John McManus comforted by Helen Hayes as Dr. Leon G. Jacobs administers Salk anti-polio vaccine (1954). Courtesy Boston Public Library.
Looking back on the COVID-19 pandemic, we reflect on the importance of the vaccine and how its rapid testing and rollout reduced the incidence of infection. However, those who feared or opposed COVID-19 vaccination due to personal beliefs or perception of risk influenced discussions in the media and the uptake of the vaccine. But hesitancy and opposition to vaccines has existed in the past, and such awareness provides needed context to the COVID-19 pandemic and vaccine within American history.
Historical accounts of mid-twentieth century American medicine primarily focused on its successes, including the development of new interventions, such as penicillin to combat bacterial infections or chemotherapy to target cancer. More recently, historians have examined the politics of medicine, revealing challenges, setbacks, and ethical dilemmas.[2] The case of the first polio vaccine, developed by University of Pittsburgh researcher, Dr. Jonas Salk, is particularly instructive, as it shows that public reception of new interventions was not always positive. Indeed, acceptance, hesitancy, and resistance comingled in the past, and considerable resources were mobilized to achieve an effective public health program. Creating a viable polio vaccine, as with the COVID-19 vaccine, was not enough; instead, allaying public misgivings through education and outreach became necessary to overcome hurdles and build trust.
Electron micrograph of the poliovirus. Photo by Dr. Fred Murphy and Sylvia Whitfield. Courtesy Centers for Disease Control and Prevention, Public Health Image Library, #1875. Via Wikimedia Commons.
Before the vaccine, American families faced an ever-present threat of polio. Polio (or infantile paralysis) is a contagious viral disease that can cause flu-like symptoms, but in a small percentage of cases causes paralysis of the limbs and breathing muscles or even death. Although not all cases of paralysis are permanent, the process of recovery is lengthy and incomplete, requiring survivors to adapt to lasting disability. By the 1950s, the incidence of polio was a widespread concern; rates increased dramatically from only 1,700 cases in 1938 to over 38,000 cases in 1954. Since the virus often infected children and emerged in epidemic form, Americans lived in fear of the disease and its potential impact on individuals and communities.[3]
In an effort to fight polio, President Franklin D. Roosevelt and his law partner, Basil O’Connor, formed the National Foundation for Infantile Paralysis (NFIP) in 1938 to sponsor health education, polio treatment, and medical research. When the first vaccine, funded by the NFIP and developed by Salk, was declared “safe, effective, and potent,” in April 1955, it represented a major scientific and public health breakthrough.[4] Although many Americans greeted this news with relief and fanfare, not everyone shared in the optimism. In order to help Americans accept the polio vaccine, NFIP officials and Salk first needed to address social and political challenges, scientific criticism, and public trepidation.
The mixed reaction towards the Salk vaccine was partially because it was discovered at a moment of considerable anxiety. Although Americans had recognized the importance of other vaccines, such as those for measles and pertussis, Cold War competition with the Soviet Union and the unfathomable consequences of the atomic bomb reminded Americans of a darker side to new technological innovations. Indeed, a growing expectation that children would live to adulthood, combined with a greater aversion to risk, meant that some Americans felt that new technologies needed to be approached with caution. Moreover, prior polio research setbacks, publicized scientific discord, manufacturing mishaps, and media sensationalism created a complex landscape for public reaction. In the face of growing uncertainty about the polio vaccine, and at a time when epidemics were increasing in both severity and regularity, Salk and the NFIP had to work to build faith in the vaccine.[5]
Earlier research failures, linked to investment in the antibody-rich human blood fraction, gamma globulin (GG), casted doubt on NFIP-funded research initiatives. Between 1951 and 1952, the NFIP sponsored Salk’s Pittsburgh competitor, Dr. William McD. Hammon, to assess the value of GG in preventing paralytic polio through injections at the height of an epidemic.[6] Although Hammon undertook a clinical trial among 55,000 children to test his theory, his dataset was undermined by diagnostic shortcomings, reporting problems, and the decision of some parents to seek private doses of the serum. Despite these flaws, Hammon concluded that GG was effective in preventing polio. In addition, Hammon’s optimistic interpretation of the results led to a series of prominent Journal of the American Medical Association articles that heralded the value of GG in preventing polio, which were later used to justify an expensive national GG immunization program between 1953 and 1955. When public health researchers discovered that GG actually made little or no difference in preventing polio, the project and its $19 million investment stood as an embarrassment and raised questions about the motives and trustworthiness of the NFIP’s wider research program.
Concerns about the NFIP laid the groundwork for further misgivings about the polio vaccine, as criticism of Salk by leading medical researchers raised doubts about his vaccine’s safety and efficacy. Hammon cautioned that people should not be too optimistic about the new vaccine as its protective benefits, if any, would not be lasting, while University of Cincinnati polio researcher, Dr. Albert B. Sabin, who was creating an alternate polio vaccine, condemned Salk’s version as dangerous. “Since there is an impression that a practicable vaccine for poliomyelitis is either at hand or immediately around the corner,” warned Sabin, “it may be best to start this discussion with the statement that such a vaccine is not now at hand and that one can only guess what is around the corner.”[7] Joining these critics, Yale School of Medicine researcher, Dr. Joseph L. Melnick, expressed concern about the possibility that traces of live virus might be present in Salk’s killed-virus vaccine, which might cause infections. These charged public critiques made by prominent medical researchers undermined public trust in the vaccine even further.
This physical therapist is assisting two polio-stricken children holding on to a rail while they exercise their lower limbs. 1963. Photo by Charles Farmer. Courtesy Centers for Disease Control and Prevention, Public Health Image Library, #2612. Via Wikimedia Commons.
Sensationalist media coverage of hypothetical health risks and the unknown outcome of a large field test fueled further anxiety. “Vaccine for Polio Affirmed as Safe: Medical Groups and Dr. Salk Repeat Assurances after Charges of Danger,” read one New York Times headline.[8] In April 1954, the NFIP funded a large field trial to assess the safety and efficacy of Salk’s prototype vaccine. Over 1.8 million children were enrolled in the study, which was closely monitored by journalists and researchers. The careful design of the experiment did little to dissuade sensationalist media coverage: for example, listeners to Walter Winchell’s popular radio show heard the claim that small coffins were being secretly manufactured to hold the bodies of children expected to die after receiving the test vaccine.[9] Newspapers and magazines amplified the story, which led some fearful parents to withdraw their children from the field test. Such alarmist media coverage eroded public confidence in the vaccine and seeded the idea that it was a premature public health experiment.
The lingering risk of polio provocation via other medical procedures also increased concerns. During the 1940s and 1950s, some physicians and health officials observed an increased incidence of paralytic polio among children receiving tonsillectomies or immunizations against pertussis, diphtheria, and tetanus. Informed by international studies on the problem, a number of public health organizations acknowledged the potential risk and advised physicians to avoid conducting tonsillectomies or injections during polio epidemics. It was not until the 1990s that the cause of polio provocation was understood and confirmed by scientists. And although the Salk vaccine promised to end the risk of polio provocation altogether by building herd immunity, those participating in the vaccine field trial could not be assured of protection.[10]
Questions about the validity of the field trial findings also had a negative impact on perceptions of the vaccine. Statistician Alexander K. Brownlee identified what he believed were significant issues with how the vaccine field trial was undertaken and assessed, claiming that there was evidence of interpretive bias and selective data use. Although Brownlee’s claims were published through academic channels and did not achieve much recognition in the media, they did impact the views of health professionals and those close to the vaccine’s development. Such criticism served to uphold a belief that the field trial was not conducted for reasons of science, but for reasons of publicity.[11]
Apprehension surrounding the polio vaccine was not limited to the field trials. After the vaccine was licensed in April 1955, production problems led to more concerns and criticism. A few manufacturers experienced challenges either in following Salk’s detailed production procedure or reliably inactivating the poliovirus to ensure a safe vaccine. On April 25, 1955, cases of vaccine-induced polio were reported in those who received batches of improperly produced vaccine by Cutter Laboratories of California. Of the 220,000 people exposed, 164 became paralyzed and 10 died. Although the incident brought about important government regulatory reforms and improved safety testing procedures, the crisis undermined confidence in the vaccine.[12]
Convincing individuals to take up the vaccine was also a challenge. For example, trypanophobia (fear of needles) was another serious hurdle for public health officials attempting to entice teens and adults into protecting themselves from polio. Once most children had received the vaccine, the focus shifted to vaccinating teens and adults. “Fright was a very real thing,” one teenager explained, who reportedly “had seen kids faint long before they were near the nurse or physician.” As this older demographic enjoyed more decision-making ability than children, personal choice affected participation and some were unwilling to be subjected to injection pain.[14]
Uptake of the vaccine was also undermined by the private nature of American medical care. Although the federal government initially allocated funds to help states pay for the vaccine, some physicians opposed free injection clinics because they claimed that such free treatment violated the doctor-patient relationship and could be construed as evidence of socialized medicine. In one case, a medical society threatened to expel members who participated in free clinics. Such professional positioning increased the challenge of vaccinating a wider demographic, as only those who could access and afford the vaccine would receive its protection.[15]
Margaret Truman in a White House broadcast for the National Foundation for Infantile Paralysis (March of Dimes). Seated, left to right: Lady Inverchapel, Margaret Truman, Roberta (Mrs. Fred) Vinson. Standing, left to right: Lady Balfour, Mrs. John Baker, and Mrs. Ralph Edwards. January 21, 1948. Photo courtesy U.S. National Archives and Records Administration. Collection HST-PHC: Photograph Collection, 1957–2006, Photographs Relating to the Administration, Family, and Personal Life of Harry S. Truman (Harry S. Truman Library, Independence, Missouri). Via Wikimedia Commons.
Faced with a litany of challenges undermining a uniform vaccination program, Salk and the NFIP launched an ambitious public relations and education program to build trust. They tried to avoid reflecting on past failures, criticisms, or setbacks, focusing instead on future polio eradication with the help of the vaccine. To aid in this initiative, Salk gave interviews to the press and presented at medical conferences. He was resolute that the vaccine was safe, worked, and was already preventing polio. Meanwhile, the NFIP organized focus groups to better understand vaccine hesitancy and aided in the establishment of grassroots health activism.[16] NFIP publicists created educational materials, wrote media releases for magazines and newspapers, organized broadcasts extolling the benefits of the vaccine, and worked with a range of health professionals to counter criticism. They also created promotional buttons, inscribed with “Get Salk Shots Now,” as well as produced a short film for cinemas, entitled Unconditional Surrender, which educated audiences on the benefits of the vaccine. Although this collaborative effort did not reach all Americans, it nevertheless made important inroads into increasing vaccine uptake.[17]
Mixed reactions to vaccines and related public health programs can be seen throughout American history—in that regard, the COVID-19 vaccine is not unique. Perceptions of the polio vaccine, for example, were marred by prior research failures, scientific debates, manufacturing problems, sensationalist media coverage, and various social and cultural factors. Salk and the NFIP played a crucial role in defending and advancing the vaccine program, which led to a marked reduction in polio after April 1955. As seen with the COVID-19 vaccine, hesitancy and opposition can be effectively challenged through education and outreach initiatives that reach wider demographics to help reduce the incidence of disease.
Stephen E. Mawdsley is a historian of American medicine at the University of Bristol, England. He is especially interested in the history of vaccination, public health, and disability activism. His last book, on the history of polio, examined the first efforts to control polio epidemics before the vaccine was discovered. His next book, on Jamaica Ginger Paralysis in 1930s America, looks at the efforts of survivors to seek justice for their condition.
Acknowledgements: Thanks to Martin Halliwell, Sophie Jones, and HCM Mawdsley.
[1] Richard Carter, Breakthrough: The Saga of Jonas Salk (New York, 1967); Michael B. A. Oldstone, Viruses, Plagues, and History (New York, 1998); Frederick C. Robbins, “The History of Polio Vaccine Development,” in Vaccines, ed. Stanley A. Plotkin and Walter A. Orenstein (Philadelphia, 2004).
[2] David M. Oshinsky, Polio: An American Story; The Crusade that Mobilized the Nation against the 20th Century’s Most Feared Disease (Oxford, 2005); Jane S. Smith, Patenting the Sun: Polio and the Salk Vaccine (New York, 1990); Allan M. Brandt, “Polio, Politics, Publicity, and Duplicity: Ethical Aspects in the Development of the Salk Vaccine,” International Journal of Health Services, 8 (1978), 257–70.
[3] Stephen E. Mawdsley, Selling Science: Polio and the Promise of Gamma Globulin (New Brunswick, 2016), 1–13.
[4] “Polio Test Report Set for April 12,” New York Times, March 23, 1955, p. 33; William L. Laurence, “Salk Polio Vaccine Proves Success; Millions Will Be Immunized Soon; City Schools Begin Shots April 25,” New York Times, April 13, 1955, p. 1; John R. Paul, A History of Poliomyelitis (New Haven, 1971), 432.
[5] Stephen E. Mawdsley, “The Politics of Polio Vaccination in Postwar America, 1950–60: Detractors and Defenders,” in The Edinburgh Companion to the Politics of American Health, ed. Martin Halliwell and Sophie A. Jones (Edinburgh, 2022), 105–19.
[6] Mawdsley, Selling Science.
[7] Oshinsky, Polio: An American Story, 178–79.
[8] Robert H. Plumb, “Vaccine for Polio Affirmed as Safe: Medical Groups and Dr. Salk Repeat Assurances after Charges of Danger,” New York Times, April 6, 1954, p. 33.
[9] “Medicine: Vaccine Safety,” Time, April 12, 1954.
[10] Stephen E. Mawdsley, “Balancing Risks: Childhood Inoculations and America’s Response to the Provocation of Paralytic Polio,” Social History of Medicine, 26 (Nov. 2013), 759–78.
[11] Alexander K. Brownlee, “Statistics of the 1954 Polio Vaccine Trials,” Journal of the American Statistical Association, 50 (1955), 1005–13; Marcia Meldrum “‘A calculated risk’: the Salk Polio Vaccine Field Trials of 1954,” British Medical Journal, 317 (Oct 31, 1998), 1233–36.
[12] Paul Offit, The Cutter Incident: How America’s First Polio Vaccine Led to the Growing Vaccine Crisis (New Haven, 2005).
[13] “Youth Conference Workshop D,” Aug. 26, 1957, p. 2, box 4, Salk and Sabin Polio Vaccine Records (March of Dimes Archives, White Plains, New York).
[14] Stephen E. Mawdsley, “‘Salk Hops’: Teen Health Activism and the Fight against Polio, 1955–1960,” Cultural and Social History, 13 (Feb. 2016), 255.
[15] Ibid.
[16] Stephen E. Mawdsley, “‘Dancing on Eggs’: Charles H. Bynum, Racial Politics, and the National Foundation for Infantile Paralysis, 1938–1954,” Bulletin of the History of Medicine, 84 (Summer 2010), 217–47.
[17] Mawdsley, “‘Salk Hops,’” 256–59.
