Now, 65 years later, we are in the midst of a similar pivotal moment. As the public awaits immunization against the coronavirus, polls have highlighted many Americans’ hesitancy to receive the vaccine. According to a Kaiser Family Foundation survey from December, approximately 71 percent of Americans said they would “definitely” or “probably” get a coronavirus vaccine — an eight-point increase from September.
This reluctance may feel disconcerting. However, we have misremembered the moment polio vaccines were released as singularly optimistic, stripping context from what eventually made national immunization a success and eradication possible. In fact, it took decades of research, a dedicated effort to build public trust and sustained leadership to conquer polio. Ending the coronavirus pandemic requires a similar collective approach.
Infantile paralysis, later known as poliomyelitis or polio, emerged in outbreaks during the first part of the 20th century. The disease primarily affected children, and most were either asymptomatic or had mild symptoms. Its paralytic form was uncommon (under 1 percent), temporarily or permanently impacting the breathing and/or mobility of survivors.
The work of President Franklin D. Roosevelt, who survived polio, significantly heightened the perceptions of polio rehabilitation and research as a fundable cause, first through the Warm Springs Foundation and president’s Birthday Balls, and then the nonpartisan National Foundation for Infantile Paralysis (NFIP) — later renamed as the March of Dimes. Long before Salk perfected his vaccine, media coverage and public health campaigns laid the foundation for its public acceptance.
To create awareness and solicit donations for research, patient mobility devices, care and rehabilitation, the NFIP disseminated carefully tailored messages to specific groups using pamphlets, radio scripts, community plays, magazine and journal articles, short films and other forms of media to reach the targeted audience. Celebrities such as Judy Garland, Mickey Rooney, Frank Sinatra, Helen Hayes and Jack Benny raised money through tours, contests and other engagements. “Poster children” visually conveyed the frightening effects of paralytic polio, and local groups held special events for the NFIP. These collective events firmly placed polio at the forefront of the public agenda.
Throughout the 1930s, ’40s and early ’50s, polio erupted in waves. After the discovery that three different strains caused polio infections, research intensified as scientists raced to develop a safe and effective vaccine. In 1952, the United States had its worst polio epidemic in history, yielding 57,628 cases, with 21,269 experiencing paralysis and 3,145 deaths. Approximately 20 percent of hospitalizations were adults, demonstrating that polio did not only infect children.
In April 1954, the Vaccine Advisory Committee of the NFIP approved Salk’s vaccine for field testing. Many parents eagerly volunteered their children to be “polio pioneers.” However, not every parent consented. Interviews were conducted with 175 mothers with eligible children. Of the 74 who did not give consent, 70 percent refused because they believed the shots to be unsafe, objected to “experimentation” or doubted the vaccine’s effectiveness.
These mothers tended to have lower education levels, compared with consenting mothers. They were less likely to have discussed the vaccine with others and listed radio or television as their primary sources of information, instead of printed NFIP leaflets or newspapers (which positively framed the vaccine), like the consenting mothers did. Ultimately, 749,236 children, ages 6 to 9 years old, across 11 states participated in the randomized, blinded experiment. Additionally, more than 1 million lower elementary students took part in the observed control study.
Public confidence in Salk’s vaccine took time. While the polio field trials were underway, a May 1954 Gallup Poll indicated that only 53 percent believed that it would work and 33 percent had no opinion either way. To bolster vaccine acceptance, the NFIP produced materials on the ongoing trials, providing radio and television updates, as well as producing educational filmstrips for doctors, teachers and others to distribute.
Following the 1955 news conference conveying the results, public confidence soared, as news of both the vaccine’s effectiveness and President Dwight D. Eisenhower’s commendation of Salk and the NFIP circulated the globe. Little debate ensued about vaccine priority. Commercial immunization continued for the targeted age group of the trials, first vaccinating children at set dates in local schools for the three required doses. Even news of Cutter Laboratories’ tainted vaccine did little overall to hinder mass immunization, in part the rampant fear of polio, the scheduled programs underway and updates from the surgeon general on improved safety protocols. By August, more than 4 million vaccine doses had been administered, as eligible recipients began to broaden to include pregnant women and more groups of children.
With support from the NFIP, American Medical Association and the U.S. Department of Health, Education and Welfare, the Ad Council launched a national campaign to encourage people to get vaccinated. Brooklyn Dodgers star Roy Campanella, Elvis Presley, Captain Kangaroo, Sammy Davis Jr., Ella Fitzgerald, Gene Autry, Dick Van Dyke and Louis Armstrong were among the celebrities endorsing the vaccine, primarily using the new medium of television to connect to the American people.
Declining polio rates demonstrated the vaccine’s effectiveness, from 14,647 cases in 1955 to 5,894 the following year. By 1957, the numbers had reduced by half from the year before, and paralytic cases decreased from 2,303 to 831. News of this continued success prompted a sense of triumph over the disease. A 1957 Gallup Poll reported that 72 percent of Americans believed that polio had been conquered.
Unfortunately, this false perception inhibited immunization of the more than 40 million people eligible for the vaccine. With most children now protected, the typical age group affected rose, with polio emerging among those over 20. Studies from this time period suggest most unvaccinated adults did not object to getting the vaccine. Rather, many had simply procrastinated, believing they were not susceptible to the virus, especially enough to receive the three required doses needed for immunity.
In response to an uptick in polio cases in 1959, the Ad Council launched new campaigns to encourage adherence to the full three doses. By 1960, these messages helped to successfully raise immunization rates and further decrease polio in the United States. As Sabin’s oral vaccine replaced Salk’s, polio became a disease of the past, at least for most of the world. The NFIP, renamed the March of Dimes, shifted its mission to promoting healthy pregnancies and preventing premature births.
Looking back, we can draw parallels from the fight against polio to this pandemic. Even more than polio, the coronavirus dominates our everyday lives and agendas. We need widespread immunization to create true herd immunity and stop its devastating toll on society. The polio vaccine process modeled the effectiveness of local and national public health campaigns that crossed platforms, targeted specific groups and deployed influential people to endorse the vaccine. It will take time and strategic messaging to create our own celebratory moment — but we can get there.