In the first decades of the twentieth century, parents in the United States lived in terror of polio. CDC is trying to solve the riddle of poliomyolsis, which kills or paralyzes thousands of people every year. Doctors didn't know how the disease spread or how to treat it. What they did know is that it mainly struck children, and that it left many of its victims paralyzed, often for life. As the century progressed, the disease kept becoming more common.
In nineteen fifty two alone, polio paralyzed three thousand children in the US. One pole of American parents found that polio was their second greatest fear, right behind atomic apocalypse. The science of understanding viruses and developing vaccines had come a long way since the era of Edward Jenner that
we talked about last week. Still, by the middle of the twentieth century, there was no vaccine to prevent polio, but scientists were about to develop not one polio vaccine, but two, and to this day we use these two very different kinds of vaccines to immunize people around the world against polio. On today's show, we'll tell the story of the cutthroat scientific rivalry that resulted in one of the greatest triumphs in American medicine, maybe two of the
greatest triumphs. I'm Jacob Goldstein. This is incubation. So both of these vaccines protect people from polio, but they work in profoundly different ways. This is also true of the scientists who developed the vaccines, Jonah Salk and Albert Saban.
Salk was everyone's idea of a hero. He was like Superman. He was good looking, he was soft spoken, polite, He's like the kind of guy you'd want your daughter to marry. And Saban was this abusive, loud mouth, obnoxious person who managed to offend even his best friends.
This is Karen Torgaily. She's an epidemiologist and she's writing a biography of Albert Saban. I asked her to tell me more about Saban, this scientist who managed to offend even his best friends.
By all accounts, he had an explosive temper, He was a perfectionist. He had little patience for people who weren't as smart as him, which.
Was basically everybody, right. He was very, very very smart, so.
Pretty much everybody.
Yeah, so that's Saban tell me about Jonah Sulk.
They had some things in common, both from Jewish families. He went to medical school at New York University, just like Saban did, because it was one of the few places that would take Jews in those days. Their paths crossed, probably for the first time woods Whole in Massachusetts.
Woods Hall the Marine Biology Institute.
Yes, so they got to know each other and they were friendly. Salk was kind of like the little brother scientists to Saban, who was by then getting well known.
Okay, and Salk at the time was maybe still in medical school. Yes, yeah, how does he get from medical school to working on polio?
So Salk moved to ann Arbor, Michigan and worked on a vaccine for flu. And the critical part of this is that the flu vaccine was made from a killed virus, not a live virus.
Karen told me that working on this killed virus flu vaccine was a key moment for Salk and really a key moment in the history of vaccines because up until this point, there was basically one way to make a viral vaccine, use a virus that's still alive, but that's attenuated or weak. But the flu vaccine that Salt helped to create was different. It was made using a killed virus,
a virus that had been completely inactivated. So now there were two potential strategies for developing a polio vaccine, attenuated or killed, and there were real trade offs between the two. An attenuated virus will multiply inside the body. This induces a stronger, more robust immune response, which is good, but if you're giving people this kind of vaccine, you better be really sure that their immune system is strong enough to handle it. Otherwise the vaccine might accidentally give people
the very disease that you're trying to prevent. So that's attenuated, and then you have a vaccine made from killed virus, which often requires boosters for long term immunity. And if you're manufacturing a killed virus vaccine, you have to be really sure that all those virus particles are actually dead, that they're totally inactivated. So there are these two options for the polio vaccine, and it really wasn't clear which
one would work better. For Salk and Saban. It was a key fork in the road and they chose different paths. Salk went to work on a killed virus vaccine. Saban chose attenuated. What is Saban's path to choosing an attenuated a weakened vaccine rather than a killed virus vaccine.
His inspiration was Max Steiler, who was given the Nobel Prize for developing yellow fever vaccine, and that was an attenuated vaccine. He was convinced that the live attenuated virus made sense for polio as well.
So Salk sets out to build this killed virus vaccine for polio. What are sort of the key moments in that quest.
There was this sort of elite group of virologists who had their own sort of old boys club, and Sulk was not really in it because he was younger and they didn't see him as being up their caliber. They decided, though, since he was interested in it, that they would put him to work. One thing that he could do is a project for typing the different kinds of polio and figuring out which ones were the virulent ones to humans,
because that had not been done. He had been sort of looking at the different strains and types and thinking, now, if I was going to make a vaccine out of this, which of these would I use? So he sort of had half the work done by the time he was finished typing these Oh.
Interesting, So it seemed like the grunt work, but it was actually like meaningful progress toward the vaccine, right.
Yeah.
So he really surprised everyone when he told them in nineteen fifty three that he had a vaccine for polio and he was ready to test it, and they had to have this field trial. There were two million children involved, and of the two million, they had a sample of people who got the vaccine and people who thought they were getting the vaccine but really didn't, so they were a control group. There was an observed group too that got nothing. Only about half a million actually got the vaccine.
So they do this giant study and what happens.
They got the results and they kept a very secret. April twelfth, nineteen fifty five, came the day when they were going to make the announcement, so people were invited to come to ann Arbor on all people wanted to know does it work? Is it safe? Says basically, yes it's safe, and yes it's effective. And then and the reporters all ran to their phones and they reported, and the church bills rang. You know, there were big, huge headlines in the newspapers. It was just like the end
of World War two. It was that happy of an occasion. Wow.
And so Saban he doesn't have a vaccine yet, he's in fact in the room when when this Sauk announcement is made. How was he feeling at this point?
He was pretty sad. His main worry was that his funding would be cut off.
So let's talk about where Saban is in his research. At this point, he was.
Within a year of having the vaccine that was made from a weekend attenuated stream, and he had tried it on his own daughters.
He tried it on his own daughters.
On his own daughters.
Well, it's interesting to think about, right, because you can think of him giving it to his daughters as like, oh, prep scientist experimenting on his children. But you can also think of it as no, he believes this thing works, and there is this terrifying disease that could paralyze or kill his children, and he has what he has good reason to believe is like an elixir that will protect them.
Yeah, of course he's going to give it to them. Yeah, remember they had to Also, you don't just get the vaccine and that's it. You have to be followed. Then you have to have blood tests, you have to have your stools analyzed to see if you're passing any virus or your stools. So they had to take these little cardboard boxes to school and if they had a bowel movement at school, then they had to give it to their teacher. So they said it was pretty embarrassing.
Anytime my kids tell me that I'm going to embarrass them, I'm going to tell.
Them that story.
On the other hand, I'm not coming up with a vaccine for polio, So it's a trade off. So to go back to before in the sort of first part of the fifties, where Sulk and Saban aware that they were racing with each other, did they feel like they were racing with each other?
Sulk was still the little brother scientist too. They thought, oh, you know, he's nice, he's making progress, but you know, he's not us. He also started to get sort of what they thought of as being uppity in a way that he wouldn't listen to anyone like.
The know it all kid.
Yeah, So for instance, Saban told him, you know, I see that you plan to use the mahoney strain in your vaccine. That is too dangerous to use in a vaccine. If any one of those got through and wasn't killed, it would kill whoever got it. And he said, oh, Albert, I have already made my decision. I've done it on my own experiments, and I'm going to stick with it. So actually what happened was there was an accident and children died from getting the Salk vaccine that was improperly
killed at one of the labs. That started this contention between the two of them. They had been colleagues, they had been friendly with each other, but then it got into sort of open warfare.
So they're having this basically a race, Salk and Saban. They're developing their vaccines in parallel. Salk wins piece, you know, like truly a national hero in the US. There's a massive vaccination campaign, and then not long after that, Saban essentially finishes developing his own vaccine, this very different vaccine, and he winds up taking it to the Soviet Union.
Right, the Soviet Union started to have these terrible polio epidemics and they didn't have a vaccine, and they knew the United States did. Saban was going over and he would carry bials of this polio vaccine seed viruses in his pockets in these boxes just you know, it is jacket. He would show them how to make the vaccine, and so they got very good at producing the vaccine, and they actually immunized seventy seven million people. It stopped their polio epidemics. It just stopped them cold.
Uh huh. I know, the Salck vaccine is a dead virus and the Saban vaccine is a live, attenuated virus. But beyond that, what are the basic differences between them?
Well, so the Salt vaccine was more expensive and it was harder to make and store. The Saban vaccine was easier because you could take it orally and you didn't have to have a trained person to give it. And so they just were able to train people to put a couple of drops of the vaccine virus on cube of sugar. And there's a great little story that goes with that. This little boy he came home from school one day and his dad was a songwriter for Disney, and so he said, oh, son, what'd you do today?
And he said, I got my polio vaccine. He said, oh, that must have hurt. I said, no, you just get these little drops and on a sugar cube and that was it, and so that's how his dad got the idea for Mary Poppins. Spoonful of sugar helps the medicine go down.
So now we have these two effective vaccines in the world. Right, the Sabin vaccine does get approved in the US not long after the Soviet trial. We have the Salk vaccine and the Sabin vaccine. How does that play out in the world.
So in the United States they stopped using the Salk vaccine. Uh why because the Sabin vaccine was cheaper and there was no need to give the Salk vaccine because you could take the Sabin vaccine once and for most people that last your lifetime. But with Salk you had to take the three initial doses and then a booster. It just made sense to switch to the to the Saban vaccine, and most countries did that.
We know that with the Salt vaccine there was that manufacturing risk where in one instance it was manufactured wrong and they made a deadly dose of vaccine. What are the risks of the Saban vaccine.
The Saban vaccine has something called vaccine associated paralytic polio, and it is when someone gets the vaccine who may have an immune disorder, and so even a very weakened poliovirus can cause polio like one in every three million doses or something.
So in the eradication effort that has been going on for the past few decades, which vaccine were they using?
Mostly these Saban vaccine.
Wow, So in a way, Salt was like the hair and Saban was like the tortoise. Like in the end, even though it seemed like Salk one Saban one.
Yeah. Well, and actually the truth is it really takes both vaccines because in our country now, what the recommendation is by the vaccine committees is that you get the Salk vaccine.
Did they ever make up with each other?
No, they didn't, and that It's interesting because one of Sabin's friends said to him one day, Albert, you have got to make up with Jonas. This is ridiculous. You are two grown men, and you just have got to make up. So he made him call Jonah Salk and they had this long, pleasant sounding conversation and at the end of it he said, Okay, well, it's been nice talking to you, and he hung up the phone and he said that Son of a Bitch.
Karen's fourth book is Albert Sabin a fierce joy. It'll be out in twenty twenty four. We'll be right back because of Sock and Saban's polio vaccines. Transmission of polio in the US ended in nineteen seventy nine, but the disease kept spreading in many other parts of the world. Ananda Bandio Patia is a deputy director for Polio at the Bill and Milindigates Foundation. He told me he first saw the impacts of polio when he was growing up in India in the nineteen eighties.
I grew up in Kolkata, a city in the eastern part of India, and I would see polio paralyzed kids in my own community used to play a lot of cricket, as you can imagine, and in our neighborhood there would be these sad instances of kids affected with polio and then all on a sudden, they would stop coming to the playing field. So it was very real.
In nineteen eighty eight, organizations like the CDC and the WHO came together and decided to do with polio what the world had done with smallpox, to wipe it from the face of the earth. At the time, it was estimated that every single day polio paralyzed a thousand children.
India led the way to really establish the proof of concept that polio can be stopped forever, including in complex geographies. And look at India. Now, it's not only the fact that India stopped polio in twenty eleven, it maintained polio free status for all these twelve years or so in between. So that's really a strong message for global health principles of eradication.
Eradicating polio in India took a lot of work and Ananda was part of it. In two thousand and six, Ananda was sent by the WA to a remote part of India, the Kosi River basin in the state of Bihar.
What was going on was this persistence of transmission, which essentially means we were seeing paralyzed children getting reported from these difficult areas of Bihar in the Kosi Basin. Despite that, attempts to vaccinate villages.
In the Kosi River basin were really hard to reach. Roads were fewer, non existent, floods were frequent, and frontline workers like Ananda had to return again and again to make sure that every last child was vaccinated.
To go there, Jacob, just to take you through that journey. I would initially take the project vehicle, it's kind of an suv, and then we would get onto boats. It would take us four hours sometimes five hours to reach those remotest villages. So we would start at four am on those boats. We would target to reach these villages
by a m. Nine am or so. Then we would conduct the vaccination campaigns in coordination with the local government agencies, the medical doctors, female frontline health workers, local villagers would join in. It's almost like a festive you know day it used to be.
And the thing you have to do this is an oral vaccine, right, so you have to put basically a couple drops of this vaccine into the mouth of what every person, every.
Kid, Yes, two drops for all children aged under five.
It's amazing that it's two drops. Like it really is like you have this magic potion, right, like we have it, we have enough of it. And the problem, the global problem, it's like we have to put two drops, just two drops of this potion into the mouth of every child under five.
Absolutely, Jacob. The strategy she was to reach each and every children in those highest risk areas. When we talk about the Kosi River and we talk about the floods. Just to give you a sense of the scale. In two thousand and six, two thousand and seven, the time that I was in there, we are talking about about two and a half million to up to three million people displaced during these floods. I mean, this is almost
like the entire population of Mississippi. You know, when we talk about these visits to these villages where you are essentially operating under a very strict time restriction because you got to get back to the mainland before the sunsets. You know, in dark it becomes very difficult. We're talking about remotest villages with a lot of difficulties. We were not waiting for people to come to us to get vaccinated.
We were going to the folks, to the villagers, to that last child, that last household.
So just to zoom out, like this is this sort of story of your experience broadly, like what is the end of the story of polio in India?
January thirteenth, twenty eleven, was the last time we detected a polio paralyzed child, and interestingly, Jacob this time around, this last child was living essentially ten miles away from my home in Kolkata, So you know, it's very personal when I look back into you know, these children, and also the trajectory of India.
Polio has not yet been eradicate. Where is there still polio in the world and why.
Right now as you and I speak, there are only two countries, to be very precise, a few subnational areas of these two countries, Pakistan and Afghanistan, where polio is still endemic, which really means that in these subnational pockets of these two countries polio has never been stopped or interrupted for a long duration of time. I would say the primary issue in Pakistan Afghanistan is of access, and I think some of the reason is still the geographic complexity.
You can draw parallels to what we saw in a Bihar in India where in some parts there were no road connectivity. In some parts there were nomadic populations always moving around. On top of that, there is the your political unrest, the civil unrest, and also the political turmoil that the two countries are going through.
Let's talk about that in some detail, and we talked about this one region parts of Pakistan and afghan understand where polio is still endemic. And then there's a set of countries primarily in Africa, where there is a risk of reinfection. So, first of all, what does that mean.
Reinfection means if we have a susceptible group of people who are either under vaccinated or unvaccinated, there is always a risk that polio will not only come back, but come back and re establish circulation because poliovirus can essentially
travel through infected people into the polio free areas. And if that area is not only getting exposed to such population coming in, but if it is also under or unvaccinated, then not only the virus comes in, but it comes in and re establishes circulation in the susceptible, under vaccinated population.
Right, Just so unclear these regions where there are problems with reinfection, where are those cases coming from?
It does vary. Given the only two endemic FOSIGN now is in those subnational areas of Pakistan and Afghanistan, typically the source would be from somewhere there.
So if we could knock it out in Pakistan and Afghanistan, we'd be done spot on.
That's the primary and the central goal. We are not only in the last mile, we're probably in that last one hundred meter, you know, dash when it comes to reaching our goals.
So we're coming to the end of this story, right, I mean I hope we're coming to the end of itself. Yes, existing in the world. How are we going to get there? And when? When is it going to happen?
Jacob I wish I had a crystal ball and really answered the when part of the question. However, let's look into the data. Even within Pakistan, it's now cornered into a few districts, a few provinces. But beyond that geographic shrinkage, the genetic lineage shrinking is essentially telling us that the virus is gasping. We need to ensure that we have full momentum for this last push, the final push, to maintain our resolve to reach that last child in that
last village of these areas. I'm very hopeful that it's it's really going to be very soon that we'll see that last child infected with polio and it will stop at that and not spread.
Thanks to my guest today Karen Turgaili and Ananda Bandiopatier on our next episode, how the RSV vaccine could dramatically reduce the number of babies coming into hospital emergency rooms each winter. Also how the development of that vaccine unlocked a whole new approach to targeting viruses.
It's like, I don't know, we're sculptors, and now we have the model of what we need to make the sculpture of, and it allows us to make ideal mimics of these proteins found on the surface of the virus.
Incubation is a co production of Pushkin Industries and Ruby Studio at iHeartMedia. It's produced by Gabriel Hunter Chang, Ariela Markowitz, and Amy Gaines McQuaid. Our editors are Julia Barton and Heron Shakerji, mastering by Anne Pope, fact checking by Joseph Friedman. Our executive producers are Katherine Girardeau and Matt Romano. I'm Jacob Goldstein. Thanks for listening.
Foonful. The sugar helps the medicine go down. Medicine go down, says the same thing over and over again. That's all you have to say.
Very good, very good.