Pioneer of Polio Eradication

COMMENT SPRING BOOKS

MEDICAL HISTORY Pioneer of polio eradication

Tilli Tansey extols a biography of determined of Pittsburgh in Pennsylva- vaccine trailblazer Jonas Salk. nia. Harry Weaver, research director of the National Foundation for Infantile n 12 April tenacity that shaped Paralysis (NFIP), invited 1955, across both his scientific him to work on typ- the United success and his pro- ing polio viruses and, OStates, “church bells fessional difficulties. eager for space, staff tolled, horns honked, Early on, at the New and equipment, Salk and sirens rang” in York University Col- accepted. He made rapid celebration: the larg- lege of Medicine, Salk progress, refining and est clinical trial ever worked with influenza replacing contemporary undertaken had expert Thomas Francis. methodologies — often in the reported that the first Jonas Salk: A Life At the time, antiviral vaccines face of criticism or even prohibi- polio vaccine was safe CHARLOTTE DECROES (against smallpox, rabies and yellow tion from the NFIP advisory commit- JACOBS and effective. So writes Oxford Univ. Press: fever) used artificially weakened live virus. tee. Weaver supported his protégé, and the Charlotte Jacobs in 2015. Salk and Francis developed an experimental foundation came to see Salk as its ‘poster her riveting biogra- technique that used killed virus to stimulate scientist’, wheeled out for public and media phy of the vaccine’s discoverer, Jonas Salk. antibody production and confer immunity, events. Fellow researchers continued to carp. Two years earlier, poliomyelitis had killed suggesting a powerful therapeutic approach. Undeterred, Salk pioneered a killed-virus or paralysed almost 36,000 US children. It In 1941, Salk followed Francis to Michi- vaccine and organized safety testing and has been estimated that before the vaccine gan, pursuing the holy grail — an influenza field trials. Those leading up to the 1955 there were 600,000 cases a year worldwide. vaccine. He modified laborious procedures announcement involved more than 1.5 mil- Salk’s triumph made him a global household to culture the virus and develop vaccine pro- lion children, tens of thousands of doctors name, and the gongs began rolling in. duction, usually with only gloves and a mask and nurses, and 220,000 volunteers. The As Jacobs shows, the tale of Salk’s discovery as protection. He supervised clinical tests on clamour attendant on success (a film was is one of grind, intrigue, rivalry, politics and patients at two psychiatric institutions, delib- mooted, to star Marlon Brando) laid Salk dirty tricks. Add commercial interests (phar- erately infecting some with influenza — a open to charges of self-aggrandisement. maceutical giant Eli Lilly made US$30 mil- practice common until the Nuremberg Code Almost immediately, problems arose. lion from polio vaccine in 1955 alone) and of 1947 offered some protection to human Batches of vaccine became contaminated, Salk’s extramarital entanglements while research subjects — and in 1945 advised the and physicians inoculated family and friends wedded to artist (and muse to Pablo Picasso) US surgeon general to vaccinate 8 million while leaving first-grade children, the most Françoise Gilot, and the mix becomes even soldiers. Without consulting Francis, Salk vulnerable group, unprotected. Over a few headier. Jacobs contextualizes the polio effort signed an exclusive contract with pharma- months, 260 individuals contracted polio with Salk’s work on influenza, multiple scle- ceutical firm Parke, Davis to provide details directly or indirectly from a single substand- rosis and HIV/AIDS — and with the Salk of production methods that he devised. This ard preparation. Several states suspended Institute for Biological Studies in La Jolla, departure from academic etiquette did not vaccination. Massachusetts halted its pro- California, which he created and directed, go unnoticed; nor did his writing for non- gramme when children had received only the and from which he was ultimately excluded. professional publications such as Parents first of three shots; in July 1955, some 4,000 Growing up in the Bronx, New York, in a Magazine. Tensions grew as Francis received contracted polio and 1,700 were paralysed. family of Russian Jewish immigrants, Salk honours, while Salk was ignored. Salk was unfairly associated with these errors was dominated by his ambitious mother. He In 1947, Jacobs recounts, Salk left to and was castigated, especially by scientific came to crave doing things his own way — a establish an influenza lab at the University colleagues. However, tighter adherence to his

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620 | NATURE | VOL 520 | 30 APRIL 2015 © 2015 Macmillan Publishers Limited. All rights reserved SPRING BOOKS COMMENT protocols and resumption of vaccination meant that six years after the vaccine was introduced, polio was almost eradicated in the United States. Much of the scientific establishment closed ranks against Salk. He was given the prestigious Lasker Award for clinical medical research in 1956, but Swedish virologist Sven Gard dealt his Nobel nomination a fatal blow by sneering that the vaccine was a technical advance, not a discovery. Nor was Salk elected to the US National Acad- emy of Sciences. Virologist Albert Sabin — bombastic, imperious and galled by Salk’s success — continued to develop a live, orally delivered poliovirus preparation. By 1961, Sabin’s vaccine had performed well in trials and the American Medical Asso- ciation began to promote it. Salk’s vaccine was, for a time, superseded, and his efforts to improve its potency stymied. Salk moved on, although he remained involved with the polio vaccine. Influenced by chemist C. P. Snow’s 1959 book The Two Cultures and the Scientific Revolution, he launched a research institute integrating social responsibility and the humanities with the biological sciences. The Salk Insti- tute recruited some of the great biologists of the time, including Jacob Bronowski, Francis Crick and Jacques Monod. But Salk was unable to translate his lofty ideals into practical management. His research from the 1960s onwards, on immune responses in cancer, multiple sclerosis and, PHYSICS later, HIV/AIDS, met with ambivalence. He was increasingly derided by the very scientists whom he had recruited. In many ways, Salk was ahead of his One hundred years of time, notably in public engagement and in his multidisciplinary agenda. A polio vaccine would have emerged without him, general relativity but it was his vision and willpower that produced the first, and a descendant of it Pedro Ferreira looks back at how Einstein himself and a is still the basis of many public-health pro- panoply of other physicists have framed the theory. grammes. Yet universal polio eradication remains a dream: cases continue to appear in Pakistan, Afghanistan and Nigeria, and ntil very recently, relativists were universes and black holes, you were left to have resurged in recent years in Syria. ■ few and often self-taught. General your own devices. That is what happened relativity still had the stigma of to me. Tilli Tansey is professor of the history of Ubeing esoteric, pointless and, well, hard. I studied engineering and did not enjoy modern medical sciences at Queen Mary, In some places you could find special- it very much. But during the course on University of London. ized graduate courses, but on the whole, electromagnetism, I discovered Albert e-mail: [email protected] if you were at all interested in expanding Einstein’s world of special relativity.

Tesla: Inventor of the Electrical Age Infinitesimal: How a Dangerous Mathematical W. Bernard Carlson Princeton Univ. Press 2015 Theory Shaped the Modern World Over-hyped eccentric or electricity wizard? Bernard Amir Alexander Oneworld 2015 Carlson’s account of Nikola Tesla’s life at the turn of the Through religious and revolutionary figures of twentieth century recalls the inventor’s great creations, the seventeenth century, Amir Alexander tells the such as the alternating-current motor, as well as the history of the struggle for mathematics’ place in unfulfilled promise of wireless power. (See Patrick society. The ‘heretical’ concept of infinitesimals, McCray’s review: Nature 497, 562–563; 2013.) the indivisible points of a line, takes centre stage.