Speaker 1: In nineteen ninety two. In February, I was born in
Speaker 1: India in a town talk called Napour. It's basically in
Speaker 1: the dead center of India if you're trying to find it.
Speaker 1: In April of nineteen ninety three, I was brought over
Speaker 1: to the States by airplane and was adapted into a
Speaker 1: family in Saint Louis, Missouri, and I was raised there
Speaker 1: until I was nineteen, and then in twenty eleven I
Speaker 1: moved to Springfield, Illinois for college. So somewhere between four
Speaker 1: and nine months of age one in India, I had polio.
Speaker 1: I also had tuberculosis as well. I was there, so
Speaker 1: we're not sure which one of those came first, but
Speaker 1: very likely one of them weakened my immune system and
Speaker 1: made it so when I had the polio vaccine.
Speaker 2: My body was possibly not able to fight it off.
Speaker 1: Because the records do show that I did get the vaccine.
Speaker 1: The orphanage also has a true of not having the
Speaker 1: best medical records, so there is a chance that maybe
Speaker 1: I was, you know, out getting my diaper changed or
Speaker 1: getting fed, and you know, when they came down the
Speaker 1: row and inoculated every child that I, you know, just
Speaker 1: wasn't there, so I could have just not gotten it either,
Speaker 1: But no other children in the orphans got polio, which
Speaker 1: leads us to think that I possibly got it from
Speaker 1: the vaccine. Growing up with polio. I don't remember having
Speaker 1: it as a child, like as a baby per se,
Speaker 1: but I remember growing up. I remember learning how to walk.
Speaker 1: When I was younger, I had a walker. I went
Speaker 1: to Shiner's Hospitals for Children in Saint Louis, which is
Speaker 1: where I got my leg brace made, and my mom
Speaker 1: can tell you exactly what tiles I took my first
Speaker 1: steps on as a child, and since then I've pretty
Speaker 1: much just been having preventive care, whether that be different braces,
Speaker 1: a couple times I've broken my leg because my lucky
Speaker 1: leg is weaker, or just different surgeries to help correct
Speaker 1: or prevent certain problems from occurring related.
Speaker 3: To the polio.
Speaker 1: And the main one as an adult that I've really
Speaker 1: run into is my official paralysis line is that T
Speaker 1: and I in my spine, and luckily it makes it
Speaker 1: just so my abdomen is weaker, but the actual paralysis.
Speaker 2: Is where my hip is in down.
Speaker 1: So as an adult, I've had issues with chronic UTIs
Speaker 1: a kidney infections secondary to the polio, and I've also
Speaker 1: had issues with arthritis and my joints, but otherwise not
Speaker 1: too terrible, at least for me. When you grow up
Speaker 1: as disabled and it's the only thing that you know
Speaker 1: that's your normal, so it's not anything like there was
Speaker 1: an accident, and I knew what being able bodied was
Speaker 1: versus being disabled, so I never had that, I guess
Speaker 1: annoyance factor there. I just was like, oh, this is
Speaker 1: how I walk, this is how I do things. I
Speaker 1: just do things a little differently.
Speaker 2: So that was an interview that we conducted with a
Speaker 2: girl named Grace, who, as you heard, came down with
Speaker 2: polio as a small child, and so we wanted to
Speaker 2: actually have something unusual, which was an actual first hand
Speaker 2: account instead of me just reading from a piece of paper,
Speaker 2: which is the norm.
Speaker 3: Which is also great, but we like that too, yeah,
Speaker 3: but even better when we can actually hear firsthand from
Speaker 3: somebody who experienced it.
Speaker 2: Yeah. So that was really fascinating and also thank you
Speaker 2: again so much Grace for that.
Speaker 3: Yes, we really appreciate it.
Speaker 2: And if you're just tuning in, this is this podcast
Speaker 2: will kill you.
Speaker 3: Welcome. I'm Aaron Welsh and I'm Erin Olman Updike. It's
Speaker 3: great to have you here.
Speaker 2: Yeah. Thanks, And in case you haven't gathered, this week,
Speaker 2: we are doing polio and let's jump right in.
Speaker 3: Yeah, let's do it. Oh wait, oh wait, it's quarantiney time.
Speaker 2: Yes, my favorite time, mine too. What are we drink
Speaker 2: in this week?
Speaker 3: This week we're drinking the sulk shot salk shot And say, okay, sounds.
Speaker 2: Like so I don't pronounce things. Well, what's in the
Speaker 2: salk shot?
Speaker 3: It is rum, orange liqueur, and lime juice rimmed with
Speaker 3: tahen yep, and we rimed the glass with tahen.
Speaker 2: We're gonna post the full recipe on all the social
Speaker 2: media so you can gather get it there. But I
Speaker 2: do have to note that this was not a true
Speaker 2: quarantini for us.
Speaker 3: We we something weird happened this week, you guys. First
Speaker 3: of all, we don't drink rum very often. No, why
Speaker 3: did we choose to use rum for this?
Speaker 2: Okay? So the reason that I was pushing for rum
Speaker 2: is because FDR, the most famous person with polio, was
Speaker 2: possibly the United States biggest drinker of all of the presidents.
Speaker 3: He was a drinking resident, he truly was.
Speaker 2: And he loved to make cocktails, and rum was one
Speaker 2: of his favorite liquors to mix. But also he made
Speaker 2: the worst cocktails of all time. It has there like
Speaker 2: there are people on record saying the President made the
Speaker 2: worst martini I have ever tasted.
Speaker 3: So our selk shot is not that bad. Actually, no,
Speaker 3: except we don't know that for sure because when we
Speaker 3: tried to make it, it turned out that my bottle of
Speaker 3: rum was water.
Speaker 2: Yeah, that was bizarre.
Speaker 3: And I don't have a sixteen year old living with me,
Speaker 3: so I don't know what's going on.
Speaker 2: So yeah, if you make this, actually make it, because
Speaker 2: we have no realm, we haven't actually tried it, let
Speaker 2: us know how it tastes.
Speaker 3: I'm very curious. So if you guys could make it
Speaker 3: and send us a picture and let us know, that
Speaker 3: would be great. That'd be great.
Speaker 2: Aaron, Yes, Aaron, I want to know about the biology
Speaker 2: of polio.
Speaker 3: I want I tell you all about it. Are you
Speaker 3: ready for this?
Speaker 2: I'd better be so.
Speaker 3: Poliomyelitis, or polio for short, is a disease that is
Speaker 3: caused by the poliovirus. That's the first thing you might
Speaker 3: have learned.
Speaker 2: Okay, check check, it's a virus.
Speaker 3: Poliovirus is an RNA virus. So if you remember that
Speaker 3: viruses are basically just genetic material surrounded by protein. Polio's
Speaker 3: genetic materials RNA and it's surrounded by a protein capsid.
Speaker 3: Polioviruses are related to enteroviruses, which are super common viruses
Speaker 3: that often cause stomach illnesses like vomiting, sort of stomach
Speaker 3: flu type illnesses, and also can cause upper respiratory illnesses.
Speaker 3: And they're also in the same family as the virus
Speaker 3: that causes the common cold, rhinoviruses.
Speaker 2: Interesting.
Speaker 3: Yeah, polioviruses are physically capable of an affecting other primates,
Speaker 3: but they are really a human specific virus in general. Okay,
Speaker 3: poliovirus itself.
Speaker 2: So, for instance, would you find another primate in the
Speaker 2: wild that has poliovirus or just humans? Right?
Speaker 3: No, you wouldn't. You only find humans naturally infected. We
Speaker 3: can infect animals in the lab that are other primates,
Speaker 3: and also certain lines of mice that we've mutated. Okay, anyways,
Speaker 3: there are three distinct zero types of the poliovirus poliovirus one, two,
Speaker 3: and three.
Speaker 2: Oh, that's easy to remember.
Speaker 3: I love it, love it when it's easy, keep it simple.
Speaker 3: These three zerotypes are antigenically distinct. So antigens again are
Speaker 3: the outside proteins that are on the surface of the
Speaker 3: virus that our bodies use to find them. So these
Speaker 3: three zerotypes are different enough that infection with one zero
Speaker 3: type of polio does not confer immunity to the other zerotypes, and.
Speaker 2: That's important in terms of vaccine developing vaccine.
Speaker 3: Definitely, big time, big time. Yeah, So the vaccines that
Speaker 3: are used are trivalent vaccines, so they cover all three
Speaker 3: zero types like try yeah, try valent, try harder. Just kidding.
Speaker 3: So poliovirus one is the most common. And something that's
Speaker 3: kind of cool is that poliovirus two has actually been
Speaker 3: declared eradicated, so there's no wild circulating poliovirus two.
Speaker 2: Whoa, that's super cool.
Speaker 3: Yeah, it's pretty exciting.
Speaker 2: And do these guys, Sorry from jumping the gun, but
Speaker 2: do these guys differ in their virulence or infectivity?
Speaker 3: Great question. I actually couldn't find a lot of good
Speaker 3: information on that. Do you know the answer?
Speaker 2: Well, I know that they do, but I don't know
Speaker 2: which is more virulent or infectious.
Speaker 3: Yeah, so I know that poliovirus type one is by
Speaker 3: far the most common, and then type two I think
Speaker 3: was the least common, So that's the one that has
Speaker 3: now been eradicated.
Speaker 2: Okay, and these are geographically distinct, like that is why
Speaker 2: they're geah Type one, two and three.
Speaker 3: Yeah, they tend to be in different geographic areas, but
Speaker 3: poliovirus one was overall like a cross the globe. Most
Speaker 3: common poliovirus is transmitted fecal oral just like cholera, so
Speaker 3: you have to actually ingest poopiness to get infected. There's
Speaker 3: a small chance that you can transmit it by coughing
Speaker 3: if you have an infection in your upper gastro intestinal tract,
Speaker 3: but it's pretty not very common, so you can imagine that,
Speaker 3: similar to cholera, the burden was historically and still tends
Speaker 3: to be heaviest in countries that have poor sanitation. But
Speaker 3: another important thing about polio that makes it very different
Speaker 3: from something like cholera is that it's considered a disease
Speaker 3: of childhood, so it tends to affect children that are
Speaker 3: under the age of five. And the reason for this,
Speaker 3: besides the fact that children are constantly shoving poop covered
Speaker 3: stuff in their mouths. Is that infection with poliovirus provides
Speaker 3: a lifetime immunity only to the strain that you're infected with,
Speaker 3: but unlike some other diseases, immunity to polio is very
Speaker 3: long lasting.
Speaker 2: And so when you talk about the infection prevalence being
Speaker 2: highest in children under the age of five, that is
Speaker 2: or recent polio infection prevalences.
Speaker 3: Or historically as well historically as yeah, okay, yeah, So
Speaker 3: it was always considered a disease of childhood, so people
Speaker 3: who were not that you couldn't get it when you
Speaker 3: were older, but you were probably exposed when you were
Speaker 3: very young, and then once you got infected, you had
Speaker 3: lifetime immunity. Right, So you could in theory be infected
Speaker 3: with other zero types, but if you lived in the
Speaker 3: same geographic region, there's probably in most regions, aren't multiple
Speaker 3: strains circulating. Okay, So about seventy five percent of people
Speaker 3: who get infected with poliovirus are totally asymptomatic. Seventy five
Speaker 3: seventy five percent. I saw estimates as high as ninety five,
Speaker 3: but I don't believe them. I believe the WHO and
Speaker 3: the CDC fair enough. Similar to cholera, though these asymptomatic
Speaker 3: people can still shed virus in their stool, so they
Speaker 3: still could be infecting others. The incubation period is around
Speaker 3: seven to ten days, but actually can vary from four
Speaker 3: to as long as thirty five, which is crazy to me.
Speaker 3: That's such a huge Well.
Speaker 2: I read that it had something to do with the
Speaker 2: amount of time that it takes to make it up
Speaker 2: to the central nervous system, and so for very tall people,
Speaker 2: your incubation period would be longer. Oh my god, are
Speaker 2: you serious, that's what I read something. Oh that's funny. Yeah,
Speaker 2: I never I guess I didn't think about that because
Speaker 2: this is only for symptomatic cases. Obviously, the incubation period, right,
Speaker 2: because incubation period again is the time from when you're
Speaker 2: infected to when you show symptoms, So most people don't
Speaker 2: really have an.
Speaker 3: Incubation period because they don't have symptoms.
Speaker 2: Yeah, seventy five percent, right, interesting.
Speaker 3: That is interesting. So also similar to what we saw
Speaker 3: in colera, people start shedding virus in their poop a
Speaker 3: few days before symptoms start, and they continue to shed
Speaker 3: for at least one to two weeks, though I saw
Speaker 3: some estimates that they can shed for up to four
Speaker 3: to six weeks, which is a really long time. So
Speaker 3: undoubtedly that's something that has made polio more difficult to control,
Speaker 3: is how long you are shedding. And this very high
Speaker 3: rate of asymptomatic cases as well, So seventy five percent
Speaker 3: of people are asymptomatic, and then the other twenty five
Speaker 3: percent of people who get infected, most of them end
Speaker 3: up with a relatively mild illness, fever, headaches, sore throat,
Speaker 3: maybe some nausea, stomach ache, vomiting since this does infect
Speaker 3: your gastrointestinal tract right fecal oral. But you're here aaron, yeah,
Speaker 3: and listeners to hear about poliomyelitis, Oh yes, aka polio.
Speaker 2: So.
Speaker 3: Poliomyelitis is the disease that happens in less than one
Speaker 3: percent of people who get infected with the poliovirus, about
Speaker 3: one in two hundred cases. This happens when the poliovirus
Speaker 3: exits your gut and travels to your central nervous system,
Speaker 3: where it attacks your motor neurons.
Speaker 2: Can I just throw something in here right now? Please
Speaker 2: do the etymology of poliomyelitis. Well, I'm gonna what are
Speaker 2: you gonna say it? Okay? Sorry, no, you go go
Speaker 2: give it to me.
Speaker 1: I love it.
Speaker 2: Okay. It's from the Greek polios meaning gray and muelos
Speaker 2: i guess, meaning marrow, and itis meaning inflammation, and so
Speaker 2: it refers to the inflammation in the gray matter of
Speaker 2: the spinal cord yiches causes the paralysis.
Speaker 3: Yeah, exactly. So myelitis is essentially an infection of the
Speaker 3: central nervous system, so you can get myelitis from other
Speaker 3: things as well, But poleomyelitis is myolitis caused by the poliovirus.
Speaker 3: Thanks for that. Sorry, No, don't be sorry. So sometimes
Speaker 3: the paralysis can be reversible, but often it is not.
Speaker 3: And of these paralytic cases, about five to ten percent
Speaker 3: of them are fatal because the paralysis affects the diaphragm
Speaker 3: or intercostal muscles, which are the muscles in between your
Speaker 3: ribs that are responsible for respiration, so you can't breathe.
Speaker 2: And was there a treatment for those cases? Eventually?
Speaker 3: Oh, I believe you may have heard of it, the
Speaker 3: iron lung. Are you gonna tell us a bit about
Speaker 3: the iron lung later? No?
Speaker 2: Oh, dang, I mean there's so much that polio has
Speaker 2: such a rich history that it is. I mean, it's
Speaker 2: a very important part.
Speaker 3: It's hard to pick and choose, right.
Speaker 2: Basically, the iron lung was a huge machine that was
Speaker 2: used to treat the patients whose diaphragm who could no
Speaker 2: longer breathe because their muscles had become paralyzed, and so
Speaker 2: it breathes for them using like a pressurized and depressurized rhythm.
Speaker 2: And there are still people that are in iron lungs today.
Speaker 3: Yeah, there's actually a video that's been making the rounds
Speaker 3: on social media, and we'll post it to our social
Speaker 3: media account as well in case you haven't seen it yet.
Speaker 3: That's about some of the last people that are still
Speaker 3: living today in an iron lung, because that's pretty interesting. So,
Speaker 3: most of the time in paralytic poleomyolitis, it's some part
Speaker 3: of the spinal cord that's attacked, so you might lose
Speaker 3: function of a limb, or you might lose function entirely
Speaker 3: in a region inferior to where the motor neurons were damaged.
Speaker 3: But the fatal cases are often because the virus infects
Speaker 3: the brain stem, and when you infect the brain stem,
Speaker 3: you can affect the cranial nerves, which again can affect breathing, swallowing, speaking,
Speaker 3: So yeah, Basically, the virus infiltrates and just destroys your
Speaker 3: motor neurons. So it's really sad.
Speaker 2: That's horrible.
Speaker 3: And if that's not horrible enough, oh great, the idea
Speaker 3: of tiny babies losing function in their limbs. And there's
Speaker 3: also post polio syndrome, which is a combination of symptoms
Speaker 3: that include progressive muscle weakness, fatigue, and pain from joint
Speaker 3: degeneration that can happen in about twenty five to forty
Speaker 3: percent of poleomyelitis cases, and this happens fifteen to forty
Speaker 3: years after infection.
Speaker 2: So just to go back to relate this back to
Speaker 2: polio infection, overall of the cases that are actually symptomatic
Speaker 2: of polio, there are a very small proportion of them
Speaker 2: that actually get poliomyelitis correct, and of those, it's the
Speaker 2: twenty five to forty percent that you're.
Speaker 3: Talking exactly, So twenty five to forty percent of people
Speaker 3: who end up with poliomyelitis that neuron involvement can go
Speaker 3: on to have post polio syndrome, and this happens fifteen
Speaker 3: to forty years after infection. So if you imagine you
Speaker 3: get polio as a baby, fifteen to forty years later,
Speaker 3: you can end up with these very in some cases,
Speaker 3: very severe and debilitating muscle symptoms, and there isn't really
Speaker 3: anything to do to prevent it, and there's not much
Speaker 3: that you can do to cure it. And from what
Speaker 3: I understand, it's not like the poliovirus is still sitting
Speaker 3: there alive in your nervous system or anything like that.
Speaker 3: It's not like herpes virus, for example, like with chicken pox,
Speaker 3: where it can re emerge as shingles. The best explanation
Speaker 3: that I've seen is that when polio attacks your motor neurons,
Speaker 3: it might not destroy all of your motor neurons, so
Speaker 3: you're left with a subset of functioning neurons and then
Speaker 3: these neuronal cell bodies, because your neurons are basically a
Speaker 3: cell body with fibers sticking out of it, then the
Speaker 3: cell bodies that are left will sprout new fibers to
Speaker 3: reinnervate the muscles that have previously lost function. But then
Speaker 3: over time, these cell bodies are essentially working way harder
Speaker 3: than a cell body would otherwise have to work, and
Speaker 3: so over time they may weaken or end up dying themselves.
Speaker 2: Right, So it's like rapid aging of your.
Speaker 3: Yeah, and so that's why you have this very late
Speaker 3: onset and it's a very progressive weakening of your muscles.
Speaker 3: From what I understand, it's not one hundred percent sure
Speaker 3: that that's the explanation, but that's the best that people
Speaker 3: have been able to come up with. Yeah, things like
Speaker 3: the severity of the initial infection, the age at which
Speaker 3: you were infected. And the thing I found really interesting
Speaker 3: is how well you recovered all affect whether or not
Speaker 3: you end up getting post polio syndrome. The better your recovery,
Speaker 3: the more likely you end up with post polio syndrome.
Speaker 2: Interesting.
Speaker 3: Yeah, and I think that's one of the things that
Speaker 3: helps support this hypothesis that if you covered really well,
Speaker 3: then your neurons regenerated a lot and then they're really
Speaker 3: working over time. Is that interesting? Yeah? That that was
Speaker 3: very very cool, I mean not cool, very it's a
Speaker 3: very interesting side effect of an infection with a virus like.
Speaker 2: This, particularly when it's no longer in your system rightaculating.
Speaker 3: Yeah. So I think that's everything about the biology. Any
Speaker 3: questions not yet good, but.
Speaker 2: We'll see. So I guess then that means that it's
Speaker 2: time for me right. Yes, it seems like I always
Speaker 2: start off the history part by saying, oh, well, the
Speaker 2: first recorded instance of whatever disease was in Egypt, and
Speaker 2: today is going to be no difference. Yeah. Yeah. There
Speaker 2: are illustrations dating from Egypt in fourteen hundred BC that
Speaker 2: show people with withered limbs and a dropped foot, which
Speaker 2: is particularly characteristic of polio.
Speaker 3: Wow.
Speaker 2: So it's been around for millennia. But it's interesting because
Speaker 2: it really didn't start to re emerge or be noted
Speaker 2: in literature or in historical accounts of the day until
Speaker 2: the seventeenth century. Then it was more just like case
Speaker 2: by case or describing a disease overall. It wasn't really
Speaker 2: in reference to epidemics.
Speaker 3: Huh.
Speaker 2: Interesting, So descriptions of matching clinical signs of polio show
Speaker 2: up in the seventeenth century. This is in contrast with
Speaker 2: many of the other diseases that we've talked about so far,
Speaker 2: all of which have kind of popped up in epidemic
Speaker 2: form at some point or another or multiple times, or
Speaker 2: at least, like leprosy, have left enough of an impact
Speaker 2: that they're written about throughout history. One of the thoughts
Speaker 2: as to why polio wasn't an epidemic disease has to
Speaker 2: do with sanitation. Prior to wide scale water treatment and
Speaker 2: sanitation measures, children were probably exposed to polio at a
Speaker 2: very young age, experienced a minor infection, or the vast
Speaker 2: majority of them did, and then it also recovered and
Speaker 2: had lifetime immunity. Obviously, there was a proportion of these
Speaker 2: individuals who became partially paralyzed as a result of infection
Speaker 2: or died or died, but studies done in the twentieth
Speaker 2: century prior to the introduction of the vaccine showed that
Speaker 2: the case fatality rate and case paralysis rate was highest
Speaker 2: in the very young, so like under a year, and
Speaker 2: then it dropped in young children like under the age
Speaker 2: of five, and then it rose in adolescents and adults
Speaker 2: like a checkmark. Which is really interesting. And this seems
Speaker 2: to suggest that the older you are when you first
Speaker 2: encounter polio, the more devastating it could be.
Speaker 3: And the more likely you were to get post polio syndromes.
Speaker 3: So that makes sense. Probably I actually know why that
Speaker 3: is because as a child, your nerves are really good
Speaker 3: at regenerating and so the older you get, the less
Speaker 3: good they are at regenerating. That makes sense, and except
Speaker 3: that when you're a tiny baby infant, you have no
Speaker 3: immune system and so you can't fight anything off. So
Speaker 3: tiny babies are going to die. Little kids are going
Speaker 3: to be okay for the most part, and then as
Speaker 3: you get older, you're not going to be able to recover.
Speaker 3: Got that medical degree for something, Hey, working on it.
Speaker 2: That's real interesting. It's only a matter of years. Yeah, So,
Speaker 2: so these epidemics were probably able to occur in the
Speaker 2: twentieth century as sanitation measures increased, the interesting and the
Speaker 2: population of already exposed people decreased, so that polio could
Speaker 2: tear through an unexposed community.
Speaker 3: That is so fascinating.
Speaker 2: It's kind of like a disease of sanitation, right, unlike
Speaker 2: a disease that we see like with cholera, where the
Speaker 2: lower the sanitation measures.
Speaker 3: And it kind of goes It's a middle ground, right,
Speaker 3: because you have to have good sanitation so that you're clean.
Speaker 3: If you have really really great sanitation, then you're not
Speaker 3: going to have fecal oral contact very often. But then
Speaker 3: if you have a little bit of sanitation so that
Speaker 3: not everyone is exposed then you have more susceptible individuals
Speaker 3: that are older, and then you can have these epidemics.
Speaker 3: That is so interesting.
Speaker 2: Yeah wow, Yeah, it's the sporadic nature of the sanitation
Speaker 2: that really would lead to these epidemics.
Speaker 3: Oh wow, that is so interesting.
Speaker 2: Well, in any case, the polio story really begins full
Speaker 2: force in the late nineteenth and early twentieth centuries when
Speaker 2: polio began appearing in epidemic form in Scandinavian countries in
Speaker 2: the US and then onto Europe.
Speaker 3: Of course, people only care about it when it's in Oh.
Speaker 2: Yeah, no, So let me make one thing clear. The
Speaker 2: only reason that there's a polio vaccine and that it
Speaker 2: is almost eradicated is because this struck wealthy children in
Speaker 2: the United States, and then it was like people actually
Speaker 2: cared about it. It's a it's a darn shame that
Speaker 2: they don't care as much about diseases that are not
Speaker 2: on their doorstep, like visual leshmaniasis.
Speaker 3: Visceral leshmaniasis is what I just said, visual yep, not
Speaker 3: what I said.
Speaker 2: It was also, of course had global distribution, but these
Speaker 2: are the countries where all of a sudden it was
Speaker 2: appearing in a more epidemic form in the past, when
Speaker 2: we've talked about epidemics or pandemics, the numbers are staggeringly huge,
Speaker 2: except in the case of leprosy, with like twenty five
Speaker 2: percent of people being infected or dying as a result
Speaker 2: of infection. By comparison, polio caused minor outbreaks initially. Its
Speaker 2: first epidemic appearances in the US in the eighteen nineties
Speaker 2: through the nineteen tens resulted in a few hundred to
Speaker 2: a few thousand cases, of which about ten percent died
Speaker 2: and forty to fifty percent were paralyzed. So side out. Yeah,
Speaker 2: these percentages correspond to reported cases.
Speaker 3: Okay, the actual.
Speaker 2: Number of polio cases was probably a lot higher. The
Speaker 2: percentages of fatal or paralytic cases was probably a lot lower.
Speaker 3: Oh because because berth cases were a lot higher, right
Speaker 3: of course.
Speaker 2: Still, though, we're talking about a few thousand cases in
Speaker 2: a country of a couple hundred million people. How then,
Speaker 2: did polio mobilize an entire country towards finding a way
Speaker 2: to stop.
Speaker 3: It because they were white babies, that's true?
Speaker 2: Well, yeah, the answer lies, and who was most impacted,
Speaker 2: and that was young, otherwise healthy children. In the early
Speaker 2: twentieth century, no one yet knew how polio was transmitted.
Speaker 2: All they knew was that one summer day, your kid
Speaker 2: would go out to play, come home in the evening,
Speaker 2: feverish and complaining of body aches, and be paralyzed or
Speaker 2: dead within days. Yeah. I mean it really struck fear
Speaker 2: into the hearts of people across the United States.
Speaker 3: I mean it would be terrifying. There's no denying that.
Speaker 2: The fear was palpable. Summer was synonymous with polio season.
Speaker 2: Everyone's pooping in the pool well, swimming pools were shut down,
Speaker 2: so you had better poop before it was shut down.
Speaker 2: Children under the age of sixteen were barred from public
Speaker 2: places such as movie theaters, in an attempt to limit
Speaker 2: disease transmission. Do not gather in groups, children's kind of
Speaker 2: the idea. The number of polio cases in a town
Speaker 2: was reported daily on the radio and in newspapers the
Speaker 2: way like baseball or football scores were reported.
Speaker 3: Wow. Interesting.
Speaker 2: It was a nation obsessed. Yeah, And as the years
Speaker 2: went on, it was clear that polio was on the rise,
Speaker 2: from the small beginnings of a few hundred cases at
Speaker 2: the turn of the century. Nineteen sixteen, for instance, saw
Speaker 2: twenty seven thousand fatal cases. Oh my god in the
Speaker 2: eastern United States, the vast majority of which, of course,
Speaker 2: were children.
Speaker 3: Wow. Okay, that's a really that's a big number.
Speaker 2: It's a big number.
Speaker 3: Yeah.
Speaker 2: And remember how I just had to throw this in here.
Speaker 2: Remember how cats were killed during outbreaks of plague. No,
Speaker 2: it happened with polio too.
Speaker 3: Wait literally, how cats don't have the receptor that poliovirus
Speaker 3: needs to infect cells.
Speaker 2: Right, but they did not know that polio was even
Speaker 2: a virus back then.
Speaker 1: I know.
Speaker 3: But how were what were cats dying of?
Speaker 2: No? No, no, no, I'm sorry. Oh they were dying of humans.
Speaker 3: People were killing cats, yeah, because they thought they were
Speaker 3: getting Oh my god.
Speaker 2: Seventy two thousand stray cats during in nineteen sixteen were
Speaker 2: rounded up and killed in New York City.
Speaker 3: Because people are stupid, I would.
Speaker 2: Say, lacking the knowledge, Okay, ignorant and acting out of fear.
Speaker 3: Oh yes, poor kitty cats.
Speaker 2: I mean. The number of theories as to what caused
Speaker 2: polio or how to treat it abounded. God. So George
Speaker 2: Washington Carver, the peut guy. Yeah, his idea was to
Speaker 2: treat polio with peanut oil.
Speaker 3: It's like today, like shovel walnut up your buttle to
Speaker 3: cure your cancer. That's not real.
Speaker 2: That's very Gwyneth Paltrow. Yeah.
Speaker 3: Treatment, Just have some some lemon jese with some paprika
Speaker 3: and giant peppers. That's my goop impression. I loved it.
Speaker 2: Yeah, uh okay, what was I saying? Oh yeah? Oh so.
Speaker 2: One unique thing that struck off, that stuck out to
Speaker 2: scientists from this epidemic was that the disease seemed to
Speaker 2: strike harder in relatively wealthy regions, which enjoyed reliably more
Speaker 2: or less clean water and sanitation systems. And this was
Speaker 2: completely unlike what had been seen in the past and
Speaker 2: was a large part of why the movement to halt
Speaker 2: polio gained so much momentum. Perhaps the most famous polio
Speaker 2: victim was Fdr. Like I already said Franklin delan Or Roosevelt,
Speaker 2: who was the thirty second President of the United States.
Speaker 2: In the summer of night eighteen twenty one, the then
Speaker 2: thirty nine year old spent several days at the family
Speaker 2: home on an island off the coast of Maine, where
Speaker 2: he filled his time with extensive physical activity. He was
Speaker 2: like sailing and running and like racing. His kids and
Speaker 2: swimming in the freezing waters, and then one evening a
Speaker 2: strange feeling came over him. He felt chilled, feverish, with
Speaker 2: numbness and deep muscle aches. He began to have trouble walking,
Speaker 2: and the paralysis spread up to his chest and down
Speaker 2: even to his fingers. He had trouble writing. The diagnosis
Speaker 2: of polio did not come for several days, in part
Speaker 2: because he was of an unusual age to be afflicted.
Speaker 3: Yeah, that's quite old, but he grew.
Speaker 2: Up probably completely like isolated. Yeah yeah. By the time
Speaker 2: that he was actually diagnosed with polio, he had lost
Speaker 2: much of the function of his legs, which he would
Speaker 2: never fully regain. Newspapers, of course, ate this story up,
Speaker 2: and he was ridiculed by his political rivals as being
Speaker 2: physically unfit for office any kind, and he responded by
Speaker 2: initiating a massive campaign which lasted throughout his life to
Speaker 2: hide his disability from public view. He had intricate leg
Speaker 2: braces designed and was very careful not to be photographed
Speaker 2: in a wheelchair. But the truth was that he would
Speaker 2: never again be able to stand on his own unaided.
Speaker 3: Wow.
Speaker 2: FDR. Coming down with polio was honestly probably the best
Speaker 2: thing that could have happened for Yeah, or rather.
Speaker 3: To the children who suffered from polio.
Speaker 2: Right, do you know whose face is on the dime? Oh?
Speaker 3: Is it Fdr?
Speaker 2: It is?
Speaker 3: That was a guess.
Speaker 2: Do you know why it's there.
Speaker 3: Because he's a ten centence good guy? That was bad? Nope,
Speaker 3: I don't know.
Speaker 2: Rewhind just kidding, No, it's okay, I'll tell you please, Okay.
Speaker 2: From the time of his infection to his death, FDR
Speaker 2: campaigned and helped raise funds for polio organizations. His first
Speaker 2: endeavor was to purchase Warm Springs, which was a retree
Speaker 2: in Georgia whose natural mineral Hot Springs were advertisers having
Speaker 2: curative benefits. So he spent so much time at Warm Springs,
Speaker 2: rebuilding the area, rehabilitating different cabins and stuff, and also
Speaker 2: providing a lot of treatment free of charge for polio patients.
Speaker 2: So it did do some good and there was also
Speaker 2: he created something called the Warm Springs Foundation, which was
Speaker 2: used to raise money for polio patients. Cool and the
Speaker 2: other huge thing that he did was to create the
Speaker 2: National Foundation for Infantile Paralysis in nineteen thirty eight. Infantile
Speaker 2: paralysis is what a lot of people called polio back then, okay,
Speaker 2: and this was an attempt to depoliticize the fundraising of
Speaker 2: money for polio victims and research. Fundraising had been going on,
Speaker 2: but it was mostly in the name of the Warm
Speaker 2: Springs Foundation, and the biggest fundraising events were on Roosevelt's birthday,
Speaker 2: which didn't exactly encourage donation from the Republicans, who was
Speaker 2: the opposing political party. The first action of the National
Speaker 2: Foundation for Infantile Paralysis it's a mouthful, was to ask
Speaker 2: people to mail dimes directly to the White House in
Speaker 2: a stunt. Today call it the March of Dimes.
Speaker 3: To mail dimes, Mail dimes, that's funny.
Speaker 2: And it was surprisingly enormously successful.
Speaker 3: Wow.
Speaker 2: People sent so many dimes that counting them individually was impossible.
Speaker 2: The dimes had to be shoveled onto a scale to
Speaker 2: be weighed. Oh my gosh, yeah.
Speaker 3: Wow.
Speaker 2: In total, over two point seven million dimes were sent
Speaker 2: to the White House.
Speaker 3: Do you know how many dollars? That is?
Speaker 2: Two hundred and seventy thousand. Thanks and so because of this,
Speaker 2: the enormous success of this stunt, the National Foundation for
Speaker 2: Infantile Paralysis eventually became the March of Dimes, which still
Speaker 2: exists today, and to honor Roosevelt's contribution to the cause,
Speaker 2: his face was put on the Dime in nineteen forty
Speaker 2: six after his death.
Speaker 3: That's really interesting. I never knew that story.
Speaker 2: Yeah. The impressive amount of money raised by the March
Speaker 2: of Dimes was used for two primary reasons, treatment and
Speaker 2: care for those afflicted by polio, and scientific research to
Speaker 2: develop a vaccine for its prevention.
Speaker 3: Cool.
Speaker 2: Yeah, it was. I mean, it was a really well
Speaker 2: funded organization. For a while. The early twentieth century was
Speaker 2: riddled with amazing medical advancements that resulted in the reduction
Speaker 2: or elimination of many diseases through the development of vaccines
Speaker 2: or antibiotics. Polio then must have seemed like some kind
Speaker 2: of cruel joke, because early research on a polio vaccine
Speaker 2: was wildly unsuccessful.
Speaker 3: Really.
Speaker 2: Yeah, and early trials in the nineteen thirties led to
Speaker 2: several children dozens I think, becoming paralyzed or dying.
Speaker 3: With the vaccine trials. Yeah, that sucks.
Speaker 2: As a result, scientists began to steer their research more
Speaker 2: towards treatments and away from vaccines. A couple of hurdles
Speaker 2: stood in the way of a successful polio vaccine. With
Speaker 2: the smallpox and yellow fever vaccines, which had already been
Speaker 2: successfully developed and deployed, there was only one strain of
Speaker 2: virus for the vaccine, so creating the vaccine was pretty straightforward.
Speaker 2: With polio, researchers didn't know at the time how many
Speaker 2: strains there were, and it wasn't until nineteen fifty one
Speaker 2: that the final number was ino, which, as you mentioned,
Speaker 2: was three. That meant that an effective vaccine would have
Speaker 2: to contain all three types of the virus. The other
Speaker 2: issue was how to grow enough virus to make vaccines.
Speaker 2: Previous reach research had indicated that the virus could only
Speaker 2: be grown in nervous tissue, which was all but impossible
Speaker 2: to grow inside a lab at the time. Then a
Speaker 2: man named John Enders tested this conventional belief by inoculating
Speaker 2: other tissue skin, muscle, kidney with the poliovirus, and it
Speaker 2: grew right.
Speaker 3: Because it actually infects your gut and it can actually
Speaker 3: I didn't mention this, but it can infect your spleen
Speaker 3: and your liver. It can actually infect a whole bunch
Speaker 3: of your tissues. But obviously they wouldn't have known that
Speaker 3: then because the only symptoms you really see or associate
Speaker 3: with poliomyelitis are the nervous symptoms.
Speaker 2: Well, he did know that, Like he did know, he said, Well,
Speaker 2: it infects your gut, so it's got to be able
Speaker 2: to exist in other gud other tissues.
Speaker 3: Okay, smart guy Ender.
Speaker 2: Well, this incredible breakthrough would be the only polio related
Speaker 2: development to earn a Nobel Prize. It revolutionized cell culture
Speaker 2: in the lab.
Speaker 3: That that's really cool.
Speaker 2: This finding, along with the discovery of the three strains,
Speaker 2: meant that the groundwork was laid for vaccine development. The
Speaker 2: March of Dimes began to essentially funnel money into the
Speaker 2: development of a vaccine. An enormous number of scientists were
Speaker 2: involved in this process. So let's meet the two men
Speaker 2: whose names you've probably heard linked to polio before, Jonas
Speaker 2: Salk and Albert Sabin. These two were similar in many ways.
Speaker 2: Both men were of Eastern European descent, both were Jewish,
Speaker 2: and both faced substantial obstacles because of this. However, Saban
Speaker 2: was older, more established and respected in the scientific community,
Speaker 2: more concerned with earning the respect and praise of his peers,
Speaker 2: his fellow researchers, Salk, on the other hand, was young,
Speaker 2: relatively young, a novice when it came to polio research,
Speaker 2: and seemed to be more interested in the celebrity spotlight
Speaker 2: over the scientific one, and was dismissive of others contributions
Speaker 2: to the development of the vaccine. According to some of
Speaker 2: his lad members, can Take, he would put his name
Speaker 2: in front of theirs.
Speaker 3: Oh that's not cool, bro.
Speaker 2: I know, I really wanted there to be a hero
Speaker 2: in this story, and they both kind of seem to
Speaker 2: have their own personal issues.
Speaker 3: I can be your hero, baby.
Speaker 2: That was good. These two would feature as the major
Speaker 2: players in one of the most contentious scientific rivalries of
Speaker 2: the twentieth century.
Speaker 3: Can I just say I wish that I was involved
Speaker 3: in a scientific rivalry?
Speaker 2: I mean, do you want to be? Yeah?
Speaker 3: It kind of sounds exciting, doesn't it.
Speaker 1: Well?
Speaker 2: Yeah, okay, So what issue do you want to take up?
Speaker 2: An arm?
Speaker 3: I don't feel strongly enough about anything. Okay, maybe later, Okay,
Speaker 3: just a thought.
Speaker 2: Get back to me on that.
Speaker 3: I will.
Speaker 2: So. The feud between Salk and Saban simmered quietly, with
Speaker 2: Sabin passive aggressively disparaging the work of Salk, but the
Speaker 2: two kept a polite front until nineteen fifty three. The
Speaker 2: previous year nineteen fifty two, had seen the highest number
Speaker 2: of polio cases in the US so far, with more
Speaker 2: than fifty seven thousand cases overall, twenty one thousand of
Speaker 2: them paralytic and three thousand fatal.
Speaker 3: Oh my gosh.
Speaker 2: Yeah, So the urgency and pressure to create a vaccine
Speaker 2: was never higher. And when Jonah Salk announced in nineteen
Speaker 2: fifty three that he had come up with a vaccine
Speaker 2: that he had successfully tested on polio afflicted and mentally
Speaker 2: disabled children, I might add, oh, God always, always, the
Speaker 2: US celebrated. Salk became a celebrity overnight, appearing on TV
Speaker 2: to tell his story, but to also caution viewers that
Speaker 2: more testing needed to be done. In response, Sabin publicly
Speaker 2: declared himself to be quote anti Salk, saying that the
Speaker 2: killed virus vaccine that Salk had developed was not enough
Speaker 2: to ensure lasting immunity and applied that it was downright dangerous.
Speaker 2: He emphasized that the only way to eliminate polio was
Speaker 2: through a live virus vaccine, which coincidentally was what he
Speaker 2: was working on at the time. Of course, Saban has
Speaker 2: a time did have some legitimacy. Salks vaccine was in
Speaker 2: no way perfect. Despite Saban and others protestations, this vaccine
Speaker 2: was the closest thing yet to a prevention for polio,
Speaker 2: and plans were drawn up for a country wide experiment.
Speaker 3: Can you remind me what year this is?
Speaker 2: So this is in nineteen fifty three when he announced, Hey,
Speaker 2: I have a vaccine that is close to being ready.
Speaker 3: But it was still under trials. At this point, it
Speaker 3: was still under trial.
Speaker 2: And so in nineteen fifty four, the testing to validate
Speaker 2: this vaccine was going to happen and it was going
Speaker 2: to be the unite the biggest public health experiment in
Speaker 2: US history to date.
Speaker 3: WHOA.
Speaker 2: So over the course of nineteen fifty four, over one
Speaker 2: point three million children would take part one point three
Speaker 2: million million, wow, with some of them receiving the vaccine
Speaker 2: and others receiving a placebo and others just being observed
Speaker 2: without receiving any sort of injection. In April nineteen fifty five,
Speaker 2: the results of the trial were in The vaccine was
Speaker 2: quote safe, effective, and potent.
Speaker 3: Thank goodness, because like one point three million children just like,
Speaker 3: oh boy, I mean, they do trials before they go
Speaker 3: to trials. But still, I mean back then it was
Speaker 3: a little more iffy. I'm sure it was.
Speaker 2: Yeah, I'm sure, definitely.
Speaker 3: Yeay. The well they did the trials just on kids
Speaker 3: who had no choice in the matter, exactly.
Speaker 2: It was estimated that this vaccine conferred protection to sixty
Speaker 2: to ninety percent of those vaccinated. Bells were rung. There
Speaker 2: was actual rejoicing in the streets. Wow, seriously, children around
Speaker 2: the world could now be protected against polio. It was
Speaker 2: a huge chafe development.
Speaker 3: That's a major deal.
Speaker 2: And Sulk was a god of science in the eyes
Speaker 2: of the public, especially after going on TV to answer
Speaker 2: the question quote who owns the patent on this vaccine
Speaker 2: with quote, well, the people, I would say, there is
Speaker 2: no patent. Can you patent the sun?
Speaker 3: Change my mind? I don't want to rivalry. I want
Speaker 3: to be a gut of science.
Speaker 2: So yeah, I mean that was a nice sentiment.
Speaker 3: Yeah.
Speaker 2: Right. So with no patent on the vaccine, drug companies
Speaker 2: were free to make and sell the vaccine. Okay, you
Speaker 2: would think that the road was free and clear for
Speaker 2: all kids to be free from the fear of polio.
Speaker 2: Not so fast, of course. Never one problem was with
Speaker 2: administering it. The US government, headed at the time by
Speaker 2: Dwight Eisenhower, didn't want to administer the vaccine at public schools,
Speaker 2: fearing that it would seem too much like socialized medicine.
Speaker 2: Oh god, mm hmmm. So they consciously chose not to
Speaker 2: plan on how to get the vaccine to kids, how
Speaker 2: to ensure that there was enough vaccine being produced, and
Speaker 2: instead just leaving it up to the drug companies and
Speaker 2: to the parents.
Speaker 3: My lordy, lordie.
Speaker 2: Some of whom the parents could not afford to pay
Speaker 2: for the vaccine. Right. But you know, this was during
Speaker 2: the time of the Cold War, and so any sort
Speaker 2: of whiff of socialism was really it.
Speaker 3: Was communism exactly, Oh dear America.
Speaker 2: Another problem was that some drug companies had better safety
Speaker 2: checks than others. Of course, one drug company, Cutter Laboratories
Speaker 2: in San Francisco, didn't check its product well enough, and
Speaker 2: they failed to disclose some of their findings, which show
Speaker 2: that there were live virus particles in the vaccine.
Speaker 3: Great cool.
Speaker 2: Over two hundred people contracted polio from that vaccine, with
Speaker 2: most severely paralyzed and eleven dying.
Speaker 3: This is a really great way of like how to
Speaker 3: kinvince people to not do vaccines is by doing it
Speaker 3: this way.
Speaker 2: Oh, it was a fiasco for sure, and it really
Speaker 2: also soured public opinion of the Salk vaccine, which was
Speaker 2: helped along by Sabin, whose virus vaccine was finally ready
Speaker 2: to test just in time. Since the US was not
Speaker 2: at all keen on the idea of another wide scale
Speaker 2: vaccine trial, Saban brought his vaccine to the Soviet Union,
Speaker 2: where in nineteen fifty nine the Russians tested, never wanting
Speaker 2: to be outdone by the US ten million children successfully.
Speaker 2: Thank goodness, that was funny. The Saban live virus vaccine
Speaker 2: eventually displaced the killed virus vaccine across the globe. It
Speaker 2: certainly had its advantages. The Saban vaccine, which was a
Speaker 2: live virus, was a weakened virus. I should say it
Speaker 2: was cheaper. Since it was an oral vaccine, whereas the
Speaker 2: Salk vaccine is injected, you did not need a trained
Speaker 2: medical professional to administer it. It was thought to be
Speaker 2: more effective and protect you for longer, and it also
Speaker 2: apparently had a broader protection recently. Also, this is a
Speaker 2: really cool thing. Recently, vaccinated individuals would shed attenuated viral
Speaker 2: particles for several days which could then be picked up
Speaker 2: by unvaccinated individuals, resulting in passive vaccination.
Speaker 3: I love that.
Speaker 2: I mean very cool.
Speaker 3: That is very awesome.
Speaker 2: That was a huge bonus.
Speaker 3: It is a major bonus. You don't have to necessarily
Speaker 3: vaccinate everyone. Great if you can, but if you can't,
Speaker 3: they're probably going to indirectly vaccinate their family members because
Speaker 3: this is transmitted fecal oral and you're shedding this attenuated
Speaker 3: weekend virus in your poop. Yep, yeah, I love it.
Speaker 2: It's very I mean, it's genius.
Speaker 3: Yeah, but yep.
Speaker 2: There was one glaring fault of the Sabin vaccine.
Speaker 3: I'd say there might be two, but they're very related.
Speaker 2: Because it was a live virus vaccine, some of those
Speaker 2: given the vaccine would develop paralytic polio. Three and one
Speaker 2: hundred million doses, which is a really small number but
Speaker 2: still very problematic. In several countries where wild polio had
Speaker 2: been completely wiped out, there were still a few dozen
Speaker 2: cases each year as all a direct result of the
Speaker 2: Saban vaccine.
Speaker 3: You know, I actually saw numbers that were much higher
Speaker 3: than that. I'm sure that they are one in seven
Speaker 3: hundred and fifty thousand, oh wouses administered will result in
Speaker 3: vaccine associated paralytic poleomiolitis.
Speaker 2: Wow.
Speaker 3: Yeah, and that's if you were fully immuno competent. Oh right,
Speaker 3: But if you are immino compromised, like in our interview
Speaker 3: with Grace she talked about having TV, if you're compromised,
Speaker 3: you are three to six thousand times more likely to
Speaker 3: end up getting vaccine associated paralytic poleomyolitis than a person
Speaker 3: who's immuno competent.
Speaker 2: Holy moly.
Speaker 3: I know. So it's it's not an insignificant fear.
Speaker 2: No. Well, and seeing this in I think the early eighties,
Speaker 2: Salk's son wrote, who was a doctor, wrote an article
Speaker 2: calling for the switch back to the safer killed virus vaccine.
Speaker 2: In response, Saban said, direct quote, he doesn't know what
Speaker 2: he's talking about. His work is completely out of focus, distorted,
Speaker 2: erroneous information just to chip off the old block, real
Speaker 2: piece of work.
Speaker 3: Saban was, this is the problem with uh.
Speaker 2: Toxic masculinity, egos.
Speaker 3: Well, toxic masculinity, but also scientific rivalries.
Speaker 2: Oh my gosh, I know is that you?
Speaker 3: I mean you gotta be able to see both sides, man, Yeah,
Speaker 3: it's there are pros and cons to both of these vaccines.
Speaker 3: I'll talk more about it too when we talk about
Speaker 3: the state of polia today.
Speaker 2: Yeah. So the craziest thing though, is that Sulk wrote
Speaker 2: that Jonah Salk's son wrote that in the early eighties
Speaker 2: and no one listened to it. No, no one listened
Speaker 2: to The live virus vaccine would continue to be used
Speaker 2: for another twenty years in the US until the CDC
Speaker 2: finally called for a return to the Salk vaccine in
Speaker 2: two thousand, which one is used today.
Speaker 3: Do you know what you were vacinated with? Because I
Speaker 3: called my mom to ask, I have no idea. At
Speaker 3: that point in time. The recommendations were kind of do
Speaker 3: whichever one you and your doctor think is best. So
Speaker 3: I called my mom to ask. I was like, do
Speaker 3: you remember I got the oral one?
Speaker 2: Oh? Wow, yeah, okay, so you're yeah.
Speaker 1: So.
Speaker 2: Polio, like smallpox, is another of the diseases that the
Speaker 2: World Health Organization targeted for eradication in nineteen eighty eight.
Speaker 2: The goal for eradication was announced to be the year
Speaker 2: two thousand, but clearly there are still cases around. So Aaron,
Speaker 2: where do we stand today.
Speaker 3: Polio today? The good news is that polio is very
Speaker 3: close to being eradicated.
Speaker 2: That is good news.
Speaker 3: So you mentioned it was nineteen eighty eight that the
Speaker 3: World Health Organization decided that that was going to be
Speaker 3: their new goal. In nineteen eighty five, the Pan American
Speaker 3: Health Organization, which is an organization we never talk about
Speaker 3: on this show, but it's also it's an organization like
Speaker 3: the World Health Organization, but it's just for the Americas,
Speaker 3: North and South America and Central America. They made it
Speaker 3: their goal in nineteen eighty five to eradicate polio from
Speaker 3: the western hemisphere by nineteen ninety and they came super close.
Speaker 3: So in nineteen ninety one, that was when the last
Speaker 3: case of wild polio virus transmission was recorded in Peru,
Speaker 3: and in nineteen ninety four, the America's region of the
Speaker 3: World Health Organization's regions, so the Americas were classified as
Speaker 3: polio free.
Speaker 2: Wow.
Speaker 3: Yeah, in nineteen ninety four. It's been a long time. Yeah,
Speaker 3: it was four years late, later than they wanted. But hey,
Speaker 3: it's not so bad.
Speaker 2: I mean, better late than never, better late than never.
Speaker 3: And again in nineteen eighty eight is when the who
Speaker 3: made it its goal to eradicate polio. They definitely haven't
Speaker 3: done it. It's twenty seventeen, polio still exists.
Speaker 2: How many cases have there been? Like list this year?
Speaker 3: Great question, great question. So they have made major progress.
Speaker 3: In nineteen eighty eight when they made it their goal,
Speaker 3: there were three hundred and fifty thousand cases estimated of
Speaker 3: polomiolitis that is now on involvement. Wow. In twenty sixteen
Speaker 3: thirty seven, Wow. Yeah, the WHO estimates that sixteen million
Speaker 3: people have been saved from paralysis. Sixteen million. Wow.
Speaker 2: I know, I know, every episode we're always like, oh
Speaker 2: that w JO. They're so amazing, But.
Speaker 3: You know, they're not a perfect organization by any means,
Speaker 3: but they really try hard.
Speaker 2: They've done great things.
Speaker 3: So nineteen ninety four, the Americas were declared polio free.
Speaker 3: In two thousand, the Western Pacific Region, which is Western Asia,
Speaker 3: Pacific Islands and Australia were declared polio free, in two
Speaker 3: thousand and two the European Region, and in twenty fourteen,
Speaker 3: and this one's very exciting, the Southeast Asia Region was
Speaker 3: declared polio free.
Speaker 2: Wow.
Speaker 3: So India was one of the places that was very,
Speaker 3: very difficult to implement polio eradication campaign because it's a
Speaker 3: massive country. It's so densely populated. There are so many
Speaker 3: parts that are remote and underdeveloped and underserved.
Speaker 2: But they did it. That's incredible.
Speaker 3: Twenty eleven was the last case of wild polio in
Speaker 3: India and it's so cool.
Speaker 2: Yeah, well, and the so just to bring it back
Speaker 2: to smallpox and the eradication campaign there smallpox, the vaccination
Speaker 2: record is a scar on your arm, right, and so
Speaker 2: it's very visible. Whereas with polio you need multiple courses
Speaker 2: yep for one and two, it's not visible, and so
Speaker 2: the records have to be really well kept. It just
Speaker 2: is overwhelmingly a lot more difficult.
Speaker 3: It's a very very difficult and logistically challenging campaign to undertake.
Speaker 3: And we talked already about how the oral polio vaccine
Speaker 3: OPV was and still is kind of the vaccine of
Speaker 3: choice for the eradication campaign. It's super cheap, I think
Speaker 3: I saw it costs fourteen cents per administration and it
Speaker 3: can be administered by anybody, so literally anyone can be
Speaker 3: trained as a volunteer. You just squeeze a drop or full.
Speaker 3: Something I thought was really cool is that included in
Speaker 3: the oral polio vaccine is vitamin A because vitamin A
Speaker 3: deficiency is a major cause of mortality in children under
Speaker 3: five in a lot of countries. So the w U
Speaker 3: estimates that they by including vitamin A in the oral
Speaker 3: polio vaccine, they estimate that one point five million childhood
Speaker 3: deaths have been prevented.
Speaker 2: Holy cow, right, that's amazing.
Speaker 3: I know. Fangirling over here, I know. And so we
Speaker 3: talked about one of the biggest risk factors of using
Speaker 3: the oral polio vaccine is that this vaccine associated paralytic polio.
Speaker 3: There's another aspect of it. We've talked about the benefits,
Speaker 3: but there's another thing that actually makes this a dangerous
Speaker 3: vaccine to use, and that's the exact flip side of
Speaker 3: the fact that you get this passive immunization of your
Speaker 3: household members. This exact same property is what allows for
Speaker 3: outbreaks of what is called circulating vaccine derived poliovirus. This
Speaker 3: has happened in Pakistan, Nigeria and Laos Democratic Republic of Laos.
Speaker 3: This what is called c VDPV. It's too many acronyms, WHOA.
Speaker 3: The vaccine derived poliovirus that is circulating can evolve to
Speaker 3: become more virulent and more like its wild type progenitor,
Speaker 3: which is fascinating and scary and scary and insane. And
Speaker 3: so this type of paralysis that's associated with the vaccine
Speaker 3: derived poliovirus is clinically indistinguishable from that that you would
Speaker 3: get from a wild poliovirus. You can tell by laboratory analysis,
Speaker 3: so we know when outbreaks are going on, what is
Speaker 3: which is causing it. So they are trying to move
Speaker 3: away from the use of OPV now that the risk
Speaker 3: of these side effects are essentially outweighing the risk of
Speaker 3: infection by wild type poliovirus in the majority of countries.
Speaker 3: We also are seeing a push towards using a mono
Speaker 3: or bivalent OPV instead of a trivalent OPV. Are they
Speaker 3: safer well in the case of poliovirus too, they're basically
Speaker 3: is no wild circulating PV two, But we do see
Speaker 3: outbreaks of vaccine derived PV two happening from the from
Speaker 3: the oral vaccine.
Speaker 2: Right, So if they moved away, so it would either
Speaker 2: be moving towards a killed virus vaccine, the objective vaccine,
Speaker 2: or it would be moving towards a bivalent or monovalent
Speaker 2: or a lax vaccine.
Speaker 3: Yeah, And so what they're actually doing is both. So
Speaker 3: the who is phasing out the use of the oral
Speaker 3: polio vaccine, they're using mono or bivalent where wild poliovirus
Speaker 3: one or three are circulating very commonly. Okay, but then
Speaker 3: they're phasing it out and they're trying to bring in
Speaker 3: the injected vaccine. But again this is much more difficult
Speaker 3: and expensive to administer in a lot of countries.
Speaker 2: Did you find anywhere that actually indicated that the Salk
Speaker 2: killed virus vaccine conferred shorter than lifetime immunity to SABAN?
Speaker 3: Great question. I haven't found anything that indicates that it
Speaker 3: confers a shorter immunity. What happens is that the IPv,
Speaker 3: the injected or the inactivated poliovirus vaccine does not confer
Speaker 3: mucosal immunity. So the immunity that you get by taking
Speaker 3: the oral vaccine directly affects your cells in your.
Speaker 2: Guts, because that is the trusmission exactly.
Speaker 3: That is the root of administration, and that is the
Speaker 3: normal root of transmission. So from what I could gather,
Speaker 3: and I haven't read every paper on this, so this
Speaker 3: is me conjecturizing based on my knowledge, the antibodies that
Speaker 3: your gut uses are IgA in general, which are different
Speaker 3: than the antibodies that circulate in your blood. So the
Speaker 3: antibodies that you make when you get injected with the
Speaker 3: inactivated poliovirus vaccine are not the same ones that your
Speaker 3: body would make. You'll make both types, but you'll make
Speaker 3: more of the kind if you get the oral polio vaccine.
Speaker 3: So what can happen is that you could potentially still
Speaker 3: get in effected. You're less likely to end up with
Speaker 3: paralytic paralysis, so you're protected, but you can still transmit
Speaker 3: and pass the poliovirus to other people if you don't
Speaker 3: have the oral polio vaccine, if that makes sense. So
Speaker 3: in a country like for example, in Norway, they have
Speaker 3: only ever used the IPv, they've never used the OPV,
Speaker 3: but they have really great sanitation, so they're not having
Speaker 3: this problem where if everyone is vaccinated with the IPv,
Speaker 3: then every individual is protected and what you're not necessarily
Speaker 3: stopping is the transmission to other people that have not
Speaker 3: been vaccinated. Does that make sense, yes, and so yeah,
Speaker 3: So that's one of the biggest differences that I found
Speaker 3: between the two of them. Both of them are effective,
Speaker 3: but in slightly different ways. And like we said, already,
Speaker 3: administration of say one dose of the IPv and one
Speaker 3: dose of the OPV like administration of both of them
Speaker 3: is actually very great, So it doesn't have to be
Speaker 3: all OPV or all IPv. There can be some combination.
Speaker 3: But in areas where there is absolutely no circulating wild polio,
Speaker 3: you're better off with the IPv because the side effects
Speaker 3: are far less and the risk of a future outbreak
Speaker 3: is lower as well. Cool So economic modeling way back
Speaker 3: in the eighties predicted that polio eradication would save forty
Speaker 3: to fifty billion US dollars between nineteen eighty eight and
Speaker 3: twenty thirty five.
Speaker 2: Which is why the global campaign started.
Speaker 3: I would assume so yes, because everything's about money. But
Speaker 3: what's interesting is that it's predicted to cost seven billion
Speaker 3: dollars between just twenty thirteen and twenty nineteen to keep
Speaker 3: this eradication effort going.
Speaker 2: Right because of the surveillance.
Speaker 3: Surveillance is super expensive. We're going to have to switch
Speaker 3: to the inactivated virus vaccine, which is more expensive. There's
Speaker 3: just a ton of costs involved in it. So I've
Speaker 3: heard a lot of critiques, and we talked about before
Speaker 3: how this eradication effort really was spearheaded and started because
Speaker 3: it was white children in wealthy countries who were being
Speaker 3: affected not only obviously, but they were being affected.
Speaker 2: Because they were affected. As how it became exactly worked on.
Speaker 3: So there are critiques that say, you know, this eradication
Speaker 3: effort itself is there's a lot of money going to
Speaker 3: it that could be spent on other.
Speaker 2: Diseases such as well.
Speaker 3: I mean, you could think of it as diseases that
Speaker 3: we think of as even more neglected than polio, like
Speaker 3: neglected chophill diseases, intechnal helmets, leshmaniasisagas. Do a plug for
Speaker 3: that one. But there's I'm not I don't know the
Speaker 3: economics of this, to be honest, all that well. And
Speaker 3: so this is my personal Aaron Norman Updeke's opinion. It
Speaker 3: doesn't have to be the opinion of this podcast will
Speaker 3: kill you unless you agree. I feel like number one,
Speaker 3: polio still sucks. It's still a terrible virus, and so
Speaker 3: in my mind, and any kid who doesn't have to
Speaker 3: get it in any country, that's a worthwhile endeavor. That's
Speaker 3: the first thing I feel like. And the second thing
Speaker 3: is that what's really cool about this polio eradication effort
Speaker 3: is that it has taken so many individuals being mobilized
Speaker 3: and the development and implementation of infrastructure that now exists
Speaker 3: in so many countries that once you have a system
Speaker 3: of infrastructure like that up and running for vaccination for polio,
Speaker 3: there's not that many steps away from being able to
Speaker 3: vaccinate for MMR, detap hepatitis A, all of these other things.
Speaker 2: MMR is, musles, mumpster rebella, Y, detap is, dig.
Speaker 3: And acellular protessis. Sorry, look, obviously it's been easier to
Speaker 3: do polio because it's an oral vaccine, but still you're
Speaker 3: having this switchover and you're still doing There is so
Speaker 3: much surveillance that happens for polio. You can also train
Speaker 3: people to do surveillance for things like cholera and influenza.
Speaker 3: But what I think is even more exciting is you
Speaker 3: can train people then to identify outbreaks of new viruses
Speaker 3: like Marburg or NEPA, which I hope we'll talk about someday.
Speaker 3: So what's exciting to me is that getting this initial
Speaker 3: setup is often one of the biggest barriers to controlling
Speaker 3: any disease. So if nothing else, this global eradication campaign
Speaker 3: has put a lot of boots on the ground in
Speaker 3: helping to develop the infrastructure that we would need to
Speaker 3: be able to do even more great public health work
Speaker 3: in the future.
Speaker 2: Right, I agree. Yeah. I feel like if you are
Speaker 2: an economically minded person, which is going to be the
Speaker 2: people who actually make these decisions, unfortunately, that the infrastructure
Speaker 2: is already set up, a lot of the cost is
Speaker 2: already invested, and that it wouldn't be that much additional
Speaker 2: effort to do some of these other global campaigns.
Speaker 3: Granted, the money just needs to keep coming, which is
Speaker 3: the second other biggest hurdle that every disease in public
Speaker 3: health campion has to deal with. But you know, polio
Speaker 3: is a it's a mostly happy ending. It's you know,
Speaker 3: we've really really decreased. Did we even say the three
Speaker 3: countries that it still exists in.
Speaker 2: I don't think so.
Speaker 3: It's Afghanistan, Pakistan, and Nigeria. I think you might have
Speaker 3: said it, but I don't remember if I did.
Speaker 2: Polio is almost gone, and that's great, right, I mean,
Speaker 2: you and I didn't have to endure closed swimming pools.
Speaker 3: That would have been well only for poop, but not
Speaker 3: for polio poop. Oh, Okay, and uh yeah, so so
Speaker 3: I don't even think we need to ask the question
Speaker 3: of how scared you need to be for this episode.
Speaker 3: It's not a big threat of bioterrorism. No, you know,
Speaker 3: recognize that it still happens. But but you have probably
Speaker 3: been vaccinated. You've definitely been vaccinated. If you've ever gone
Speaker 3: to school, you've been vaccinated. Well, sources time, yep, let's
Speaker 3: do it. I read a couple of books to get
Speaker 3: my information. The first is called Polio An American Story.
Speaker 3: It is by David Oshinsky and.
Speaker 2: It is a really great look at polio in the
Speaker 2: United States, sort of the drive to create this vaccine,
Speaker 2: and concentrates a lot on Fdr Saban Salk, basically what
Speaker 2: I talked about today.
Speaker 3: Cool.
Speaker 2: Another great one, which had a better overview of the
Speaker 2: history and it's a general book, is called Viruses, Plagues
Speaker 2: and History by Michael Oldstone. And finally I want to
Speaker 2: put in a plug for a book called Small Steps
Speaker 2: The Year I Got Polio, and it's by a woman
Speaker 2: named peg Carrott. I think is how you say her name?
Speaker 2: And I did not read this, but it was recommended
Speaker 2: to us by Grace and it's supposed to be a
Speaker 2: great first hand account, like a memoir of this girl
Speaker 2: experience with polio and she when she contracted it at
Speaker 2: the age of thirteen. I believe.
Speaker 3: Oh, that sounds really interesting.
Speaker 2: So that's all I got.
Speaker 3: I want to give a shout out to the Polio
Speaker 3: Global Eradication Initiative, which is funded by not only the WHO,
Speaker 3: even though we talked about them most today, It's also
Speaker 3: funded by UNICEF, Rotary International, the CDC, and the Bill
Speaker 3: and Melinda Gates Foundation, as well as of course all
Speaker 3: the governments in the countries that they operate. And finally,
Speaker 3: this review called Impact of Inactivated Poliovirus Vaccine on mucosal
Speaker 3: immunity Implications for the Polio Eradication Endgame by Edward Parker
Speaker 3: at All in Expert Review of Vaccines, published in twenty fifteen.
Speaker 3: You know, my citations are always so much more boring
Speaker 3: than your Stargyep. No, sorry I almost did too. Sorry,
Speaker 3: no offense, Eddie Parker.
Speaker 2: I'm sure that they're chock full of good information.
Speaker 3: It's really it is actually a very interesting article to read.
Speaker 3: But you guess you gotta like the articles things. I
Speaker 3: guess the books are more accessible.
Speaker 2: I want to give a huge shout out to Grace
Speaker 2: who was so awesome in letting us inner you her
Speaker 2: and share her story with us, and also to Bloodmobile
Speaker 2: as per Usu who provided all the music for this episode.
Speaker 3: Yep, thank you so much. Thank you Grace so much
Speaker 3: for talking with us. It was amazing and awesome and
Speaker 3: I hope all of you listeners.
Speaker 2: Enjoyed it, rate, review, and subscribe. Please please please follow
Speaker 2: us on social media.
Speaker 3: Yep, and wash your hands, you filthy animals.