Georgians living with polio say don’t forget

Polio ravaged human bodies for hundreds of years, but the misery began to wane 70 years ago when two polio vaccines developed in the U.S. halted the virus’ spread.

Many Georgians who caught polio in the 1950s as children survived and led fulfilling lives despite their injuries. But in their later years, they experience a return of the pains and deficits that plagued them as children. The condition, called post-polio, can bring unrelenting aches, muscle pains and brain fog. Many have become wheelchair bound.

“It’s difficult for me to discuss polio or post-polio,” said Wesley Moss of Marietta. “I’ve worn a long leg brace on my left leg since I was about 2 years old.”

Survivors say the fact that few young Americans know about polio compounds their suffering.

Carol Crumby of Decatur is now in her 70s and deals with falls and shooting pain that make it hard for her to move. She is thankful for orthotics and her roll aider chair. But she says “polio is no joke. I wouldn’t wish this on my worst enemy.”

Atlanta-area people living with post-polio maladies worry that a climate of anti-vaccine skepticism could set back the United States’ success in eliminating viruses like polio and measles, both of which could return if people stop getting vaccinated.

The story of polio’s eradication highlights how post-War World II scientific breakthroughs allowed U.S. industry to produce vaccines at scale. It also shows how, when those processes went horribly wrong, the newly formed, Atlanta-based Centers for Disease Control and Prevention was able to use the relatively new science of epidemiology to trace and solve outbreaks.

Credit: AJC Archive

Credit: AJC Archive

What is polio?

Poliomyelitis — commonly known as polio — is a highly infectious viral disease that often afflicts children. It is transmitted via droplets or aerosols from the throat and by fecal contamination of hands, utensils, food and water. In many people, symptoms resemble the flu. In some patients, however, the virus enters nerve cells in the brain or spine, where it multiplies and kills the cells that control muscle movement. When that happens, a polio sufferer experiences paralysis, usually in the arms and legs. It can also affect the muscles that move the lungs, which can be fatal.

Credit: AJC Archive

According to the CDC, 70% of people infected with polio experience no symptoms. About 25% experience mild or flu-like symptoms and a smaller proportion of people will develop more serious symptoms that affect the brain and spinal cord, including pins and needles in the legs, meningitis (infection of the covering of the spinal cord and/or brain) and paralysis or weakness in the arms, legs or both.

When was polio most common?

Polio has been around for thousands of years. Ancient Egyptian images show children walking with canes, with withered limbs characteristic of the disease. It became episodic with outbreaks during the late 19th century in rural areas of Europe and the U.S.

In 1840, a German doctor formally identified polio as a condition in its own right. Polio epidemics were common every summer in the U.S. starting in 1916. The worst occurred in the 1940s and ‘50s. In a 1949 epidemic, there were 42,000 cases of polio reported and nearly 3,000 deaths.

Credit: ASSOCIATED PRESS

How did vaccines nearly end polio?

Two vaccines developed in the U.S. in the 1950s helped nearly end new polio infections here and abroad.

At the University of Pittsburgh, Dr. Jonas Salk created the inactivated (dead) polio vaccine (IPV) in 1955. It was administered as a shot in the arm or leg. By 1957, annual cases in the U.S. dropped from 58,000 to 5,600; and by 1961, only 161 cases remained. Six pharmaceutical companies were licensed to produce Salk’s vaccine, and he did not profit from sharing the formulation or production processes. The injectable vaccine was slower to administer, but proved to be safer.

Salk’s inactivated polio vaccine is the only polio vaccine now available in the United States, where 93% of children are vaccinated, according to the CDC.

At the University of Cincinnati, physician and microbiologist Dr. Albert Sabin created a live attenuated vaccine that could be administered orally. Like Salk, he tested it on himself, his family and in trials on humans and monkeys.

Both vaccines were used in the U.S., but Sabin’s would eventually be used more widely, and primarily outside of the U.S., because it was cheaper and could be administered quickly in rural areas.

When Julie Andrews sang “A Spoonful of Sugar” in the Disney movie “Mary Poppins,” she was referring to the common practice of adding a sugar cube to Sabin’s oral polio vaccine, the song’s author told NPR.

The vaccine controversy

Salk’s vaccine roll out got off to a rough start in 1955, when California’s Cutter Laboratories botched production and created a product that actually gave 220,000 people polio, left 164 severely paralyzed, and led to 10 deaths, according to American infectious diseases physician and vaccinologist Dr. Paul Offit.

The recently formed CDC found the outbreak, contained it and helped fix the production process. The vaccine would go on to become one of the safest and most efficacious ever produced.

The situation with Sabin’s oral polio vaccine (OPV) was more complicated. In very rare cases, the weakened form of a live polio virus in Sabin’s vaccine caused polio in some children. All told, the oral vaccine has been administered over 10 billion times to three billion children and has prevented over 13 million polio cases.

Sabin’s vaccine was seen as the best option for poor countries because it induces strong immunity in the gut and spreads through the stool of immunized children, protecting even those who do not get the vaccine drops, according to Science magazine. The vaccine has helped bring down polio cases by more than 99.9% since the eradication program began in 1988, according to the World Health Organization.

Dr. William Foege, former CDC Director and emeritus professor at Emory University, said the World Health Organization (WHO) waited too long to add the Salk vaccine to the Sabin vaccine after the latter was found to cause polio in an extremely small number of vaccine recipients.

“I knew Salk and Sabin,” Foege told The Atlanta Journal-Constitution. “Sabin was adamant that this didn’t happen, though it did.”

“There have been so many mistakes with global eradication of polio,” Foege continued. “We could see what was happening. In 1992, we did a talk in New Delhi and we had determined by then that the WHO approach to the program, which was to use Sabin vaccines, was inadequate. We recommended using the Salk vaccine in addition to the Sabin vaccine. The WHO wouldn’t consider this because the Salk vaccine was more expensive and more difficult to administer.”

Today, the WHO uses the Salk vaccine, in addition to the Sabin vaccine, Foege said.

In Pakistan, which is still struggling to eradicate polio, one dose of IPV (Salk’s vaccine) and multiple doses of OPV (Sabin’s vaccine) are given to children to confer full protection against polio. Once polio is eradicated, IPV will be the only vaccine available for routine use in that country, according to a Pakistani government website.

In the U.S., where polio has been eradicated but is brought into the country by travelers, only the Salk (inactivated) vaccine is used.

Foege says the Salk vaccine was a miracle that needs to remain in popular memory.

“I lived through those days — we couldn’t go to the movies in the summer time, or the swimming pool, out of fear of catching polio,” he said. “The public demanded a vaccine for polio. That’s just how scary it was.”

Credit: Mohammad Sajjad

Is polio still around?

Yes. As of 2022, poliovirus remains endemic in two countries, Pakistan and Afghanistan, and has been nearly eliminated in India and Nigeria.

Steve Stirling is CEO emeritus of Brunswick-based charity MAP International, which distributes donated medicines to needy countries. He also contracted polio as a child, and says the world community needs to come together for one final push to eradicate the virus.

“I don’t think Americans know how close we are,” he said. “The Rotarians do though, since they have been supporting the program for some time. They are also the heroes of polio as business leaders worldwide who work to make vaccine access available for all.”

Rotary has spent more than $2.8 billion on polio eradication worldwide, Stirling said.

In Pakistan, more than 200 polio workers and guards have been assassinated by religious fanatics who wrongly believe the polio vaccine sterilizes children. In February, unidentified gunmen shot and killed a police officer working on Pakistan’s first polio vaccination drive of the year, The Associated Press reported. Health workers in the country are accompanied by thousands of police officers as they go house to house to vaccinate children.

Stirling has seen this tension firsthand in his work to bring vaccines to poor countries.

“I met a woman in India whose child had polio,” he said. “She wanted to vaccinate her other child. But her husband threatened to kill her if she did so because he thought the ‘sterile’ label on the vaccine would make the child sterile — completely untrue, but that is what some people believe.”

Indian health workers vaccinate many children when they visit towns. In order to keep track, they mark a child’s finger with ink, Stirling said.

“They do this because some parents try to get their children vaccinated many times, thinking that it would make the child safer from polio, which isn’t true,” he said. “The woman I met asked them to mark the child’s toe so her husband wouldn’t find out.”

Credit: AJC Archive

Why are there so many black-and-white photos of children in plaster casts and large metal machines?

Dr. Dale Strasser, an emeritus professor in Emory University’s department of rehabilitation medicine, treated about 500 patients for polio during his career. Many were longtime members of the Ebenezer Baptist Church in Atlanta.

He said children were put in plaster casts to slow down polio contractures, a shortening and hardening of muscles, tendons or other tissue, that often leads to deformity and rigid joints.

“The polio patients couldn’t move because their neuromuscular systems weren’t firing,” Strasser said. “The children experienced a sort of paralysis.”

Still others spent hours a day inside the iron lung machine, invented in 1927 at Harvard University. The machine pulls air into and out of the lungs by changing the pressure in an airtight metal box. A later model included a sliding tray and was called “the cookie tray.”

Some polio survivors in Texas and Oklahoma still sleep in iron lungs.