Speaker 1: In the first decades of the twentieth century, parents in
Speaker 1: the United States lived in terror of polio. CDC is
Speaker 1: trying to solve the riddle of poliomyolsis, which kills or
Speaker 1: paralyzes thousands of people every year. Doctors didn't know how
Speaker 1: the disease spread or how to treat it. What they
Speaker 1: did know is that it mainly struck children, and that
Speaker 1: it left many of its victims paralyzed, often for life.
Speaker 1: As the century progressed, the disease kept becoming more common.
Speaker 1: In nineteen fifty two alone, polio paralyzed three thousand children
Speaker 1: in the US. One pole of American parents found that
Speaker 1: polio was their second greatest fear, right behind atomic apocalypse.
Speaker 1: The science of understanding viruses and developing vaccines had come
Speaker 1: a long way since the era of Edward Jenner that
Speaker 1: we talked about last week. Still, by the middle of
Speaker 1: the twentieth century, there was no vaccine to prevent polio,
Speaker 1: but scientists were about to develop not one polio vaccine,
Speaker 1: but two, and to this day we use these two
Speaker 1: very different kinds of vaccines to immunize people around the
Speaker 1: world against polio. On today's show, we'll tell the story
Speaker 1: of the cutthroat scientific rivalry that resulted in one of
Speaker 1: the greatest triumphs in American medicine, maybe two of the
Speaker 1: greatest triumphs. I'm Jacob Goldstein. This is incubation. So both
Speaker 1: of these vaccines protect people from polio, but they work
Speaker 1: in profoundly different ways. This is also true of the
Speaker 1: scientists who developed the vaccines, Jonah Salk and Albert Saban.
Speaker 2: Salk was everyone's idea of a hero. He was like Superman.
Speaker 2: He was good looking, he was soft spoken, polite, He's
Speaker 2: like the kind of guy you'd want your daughter to marry.
Speaker 2: And Saban was this abusive, loud mouth, obnoxious person who
Speaker 2: managed to offend even his best friends.
Speaker 1: This is Karen Torgaily. She's an epidemiologist and she's writing
Speaker 1: a biography of Albert Saban. I asked her to tell
Speaker 1: me more about Saban, this scientist who managed to offend
Speaker 1: even his best friends.
Speaker 2: By all accounts, he had an explosive temper, He was
Speaker 2: a perfectionist. He had little patience for people who weren't
Speaker 2: as smart as him, which.
Speaker 1: Was basically everybody, right. He was very, very very smart, so.
Speaker 2: Pretty much everybody.
Speaker 1: Yeah, so that's Saban tell me about Jonah Sulk.
Speaker 2: They had some things in common, both from Jewish families.
Speaker 2: He went to medical school at New York University, just
Speaker 2: like Saban did, because it was one of the few
Speaker 2: places that would take Jews in those days. Their paths crossed,
Speaker 2: probably for the first time woods Whole in Massachusetts.
Speaker 1: Woods Hall the Marine Biology Institute.
Speaker 2: Yes, so they got to know each other and they
Speaker 2: were friendly. Salk was kind of like the little brother
Speaker 2: scientists to Saban, who was by then getting well known.
Speaker 1: Okay, and Salk at the time was maybe still in
Speaker 1: medical school. Yes, yeah, how does he get from medical
Speaker 1: school to working on polio?
Speaker 2: So Salk moved to ann Arbor, Michigan and worked on
Speaker 2: a vaccine for flu. And the critical part of this
Speaker 2: is that the flu vaccine was made from a killed virus,
Speaker 2: not a live virus.
Speaker 1: Karen told me that working on this killed virus flu
Speaker 1: vaccine was a key moment for Salk and really a
Speaker 1: key moment in the history of vaccines because up until
Speaker 1: this point, there was basically one way to make a
Speaker 1: viral vaccine, use a virus that's still alive, but that's
Speaker 1: attenuated or weak. But the flu vaccine that Salt helped
Speaker 1: to create was different. It was made using a killed virus,
Speaker 1: a virus that had been completely inactivated. So now there
Speaker 1: were two potential strategies for developing a polio vaccine, attenuated
Speaker 1: or killed, and there were real trade offs between the two.
Speaker 1: An attenuated virus will multiply inside the body. This induces
Speaker 1: a stronger, more robust immune response, which is good, but
Speaker 1: if you're giving people this kind of vaccine, you better
Speaker 1: be really sure that their immune system is strong enough
Speaker 1: to handle it. Otherwise the vaccine might accidentally give people
Speaker 1: the very disease that you're trying to prevent. So that's attenuated,
Speaker 1: and then you have a vaccine made from killed virus,
Speaker 1: which often requires boosters for long term immunity. And if
Speaker 1: you're manufacturing a killed virus vaccine, you have to be
Speaker 1: really sure that all those virus particles are actually dead,
Speaker 1: that they're totally inactivated. So there are these two options
Speaker 1: for the polio vaccine, and it really wasn't clear which
Speaker 1: one would work better. For Salk and Saban. It was
Speaker 1: a key fork in the road and they chose different paths.
Speaker 1: Salk went to work on a killed virus vaccine. Saban
Speaker 1: chose attenuated. What is Saban's path to choosing an attenuated
Speaker 1: a weakened vaccine rather than a killed virus vaccine.
Speaker 2: His inspiration was Max Steiler, who was given the Nobel
Speaker 2: Prize for developing yellow fever vaccine, and that was an
Speaker 2: attenuated vaccine. He was convinced that the live attenuated virus
Speaker 2: made sense for polio as well.
Speaker 1: So Salk sets out to build this killed virus vaccine
Speaker 1: for polio. What are sort of the key moments in
Speaker 1: that quest.
Speaker 2: There was this sort of elite group of virologists who
Speaker 2: had their own sort of old boys club, and Sulk
Speaker 2: was not really in it because he was younger and
Speaker 2: they didn't see him as being up their caliber. They decided, though,
Speaker 2: since he was interested in it, that they would put
Speaker 2: him to work. One thing that he could do is
Speaker 2: a project for typing the different kinds of polio and
Speaker 2: figuring out which ones were the virulent ones to humans,
Speaker 2: because that had not been done. He had been sort
Speaker 2: of looking at the different strains and types and thinking, now,
Speaker 2: if I was going to make a vaccine out of this,
Speaker 2: which of these would I use? So he sort of
Speaker 2: had half the work done by the time he was
Speaker 2: finished typing these Oh.
Speaker 1: Interesting, So it seemed like the grunt work, but it
Speaker 1: was actually like meaningful progress toward the vaccine, right.
Speaker 3: Yeah.
Speaker 2: So he really surprised everyone when he told them in
Speaker 2: nineteen fifty three that he had a vaccine for polio
Speaker 2: and he was ready to test it, and they had
Speaker 2: to have this field trial. There were two million children involved,
Speaker 2: and of the two million, they had a sample of
Speaker 2: people who got the vaccine and people who thought they
Speaker 2: were getting the vaccine but really didn't, so they were
Speaker 2: a control group. There was an observed group too that
Speaker 2: got nothing. Only about half a million actually got the vaccine.
Speaker 1: So they do this giant study and what happens.
Speaker 2: They got the results and they kept a very secret.
Speaker 2: April twelfth, nineteen fifty five, came the day when they
Speaker 2: were going to make the announcement, so people were invited
Speaker 2: to come to ann Arbor on all people wanted to
Speaker 2: know does it work? Is it safe? Says basically, yes
Speaker 2: it's safe, and yes it's effective. And then and the
Speaker 2: reporters all ran to their phones and they reported, and
Speaker 2: the church bills rang. You know, there were big, huge
Speaker 2: headlines in the newspapers. It was just like the end
Speaker 2: of World War two. It was that happy of an occasion. Wow.
Speaker 1: And so Saban he doesn't have a vaccine yet, he's
Speaker 1: in fact in the room when when this Sauk announcement
Speaker 1: is made. How was he feeling at this point?
Speaker 2: He was pretty sad. His main worry was that his
Speaker 2: funding would be cut off.
Speaker 1: So let's talk about where Saban is in his research.
Speaker 1: At this point, he was.
Speaker 2: Within a year of having the vaccine that was made
Speaker 2: from a weekend attenuated stream, and he had tried it
Speaker 2: on his own daughters.
Speaker 1: He tried it on his own daughters.
Speaker 2: On his own daughters.
Speaker 1: Well, it's interesting to think about, right, because you can
Speaker 1: think of him giving it to his daughters as like, oh,
Speaker 1: prep scientist experimenting on his children. But you can also
Speaker 1: think of it as no, he believes this thing works,
Speaker 1: and there is this terrifying disease that could paralyze or
Speaker 1: kill his children, and he has what he has good
Speaker 1: reason to believe is like an elixir that will protect them.
Speaker 2: Yeah, of course he's going to give it to them. Yeah,
Speaker 2: remember they had to Also, you don't just get the
Speaker 2: vaccine and that's it. You have to be followed. Then
Speaker 2: you have to have blood tests, you have to have
Speaker 2: your stools analyzed to see if you're passing any virus
Speaker 2: or your stools. So they had to take these little
Speaker 2: cardboard boxes to school and if they had a bowel
Speaker 2: movement at school, then they had to give it to
Speaker 2: their teacher. So they said it was pretty embarrassing.
Speaker 1: Anytime my kids tell me that I'm going to embarrass them,
Speaker 1: I'm going to tell.
Speaker 2: Them that story.
Speaker 1: On the other hand, I'm not coming up with a
Speaker 1: vaccine for polio, So it's a trade off. So to
Speaker 1: go back to before in the sort of first part
Speaker 1: of the fifties, where Sulk and Saban aware that they
Speaker 1: were racing with each other, did they feel like they
Speaker 1: were racing with each other?
Speaker 2: Sulk was still the little brother scientist too. They thought, oh,
Speaker 2: you know, he's nice, he's making progress, but you know,
Speaker 2: he's not us. He also started to get sort of
Speaker 2: what they thought of as being uppity in a way
Speaker 2: that he wouldn't listen to anyone like.
Speaker 1: The know it all kid.
Speaker 2: Yeah, So for instance, Saban told him, you know, I
Speaker 2: see that you plan to use the mahoney strain in
Speaker 2: your vaccine. That is too dangerous to use in a vaccine.
Speaker 2: If any one of those got through and wasn't killed,
Speaker 2: it would kill whoever got it. And he said, oh, Albert,
Speaker 2: I have already made my decision. I've done it on
Speaker 2: my own experiments, and I'm going to stick with it.
Speaker 2: So actually what happened was there was an accident and
Speaker 2: children died from getting the Salk vaccine that was improperly
Speaker 2: killed at one of the labs. That started this contention
Speaker 2: between the two of them. They had been colleagues, they
Speaker 2: had been friendly with each other, but then it got
Speaker 2: into sort of open warfare.
Speaker 1: So they're having this basically a race, Salk and Saban.
Speaker 1: They're developing their vaccines in parallel. Salk wins piece, you know,
Speaker 1: like truly a national hero in the US. There's a
Speaker 1: massive vaccination campaign, and then not long after that, Saban
Speaker 1: essentially finishes developing his own vaccine, this very different vaccine,
Speaker 1: and he winds up taking it to the Soviet Union.
Speaker 2: Right, the Soviet Union started to have these terrible polio
Speaker 2: epidemics and they didn't have a vaccine, and they knew
Speaker 2: the United States did. Saban was going over and he
Speaker 2: would carry bials of this polio vaccine seed viruses in
Speaker 2: his pockets in these boxes just you know, it is jacket.
Speaker 2: He would show them how to make the vaccine, and
Speaker 2: so they got very good at producing the vaccine, and
Speaker 2: they actually immunized seventy seven million people. It stopped their
Speaker 2: polio epidemics. It just stopped them cold.
Speaker 1: Uh huh. I know, the Salck vaccine is a dead
Speaker 1: virus and the Saban vaccine is a live, attenuated virus.
Speaker 1: But beyond that, what are the basic differences between them?
Speaker 2: Well, so the Salt vaccine was more expensive and it
Speaker 2: was harder to make and store. The Saban vaccine was
Speaker 2: easier because you could take it orally and you didn't
Speaker 2: have to have a trained person to give it. And
Speaker 2: so they just were able to train people to put
Speaker 2: a couple of drops of the vaccine virus on cube
Speaker 2: of sugar. And there's a great little story that goes
Speaker 2: with that. This little boy he came home from school
Speaker 2: one day and his dad was a songwriter for Disney,
Speaker 2: and so he said, oh, son, what'd you do today?
Speaker 2: And he said, I got my polio vaccine. He said, oh,
Speaker 2: that must have hurt. I said, no, you just get
Speaker 2: these little drops and on a sugar cube and that
Speaker 2: was it, and so that's how his dad got the
Speaker 2: idea for Mary Poppins. Spoonful of sugar helps the medicine
Speaker 2: go down.
Speaker 1: So now we have these two effective vaccines in the world. Right,
Speaker 1: the Sabin vaccine does get approved in the US not
Speaker 1: long after the Soviet trial. We have the Salk vaccine
Speaker 1: and the Sabin vaccine. How does that play out in
Speaker 1: the world.
Speaker 2: So in the United States they stopped using the Salk vaccine.
Speaker 2: Uh why because the Sabin vaccine was cheaper and there
Speaker 2: was no need to give the Salk vaccine because you
Speaker 2: could take the Sabin vaccine once and for most people
Speaker 2: that last your lifetime. But with Salk you had to
Speaker 2: take the three initial doses and then a booster. It
Speaker 2: just made sense to switch to the to the Saban vaccine,
Speaker 2: and most countries did that.
Speaker 1: We know that with the Salt vaccine there was that
Speaker 1: manufacturing risk where in one instance it was manufactured wrong
Speaker 1: and they made a deadly dose of vaccine. What are
Speaker 1: the risks of the Saban vaccine.
Speaker 2: The Saban vaccine has something called vaccine associated paralytic polio,
Speaker 2: and it is when someone gets the vaccine who may
Speaker 2: have an immune disorder, and so even a very weakened
Speaker 2: poliovirus can cause polio like one in every three million
Speaker 2: doses or something.
Speaker 1: So in the eradication effort that has been going on
Speaker 1: for the past few decades, which vaccine were they using?
Speaker 2: Mostly these Saban vaccine.
Speaker 1: Wow, So in a way, Salt was like the hair
Speaker 1: and Saban was like the tortoise. Like in the end,
Speaker 1: even though it seemed like Salk one Saban one.
Speaker 2: Yeah. Well, and actually the truth is it really takes
Speaker 2: both vaccines because in our country now, what the recommendation
Speaker 2: is by the vaccine committees is that you get the
Speaker 2: Salk vaccine.
Speaker 1: Did they ever make up with each other?
Speaker 2: No, they didn't, and that It's interesting because one of
Speaker 2: Sabin's friends said to him one day, Albert, you have
Speaker 2: got to make up with Jonas. This is ridiculous. You
Speaker 2: are two grown men, and you just have got to
Speaker 2: make up. So he made him call Jonah Salk and
Speaker 2: they had this long, pleasant sounding conversation and at the
Speaker 2: end of it he said, Okay, well, it's been nice
Speaker 2: talking to you, and he hung up the phone and
Speaker 2: he said that Son of a Bitch.
Speaker 1: Karen's fourth book is Albert Sabin a fierce joy. It'll
Speaker 1: be out in twenty twenty four. We'll be right back
Speaker 1: because of Sock and Saban's polio vaccines. Transmission of polio
Speaker 1: in the US ended in nineteen seventy nine, but the
Speaker 1: disease kept spreading in many other parts of the world.
Speaker 1: Ananda Bandio Patia is a deputy director for Polio at
Speaker 1: the Bill and Milindigates Foundation. He told me he first
Speaker 1: saw the impacts of polio when he was growing up
Speaker 1: in India in the nineteen eighties.
Speaker 3: I grew up in Kolkata, a city in the eastern
Speaker 3: part of India, and I would see polio paralyzed kids
Speaker 3: in my own community used to play a lot of cricket,
Speaker 3: as you can imagine, and in our neighborhood there would
Speaker 3: be these sad instances of kids affected with polio and
Speaker 3: then all on a sudden, they would stop coming to
Speaker 3: the playing field. So it was very real.
Speaker 1: In nineteen eighty eight, organizations like the CDC and the
Speaker 1: WHO came together and decided to do with polio what
Speaker 1: the world had done with smallpox, to wipe it from
Speaker 1: the face of the earth. At the time, it was
Speaker 1: estimated that every single day polio paralyzed a thousand children.
Speaker 3: India led the way to really establish the proof of
Speaker 3: concept that polio can be stopped forever, including in complex geographies.
Speaker 3: And look at India. Now, it's not only the fact
Speaker 3: that India stopped polio in twenty eleven, it maintained polio
Speaker 3: free status for all these twelve years or so in between.
Speaker 3: So that's really a strong message for global health principles
Speaker 3: of eradication.
Speaker 1: Eradicating polio in India took a lot of work and
Speaker 1: Ananda was part of it. In two thousand and six,
Speaker 1: Ananda was sent by the WA to a remote part
Speaker 1: of India, the Kosi River basin in the state of Bihar.
Speaker 3: What was going on was this persistence of transmission, which
Speaker 3: essentially means we were seeing paralyzed children getting reported from
Speaker 3: these difficult areas of Bihar in the Kosi Basin. Despite that,
Speaker 3: attempts to vaccinate villages.
Speaker 1: In the Kosi River basin were really hard to reach.
Speaker 1: Roads were fewer, non existent, floods were frequent, and frontline
Speaker 1: workers like Ananda had to return again and again to
Speaker 1: make sure that every last child was vaccinated.
Speaker 3: To go there, Jacob, just to take you through that journey.
Speaker 3: I would initially take the project vehicle, it's kind of
Speaker 3: an suv, and then we would get onto boats. It
Speaker 3: would take us four hours sometimes five hours to reach
Speaker 3: those remotest villages. So we would start at four am
Speaker 3: on those boats. We would target to reach these villages
Speaker 3: by a m. Nine am or so. Then we would
Speaker 3: conduct the vaccination campaigns in coordination with the local government agencies,
Speaker 3: the medical doctors, female frontline health workers, local villagers would
Speaker 3: join in. It's almost like a festive you know day
Speaker 3: it used to be.
Speaker 1: And the thing you have to do this is an
Speaker 1: oral vaccine, right, so you have to put basically a
Speaker 1: couple drops of this vaccine into the mouth of what
Speaker 1: every person, every.
Speaker 3: Kid, Yes, two drops for all children aged under five.
Speaker 1: It's amazing that it's two drops. Like it really is
Speaker 1: like you have this magic potion, right, like we have it,
Speaker 1: we have enough of it. And the problem, the global problem,
Speaker 1: it's like we have to put two drops, just two
Speaker 1: drops of this potion into the mouth of every child
Speaker 1: under five.
Speaker 3: Absolutely, Jacob. The strategy she was to reach each and
Speaker 3: every children in those highest risk areas. When we talk
Speaker 3: about the Kosi River and we talk about the floods.
Speaker 3: Just to give you a sense of the scale. In
Speaker 3: two thousand and six, two thousand and seven, the time
Speaker 3: that I was in there, we are talking about about
Speaker 3: two and a half million to up to three million
Speaker 3: people displaced during these floods. I mean, this is almost
Speaker 3: like the entire population of Mississippi. You know, when we
Speaker 3: talk about these visits to these villages where you are
Speaker 3: essentially operating under a very strict time restriction because you
Speaker 3: got to get back to the mainland before the sunsets.
Speaker 3: You know, in dark it becomes very difficult. We're talking
Speaker 3: about remotest villages with a lot of difficulties. We were
Speaker 3: not waiting for people to come to us to get vaccinated.
Speaker 3: We were going to the folks, to the villagers, to
Speaker 3: that last child, that last household.
Speaker 1: So just to zoom out, like this is this sort
Speaker 1: of story of your experience broadly, like what is the
Speaker 1: end of the story of polio in India?
Speaker 3: January thirteenth, twenty eleven, was the last time we detected
Speaker 3: a polio paralyzed child, and interestingly, Jacob this time around,
Speaker 3: this last child was living essentially ten miles away from
Speaker 3: my home in Kolkata, So you know, it's very personal
Speaker 3: when I look back into you know, these children, and
Speaker 3: also the trajectory of India.
Speaker 1: Polio has not yet been eradicate. Where is there still
Speaker 1: polio in the world and why.
Speaker 3: Right now as you and I speak, there are only
Speaker 3: two countries, to be very precise, a few subnational areas
Speaker 3: of these two countries, Pakistan and Afghanistan, where polio is
Speaker 3: still endemic, which really means that in these subnational pockets
Speaker 3: of these two countries polio has never been stopped or
Speaker 3: interrupted for a long duration of time. I would say
Speaker 3: the primary issue in Pakistan Afghanistan is of access, and
Speaker 3: I think some of the reason is still the geographic complexity.
Speaker 3: You can draw parallels to what we saw in a
Speaker 3: Bihar in India where in some parts there were no
Speaker 3: road connectivity. In some parts there were nomadic populations always
Speaker 3: moving around. On top of that, there is the your
Speaker 3: political unrest, the civil unrest, and also the political turmoil
Speaker 3: that the two countries are going through.
Speaker 1: Let's talk about that in some detail, and we talked
Speaker 1: about this one region parts of Pakistan and afghan understand
Speaker 1: where polio is still endemic. And then there's a set
Speaker 1: of countries primarily in Africa, where there is a risk
Speaker 1: of reinfection. So, first of all, what does that mean.
Speaker 3: Reinfection means if we have a susceptible group of people
Speaker 3: who are either under vaccinated or unvaccinated, there is always
Speaker 3: a risk that polio will not only come back, but
Speaker 3: come back and re establish circulation because poliovirus can essentially
Speaker 3: travel through infected people into the polio free areas. And
Speaker 3: if that area is not only getting exposed to such
Speaker 3: population coming in, but if it is also under or unvaccinated,
Speaker 3: then not only the virus comes in, but it comes
Speaker 3: in and re establishes circulation in the susceptible, under vaccinated population.
Speaker 1: Right, Just so unclear these regions where there are problems
Speaker 1: with reinfection, where are those cases coming from?
Speaker 3: It does vary. Given the only two endemic FOSIGN now
Speaker 3: is in those subnational areas of Pakistan and Afghanistan, typically
Speaker 3: the source would be from somewhere there.
Speaker 1: So if we could knock it out in Pakistan and Afghanistan,
Speaker 1: we'd be done spot on.
Speaker 3: That's the primary and the central goal. We are not
Speaker 3: only in the last mile, we're probably in that last
Speaker 3: one hundred meter, you know, dash when it comes to
Speaker 3: reaching our goals.
Speaker 1: So we're coming to the end of this story, right,
Speaker 1: I mean I hope we're coming to the end of itself. Yes,
Speaker 1: existing in the world. How are we going to get there?
Speaker 1: And when? When is it going to happen?
Speaker 3: Jacob I wish I had a crystal ball and really
Speaker 3: answered the when part of the question. However, let's look
Speaker 3: into the data. Even within Pakistan, it's now cornered into
Speaker 3: a few districts, a few provinces. But beyond that geographic shrinkage,
Speaker 3: the genetic lineage shrinking is essentially telling us that the
Speaker 3: virus is gasping. We need to ensure that we have
Speaker 3: full momentum for this last push, the final push, to
Speaker 3: maintain our resolve to reach that last child in that
Speaker 3: last village of these areas. I'm very hopeful that it's
Speaker 3: it's really going to be very soon that we'll see
Speaker 3: that last child infected with polio and it will stop
Speaker 3: at that and not spread.
Speaker 1: Thanks to my guest today Karen Turgaili and Ananda Bandiopatier
Speaker 1: on our next episode, how the RSV vaccine could dramatically
Speaker 1: reduce the number of babies coming into hospital emergency rooms
Speaker 1: each winter. Also how the development of that vaccine unlocked
Speaker 1: a whole new approach to targeting viruses.
Speaker 4: It's like, I don't know, we're sculptors, and now we
Speaker 4: have the model of what we need to make the
Speaker 4: sculpture of, and it allows us to make ideal mimics
Speaker 4: of these proteins found on the surface of the virus.
Speaker 1: Incubation is a co production of Pushkin Industries and Ruby
Speaker 1: Studio at iHeartMedia. It's produced by Gabriel Hunter Chang, Ariela Markowitz,
Speaker 1: and Amy Gaines McQuaid. Our editors are Julia Barton and
Speaker 1: Heron Shakerji, mastering by Anne Pope, fact checking by Joseph Friedman.
Speaker 1: Our executive producers are Katherine Girardeau and Matt Romano. I'm
Speaker 1: Jacob Goldstein. Thanks for listening.
Speaker 2: Foonful. The sugar helps the medicine go down. Medicine go down,
Speaker 2: says the same thing over and over again. That's all
Speaker 2: you have to say.
Speaker 1: Very good, very good.