboratory animals, it next had to be tested on human beings. On July 2, 1952, assisted by the staff at the D.T. Watson Home for Crippled Children, Jonas Salk injected 43 children with his killed-virus vaccine. A few weeks after the Watson tests, Salk injected children at the Polk State School for the retarded and feeble-minded.[29] In November 1953, at a conference in New York's Waldorf-Astoria Hotel, he said, "I will be personally responsible for the vaccine." He announced that his wife and three sons had been among the first volunteers to be inoculated with his vaccine.[30]
Salk in 1955 at the University of Pittsburgh

It was critical that Salk develop the trust of the U.S. public for his experiments and the mass tests that would become necessary. An associate of his noted, "That boy really suffers when he sees a paralytic case. You look at him and you see him thinking, 'My God, this can be prevented'."[31] An article in Wisdom notes that at one point, "he even thought of giving up virus research":

"But as he was sitting in a park and watching children play, he realized how important his work was. He saw that there were thousands of children and adults who would never walk again and whose bodies would be paralyzed. He realized his awesome responsibility, and so he continued his task with renewed vigor."[20]

As a result of Salk's preliminary results in 1954, "when polio was destroying more American children than any other communicable disease, his vaccine was ready for field testing."[2]

Field trials

Magazine photo of Jonas Salk in laboratory

The field trial set up to test the vaccine developed by Salk and his research team was, according to O'Neill, "the most elaborate program of its kind in history, involving 20,000 physicians and public health officers, 64,000 school personnel, and 220,000 volunteers,"[2] with over 1,800,000 school children participating in the trial.[4] A 1954 Gallup poll showed that more Americans knew about the polio field trials than could give the full name of the President.
March of Dimes poster circa 1957

According to medical author Paul Offit, "more Americans had participated in the funding, development, and testing of the polio vaccine than had participated in the nomination and election of the president."[32]:54 At least 100 million people had contributed to the March of Dimes, and seven million had donated their time and labor, as well.[2] They included fund-raisers, committee workers, and volunteers at clinics and record centers.

Doris Fleischer, a disability historian, noted that O'Connor was willing to take whatever risks necessary to serve the purposes of the foundation. She writes, "When O'Connor realized that success seemed imminent, he allowed the foundation to go into debt to finance the final research required to develop the Salk vaccine. His 'passionate' devotion to this task became almost 'obsessive' when his daughter, a mother of five, told him that she had contracted the illness, saying, 'I've gotten some of your polio.'"[33]

With the hopes of the world upon him, "Salk worked sixteen hours a day, seven days a week, for years . . .", wrote Denenberg.[34] It had been, Salk later described, "two and a half years of drudgery and hard work."[9]:44 The results of the tests were eventually deemed successful and, O'Neill wrote, "Salk had justified Basil O'Connor's faith."[2]

The research by Salk was not without controversy. Esther Lederberg, a well-known microbiologist, felt that Salk needed detailed records to ensure that his vaccine was as effective as claimed.[35]

Developing a vaccine

Newspaper headlines about polio vaccine tests (April 13, 1955).

Test results announced

On April 12, 1955, Dr. Thomas Francis, Jr., of the University of Michigan, the monitor of the test results, "declared the vaccine to be safe and effective." The announcement was made at the University of Michigan, exactly 10 years to the day after the death of President Roosevelt. Five hundred people, including 150 press, radio, and television reporters, filled the room; 16 television and newsreel cameras stood on a long platform at the back, and 54,000 physicians, sitting in movie theaters across the country, watched the broadcast on closed-circuit television. Eli Lilly and Company paid $250,000 to broadcast the event. Americans turned on their radios to hear the details, department stores set up loudspeakers, and judges suspended trials so everyone in the courtroom could hear. Europeans listened on the Voice of America. Paul Offit writes about the event:
Shopkeeper expresses a nation's gratitude for Dr. Salk's discovery (April 13, 1955)
"The presentation was numbing, but the results were clear: the vaccine worked. Inside the auditorium Americans tearfully and joyfully embraced the results. By the time Thomas Francis stepped down from the podium, church bells were ringing across the country, factories were observing moments of silence, synagogues and churches were holding prayer meetings, and parents and teachers were weeping. One shopkeeper painted a sign on his window: 'Thank you, Dr. Salk.' 'It was as if a war had ended', one observer recalled."[32]:56
"The report", wrote The New York Times, "was a medical classic." Dr. Francis reported that the vaccinations had been 80 to 90% effective on the basis of results in 11 states. Overall, the vaccine was administered to over 440,000 children in 44 states, three Canadian provinces, and Helsinki, Finland,[4] and the final report required the evaluation of 144,000,000 separate items of information.
After the announcement, when asked whether the effectiveness of the vaccine could be improved, Salk said, "Theoretically, the new 1955 vaccines and vaccination procedures may lead to 100 percent protection from paralysis of all those vaccinated."[36]

"A victory for the whole nation"

Dr. Jonas Salk receiving a Gold Medal from President Eisenhower (January 27, 1956).

Salk’s new vaccine was transformed by Alan John Beale’s team, based in Glaxo, England, into something which could be manufactured on the enormous scale which the widespread threat of poliomyelitis required. Within minutes of Francis's declaration that the vaccine was safe and effective, the news of the event was carried coast to coast by wire services and radio and television newscasts. According to Debbie Bookchin, "across the nation there were spontaneous celebrations... business came to a halt as the news spread. The mayor of New York City interrupted a city council meeting to announce the news, adding, 'I think we are all quite proud that Dr. Salk is a graduate of City College.'"[9]:46 "By the next morning", writes Bookchin, "politicians around the country were falling over themselves trying to figure out ways they could congratulate Salk, with several suggesting special medals and honors be awarded.... In the Eisenhower White House, plans were already afoot to present Salk a special presidential medal designating him "a benefactor of mankind" in a Rose Garden ceremony.

It was also declared "a victory for the whole nation" as Jonas Salk became "world famous overnight and was showered with awards", wrote O'Neill. The governor of Pennsylvania had a medal struck, and the state legislature gave him a chaired professorship. However, New York City could not get him to accept a ticker tape parade. Instead, New York created eight "Jonas Salk Scholarships" for future medical students. He received a Presidential Citation, the nation's first Congressional Medal for Distinguished Civilian Service, and a large number of honorary degrees and related honors.[2]:138

According to O'Neill, "April 12th had almost become a national holiday: people observed moments of silence, rang bells, honked horns, blew factory whistles, fired salutes, kept their red lights red in brief periods of tribute, took the rest of the day off, closed their schools or convoked fervid assemblies therein, drank toasts, hugged children, attended church, smiled at strangers, and forgave enemies."[2]:138

By July, movie studios were already fighting for the motion-picture rights to his film biography. Twentieth Century-Fox began writing a screenplay and Warner Brothers filed a claim to the title The Triumph of Dr. Jonas Salk shortly after the formal announcement of the vaccine.[37]

Global acceptance and hope

Six months before Salk's announcement, optimism and hope were so widespread, the Polio Fund in the U.S. had already contracted to purchase enough of the Salk vaccine to immunize 9,000,000 children and pregnant women the following year.[38] And around the world, the official news prompted an immediate international rush to vaccinate. Medical historian Debbie Bookchin writes, "Canada, Sweden, Denmark, Norway, West Germany, the Netherlands, Switzerland, and Belgium all announced plans to either immediately begin polio immunization campaigns using Salk's vaccine or to gear up to quickly do so. "Overnight", she adds, "Salk had become an international hero and a household name. His vaccine was a modern medical miracle."[9]:47 Because Salk was the first to prove that a 'killed'-virus could prevent polio, medical historian Paul Offit wrote in 2007 that "for this observation alone, Salk should have been awarded the Nobel Prize.[32] Virologist Isabel Morgan had earlier shown and published that a 'killed'-virus could prevent polio, although she did not test her vaccines on humans. Morgan's work, nonetheless, was a key link in the chain of progress toward the killed-virus polio vaccine for humans later developed and tested by Salk.

By the summer of 1957, over two years later, 100 million doses had been distributed throughout the United States and "reported complications following their administration have been remarkably rare", noted the scientists at the International Polio Conference in Geneva. Scientists from other nations reported similar experiences: Denmark, for example, "reported only a few sporadic cases among the 2,500,000 ... who received the vaccine." Australia reported virtually no polio during her past summer season.[39]

Other countries where the vaccine was not yet in use suffered continued epidemics, however. In 1957, Hungary, for example, reported a severe epidemic requiring emergency international assistance. By the first half of the year, it had 713 reported cases and a death rate of 6.6%, and the peak infection months of summer were still ahead. Canada sent a shipment of vaccine to Hungary by a refrigerated plane, and Britain and Sweden sent iron lungs. A few years later, during a polio outbreak in Canada, "masked bandits" stole 75,000 Salk vaccine shots from a Montreal university research center.[40]

Worldwide eradication successes and failures

By the end of 1990, an estimated 500,000 annual cases worldwide of paralysis resulting from polio had been prevented due to immunization programs carried out by the World Health Organization (WHO),UNICEF, and many other organizations, and in 1991, transmission of polio was declared as "interrupted" in the Western Hemisphere.

In developing countries, estimates in 1988 ran as high as 350,000 cases each year.[41] As a result, in 2002, more than 500 million children were immunized in 93 countries,[21]:112 and by December 2002, there were only 1,924 cases worldwide, mostly in India,[42] with six other countries where polio was still endemic: Afghanistan, Egypt, Niger, Nigeria, Pakistan, and Somalia.[43] By early 2014, however, the WHO listed only three remaining countries where polio was still endemic, Pakistan, Afghanistan and Nigeria, and declared Pakistan's city of Peshawar as the world's "largest reservoir" of polio.[44] Pakistan's high numbers are attributed partly to the fact that religious extremists have preached the conspiracy theory that the vaccine is actually a western conspiracy to sterilize the population. As a result, many have gone unvaccinated, with 65 vaccine workers having been killed by extremists since December 2012 and cases increasing 400% during 2014 alone.[45]

China

In 1993, China initiated a national immunization program, with over 80 million children getting vaccinated in just two days; by the following year, the country reported only five cases of polio.[46]

India

In 1981, India reported over 38,000 cases of polio. By 1999, intensive vaccination campaigns had succeeded in eradicating the type 2 strain of virus from India. Microsoft cofounder Bill Gates sponsored a campaign to eradicate polio, and the Bill & Melinda Gates Foundation committed nearly $1 billion to health and development projects throughout India.[47] The last case of polio in India, in two-year-old Rukhsaar Khatoon, was confirmed on January 13, 2011. India was removed from the list of polio-endemic countries in 2012, and marked two years without a case of polio on January 13, 2013.[48] As no new cases were found by January 2014, the nation was officially declared polio-free.[42]

Africa

In 2003, after an outbreak in Nigeria, international organizations spent $10 million to vaccinate 15 million children in Nigeria and neighboring countries.[21]:112

Latin America

During the 1970s, Latin America had an estimated 15,000 paralysis cases, with about 1,750 deaths each year from polio. By 1991, the last case of polio was reported in Latin America and the Caribbean, and polio has now been declared as fully eliminated from the region.[49]

Remaining eradication efforts

In 1988, numerous international medical organizations launched a campaign to eradicate polio globally, as had been successfully done for smallpox. By 2003, polio had been eradicated in all but a few countries, among them Afghanistan, India, Nigeria, and Pakistan[50] However, mullahs in northern Nigeria began to oppose the vaccination program, claiming that it was a plot to spread AIDS and sterility, and prevented any vaccination. Polio cases in Nigeria tripled over the next three years.[50]

Environmental scientist Lester Brown speculates that Nigerian Muslims may have spread the disease to Muslims of other polio-free countries during their annual pilgrimage to Mecca, in Saudi Arabia. With these same fears, Saudi Arabian officials imposed polio vaccination requirement on certain visitors.

In Pakistan in 2007, opposition was violent to vaccinations in the Northwest Frontier Province, where a doctor and a health worker in the polio eradication program were killed. Since then, the Taliban has blocked all vaccinations in the Swat Valley of Pakistan. As a result, Pakistan was the only country in 2010 to record an increase in cases of polio, according to the WHO, along with having the highest incidence of polio in the world.[51] Meanwhile, the Bill & Melinda Gates Foundation, which has spent $1.5 billion, plans to spend another $1.8 billion through 2018 to help eradicate the virus.[52]

New medical research projects urged

Just two weeks after the vaccine was announced, Senator Hubert H. Humphrey (Democrat, Minnesota) urged President Dwight D. Eisenhower "to show the nation's gratitude to Dr. Jonas E. Salk for his new polio vaccine by 'loosening the purse-strings' on federal medical research."[53] Salk knew it would take time to verify his theories and improve the vaccine. "He still wants to find out a number of things about polio", wrote The New York Times that summer. Questions remained: "How long will the immunity last? Are there any children who cannot be immunized? What improvements can be made?" Beyond that, "he has far bigger goals—'more in the nature of dreams right now'—involving other diseases."[31]

Over the next few years, while trying to perfect the polio vaccine, Salk had begun working unannounced, on a cure for cancer. A 1958 article in The New York Times confirmed "that he had been conducting experiments on cancer patients." The news was leaked after a Pittsburgh newspaper, the Sun-Telegraph, reported that he had been giving injections to children suffering from cancer. Salk stated afterwards, "It is true that we have been conducting experiments in many persons with a variety of cancer and cancer-like conditions ... but we have no treatment for cancer. Our studies are of a strictly exploratory nature..."[54] In 1965, he also said "a vaccine for the common cold is a matter of time and of solving some technical problems."[55]

Final conquest of polio and the Sabin vaccine controversy

U.S. postage stamp, 1957

Years before the Salk vaccine was officially announced as safe, Dr. Albert Sabin had joined in the search for a vaccine, using a 'live'-virus, as opposed to Salk's 'killed'-virus. Sabin, however, had been "openly hostile to Salk." Debbie Bookchin writes that he had been "perhaps accurately guessing that Salk was about to challenge him for ascendancy in the polio world." After one presentation that Salk made to a medical conference, "Sabin mounted a full-scale offensive, engaging in a piecemeal demolition of his presentation."[9] However, the National Foundation "swiftly put its full weight behind Salk. Here, finally, was a polio researcher, they said, who had accomplished something."[9]

By 1962, polio had become almost extinct, with only 910 cases reported that year—down from 37,476 in 1954. "It's a matter of principle", Salk said. "It is not a Salk versus Sabin controversy, a competition between two people... I had worked with influenza viruses, helping to establish the efficacy of a 'killed'-virus vaccine... I demonstrated that it could be 100% effective if the quantity of virus in the vaccine was sufficient."[56] That same year, the state of New York's Health Department recommended "that the Salk vaccine be given preference over the Sabin oral vaccine..."[57]

On October 20, 1998, after 18 years of using the Sabin vaccine, however, the federal government recommended that children use the Salk vaccine exclusively. Sabin's polio vaccine is no longer available in the United States.[32]:127

While OPV is not recommended by the CDC, its website explained that Sabin's OPV is more suited to areas where polio is endemic, because of "its advantages over IPV in providing intestinal immunity and providing secondary spread of the vaccine to unprotected contacts."[58]

On January 4, 2013, the World Health Organization called for the Sabin OPV, which contains the type 2 strain of poliovirus, to be phased out as soon as possible; although the type 2 strain has been eradicated in the wild, vaccine-derived strains still circulate in polio-endemic nations. A different OPV would continue to be administered, protecting against types 1 and 3, which are both still endemic in the wild in Nigeria, Afghanistan, and Pakistan. The WHO also called for the rapid introduction of the Salk IPV, which will be used along with OPV during a transition period. Once types 1 and 3 cease to be endemic, the OPV will be phased out, and the Salk vaccine will be used exclusively.[59]

Looking back—public confusion over which vaccine to use

In September 1962, public health officials in the U.S. and Canada faced a "major dilemma": whether to continue using the recently begun Sabin vaccine inoculations until further studies were conducted, due to reports of polio cases among persons who had received it. The U.S. Surgeon General, Luther Terry, recommended a temporary halt due to 16 cases of confirmed polio in adults. And "the Canadian Federal Health Department recommended against mass use of the [Sabin] oral vaccine pending further study of its effects." One of the unfortunate results caused by the controversy was that "many authorities have deplored the confusion that has been created in the public mind."[60]

Due to the American Medical Association's (AMA) "obstructive tactics, however, which caused numerous delays", writes O'Neill, the AMA had called for mass vaccinations in early 1962 employing Sabin's vaccine rather than Salk's. However, writes O'Neill, "as 'live'-virus was more dangerous, it caused an unknown number of polio cases... [but] the medical establishment seemed not to mind, having gotten its own way at last." But, concludes O'Neill, "polio was conquered all the same, even if not so quickly and safely as it might have been."[2]:139

In 1980, Salk pointed out the renewed interest in his killed virus vaccine, particularly in developing countries. "The 'live' virus vaccine is highly effective in developed countries ...", he said, "but in the developing countries, where polio is on the increase, the drawback is that the live virus fails to establish the infection that leads to immunity because of intestinal inhibitors in the population."[56] Recent evidence of this was found in Iran, where a number of children receiving the oral vaccine became infected with polio, leading Iranian researchers to recommend using the killed virus in the future.[61]

Basil O'Connor enters the controversy

Two months after the Salk vaccine was announced to the world, in 1955, Basil O'Connor found it necessary to respond to critics of the vaccine, especially Dr. Sabin. As the President of the National Foundation for Infantile Paralysis, he said, during a news conference before a congressional group in Washington, that "criticism of the Salk vaccine program by Dr. Albert Sabin of the University of Cincinnati was 'old stuff'." According to The New York Times, "Dr. Sabin recommended at a hearing before a House investigating subcommittee that Salk inoculations be suspended" until a safer preparation could be perfected.[62] O'Connor responded in a prepared statement: (excerpt)
"He's been using it [criticism] for years. He used it in an attempt to stop the field trials of the Salk vaccine... The Salk vaccine is safe and effective and will protect children from paralytic polio to the extent of 60 to 90 percent... In the United States, Canada and Denmark, 7,675,000 children have actually received the Salk vaccine with no untoward results. There could be no better proof of its safety than this. No vaccine in the history of the world has ever had such a test for safety. Anyone who would seek to prevent its use for other than unanswerable scientific reasons would be acting neither as a scientist nor as a humanitarian....
"Those who would prevent its 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."[62]
However, a year and a half after the Salk vaccine was introduced, a Sabin vaccine had still not yet been tested on humans. Sabin himself said, in October 1956, that "the Salk vaccine is still the only protection against polio available to the public." He was hoping to be able to start tests on humans by the end of the year or by 1957.[63]

The Cutter incident

In 1955, Cutter Laboratories was one of several companies licensed by the United States government to produce Salk's polio vaccine. In what came to be known as the Cutter incident, a production error caused some lots of the Cutter vaccine to be tainted with live polio virus. It was one of the worst pharmaceutical disasters in U.S. history and caused several thousand children to be exposed to live polio virus, causing 56 cases of paralytic polio and five deaths.[64]

10th-anniversary ceremonies

On April 12, 1965, leaders of the Senate and House presented Salk with a joint resolution expressing the nation's gratitude to him, his colleagues in the project, and the March of Dimes, which helped to finance the work. President Lyndon B. Johnson called him to the White House to congratulate him personally. Dr. Luther Terry, Surgeon General of the United States, said in a statement marking the anniversary that only 121 cases of polio were reported the previous year, as opposed to more than 28,000 ten years before. "This represents an historic triumph of preventive medicine—unparalleled in history", Dr. Terry said.[55]

30th anniversary—"Jonas Salk Day"

On May 6, 1985, President Ronald Reagan proclaimed that day to be "Jonas Salk Day". His proclamation read, in part:
One of the greatest challenges to mankind always has been eradicating the presence of debilitating disease. Until just thirty years ago poliomyelitis occurred in the United States and throughout the world in epidemic proportions, striking tens of thousands and killing thousands in our own country each year. Dr. Jonas E. Salk changed all that. This year we observe the 30th anniversary of the licensing and manufacturing of the vaccine discovered by this great American. Even before another successful vaccine was discovered, Dr. Salk's discovery had reduced polio and its effects by 97 percent. Today, polio is not a familiar disease to younger Americans, and many have difficulty appreciating the magnitude of the disorder that the Salk vaccine virtually wiped from the face of the Earth.[65]

Becoming a public figure

Celebrity versus privacy

With David Ben-Gurion in Jerusalem, 1959

Salk preferred not to have his career as a scientist affected by too much personal attention, as he had always tried to remain independent and private in his research and life, but this proved to be impossible. "Young man, a great tragedy has befallen you—you've lost your anonymity", the television personality Ed Murrow said to Salk shortly after the onslaught of media attention.[56] When Murrow asked him, "Who owns this patent?", Salk replied, "No one. Could you patent the sun?"[66] The vaccine is calculated to be worth $7 billion had it been patented.[67] However, lawyers from the National Foundation for Infantile Paralysis did look into the possibility of a patent, but ultimately determined that the vaccine was not a patentable invention because of prior art.[68]

Author Jon Cohen noted, "Jonas Salk made scientists and journalists alike go goofy. As one of the only living scientists whose face was known the world over, Salk, in the public's eye, had a superstar aura. Airplane pilots would announce that he was on board and passengers would burst into applause. Hotels routinely would upgrade him into their penthouse suites. A meal at a restaurant inevitably meant an interruption from an admirer, and scientists approached him with drop-jawed wonder as though some of the stardust might rub off."[69]

For the most part, however, Salk was "appalled at the demands on the public figure he has become and resentful of what he considers to be the invasion of his privacy", wrote The New York Times, a few months after his vaccine announcement.[31] The Times article noted, "at 40, the once obscure scientist ... was lifted from his laboratory almost to the level of a folk hero." He received a presidential citation, a score of awards, four honorary degrees, half a dozen foreign decorations, and letters from thousands of fellow citizens. His alma mater, City College of New York, gave him an honorary degree as Doctor of Laws. But "despite such very nice tributes", The New York Times wrote, "Salk is profoundly disturbed by the torrent of fame that has descended upon him.... He talks continually about getting out of the limelight and back to his laboratory... because of his genuine distaste for publicity, which he believes is inappropriate for a scientist."[31]

During a 1980 interview, 25 years later, he said, "It's as if I've been a public property ever since, having to respond to external, as well as internal, impulses.... It's brought me enormous gratification, opened many opportunities, but at the same time placed many burdens on me. It altered my career, my relationships with colleagues; I am a public figure, no longer one of them."[56]

Maintaining his individuality

"If Salk the scientist sounds austere", wrote The New York Times, "Salk the man is a person of great warmth and tremendous enthusiasm. People who meet him generally like him." A Washington newspaper correspondent commented, "He could sell me the Brooklyn Bridge, and I never bought anything before." Award-winning geneticist Walter Nelson-Rees called him "a renaissance scientist: brilliant, sophisticated, driven... a fantastic creature."[70]:127

He enjoys talking to people he likes, and "he likes a lot of people", wrote the Times. "He talks quickly, articulately, and often in complete paragraphs." And "He has very little perceptible interest in the things that interest most people—such as making money." That belongs "in the category of mink coats and Cadillacs—unnecessary", he said.[31]

Establishing the Salk Institute

The Salk Institute at La Jolla

In the years after Salk's discovery, many supporters, in particular the National Foundation, "helped him build his dream of a research complex for the investigation of biological phenomena 'from cell to society'."[attribution needed] Called the Salk Institute for Biological Studies, it opened in 1963 in the San Diego neighborhood of La Jolla. Salk believed that the institution would help new and upcoming scientists along in their careers, as he said himself, "I thought how nice it would be if a place like this existed and I was invited to work there." This was something that Salk was deprived of early in his life, but due to his achievements, was able to provide for future scientists.

In 1966, Salk described his "ambitious plan for the creation of a kind of Socratic academy where the supposedly alienated two cultures of science and humanism will have a favorable atmosphere for cross-fertilization."[71] Author and journalist Howard Taubman explained:
"Although he is distinctly future-oriented, Dr. Salk has not lost sight of the institute's immediate aim, which is the development and use of the new biology, called molecular and cellular biology, described as part physics, part chemistry and part biology. The broad-gauged purpose of this science is to understand man's life processes.
"There is talk here of the possibility, once the secret of how the cell is triggered to manufacture antibodies is discovered, that a single vaccine may be developed to protect a child against many common infectious diseases. There is speculation about the power to isolate and perhaps eliminate genetic errors that lead to birth defects.
"Dr. Salk, a creative man himself, hopes that the institute will do its share in probing the wisdom of nature and thus help enlarge the wisdom of man. For the ultimate purpose of science, humanism and the arts, in his judgment, is the freeing of each individual to cultivate his full creativity, in whichever direction it leads. . . As if to prepare for Socratic encounters such as these, the institute's architect, Louis Kahn, has installed blackboards in place of concrete facings on the walls along the walks."[71]
The New York Times, in a 1980 article celebrating the 25th anniversary of the Salk vaccine, described the current workings at the facility:
"At the institute, a magnificent complex of laboratories and study units set on a bluff overlooking the Pacific, Dr. Salk holds the titles of founding director and resident fellow. His own laboratory group is concerned with the immunologic aspects of cancer and the mechanisms of autoimmune disease, such as multiple sclerosis, in which the immune system attacks the body's own tissues.[56]
In an interview about his future hopes at the institute, he said, "In the end, what may have more significance is my creation of the institute and what will come out of it, because of its example as a place for excellence, a creative environment for creative minds."
Francis Crick, codiscoverer of the structure of the DNA molecule, was a leading professor at the institute until his death in 2004.

AIDS vaccine work

Beginning in the mid-1980s, Salk also engaged in research to develop a vaccine for another, more recent plague, AIDS. To further this research, he cofounded the Immune Response Corporation with Kevin Kimberlin, to search for a vaccine, and patented Remune, an immune-based therapy.[72] The AIDS vaccine project was discontinued in 2007, 12 years after Jonas Salk's death in 1995.

Although many advances have been made in treating AIDS, "the world still waited for the miracle vaccine the conqueror of polio had sought", wrote historian Alan Axelrod.[73]:294

Salk's "biophilosophy"

Jonas Salk during a 1988 Centers for Disease Control visit

In 1966, The New York Times referred to him as the "Father of Biophilosophy." According to Times journalist and author Howard Taubman, "he never forgets... there is a vast amount of darkness for man to penetrate. As a biologist, he believes that his science is on the frontier of tremendous new discoveries; and as a philosopher, he is convinced that humanists and artists have joined the scientists to achieve an understanding of man in all his physical, mental and spiritual complexity. Such interchanges might lead, he would hope, to a new and important school of thinkers he would designate as biophilosophers."[71]

Salk describes his "biophilosophy" as the application of a "biological, evolutionary point of view to philosophical, cultural, social and psychological problems." He went into more detail in two of his books, Man's Unfolding, and The Survival of the Wisest. In an interview in 1980, he described his thoughts on the subject, including his feeling that a sharp rise and an expected leveling off in the human population would take place and eventually bring a change in human attitudes:
"I think of biological knowledge as providing useful analogies for understanding human nature.... People think of biology in terms of such practical matters as drugs, but its contribution to knowledge about living systems and ourselves will in the future be equally important.... In the past epoch, man was concerned with death, high mortality; his attitudes were antideath, antidisease", he says. "In the future, his attitudes will be expressed in terms of prolife and prohealth. The past was dominated by death control; in the future, birth control will be more important. These changes we're observing are part of a natural order and to be expected from our capacity to adapt. It's much more important to cooperate and collaborate. We are the co-authors with nature of our destiny."[56]
His definition of a "biophilosopher" is "Someone who draws upon the scriptures of nature, recognizing that we are the product of the process of evolution, and understands that we have become the process itself, through the emergence and evolution of our consciousness, our awareness, our capacity to imagine and anticipate the future, and to choose from among alternatives."[74]

Personal life

The day after his graduation from medical school in 1939, Salk married Donna Lindsay, a master's candidate at the New York College of Social Work. David Oshinsky writes that her father, Elmer Lindsay, "a wealthy Manhattan dentist, viewed Salk as a social inferior, several cuts below Donna's former suitors." Eventually, her father agreed to the marriage on two conditions: first, Salk must wait until he could be listed as an official M.D. on the wedding invitations, and second, he must improve his "rather pedestrian status" by giving himself a middle name."[10]

They had three children: Peter, Darrell, and Jonathan Salk. In 1968, they divorced, and in 1970, Salk married Françoise Gilot, the former mistress of Pablo Picasso.

Jonas Salk died from heart failure at the age of 80 on June 23, 1995, in La Jolla,[75] and was buried at El Camino Memorial Park in San Diego.[76]

Honors and recognition

"... in recognition of his 'historical medical' discovery... Dr. Salk's achievement is meritorious service of the highest magnitude and dimension for the commonwealth, the country and mankind." The governor, who had three children, said that "as a parent he was 'humbly thankful to Dr. Salk,' and as Governor, 'proud to pay him tribute'."[77]
  • 1955, City University of New York creates the Salk Scholarship fund which it awards to multiple outstanding pre-med students each year
  • 1956, awarded the Lasker Award
  • 1957, the Municipal Hospital building, where Salk conducted his polio research at the University of Pittsburgh, is renamed Jonas Salk Hall and is home to the University's School of Pharmacy and Dentistry.[78]
  • 1958, awarded the James D. Bruce Memorial Award
Salk's bronze bust in the Polio Hall of Fame
"Because of Doctor Jonas E. Salk, our country is free from the cruel epidemics of poliomyelitis that once struck almost yearly. Because of his tireless work, untold hundreds of thousands who might have been crippled are sound in body today. These are Doctor Salk's true honors, and there is no way to add to them. This Medal of Freedom can only express our gratitude, and our deepest thanks."

Documentary films

  • On April 12, 2010, to help celebrate the 55th anniversary of the Salk vaccine, a new 66-minute documentary, The Shot Felt 'Round the World, had its world premiere. Directed by Tjardus Greidanus[84] and produced by Laura Davis,[85] the documentary was conceived by Hollywood screenwriter and producer Carl Kurlander to bring "a fresh perspective on the era."[86]
  • In 2014, actor and director Robert Redford, who was once struck with a mild case of polio when he was a child, directed a documentary about the Salk Institute in La Jolla.[87]

Salk's book publications

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