Magazine

A Most Victorious Vaccine


SPLENDID SOLUTION

Jonas Salk and the

Conquest of Polio

By Jeffrey Kluger

Putnam; 373pp; $25.95

(Readers'

Reviews below)

Editor's Review

The Good A gripping account of the 1950s race to develop a vaccine against polio.

The Bad In parts, the book is too tightly focused on the unassuming Jonas Salk.

The Bottom Line A frequently compelling reminder of the difficulty of combating virulent diseases.

Polio ought to be a disease of the past. This year marks the 50th anniversary of the momentous announcement that Dr. Jonas Salk had created a vaccine that was "safe, effective, and potent" -- sparking jubilation around the world. Thanks to that vaccine, there has been no polio epidemic in the U.S. since the late 1950s, and the World Health Organization (WHO) aims to wipe out the disease by 2008. Nevertheless, WHO reported in February that three people were afflicted with polio in the holy city of Mecca, in Saudi Arabia. Because of the failure by some nations to vaccinate all their children, polio was reported in six countries last year, and the worldwide total of cases rose 50%, to 1,185.

Splendid Solution: Jonas Salk and the Conquest of Polio by Jeffrey Kluger couldn't be more timely. Kluger, a Time senior writer and co-author of the book on which the movie Apollo 13 was based, chronicles the terrible polio epidemics in the first half of the 20th century and the Herculean scientific effort by Salk and his colleagues to create a vaccine quickly.

Kluger nails down the details in this story of a Manhattan Project against polio. He graphically describes the battling scientific camps, the setbacks, and the rising toll of dead and crippled children that lent such urgency to the effort. Less gripping are those swaths of the book that are essentially a biography of Salk, who simply wasn't a colorful character. A second book, due out in April -- Polio: An American Story by historian David M. Oshinsky -- takes a larger view, focusing on the cultural and historic forces behind the vaccine effort. But the unassuming Salk is at the center of both books.

That's as it should be, because this methodical scientist was one of the undisputed heroes of the 20th century. It's hard to imagine today what it was like to confront polio in the prevaccine era. Polio is transmitted by contact with an infected person, and in the years after 1900 it began to reach epidemic proportions. In 1916, the U.S. reported 27,000 cases, 6,000 of them fatal and almost all of them among young children. In 1952, polio struck 57,879.

Kluger movingly describes the panic that gripped the U.S. every summer, the season for polio. Parents kept their children locked inside and scrupulously clean in hopes of thwarting the virus. But it struck without warning, paralyzing its victims within hours -- most of them never fully to recover. Adults weren't safe either: In 1921 it crippled 39-year-old Franklin D. Roosevelt. He was determined to spare others, and 17 years later, after becoming President, Roosevelt created the first private foundation dedicated to eradicating a disease, the National Foundation for Infantile Paralysis (NFIP). It quickly became known by the the name of its most effective fund-raiser, the March of Dimes.

Salk finished medical school just as the NFIP was getting started. He helped develop the first successful flu vaccine during World War II and in 1947 set up his own lab at the University of Pittsburgh to study polio.

It is at this point in the chronology that Splendid Solution becomes truly riveting. Polio research was dominated by two camps. One, led by Albert Sabin, believed the most effective approach would be a vaccine containing a weakened but still-living virus. Live-virus vaccines had been used for other diseases, and although there was always the potential that the vaccine itself could cause the disease, the approach was well-established. Salk wanted to use a more novel, killed-virus method. Such vaccines can be hard to mass-produce, but Salk felt they were safer.

Salk's method won out primarily because he developed his vaccine first. In 1954, the NFIP undertook the largest clinical trial ever, inoculating 1.8 million schoolchildren. On Apr. 12, 1955, before a huge press conference at the University of Michigan in Ann Arbor, NFIP scientists reported that the vaccine worked. Salk became a national hero, but the public adulation and his failure to acknowledge publicly the contributions of his lab staff caused the scientific community to turn against him.

It is here that Kluger lets the reader down, giving only a cursory account of the fates of the key players. Sabin did create a live-virus vaccine, and the controversy over the two approaches raged for decades. It was only in 2000 that the U.S. decided the killed-virus vaccine was superior, because the few cases of polio reported during the years that both were in use could be directly traced to the live vaccine.

Kluger's book is well-written, but his hagiographic treatment of Salk diminishes his effort. Still, it is worth delving into the history of this important episode in medicine as a reminder of how difficult the battle can be against virulent diseases -- and how worthwhile.

By Catherine Arnst


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