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Home , Albert Sabin, Jonas Salk

Adisease consigned to the history books

by Anatolij Vasilievich Pichoushkov

fter World War 11, the against poliomyelitis, it transpired that streets of the broken immunity to one type of did and deserted towns of not guarantee immunity to the others. Europe witnessed the A had to be found that would return of soldiers confer immunity from all three types of crippledA on the battlefield, but also saw . The American scientist Jonas an increasing number of children and Salk produced the first vaccine, pre­ adults who walked with a strange gait, paring it from grown on the with paralysed arms or legs, twisted liver tissue of monkeys. When the torso or paralysis in other groups of vaccine viruses were inactivated, they muscles. And so poliomyelitis, an infec­ retained their immunogenic properties. tion causing invalidity and death, added to people's troubles in that difficult post-war time. The other Or Anatolij Vasilievich Pichoushkov is Departmental Head at the names of this disease - infectious Directorate of of the infantile paralysis, epidemic infantile Ministry of Health of the USSR. paralysis - show that this epidemic strikes the central nervous system, and usually affects young This was a great step forward in the children, although adults too can technology of prevention. The suffer. vaccine was ready: tested it Under normal conditions, animals on himself and on volunteers, mostly are not affected by polio. The infection students who wished to take part in is therefore transmitted by either this important experiment. No side­ human sufferers or human carriers. effects were noted in adults, but the The causative agent is transmitted vaccine was meant mainly for children. mainly through the fecal-oral route. How would the child's organism react Foodstuffs are particularly important to such a powerful virus, even though here. Dirty hands transmit the infec­ the virus was dead? Or Salk injected tion, as do contaminated linen and his own sons. It was only after that that Research scientists in the USSR have household objects, and the virus can he passed on the method for prepar­ made major contributions to vaccine be transmitted in airborne droplets. So, ing the vaccine to private pharma­ technology. apart from , polio pre­ ceutical companies in the USA. vention must focus on general sani­ Unfortunately, one of the firms misap­ tation and hygiene, personal plied Salk's method and prepared its immunological and epidemiological cleanliness, prevention of contacts vaccine containing live virus, which effectiveness. The results obtained between polio sufferers and healthy infected inoculated children. There were encouraging, but scientists conti­ children, fly control, and compulsory was a public outcry and the media nued their research for a still more boiling of milk and water. reacted sharply. A court case reviewed effective vaccine. The high incidence of the disease in the facts and cleared Salk and his began to develop a live practically every country in the 1940s vaccine. vaccine. The problem was that of and caused great concern Scientists established the truth and obtaining non-virulent but highly among health workers and in the rebuilt public confidence in the vac­ immunogenic viruses - and he solved community at large. The intense cre­ cine. Mass continued and it. After testing the vaccine on animals, ative activity of some of the greatest brought great gains. Soviet scientists Sabin tried it on himself and then on scientists in the world revealed the played a significant part in this "rehabi­ his daughters; this was another drama­ secrets of the causative agent, and the litation." Mihail P. Chumakov and his tic episode in , as Sabin pathological processes in the organism team quickly assimilated the tech­ anxiously waited for days and weeks. of its victim. nology and organized rapid produc­ The children were the first to be given The causative agent of the disease tion of vaccine and the of live attenuated polio virus. Their was named poliovirus, and there are eight million Soviet citizens. They health, the invention and the vaccine several varieties. As were made detailed observations of the hung in the balance. being developed for specific protection organism's reaction to the vaccine, and The work of the scientists continued.

10 WORLD HEALTH . December 1989 Neurologists under Sabin established The two scientists tested the vaccine Lithuania since 1966. From 22,054 that the viruses multiply in the intestine on themselves and there were no cases in 1958, the incidence fell to 128 and cause the disease when they ill-effects. Yet in the course of develop­ cases in 1968. In 1988, there was a penetrate the spinal cord. The logical ment within the human organism, the total of 165 new cases in the whole of solution was to introduce the vaccine vaccine virus might revert to its original the Soviet Union, 118 of them in the orally so that it could multiply in the form. The scientists took multiple three Republics of Uzbekistan, Azerbai­ intestine and produce immunity. This doses of the vaccine, and then Smoro­ jan and T urkmenia. proved to be the correct approach and dintsev inoculated his grand-daughter. But why were the hopeful results of it set the course of further research the early years followed by stagnation? and wide-scale use of the vaccine. Mass campaign In the early stages, the popularity of The Soviet scientists Mihail Chuma­ Between 1959 and 1969 a mass polio vaccination made organization kov and Anatolij Smorodintsev played campaign of polio immunization was relatively easy. There was no need to a crucial role in this work. A research initiated in the Soviet Union, using live, explain its advantages, since parents of institute was established in Moscow for oral poliomyelitis vaccine. Soon more small children were careful to observe the study of poliomyelitis and produc­ than 77 million people between the the vaccination timetables. But the tion of vaccine. The hard work conti­ ages of two ·months and 55 years had subsequent fall in incidence to a few nued. Vaccine prepared from live virus been immunized, and the ultimate dozen cases a year led adults and has indisputable advantages, but there coverage of children in the target parents t0 drop their guard, so that in were possible risks: age-group was 98 to 99 per cent. The some areas there were outbreaks of might become dangerous again, its incidence of polio decreased sharply, the disease and in others a low but virulence might return; and children and presently it was eradicated from a steady annual incidence. The epidem­ might be infected by the newly danger­ number of Republics. No cases of polio iological situation in the Soviet Union ous virus. Animal testing was com­ have been notified in Estonia since has not changed for many years, while pleted, but polio is special to mankind. 1962, in Latvia since 1964 and in many countries of the world have

W ORLD HEALTH. Dece mber 1989 11 A disease consigned to the history books declared polio eradicated. In 1988, 25 of the 32 European countries had no cases; of the 220 new cases, 197 occurred in , the Soviet Union and Turkey. The Ministry of Health of the USSR has put forward its own national eradication programme over the next few years. This naturally differs from that of other countries because of the variety of social and climatic condi­ tions, the level of incidence and other factors. In regions with the highest incidence, there will be a single cam­ paign for mass vaccination of all children, while in others there will be strict observance of maximum vaccine coverage of all children in the target age-group. Clinical and laboratory diagnosis of polio has been unified, and centres for further training of medical personnel in diagnosis and treatment have been designated. A "told chain" for transport and storage of vaccines is in place. Each Republic is to prepare a plan of action for eradi­ cation on its own territory, designating laboratories for serological and virolo­ gical diagnosis. Certain sectors of the population will of course be targeted for a large-scale information cam­ paign in the press, on radio and on television. Eradication of polio in the USSR is of great political and social signifi­ cance. It will be a great tribute to Salk, Sabin, Chumakov and Smorodintsev if we succeed. Perhaps our descendants will only learn about the disease Dr Jonas E. Salk (above) produced an injectable against from history books, and they will say polio in 1951, and Dr Albert Sabin (below) a live oral vaccine later in the "Our ancestors in the ·twentieth 1950s. These breakthroughs by U.S. scientists were followed up worldwide century suffered from something called and, particularly in the USSR, vaccine production was geared up for mass poliomyelitis." • immunization.

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