Feature Article The March of Dimes and Polio: Lessons in Vaccine Advocacy for Health Educators Dawn Larsen ABSTRACT The polio vaccine became available in 1955, due almost entirely to the efforts of the March of Dimes. In 1921, Franklin Roosevelt gave a public face to polio and mounted a campaign to prevent it, establishing the National Foundation for Infantile Paralysis in 1938. During the Depression, U.S. citizens were asked to contribute one dime. Entertainer Eddie Cantor suggested the name the March of Dimes, paraphrasing the popular newsreel “The March of Time.” Jonas Salk advocated a killed-virus vaccine while Albert Sabin proposed a live-virus vaccine. Both competed for both recognition and funding from the March of Dimes. In 1955 Salk’s vaccine was adopted, nationwide vaccination programs were implemented, and polio rates dropped by 80 percent. In 1961, Sabin’s vaccine, endorsed by the American Medical Association, became the vaccine of choice. The World Health Assembly advocated polio eradication by the year 2000. By 2004 eradication efforts were threatened by allegations linking vaccines to chronic diseases. Immunization dropped and polio resurfaced in the U.S., Australia, Africa and Russia. Research linking vaccines to chronic disease was dis- credited, but vaccine opponents remain active. Health educators are well positioned to mitigate damage caused by the anti-vaccine movement and address barriers to immunization efforts. Larsen D. The March of Dimes and polio: lessons in vaccine advocacy for health educators. Am J Health Educ. 2012;43(1):47-54. Submitted May 30, 2011. Accepted July 9, 2011. In 2008, The March of Dimes cel- prenatal health promotion programs, and of the virus that has been ranked second ebrated its 70th anniversary. During the identification of folic acid as a preventive among the top 10 public health disasters 20th Century, few non-profit, volunteer for neural tube defects in babies.6-8 Despite of the 20th Century.10 organizations contributed more to the these significant achievements, the March By the beginning of the 21st Century, realm of public health or demonstrated of Dimes remains best known for its role however, a growing contingent of activists more unwavering commitment to improv- in developing the polio vaccine. Beginning arguing against the use of vaccines was ing the health of babies and children. The with the first recorded epidemic in 1916, the becoming extremely vocal. Public health March of Dimes has been instrumental poorly understood polio virus crippled or advocates were compelled to defend immu- in developing a screening test for PKU,1-3 killed tens of thousands in the first half of nization against critics who alleged possible demonstrating the relationship between the 20th Century. The worst outbreak oc- maternal alcohol consumption and birth curred in 1952, when 57,000 cases resulted Dawn Larsen is a professor and graduate coor- defects,4 developing neonatal intensive in over 3,000 deaths and over 21,000 cases dinator in the Department of Health Science, care units and surfactant therapy for pre- of paralysis.9 The polio vaccine became Minnesota State University Mankato, Mankato, mature babies,5 establishment of worksite available in 1955, ending widespread fear MN 56001; E-mail: [email protected]. American Journal of Health Education — January/February 2012, Volume 43, No. 1 47 Dawn Larsen links between vaccines and rapidly increas- as Pigtown. When the first deaths were New Jersey, confounding theories that the ing autism rates.11,12 By 2004, worldwide reported, investigators dispatched from disease resulted from ignorance and sub- eradication attempts were threatened by un- the Health Department diagnosed the standard living conditions.18 Health officials founded allegations that vaccines contained, cause as polio.16,17 The rapidly expand- continued to be puzzled by the higher preva- among other things, HIV and infertility ing immigrant population was blamed, lence of the disease among well-nourished agents.13 Misperception about the benefits as it had been for previous epidemics. In children in affluent areas with low popula- and risks of vaccines led to a significant the mid-19th Century the Irish had been tion density and high sanitation standards. polio epidemic in Africa, where the disease blamed for cholera in New York City, and This suggested to some researchers that threatened to make a comeback.14 Jewish immigrants had been accused of early exposure to substandard sanitation This conflict threatens one of the great spreading tuberculosis several decades might provide a natural immunization to milestones in public health, and should be later.18 Immigrants had been marginalized the disease.16 of significant concern for health educators. into crowded, unsanitary living conditions, Few people are aware of the challenges and and became convenient scapegoats. Italians POLIO AND FRANKLIN D. ROOSEVELT obstacles faced by early attempts to control endured the greatest stigma, and were said The public face of polio was changed polio. The history of polio, and the parallel to have imported “deadly germs” from forever on September 16, 1921, when the history of the March of Dimes, reveals the southern Europe.17 front page story of the New York Times determination and drive of an unlikely team The assumption that immigrants were revealed that Franklin D. Roosevelt was ill of advocates, researchers, politicians, public responsible for infectious disease spurred with poliomyelitis.22 Predominant theories relations experts and educators. In illustrat- traditional public health strategies such as still focused on children from disadvantaged ing the tenacity of the March of Dimes, the sewage regulation, water purification, and areas as primary victims, so the affliction of story of polio can provide important policy sanitation reform. Trash was removed and a well-educated, wealthy, socially prominent lessons for educators, advocates and policy- extreme measures were taken to eliminate man who was thirty-nine years old was espe- makers who feel strongly about preserving stray animals. The New York Times19(p. 1) cially puzzling. Subsequent discoveries that the public’s trust and confidence in the reported “72,000 Cats Killed in Paralysis early exposure to less sanitary conditions immunization policies of a strong public Fear.” Attempting to prevent the outward did indeed confer some protection seem to health system. migration of germs from specific Italian be supported by Roosevelt’s medical history. neighborhoods, public officials condemned Sheltered from early childhood illness by EARLY POLIO EPIDEMICS buildings, closed public places and cancelled wealth and private schooling, his departure The agent of polio is a virus, transmitted ethnic festivals.16 Angered by being singled for boarding school in adolescence signaled by contact with fecal matter both directly out, newly formed Italian neighborhood a dramatic succession of afflictions: typhoid and indirectly.15 The portal of entry for the organizations sent threatening letters to fever, sinus and tonsil infections, stomach virus is the mouth, and the virus breeds the Board of Health demanding that the problems, throat pain and a case of Spanish rapidly in the small intestine, frequently stigmatization stop and their children be left influenza resulting in a nearly fatal case of producing only mild infection with few or alone.16 All children in New York City were double pneumonia.23 Historians note that no noticeable symptoms. Invasion of the suspect by the middle of July, however, and Roosevelt may have been exposed to the central nervous system is rare but potentially those under 16 were required to obtain a virus during the peak summer season, when deadly, as the virus destroys critical neu- “health certificate” stating they were “polio his immune system had been weakened by rons that stimulate contraction of muscle free” in order to leave the state. On a single stress and exhaustion, and subsequently en- fibers.15 This was not known when polio day in late July the Health Department is- gaged in strenuous exercise that exacerbated clusters first appeared, nor was there any sued 3,376 certificates.20(p. 1) the accompanying paralysis.23 explanation for why the condition primarily Despite these extreme measures, the dis- Recent research has suggested that affected children, affected more boys than ease continued to spread, and by August ad- Roosevelt may have been suffering from girls, and spiked during certain times of the ditional cases were reported in upstate New Guillain-Barre Syndrome rather than po- year. The uncertainly and ignorance bred York as well as New Jersey, Connecticut and lio. Authors of the research feel they have fear, victimization and stigmatization and Pennsylvania. Outbreaks continued through a strong clinical case, while conceding that: hampered public efforts to understand and October, resulting in 27,000 deaths. Of the (1) they did not examine Roosevelt, and control the disease. 2,400 deaths in New York City, 80 percent in- (2) Roosevelt had excellent physicians who The first recorded polio epidemic in the volved children under five.21 Quarantine and were experts in their field.24, 25At the time, United States occurred in June of 1916.16 sanitation measures had proven ineffective. however, Roosevelt, his family, the medical The initial victims were children of Italian Rates were consistently higher in wealthier community and the American people all immigrants in a Brooklyn enclave known communities in New York, Pennsylvania and believed that he had polio. This belief was 48 American Journal of Health Education — January/February 2012, Volume 43, No. 1 Dawn Larsen largely responsible for his efforts to mount relations experts to promote Warm Springs. source and a cure for the disease. Emerging a campaign to conquer the disease, and ul- Fundraising campaigns took the form of an- public relations strategies were used both timately responsible for the establishment nual balls to celebrate Roosevelt’s birthday to establish polio as the nation’s premier of the March of Dimes.