1 00:00:02,080 --> 00:00:04,760 Speaker 1: In the first decades of the twentieth century, parents in 2 00:00:04,800 --> 00:00:10,760 Speaker 1: the United States lived in terror of polio. CDC is 3 00:00:10,840 --> 00:00:15,000 Speaker 1: trying to solve the riddle of poliomyolsis, which kills or 4 00:00:15,040 --> 00:00:19,480 Speaker 1: paralyzes thousands of people every year. Doctors didn't know how 5 00:00:19,480 --> 00:00:22,320 Speaker 1: the disease spread or how to treat it. What they 6 00:00:22,320 --> 00:00:24,880 Speaker 1: did know is that it mainly struck children, and that 7 00:00:24,920 --> 00:00:28,400 Speaker 1: it left many of its victims paralyzed, often for life. 8 00:00:28,480 --> 00:00:31,720 Speaker 1: As the century progressed, the disease kept becoming more common. 9 00:00:32,040 --> 00:00:35,960 Speaker 1: In nineteen fifty two alone, polio paralyzed three thousand children 10 00:00:36,000 --> 00:00:39,800 Speaker 1: in the US. One pole of American parents found that 11 00:00:39,800 --> 00:00:44,239 Speaker 1: polio was their second greatest fear, right behind atomic apocalypse. 12 00:00:46,880 --> 00:00:50,200 Speaker 1: The science of understanding viruses and developing vaccines had come 13 00:00:50,200 --> 00:00:52,440 Speaker 1: a long way since the era of Edward Jenner that 14 00:00:52,479 --> 00:00:55,400 Speaker 1: we talked about last week. Still, by the middle of 15 00:00:55,440 --> 00:00:58,760 Speaker 1: the twentieth century, there was no vaccine to prevent polio, 16 00:00:59,120 --> 00:01:02,080 Speaker 1: but scientists were about to develop not one polio vaccine, 17 00:01:02,240 --> 00:01:05,760 Speaker 1: but two, and to this day we use these two 18 00:01:06,120 --> 00:01:09,600 Speaker 1: very different kinds of vaccines to immunize people around the 19 00:01:09,600 --> 00:01:15,520 Speaker 1: world against polio. On today's show, we'll tell the story 20 00:01:15,520 --> 00:01:18,800 Speaker 1: of the cutthroat scientific rivalry that resulted in one of 21 00:01:18,840 --> 00:01:23,520 Speaker 1: the greatest triumphs in American medicine, maybe two of the 22 00:01:23,520 --> 00:01:33,000 Speaker 1: greatest triumphs. I'm Jacob Goldstein. This is incubation. So both 23 00:01:33,040 --> 00:01:36,039 Speaker 1: of these vaccines protect people from polio, but they work 24 00:01:36,120 --> 00:01:39,480 Speaker 1: in profoundly different ways. This is also true of the 25 00:01:39,560 --> 00:01:43,440 Speaker 1: scientists who developed the vaccines, Jonah Salk and Albert Saban. 26 00:01:44,600 --> 00:01:50,280 Speaker 2: Salk was everyone's idea of a hero. He was like Superman. 27 00:01:51,200 --> 00:01:55,280 Speaker 2: He was good looking, he was soft spoken, polite, He's 28 00:01:55,360 --> 00:01:58,800 Speaker 2: like the kind of guy you'd want your daughter to marry. 29 00:01:59,760 --> 00:02:07,800 Speaker 2: And Saban was this abusive, loud mouth, obnoxious person who 30 00:02:07,840 --> 00:02:10,600 Speaker 2: managed to offend even his best friends. 31 00:02:11,080 --> 00:02:14,440 Speaker 1: This is Karen Torgaily. She's an epidemiologist and she's writing 32 00:02:14,440 --> 00:02:17,160 Speaker 1: a biography of Albert Saban. I asked her to tell 33 00:02:17,160 --> 00:02:20,200 Speaker 1: me more about Saban, this scientist who managed to offend 34 00:02:20,280 --> 00:02:21,480 Speaker 1: even his best friends. 35 00:02:21,840 --> 00:02:27,520 Speaker 2: By all accounts, he had an explosive temper, He was 36 00:02:27,600 --> 00:02:31,880 Speaker 2: a perfectionist. He had little patience for people who weren't 37 00:02:31,880 --> 00:02:33,680 Speaker 2: as smart as him, which. 38 00:02:33,440 --> 00:02:36,840 Speaker 1: Was basically everybody, right. He was very, very very smart, so. 39 00:02:36,880 --> 00:02:38,040 Speaker 2: Pretty much everybody. 40 00:02:38,120 --> 00:02:42,280 Speaker 1: Yeah, so that's Saban tell me about Jonah Sulk. 41 00:02:43,280 --> 00:02:45,959 Speaker 2: They had some things in common, both from Jewish families. 42 00:02:46,200 --> 00:02:49,800 Speaker 2: He went to medical school at New York University, just 43 00:02:49,880 --> 00:02:52,639 Speaker 2: like Saban did, because it was one of the few 44 00:02:52,680 --> 00:02:57,639 Speaker 2: places that would take Jews in those days. Their paths crossed, 45 00:02:57,919 --> 00:03:03,440 Speaker 2: probably for the first time woods Whole in Massachusetts. 46 00:03:02,760 --> 00:03:05,959 Speaker 1: Woods Hall the Marine Biology Institute. 47 00:03:06,160 --> 00:03:09,040 Speaker 2: Yes, so they got to know each other and they 48 00:03:09,080 --> 00:03:12,560 Speaker 2: were friendly. Salk was kind of like the little brother 49 00:03:12,720 --> 00:03:17,280 Speaker 2: scientists to Saban, who was by then getting well known. 50 00:03:17,400 --> 00:03:19,480 Speaker 1: Okay, and Salk at the time was maybe still in 51 00:03:19,560 --> 00:03:22,959 Speaker 1: medical school. Yes, yeah, how does he get from medical 52 00:03:22,960 --> 00:03:24,520 Speaker 1: school to working on polio? 53 00:03:25,120 --> 00:03:28,920 Speaker 2: So Salk moved to ann Arbor, Michigan and worked on 54 00:03:29,800 --> 00:03:33,680 Speaker 2: a vaccine for flu. And the critical part of this 55 00:03:34,000 --> 00:03:38,800 Speaker 2: is that the flu vaccine was made from a killed virus, 56 00:03:39,480 --> 00:03:40,560 Speaker 2: not a live virus. 57 00:03:42,720 --> 00:03:45,280 Speaker 1: Karen told me that working on this killed virus flu 58 00:03:45,360 --> 00:03:48,440 Speaker 1: vaccine was a key moment for Salk and really a 59 00:03:48,520 --> 00:03:52,120 Speaker 1: key moment in the history of vaccines because up until 60 00:03:52,120 --> 00:03:54,280 Speaker 1: this point, there was basically one way to make a 61 00:03:54,360 --> 00:03:58,640 Speaker 1: viral vaccine, use a virus that's still alive, but that's 62 00:03:58,800 --> 00:04:02,600 Speaker 1: attenuated or weak. But the flu vaccine that Salt helped 63 00:04:02,600 --> 00:04:06,320 Speaker 1: to create was different. It was made using a killed virus, 64 00:04:06,680 --> 00:04:11,600 Speaker 1: a virus that had been completely inactivated. So now there 65 00:04:11,600 --> 00:04:16,320 Speaker 1: were two potential strategies for developing a polio vaccine, attenuated 66 00:04:16,560 --> 00:04:19,800 Speaker 1: or killed, and there were real trade offs between the two. 67 00:04:20,400 --> 00:04:24,480 Speaker 1: An attenuated virus will multiply inside the body. This induces 68 00:04:24,640 --> 00:04:28,760 Speaker 1: a stronger, more robust immune response, which is good, but 69 00:04:29,040 --> 00:04:32,080 Speaker 1: if you're giving people this kind of vaccine, you better 70 00:04:32,120 --> 00:04:34,880 Speaker 1: be really sure that their immune system is strong enough 71 00:04:34,920 --> 00:04:38,440 Speaker 1: to handle it. Otherwise the vaccine might accidentally give people 72 00:04:38,520 --> 00:04:42,520 Speaker 1: the very disease that you're trying to prevent. So that's attenuated, 73 00:04:42,760 --> 00:04:45,120 Speaker 1: and then you have a vaccine made from killed virus, 74 00:04:45,240 --> 00:04:49,320 Speaker 1: which often requires boosters for long term immunity. And if 75 00:04:49,360 --> 00:04:52,279 Speaker 1: you're manufacturing a killed virus vaccine, you have to be 76 00:04:52,400 --> 00:04:56,159 Speaker 1: really sure that all those virus particles are actually dead, 77 00:04:56,320 --> 00:05:00,760 Speaker 1: that they're totally inactivated. So there are these two options 78 00:05:00,800 --> 00:05:04,440 Speaker 1: for the polio vaccine, and it really wasn't clear which 79 00:05:04,480 --> 00:05:07,159 Speaker 1: one would work better. For Salk and Saban. It was 80 00:05:07,200 --> 00:05:10,120 Speaker 1: a key fork in the road and they chose different paths. 81 00:05:10,640 --> 00:05:13,760 Speaker 1: Salk went to work on a killed virus vaccine. Saban 82 00:05:13,960 --> 00:05:19,720 Speaker 1: chose attenuated. What is Saban's path to choosing an attenuated 83 00:05:19,760 --> 00:05:23,080 Speaker 1: a weakened vaccine rather than a killed virus vaccine. 84 00:05:23,440 --> 00:05:29,360 Speaker 2: His inspiration was Max Steiler, who was given the Nobel 85 00:05:29,440 --> 00:05:33,560 Speaker 2: Prize for developing yellow fever vaccine, and that was an 86 00:05:33,560 --> 00:05:39,520 Speaker 2: attenuated vaccine. He was convinced that the live attenuated virus 87 00:05:39,560 --> 00:05:41,559 Speaker 2: made sense for polio as well. 88 00:05:42,200 --> 00:05:46,600 Speaker 1: So Salk sets out to build this killed virus vaccine 89 00:05:46,640 --> 00:05:49,960 Speaker 1: for polio. What are sort of the key moments in 90 00:05:50,000 --> 00:05:51,520 Speaker 1: that quest. 91 00:05:52,279 --> 00:05:56,040 Speaker 2: There was this sort of elite group of virologists who 92 00:05:56,960 --> 00:06:00,559 Speaker 2: had their own sort of old boys club, and Sulk 93 00:06:00,720 --> 00:06:03,280 Speaker 2: was not really in it because he was younger and 94 00:06:03,320 --> 00:06:08,919 Speaker 2: they didn't see him as being up their caliber. They decided, though, 95 00:06:09,200 --> 00:06:11,400 Speaker 2: since he was interested in it, that they would put 96 00:06:11,480 --> 00:06:14,520 Speaker 2: him to work. One thing that he could do is 97 00:06:15,000 --> 00:06:19,440 Speaker 2: a project for typing the different kinds of polio and 98 00:06:19,640 --> 00:06:22,680 Speaker 2: figuring out which ones were the virulent ones to humans, 99 00:06:23,720 --> 00:06:27,360 Speaker 2: because that had not been done. He had been sort 100 00:06:27,400 --> 00:06:31,720 Speaker 2: of looking at the different strains and types and thinking, now, 101 00:06:31,720 --> 00:06:33,560 Speaker 2: if I was going to make a vaccine out of this, 102 00:06:33,839 --> 00:06:37,800 Speaker 2: which of these would I use? So he sort of 103 00:06:37,839 --> 00:06:39,640 Speaker 2: had half the work done by the time he was 104 00:06:39,640 --> 00:06:41,679 Speaker 2: finished typing these Oh. 105 00:06:41,520 --> 00:06:44,120 Speaker 1: Interesting, So it seemed like the grunt work, but it 106 00:06:44,160 --> 00:06:49,159 Speaker 1: was actually like meaningful progress toward the vaccine, right. 107 00:06:49,480 --> 00:06:49,800 Speaker 3: Yeah. 108 00:06:50,520 --> 00:06:54,520 Speaker 2: So he really surprised everyone when he told them in 109 00:06:54,600 --> 00:06:59,719 Speaker 2: nineteen fifty three that he had a vaccine for polio 110 00:07:00,720 --> 00:07:07,320 Speaker 2: and he was ready to test it, and they had 111 00:07:07,360 --> 00:07:13,400 Speaker 2: to have this field trial. There were two million children involved, 112 00:07:13,960 --> 00:07:17,080 Speaker 2: and of the two million, they had a sample of 113 00:07:17,160 --> 00:07:20,680 Speaker 2: people who got the vaccine and people who thought they 114 00:07:20,680 --> 00:07:23,480 Speaker 2: were getting the vaccine but really didn't, so they were 115 00:07:23,520 --> 00:07:27,240 Speaker 2: a control group. There was an observed group too that 116 00:07:27,560 --> 00:07:32,920 Speaker 2: got nothing. Only about half a million actually got the vaccine. 117 00:07:33,240 --> 00:07:36,720 Speaker 1: So they do this giant study and what happens. 118 00:07:37,280 --> 00:07:40,560 Speaker 2: They got the results and they kept a very secret. 119 00:07:41,400 --> 00:07:45,480 Speaker 2: April twelfth, nineteen fifty five, came the day when they 120 00:07:45,520 --> 00:07:48,360 Speaker 2: were going to make the announcement, so people were invited 121 00:07:48,400 --> 00:07:51,680 Speaker 2: to come to ann Arbor on all people wanted to 122 00:07:51,720 --> 00:07:57,120 Speaker 2: know does it work? Is it safe? Says basically, yes 123 00:07:57,240 --> 00:08:00,200 Speaker 2: it's safe, and yes it's effective. And then and the 124 00:08:00,240 --> 00:08:03,560 Speaker 2: reporters all ran to their phones and they reported, and 125 00:08:03,680 --> 00:08:08,880 Speaker 2: the church bills rang. You know, there were big, huge 126 00:08:09,000 --> 00:08:12,560 Speaker 2: headlines in the newspapers. It was just like the end 127 00:08:12,640 --> 00:08:17,800 Speaker 2: of World War two. It was that happy of an occasion. Wow. 128 00:08:18,200 --> 00:08:22,800 Speaker 1: And so Saban he doesn't have a vaccine yet, he's 129 00:08:22,800 --> 00:08:26,560 Speaker 1: in fact in the room when when this Sauk announcement 130 00:08:26,640 --> 00:08:29,360 Speaker 1: is made. How was he feeling at this point? 131 00:08:29,600 --> 00:08:33,640 Speaker 2: He was pretty sad. His main worry was that his 132 00:08:33,760 --> 00:08:35,040 Speaker 2: funding would be cut off. 133 00:08:35,720 --> 00:08:38,959 Speaker 1: So let's talk about where Saban is in his research. 134 00:08:39,480 --> 00:08:41,079 Speaker 1: At this point, he was. 135 00:08:41,040 --> 00:08:44,959 Speaker 2: Within a year of having the vaccine that was made 136 00:08:44,960 --> 00:08:49,880 Speaker 2: from a weekend attenuated stream, and he had tried it 137 00:08:49,920 --> 00:08:51,000 Speaker 2: on his own daughters. 138 00:08:51,559 --> 00:08:53,479 Speaker 1: He tried it on his own daughters. 139 00:08:53,120 --> 00:08:54,160 Speaker 2: On his own daughters. 140 00:08:54,800 --> 00:08:57,480 Speaker 1: Well, it's interesting to think about, right, because you can 141 00:08:57,520 --> 00:08:59,880 Speaker 1: think of him giving it to his daughters as like, oh, 142 00:09:00,040 --> 00:09:03,240 Speaker 1: prep scientist experimenting on his children. But you can also 143 00:09:03,240 --> 00:09:05,720 Speaker 1: think of it as no, he believes this thing works, 144 00:09:05,760 --> 00:09:08,719 Speaker 1: and there is this terrifying disease that could paralyze or 145 00:09:08,800 --> 00:09:12,200 Speaker 1: kill his children, and he has what he has good 146 00:09:12,240 --> 00:09:15,640 Speaker 1: reason to believe is like an elixir that will protect them. 147 00:09:15,720 --> 00:09:17,679 Speaker 2: Yeah, of course he's going to give it to them. Yeah, 148 00:09:17,760 --> 00:09:20,280 Speaker 2: remember they had to Also, you don't just get the 149 00:09:20,360 --> 00:09:23,679 Speaker 2: vaccine and that's it. You have to be followed. Then 150 00:09:23,760 --> 00:09:26,160 Speaker 2: you have to have blood tests, you have to have 151 00:09:26,360 --> 00:09:30,679 Speaker 2: your stools analyzed to see if you're passing any virus 152 00:09:30,800 --> 00:09:32,640 Speaker 2: or your stools. So they had to take these little 153 00:09:32,679 --> 00:09:36,640 Speaker 2: cardboard boxes to school and if they had a bowel 154 00:09:36,679 --> 00:09:39,040 Speaker 2: movement at school, then they had to give it to 155 00:09:39,080 --> 00:09:42,319 Speaker 2: their teacher. So they said it was pretty embarrassing. 156 00:09:43,360 --> 00:09:45,800 Speaker 1: Anytime my kids tell me that I'm going to embarrass them, 157 00:09:45,880 --> 00:09:46,760 Speaker 1: I'm going to tell. 158 00:09:46,600 --> 00:09:47,400 Speaker 2: Them that story. 159 00:09:48,760 --> 00:09:50,280 Speaker 1: On the other hand, I'm not coming up with a 160 00:09:50,360 --> 00:09:53,960 Speaker 1: vaccine for polio, So it's a trade off. So to 161 00:09:54,000 --> 00:09:55,920 Speaker 1: go back to before in the sort of first part 162 00:09:55,960 --> 00:10:00,199 Speaker 1: of the fifties, where Sulk and Saban aware that they 163 00:10:00,200 --> 00:10:02,160 Speaker 1: were racing with each other, did they feel like they 164 00:10:02,160 --> 00:10:03,240 Speaker 1: were racing with each other? 165 00:10:04,120 --> 00:10:08,400 Speaker 2: Sulk was still the little brother scientist too. They thought, oh, 166 00:10:08,600 --> 00:10:11,160 Speaker 2: you know, he's nice, he's making progress, but you know, 167 00:10:11,240 --> 00:10:14,640 Speaker 2: he's not us. He also started to get sort of 168 00:10:14,679 --> 00:10:18,719 Speaker 2: what they thought of as being uppity in a way 169 00:10:18,760 --> 00:10:20,719 Speaker 2: that he wouldn't listen to anyone like. 170 00:10:20,679 --> 00:10:21,760 Speaker 1: The know it all kid. 171 00:10:22,080 --> 00:10:27,320 Speaker 2: Yeah, So for instance, Saban told him, you know, I 172 00:10:27,360 --> 00:10:31,280 Speaker 2: see that you plan to use the mahoney strain in 173 00:10:31,320 --> 00:10:35,400 Speaker 2: your vaccine. That is too dangerous to use in a vaccine. 174 00:10:35,520 --> 00:10:38,440 Speaker 2: If any one of those got through and wasn't killed, 175 00:10:39,080 --> 00:10:42,640 Speaker 2: it would kill whoever got it. And he said, oh, Albert, 176 00:10:42,679 --> 00:10:46,160 Speaker 2: I have already made my decision. I've done it on 177 00:10:46,760 --> 00:10:49,120 Speaker 2: my own experiments, and I'm going to stick with it. 178 00:10:50,080 --> 00:10:54,520 Speaker 2: So actually what happened was there was an accident and 179 00:10:55,240 --> 00:10:58,840 Speaker 2: children died from getting the Salk vaccine that was improperly 180 00:10:59,520 --> 00:11:04,400 Speaker 2: killed at one of the labs. That started this contention 181 00:11:04,679 --> 00:11:07,640 Speaker 2: between the two of them. They had been colleagues, they 182 00:11:07,840 --> 00:11:10,520 Speaker 2: had been friendly with each other, but then it got 183 00:11:10,559 --> 00:11:12,719 Speaker 2: into sort of open warfare. 184 00:11:14,320 --> 00:11:17,560 Speaker 1: So they're having this basically a race, Salk and Saban. 185 00:11:17,800 --> 00:11:22,280 Speaker 1: They're developing their vaccines in parallel. Salk wins piece, you know, 186 00:11:22,480 --> 00:11:25,760 Speaker 1: like truly a national hero in the US. There's a 187 00:11:25,800 --> 00:11:30,240 Speaker 1: massive vaccination campaign, and then not long after that, Saban 188 00:11:30,840 --> 00:11:34,920 Speaker 1: essentially finishes developing his own vaccine, this very different vaccine, 189 00:11:35,080 --> 00:11:37,320 Speaker 1: and he winds up taking it to the Soviet Union. 190 00:11:37,520 --> 00:11:41,760 Speaker 2: Right, the Soviet Union started to have these terrible polio 191 00:11:41,880 --> 00:11:45,480 Speaker 2: epidemics and they didn't have a vaccine, and they knew 192 00:11:45,480 --> 00:11:49,360 Speaker 2: the United States did. Saban was going over and he 193 00:11:49,400 --> 00:11:53,800 Speaker 2: would carry bials of this polio vaccine seed viruses in 194 00:11:53,880 --> 00:12:00,680 Speaker 2: his pockets in these boxes just you know, it is jacket. 195 00:12:01,080 --> 00:12:03,640 Speaker 2: He would show them how to make the vaccine, and 196 00:12:03,679 --> 00:12:06,760 Speaker 2: so they got very good at producing the vaccine, and 197 00:12:06,800 --> 00:12:12,200 Speaker 2: they actually immunized seventy seven million people. It stopped their 198 00:12:12,679 --> 00:12:15,120 Speaker 2: polio epidemics. It just stopped them cold. 199 00:12:15,200 --> 00:12:17,559 Speaker 1: Uh huh. I know, the Salck vaccine is a dead 200 00:12:17,720 --> 00:12:20,640 Speaker 1: virus and the Saban vaccine is a live, attenuated virus. 201 00:12:20,640 --> 00:12:23,760 Speaker 1: But beyond that, what are the basic differences between them? 202 00:12:24,000 --> 00:12:28,080 Speaker 2: Well, so the Salt vaccine was more expensive and it 203 00:12:28,160 --> 00:12:30,880 Speaker 2: was harder to make and store. The Saban vaccine was 204 00:12:31,480 --> 00:12:35,120 Speaker 2: easier because you could take it orally and you didn't 205 00:12:35,160 --> 00:12:37,640 Speaker 2: have to have a trained person to give it. And 206 00:12:37,760 --> 00:12:40,880 Speaker 2: so they just were able to train people to put 207 00:12:41,000 --> 00:12:46,240 Speaker 2: a couple of drops of the vaccine virus on cube 208 00:12:46,280 --> 00:12:49,760 Speaker 2: of sugar. And there's a great little story that goes 209 00:12:49,760 --> 00:12:52,600 Speaker 2: with that. This little boy he came home from school 210 00:12:52,640 --> 00:12:56,120 Speaker 2: one day and his dad was a songwriter for Disney, 211 00:12:56,920 --> 00:13:00,520 Speaker 2: and so he said, oh, son, what'd you do today? 212 00:13:00,559 --> 00:13:03,800 Speaker 2: And he said, I got my polio vaccine. He said, oh, 213 00:13:03,880 --> 00:13:06,880 Speaker 2: that must have hurt. I said, no, you just get 214 00:13:06,880 --> 00:13:10,360 Speaker 2: these little drops and on a sugar cube and that 215 00:13:10,480 --> 00:13:15,640 Speaker 2: was it, and so that's how his dad got the 216 00:13:15,679 --> 00:13:19,400 Speaker 2: idea for Mary Poppins. Spoonful of sugar helps the medicine 217 00:13:19,400 --> 00:13:19,760 Speaker 2: go down. 218 00:13:21,920 --> 00:13:26,000 Speaker 1: So now we have these two effective vaccines in the world. Right, 219 00:13:26,080 --> 00:13:28,400 Speaker 1: the Sabin vaccine does get approved in the US not 220 00:13:28,520 --> 00:13:31,559 Speaker 1: long after the Soviet trial. We have the Salk vaccine 221 00:13:32,240 --> 00:13:34,959 Speaker 1: and the Sabin vaccine. How does that play out in 222 00:13:35,000 --> 00:13:35,480 Speaker 1: the world. 223 00:13:35,800 --> 00:13:40,040 Speaker 2: So in the United States they stopped using the Salk vaccine. 224 00:13:41,000 --> 00:13:45,679 Speaker 2: Uh why because the Sabin vaccine was cheaper and there 225 00:13:45,720 --> 00:13:48,720 Speaker 2: was no need to give the Salk vaccine because you 226 00:13:48,760 --> 00:13:52,920 Speaker 2: could take the Sabin vaccine once and for most people 227 00:13:52,960 --> 00:13:56,400 Speaker 2: that last your lifetime. But with Salk you had to 228 00:13:56,440 --> 00:13:59,440 Speaker 2: take the three initial doses and then a booster. It 229 00:13:59,520 --> 00:14:03,280 Speaker 2: just made sense to switch to the to the Saban vaccine, 230 00:14:03,320 --> 00:14:04,520 Speaker 2: and most countries did that. 231 00:14:05,440 --> 00:14:07,480 Speaker 1: We know that with the Salt vaccine there was that 232 00:14:08,160 --> 00:14:12,480 Speaker 1: manufacturing risk where in one instance it was manufactured wrong 233 00:14:12,520 --> 00:14:15,880 Speaker 1: and they made a deadly dose of vaccine. What are 234 00:14:15,920 --> 00:14:18,800 Speaker 1: the risks of the Saban vaccine. 235 00:14:19,120 --> 00:14:24,560 Speaker 2: The Saban vaccine has something called vaccine associated paralytic polio, 236 00:14:25,640 --> 00:14:29,040 Speaker 2: and it is when someone gets the vaccine who may 237 00:14:29,200 --> 00:14:34,520 Speaker 2: have an immune disorder, and so even a very weakened 238 00:14:34,560 --> 00:14:40,560 Speaker 2: poliovirus can cause polio like one in every three million 239 00:14:40,640 --> 00:14:41,800 Speaker 2: doses or something. 240 00:14:42,160 --> 00:14:46,160 Speaker 1: So in the eradication effort that has been going on 241 00:14:46,240 --> 00:14:50,120 Speaker 1: for the past few decades, which vaccine were they using? 242 00:14:50,440 --> 00:14:53,120 Speaker 2: Mostly these Saban vaccine. 243 00:14:53,320 --> 00:14:56,880 Speaker 1: Wow, So in a way, Salt was like the hair 244 00:14:57,360 --> 00:14:59,520 Speaker 1: and Saban was like the tortoise. Like in the end, 245 00:14:59,600 --> 00:15:02,400 Speaker 1: even though it seemed like Salk one Saban one. 246 00:15:02,520 --> 00:15:06,440 Speaker 2: Yeah. Well, and actually the truth is it really takes 247 00:15:06,480 --> 00:15:10,840 Speaker 2: both vaccines because in our country now, what the recommendation 248 00:15:11,080 --> 00:15:14,200 Speaker 2: is by the vaccine committees is that you get the 249 00:15:14,240 --> 00:15:16,040 Speaker 2: Salk vaccine. 250 00:15:16,280 --> 00:15:20,600 Speaker 1: Did they ever make up with each other? 251 00:15:21,600 --> 00:15:25,800 Speaker 2: No, they didn't, and that It's interesting because one of 252 00:15:26,200 --> 00:15:30,560 Speaker 2: Sabin's friends said to him one day, Albert, you have 253 00:15:30,720 --> 00:15:34,080 Speaker 2: got to make up with Jonas. This is ridiculous. You 254 00:15:34,160 --> 00:15:36,720 Speaker 2: are two grown men, and you just have got to 255 00:15:36,760 --> 00:15:40,320 Speaker 2: make up. So he made him call Jonah Salk and 256 00:15:40,400 --> 00:15:46,160 Speaker 2: they had this long, pleasant sounding conversation and at the 257 00:15:46,280 --> 00:15:49,000 Speaker 2: end of it he said, Okay, well, it's been nice 258 00:15:49,040 --> 00:15:51,880 Speaker 2: talking to you, and he hung up the phone and 259 00:15:51,960 --> 00:15:53,880 Speaker 2: he said that Son of a Bitch. 260 00:15:59,240 --> 00:16:03,280 Speaker 1: Karen's fourth book is Albert Sabin a fierce joy. It'll 261 00:16:03,280 --> 00:16:06,280 Speaker 1: be out in twenty twenty four. We'll be right back 262 00:16:12,920 --> 00:16:16,520 Speaker 1: because of Sock and Saban's polio vaccines. Transmission of polio 263 00:16:16,600 --> 00:16:19,400 Speaker 1: in the US ended in nineteen seventy nine, but the 264 00:16:19,480 --> 00:16:21,720 Speaker 1: disease kept spreading in many other parts of the world. 265 00:16:22,600 --> 00:16:26,160 Speaker 1: Ananda Bandio Patia is a deputy director for Polio at 266 00:16:26,160 --> 00:16:29,160 Speaker 1: the Bill and Milindigates Foundation. He told me he first 267 00:16:29,200 --> 00:16:31,320 Speaker 1: saw the impacts of polio when he was growing up 268 00:16:31,320 --> 00:16:32,760 Speaker 1: in India in the nineteen eighties. 269 00:16:33,440 --> 00:16:36,640 Speaker 3: I grew up in Kolkata, a city in the eastern 270 00:16:36,760 --> 00:16:41,640 Speaker 3: part of India, and I would see polio paralyzed kids 271 00:16:42,120 --> 00:16:44,880 Speaker 3: in my own community used to play a lot of cricket, 272 00:16:45,040 --> 00:16:48,840 Speaker 3: as you can imagine, and in our neighborhood there would 273 00:16:48,920 --> 00:16:54,320 Speaker 3: be these sad instances of kids affected with polio and 274 00:16:54,400 --> 00:16:56,760 Speaker 3: then all on a sudden, they would stop coming to 275 00:16:56,840 --> 00:16:59,320 Speaker 3: the playing field. So it was very real. 276 00:17:00,400 --> 00:17:03,480 Speaker 1: In nineteen eighty eight, organizations like the CDC and the 277 00:17:03,560 --> 00:17:06,760 Speaker 1: WHO came together and decided to do with polio what 278 00:17:06,880 --> 00:17:10,440 Speaker 1: the world had done with smallpox, to wipe it from 279 00:17:10,440 --> 00:17:13,679 Speaker 1: the face of the earth. At the time, it was 280 00:17:13,800 --> 00:17:18,560 Speaker 1: estimated that every single day polio paralyzed a thousand children. 281 00:17:19,760 --> 00:17:23,879 Speaker 3: India led the way to really establish the proof of 282 00:17:24,040 --> 00:17:32,280 Speaker 3: concept that polio can be stopped forever, including in complex geographies. 283 00:17:32,600 --> 00:17:35,840 Speaker 3: And look at India. Now, it's not only the fact 284 00:17:35,840 --> 00:17:41,320 Speaker 3: that India stopped polio in twenty eleven, it maintained polio 285 00:17:41,359 --> 00:17:46,399 Speaker 3: free status for all these twelve years or so in between. 286 00:17:47,160 --> 00:17:51,639 Speaker 3: So that's really a strong message for global health principles 287 00:17:51,680 --> 00:17:52,400 Speaker 3: of eradication. 288 00:17:53,720 --> 00:17:56,200 Speaker 1: Eradicating polio in India took a lot of work and 289 00:17:56,240 --> 00:17:58,480 Speaker 1: Ananda was part of it. In two thousand and six, 290 00:17:58,520 --> 00:18:01,440 Speaker 1: Ananda was sent by the WA to a remote part 291 00:18:01,480 --> 00:18:04,560 Speaker 1: of India, the Kosi River basin in the state of Bihar. 292 00:18:05,640 --> 00:18:10,200 Speaker 3: What was going on was this persistence of transmission, which 293 00:18:10,320 --> 00:18:16,200 Speaker 3: essentially means we were seeing paralyzed children getting reported from 294 00:18:16,320 --> 00:18:22,600 Speaker 3: these difficult areas of Bihar in the Kosi Basin. Despite that, 295 00:18:22,640 --> 00:18:25,399 Speaker 3: attempts to vaccinate villages. 296 00:18:25,040 --> 00:18:27,440 Speaker 1: In the Kosi River basin were really hard to reach. 297 00:18:27,920 --> 00:18:31,640 Speaker 1: Roads were fewer, non existent, floods were frequent, and frontline 298 00:18:31,640 --> 00:18:34,520 Speaker 1: workers like Ananda had to return again and again to 299 00:18:34,560 --> 00:18:37,120 Speaker 1: make sure that every last child was vaccinated. 300 00:18:37,920 --> 00:18:41,560 Speaker 3: To go there, Jacob, just to take you through that journey. 301 00:18:41,760 --> 00:18:45,159 Speaker 3: I would initially take the project vehicle, it's kind of 302 00:18:45,240 --> 00:18:49,719 Speaker 3: an suv, and then we would get onto boats. It 303 00:18:49,760 --> 00:18:54,399 Speaker 3: would take us four hours sometimes five hours to reach 304 00:18:54,640 --> 00:18:59,560 Speaker 3: those remotest villages. So we would start at four am 305 00:19:00,200 --> 00:19:05,040 Speaker 3: on those boats. We would target to reach these villages 306 00:19:05,119 --> 00:19:09,600 Speaker 3: by a m. Nine am or so. Then we would 307 00:19:10,040 --> 00:19:16,240 Speaker 3: conduct the vaccination campaigns in coordination with the local government agencies, 308 00:19:16,320 --> 00:19:22,879 Speaker 3: the medical doctors, female frontline health workers, local villagers would 309 00:19:22,960 --> 00:19:27,040 Speaker 3: join in. It's almost like a festive you know day 310 00:19:27,240 --> 00:19:27,960 Speaker 3: it used to be. 311 00:19:28,160 --> 00:19:29,560 Speaker 1: And the thing you have to do this is an 312 00:19:29,640 --> 00:19:32,159 Speaker 1: oral vaccine, right, so you have to put basically a 313 00:19:32,200 --> 00:19:35,879 Speaker 1: couple drops of this vaccine into the mouth of what 314 00:19:36,160 --> 00:19:37,840 Speaker 1: every person, every. 315 00:19:37,720 --> 00:19:42,680 Speaker 3: Kid, Yes, two drops for all children aged under five. 316 00:19:43,520 --> 00:19:46,480 Speaker 1: It's amazing that it's two drops. Like it really is 317 00:19:46,520 --> 00:19:48,919 Speaker 1: like you have this magic potion, right, like we have it, 318 00:19:49,200 --> 00:19:51,879 Speaker 1: we have enough of it. And the problem, the global problem, 319 00:19:51,880 --> 00:19:54,200 Speaker 1: it's like we have to put two drops, just two 320 00:19:54,320 --> 00:19:57,280 Speaker 1: drops of this potion into the mouth of every child 321 00:19:57,400 --> 00:19:57,920 Speaker 1: under five. 322 00:19:58,000 --> 00:20:02,159 Speaker 3: Absolutely, Jacob. The strategy she was to reach each and 323 00:20:02,480 --> 00:20:08,000 Speaker 3: every children in those highest risk areas. When we talk 324 00:20:08,080 --> 00:20:12,320 Speaker 3: about the Kosi River and we talk about the floods. 325 00:20:13,000 --> 00:20:15,720 Speaker 3: Just to give you a sense of the scale. In 326 00:20:15,800 --> 00:20:18,640 Speaker 3: two thousand and six, two thousand and seven, the time 327 00:20:18,680 --> 00:20:21,840 Speaker 3: that I was in there, we are talking about about 328 00:20:21,960 --> 00:20:26,440 Speaker 3: two and a half million to up to three million 329 00:20:27,320 --> 00:20:33,359 Speaker 3: people displaced during these floods. I mean, this is almost 330 00:20:33,440 --> 00:20:38,040 Speaker 3: like the entire population of Mississippi. You know, when we 331 00:20:38,119 --> 00:20:41,720 Speaker 3: talk about these visits to these villages where you are 332 00:20:41,840 --> 00:20:49,520 Speaker 3: essentially operating under a very strict time restriction because you 333 00:20:49,640 --> 00:20:53,560 Speaker 3: got to get back to the mainland before the sunsets. 334 00:20:53,640 --> 00:20:56,960 Speaker 3: You know, in dark it becomes very difficult. We're talking 335 00:20:57,000 --> 00:21:02,800 Speaker 3: about remotest villages with a lot of difficulties. We were 336 00:21:02,880 --> 00:21:07,440 Speaker 3: not waiting for people to come to us to get vaccinated. 337 00:21:08,160 --> 00:21:11,960 Speaker 3: We were going to the folks, to the villagers, to 338 00:21:12,040 --> 00:21:15,160 Speaker 3: that last child, that last household. 339 00:21:19,600 --> 00:21:22,120 Speaker 1: So just to zoom out, like this is this sort 340 00:21:22,119 --> 00:21:25,280 Speaker 1: of story of your experience broadly, like what is the 341 00:21:26,280 --> 00:21:28,119 Speaker 1: end of the story of polio in India? 342 00:21:29,160 --> 00:21:35,120 Speaker 3: January thirteenth, twenty eleven, was the last time we detected 343 00:21:35,560 --> 00:21:40,400 Speaker 3: a polio paralyzed child, and interestingly, Jacob this time around, 344 00:21:41,000 --> 00:21:46,720 Speaker 3: this last child was living essentially ten miles away from 345 00:21:46,840 --> 00:21:51,320 Speaker 3: my home in Kolkata, So you know, it's very personal 346 00:21:51,320 --> 00:21:54,520 Speaker 3: when I look back into you know, these children, and 347 00:21:54,560 --> 00:21:57,520 Speaker 3: also the trajectory of India. 348 00:21:58,200 --> 00:22:02,280 Speaker 1: Polio has not yet been eradicate. Where is there still 349 00:22:02,320 --> 00:22:04,359 Speaker 1: polio in the world and why. 350 00:22:04,800 --> 00:22:07,360 Speaker 3: Right now as you and I speak, there are only 351 00:22:07,720 --> 00:22:13,320 Speaker 3: two countries, to be very precise, a few subnational areas 352 00:22:13,359 --> 00:22:19,520 Speaker 3: of these two countries, Pakistan and Afghanistan, where polio is 353 00:22:19,600 --> 00:22:25,560 Speaker 3: still endemic, which really means that in these subnational pockets 354 00:22:25,600 --> 00:22:29,720 Speaker 3: of these two countries polio has never been stopped or 355 00:22:29,800 --> 00:22:33,520 Speaker 3: interrupted for a long duration of time. I would say 356 00:22:33,560 --> 00:22:40,440 Speaker 3: the primary issue in Pakistan Afghanistan is of access, and 357 00:22:40,480 --> 00:22:45,359 Speaker 3: I think some of the reason is still the geographic complexity. 358 00:22:45,400 --> 00:22:48,480 Speaker 3: You can draw parallels to what we saw in a 359 00:22:48,520 --> 00:22:51,960 Speaker 3: Bihar in India where in some parts there were no 360 00:22:52,160 --> 00:22:56,960 Speaker 3: road connectivity. In some parts there were nomadic populations always 361 00:22:57,000 --> 00:23:00,280 Speaker 3: moving around. On top of that, there is the your 362 00:23:00,280 --> 00:23:05,840 Speaker 3: political unrest, the civil unrest, and also the political turmoil 363 00:23:05,880 --> 00:23:08,280 Speaker 3: that the two countries are going through. 364 00:23:08,640 --> 00:23:11,160 Speaker 1: Let's talk about that in some detail, and we talked 365 00:23:11,160 --> 00:23:16,000 Speaker 1: about this one region parts of Pakistan and afghan understand 366 00:23:16,119 --> 00:23:18,920 Speaker 1: where polio is still endemic. And then there's a set 367 00:23:18,960 --> 00:23:21,240 Speaker 1: of countries primarily in Africa, where there is a risk 368 00:23:21,280 --> 00:23:23,600 Speaker 1: of reinfection. So, first of all, what does that mean. 369 00:23:24,760 --> 00:23:30,920 Speaker 3: Reinfection means if we have a susceptible group of people 370 00:23:31,560 --> 00:23:37,840 Speaker 3: who are either under vaccinated or unvaccinated, there is always 371 00:23:37,840 --> 00:23:41,640 Speaker 3: a risk that polio will not only come back, but 372 00:23:41,960 --> 00:23:47,880 Speaker 3: come back and re establish circulation because poliovirus can essentially 373 00:23:48,040 --> 00:23:54,159 Speaker 3: travel through infected people into the polio free areas. And 374 00:23:54,440 --> 00:23:58,760 Speaker 3: if that area is not only getting exposed to such 375 00:23:59,200 --> 00:24:05,000 Speaker 3: population coming in, but if it is also under or unvaccinated, 376 00:24:05,640 --> 00:24:08,600 Speaker 3: then not only the virus comes in, but it comes 377 00:24:08,640 --> 00:24:15,760 Speaker 3: in and re establishes circulation in the susceptible, under vaccinated population. 378 00:24:16,280 --> 00:24:20,200 Speaker 1: Right, Just so unclear these regions where there are problems 379 00:24:20,200 --> 00:24:23,000 Speaker 1: with reinfection, where are those cases coming from? 380 00:24:23,480 --> 00:24:28,119 Speaker 3: It does vary. Given the only two endemic FOSIGN now 381 00:24:28,520 --> 00:24:34,120 Speaker 3: is in those subnational areas of Pakistan and Afghanistan, typically 382 00:24:34,240 --> 00:24:36,520 Speaker 3: the source would be from somewhere there. 383 00:24:37,280 --> 00:24:40,200 Speaker 1: So if we could knock it out in Pakistan and Afghanistan, 384 00:24:40,400 --> 00:24:41,840 Speaker 1: we'd be done spot on. 385 00:24:42,119 --> 00:24:46,080 Speaker 3: That's the primary and the central goal. We are not 386 00:24:46,160 --> 00:24:49,119 Speaker 3: only in the last mile, we're probably in that last 387 00:24:49,480 --> 00:24:52,720 Speaker 3: one hundred meter, you know, dash when it comes to 388 00:24:52,800 --> 00:24:54,119 Speaker 3: reaching our goals. 389 00:24:55,720 --> 00:24:58,239 Speaker 1: So we're coming to the end of this story, right, 390 00:24:58,280 --> 00:25:01,040 Speaker 1: I mean I hope we're coming to the end of itself. Yes, 391 00:25:01,359 --> 00:25:05,360 Speaker 1: existing in the world. How are we going to get there? 392 00:25:05,720 --> 00:25:07,639 Speaker 1: And when? When is it going to happen? 393 00:25:08,560 --> 00:25:12,200 Speaker 3: Jacob I wish I had a crystal ball and really 394 00:25:12,280 --> 00:25:16,920 Speaker 3: answered the when part of the question. However, let's look 395 00:25:16,960 --> 00:25:23,400 Speaker 3: into the data. Even within Pakistan, it's now cornered into 396 00:25:23,440 --> 00:25:29,840 Speaker 3: a few districts, a few provinces. But beyond that geographic shrinkage, 397 00:25:30,320 --> 00:25:35,359 Speaker 3: the genetic lineage shrinking is essentially telling us that the 398 00:25:35,440 --> 00:25:41,159 Speaker 3: virus is gasping. We need to ensure that we have 399 00:25:41,400 --> 00:25:46,520 Speaker 3: full momentum for this last push, the final push, to 400 00:25:46,760 --> 00:25:51,439 Speaker 3: maintain our resolve to reach that last child in that 401 00:25:51,600 --> 00:25:56,240 Speaker 3: last village of these areas. I'm very hopeful that it's 402 00:25:56,280 --> 00:26:00,679 Speaker 3: it's really going to be very soon that we'll see 403 00:26:00,720 --> 00:26:04,400 Speaker 3: that last child infected with polio and it will stop 404 00:26:05,040 --> 00:26:07,080 Speaker 3: at that and not spread. 405 00:26:09,800 --> 00:26:13,800 Speaker 1: Thanks to my guest today Karen Turgaili and Ananda Bandiopatier 406 00:26:18,160 --> 00:26:21,760 Speaker 1: on our next episode, how the RSV vaccine could dramatically 407 00:26:21,760 --> 00:26:25,119 Speaker 1: reduce the number of babies coming into hospital emergency rooms 408 00:26:25,119 --> 00:26:29,360 Speaker 1: each winter. Also how the development of that vaccine unlocked 409 00:26:29,400 --> 00:26:31,720 Speaker 1: a whole new approach to targeting viruses. 410 00:26:32,280 --> 00:26:34,760 Speaker 4: It's like, I don't know, we're sculptors, and now we 411 00:26:34,840 --> 00:26:36,960 Speaker 4: have the model of what we need to make the 412 00:26:37,000 --> 00:26:40,160 Speaker 4: sculpture of, and it allows us to make ideal mimics 413 00:26:40,400 --> 00:26:45,520 Speaker 4: of these proteins found on the surface of the virus. 414 00:26:48,400 --> 00:26:51,480 Speaker 1: Incubation is a co production of Pushkin Industries and Ruby 415 00:26:51,560 --> 00:26:56,320 Speaker 1: Studio at iHeartMedia. It's produced by Gabriel Hunter Chang, Ariela Markowitz, 416 00:26:56,359 --> 00:26:59,800 Speaker 1: and Amy Gaines McQuaid. Our editors are Julia Barton and 417 00:27:00,040 --> 00:27:04,240 Speaker 1: Heron Shakerji, mastering by Anne Pope, fact checking by Joseph Friedman. 418 00:27:04,560 --> 00:27:08,200 Speaker 1: Our executive producers are Katherine Girardeau and Matt Romano. I'm 419 00:27:08,280 --> 00:27:10,080 Speaker 1: Jacob Goldstein. Thanks for listening. 420 00:27:19,080 --> 00:27:25,800 Speaker 2: Foonful. The sugar helps the medicine go down. Medicine go down, 421 00:27:26,359 --> 00:27:28,159 Speaker 2: says the same thing over and over again. That's all 422 00:27:28,160 --> 00:27:28,600 Speaker 2: you have to say. 423 00:27:28,760 --> 00:27:30,240 Speaker 1: Very good, very good.