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The slow, frustrating effort to vaccinate young children — against polio

Mimi Meade, 7, winces as she receives the polio vaccine on April 26, 1954, in McLean, Va. (Harvey Georges/AP)
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A highly effective vaccine had countered a deadly virus, and America was moving on. Only the virus hadn’t disappeared, of course, and millions of unvaccinated young children remained vulnerable to its devastating impacts.

The year was 1961, and the virus was polio. It had been six years since Jonas Salk’s heralded vaccine was approved, and cases of the disease had plummeted following remarkably successful vaccination drives.

Yet scattered outbreaks continued, especially in poor urban areas. Barely more than half of the U.S. population had been vaccinated, and President John F. Kennedy was particularly concerned that 4.8 million children — most of them under age 5 — had yet to receive their shots.

“I hope that the renewed drive this spring and summer to provide vaccination for all Americans, and particularly those who are young, will have the wholehearted support of every parent in America,” Kennedy said at an April 1961 news conference.

Even though many parents did embrace the vaccine, the nation’s experience with polio showed the challenge of immunizing the youngest children — a challenge that is replaying today in the coronavirus pandemic.

After more than two years of the pandemic, the Food and Drug Administration authorized vaccines for children under 5 on Friday, with shots expected to be available next week. But only 1 in 5 parents say they’ll get those young children immunized as soon as possible, according to a report published last month by the Kaiser Family Foundation. Children ages 5 to 11 became eligible for the vaccine in November, but only 4 in 10 parents said their children in that age group had gotten vaccinated, the report stated.

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Unlike the coronavirus, however, polio struck children the hardest. That is why Kennedy and public health authorities were particularly concerned about the vaccination gap among kids.

Parents had been counting on a vaccine as horror stories of paralysis and death among children had piled up since the first recorded polio epidemic in the United States in 1894. Nearly 1.5 million schoolchildren participated in the mass Salk trials, according to David Oshinsky’s “Polio: An American Story.” Volunteering for the experiment was seen as a privilege; on the parental consent forms, the standard phrase “I give my permission” was changed to “I hereby request,” Oshinsky noted.

But while schools served as a “safety net” and later helped administer a high volume of vaccines, uptake for babies and preschoolers lagged, said James Colgrove, a professor of sociomedical sciences at Columbia University.

Before 1955, children between ages of 5 and 9 were at the greatest risk of getting polio, according to Elena Conis, author of “Vaccine Nation: America’s Changing Relationship with Immunization.” By the end of the decade, however, the paralytic cases were concentrated in children under 5.

This was particularly pronounced among poorer families in cities. When an outbreak of polio struck Providence, R.I., in 1960, for instance, epidemiologists found that the cases were almost entirely confined to children in the city’s poorest areas, wrote Conis, a professor of journalism at the University of California at Berkeley.

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A primary reason for the disparities with the polio vaccine, she said, was that child visits had shifted from public clinics to private pediatrician offices, which were “increasingly the domain of the middle class.” The Salk vaccine required three injections, plus a booster, which meant multiple trips to the doctor.

Kennedy aimed to close the vaccine gap with the Vaccination Assistance Act of 1962, which gave states money to carry out mass immunization programs for polio as well as diphtheria, tetanus and pertussis. It also established the leadership role of the federal government in coordinating immunization policy — a role that has become particularly important, and controversial, during the coronavirus pandemic.

“The story of vaccination and society in modern times begins with Kennedy’s proposal,” Conis wrote.

The federal government also launched public health campaigns. One of them, “Babies and Breadwinners,” was aimed at getting the vaccines to babies and men, who, while not as vulnerable as children, were nonetheless at risk. (Franklin D. Roosevelt, who was paralyzed from the waist down after being diagnosed with polio at age 39, was the most famous case.)

Months after Kennedy’s news conference, the government licensed Albert Sabin’s oral polio vaccine. The relative ease of delivery of oral doses ushered in a renewed vaccination campaign, Colgrove said. On “Sabin Sundays,” millions of children, as well as adults, showed up at churches and schools for their free doses, often delivered on sugar cubes. A federal public health campaign featured Wellbee, a cartoon bee that urged kids to “drink the free polio vaccine.”

It wasn’t until 1979 that the United States was declared polio-free, thanks to widespread use of the vaccine.

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Polio vaccines shifted the disease’s epidemiology — concentrating cases primarily in poor urban areas with low vaccination rates — in a pattern that continued for other diseases when vaccines became available. Just a few years after the first measles vaccine hit the market in 1963, Conis wrote, new outbreaks were concentrated in low-income urban neighborhoods, where vaccination rates were lower.

Also in the 1960s came a new round of vaccine hesitancy among some middle-class parents, many of them influenced by the social movements of the time. They began to question the need for immunizations, particularly for diseases like measles that, though potentially fatal, had seemed a routine part of childhood, Conis said.

Continued outbreaks of preventable diseases prompted a shift away from persuasion and toward compulsion when it came to children.

In 1968, half the states required immunizations for school entry. “To reach the single preschool child in the slum is difficult, but to mount a campaign to attain really high levels of immunization in kindergarteners, and the 1st, 2nd graders in school should be relatively easy,” one Centers for Disease and Prevention official said, according to “Vaccine Nation.”

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In 1977, the federal government provided money to help states implement mandatory immunization programs, including monitoring progress and auditing student records. As a result, all states had mandatory immunization requirements for school by 1981, according to Colgrove.

Colgrove said the lesson from the country’s experiences with polio and other transmissible diseases is that the most effective way to ensure vaccination for the youngest children is to require it before they can start school.

But whether that lesson applies to covid is an open question. Children are not affected as severely as adults. Coronavirus vaccines were developed and rolled out at record speed, and more than half of parents with children under 5 say they don’t have enough information about the safety or effectiveness of the vaccine, according to the Kaiser report published last month.

On top of that, distrust of institutions, including the government, runs high. “It’s just a more complicated vaccine to promote through the schools,” Colgrove said. Speaking of the successful polio vaccination drives in schools, he added, “We’re not in that environment anymore.”