The Polio Era to the COVID-19 Pandemic

When I first visited India in 2005, the country still had 66 cases of polio era. But when I flew to India this past January, I landed in a country that had been polio-free for nearly six years. India achieved its polio elimination milestone in 2014, along with the rest of the World Health Organization’s South-East Asia Region.

The Polio Era to the COVID-19 Pandemic

In fact, the whole reason I was flying to India was to observe India’s National Immunization Days, an initiative begun in 1995 by the Indian government with Rotary International and its Global Polio Eradication Initiative partners. Rotary had flown me there so I could see how a country of 1.4 billion people mobilized community leaders, healthcare workers, local volunteers and Rotary club member volunteers from around the world to administer the oral polio vaccine to every single child under 5 in the country.

Four doses of the vaccine are usually adequate to protect children against poliovirus, but those who live in areas where polio thrives—regions with hot weather and poor sanitary conditions—often need additional doses for full protection, so even previously immunized children receive the vaccine during the biannual National Immunization Days. The only two countries where wild polio cases still occur are Afghanistan and Pakistan. As India’s neighbor, Pakistan in particular could be a potential source of imported cases.

Yet even while there, the idea of polio—the disease itself—felt remote. I saw evidence of polio’s destruction in some Indians I passed on the street, who had a halting gait or a missing limb, and we visited a polio ward not far from Delhi. But the everpresent fear of a disease that might ravage my community the way polio did in the US in the 1950s, the same fear that brought eager parents out with their children to get vaccinated during those immunization days, wasn’t something I had ever personally experienced.

The irony, of course, is that I would, very soon. Even as I was flying home in late January, a new coronavirus that didn’t even have a name yet was silently making its way across the world too. I wouldn’t find out until months later how lucky I had been not to catch Covid during my trip home. My memories of my recent India trip, specifically to observe nationwide polio immunization, are unavoidably entwined with the experience of descending into the largest pandemic in a century.

It’s no surprise then that I’ve frequently wondered about what parallels might exist between today and the polio epidemics my parents lived through. As I spoke with people familiar with those years, I discovered that trying to compare the eras is more complicated than I expected.

Some aspects are predictably similar, particularly the anxiety and uncertainty that accompany a serious but invisible threat lurking throughout a community that previously felt safe.

“There was anxiety always,” said Ann Lee Hussey, who was 17 months old when she contracted polio in 1955, just months after the vaccine became available. Though her four older siblings all developed a fever that was likely from polio, Hussey was the only one to develop paralysis.

“Friends would go home when school was out and were never allowed to see their friends in the summer,” she said. “Parks were closed, swimming pools were closed—they didn’t see their friends again until they returned to school, and there was always one seat that was empty because somebody didn’t come back at all.”

As with Covid-19, not everyone who contracted polio showed symptoms, but those “silent carriers” could still transmit the virus to others. And polio lacked a cure.

“I can especially relate to the fact that they didn’t know how to treat polio,” Hussey said. “They learned as they went, and that’s what we’re doing with Covid-19.”

Another similarity is the heartbreaking isolation that sick patients experience.

“I was in hospital for five months, and I can recall laying in my bed and looking out the window and seeing my brother on the other side, but they wouldn’t let him in,” Hussey said. And she worries about the potential for another similarity: long-term effects from the disease we don’t yet know about. “At the time people had polio, they didn’t know about post-polio syndrome,” she said, referring to the condition that can affect up to 40% of polio survivors decades after their infection.

Peter Salk, who was 10 years old when his father Jonas Salk developed the polio vaccine, lived in the country during those years and doesn’t remember as much about closures in the summer. But he does remember the summer his family stopped going to Lake Erie as they had for the previous seven years.

“My parents just wouldn’t take us because of polio,” said Salk, today president of the Jonas Salk Legacy Foundation and professor of infectious disease and epidemiology at the University of Pittsburgh. And he recalled stories from others who couldn’t go to summer camp or the movies.

It was the town’s only movie theater shutting its doors that James Cherry, MD, an infectious disease pediatrician and a professor at UCLA’s David Geffen School of Medicine, remembers most clearly. He was in medical school when the vaccine came out, but he recalls how big a deal it was when he was younger to go two miles to the next town to see a movie—only to discover that theater was closed too. He also remembers the swimming pools closing, since a major transmission method of polio was through water.

“Once there was polio, swimming pools would close,” he said. In the Pulitzer Prize-winning book Polio: An American Story, historian David Oshinsky describes how communities across the US tried to manage the invisible threat, including closing their borders, not allowing trains or buses to stop, or not allowing outsiders to disembark in the town.

But those scattered local measures differ vastly from the statewide and nationwide shutdowns of March and April that remain in effect in many places. And aside from the fear that led the local theater to close for the summer, “There’s really nothing similar,” Cherry said about today’s pandemic and past US polio epidemics. He focused especially on the viruses themselves: polio was an ancient enterovirus that people had lived with for millennia, whereas a brand new coronavirus causes Covid-19.

The ages of those most vulnerable also differs, pointed out Stanley Plotkin, MD, a CDC veteran and vaccine developer responsible for the rubella vaccine. With polio, it was primarily parents terrified for their children, even though adults could catch polio too, but with Covid-19, it’s older adults most at risk.

The biggest difference, however, has nothing to do with the virus itself.

“This is a different world,” Salk said. People today are not used to facing as much serious infectious disease as in the 50s, when nearly everyone caught measles, pertussis, rubella, chickenpox and other diseases. Even more profoundly, something has also changed in the way people think about science, business and government, Salk said. There’s been an “evolution of skepticism” that has eroded people’s trust.

“There was some innocence, in a sense, in the 50s,” Salk said. He described the polio vaccine’s reception, “a huge gift given by science to the people of this country that was absolutely welcomed and wanted, but we’re living in a different age right now. People want a vaccine, but they’re suspicious,” he said, compared to the 50s when parents eagerly signed up 1.8 million children to participate in clinical trials funded almost entirely through private donations.

Plotkin agreed, pointing out the rampant misinformation that has particularly thrived on platforms like Twitter, Facebook and Instagram.

“I do think that social media has allowed incorrect information and stupid ideas to circulate, which was not so easy in the past,” he said.

Disease outbreaks have always been fertile ground for conspiracy theories and outlandishly (or seductively) false ideas to thrive, and polio epidemics were no different: Word of mouth implicated everything from cats to ice cream during US polio epidemics. But never has there been so much misinformation and conspiracy theories traveling so widely so fast from so many different sources as today. And that phenomenon intersects with two other major differences today: politics and US journalism.

Cherry expressed frustrated with the intransigence of the Republican party in not acknowledging the reality of the virus for so long and still, in various states and communities across the country, not taking the threat seriously enough to enact measures to protect public health.

Plotkin was also concerned about how politicized the pandemic has become, particularly as the CDC, where Plotkin was an officer in the 1950s, has been sidelined.

“The CDC should have been the source of reliable information that everybody will listen to, but in the place of that, we have conflicting advice from politicians and governors, to say nothing of the president,” Plotkin said. “When the polio vaccine came out, you didn’t see Democrats saying Eisenhower is lying to us, the vaccine is going to kill us, that sort of thing. I think the distrust is much, much greater than it was, and it’s because society is so split.”

He attributes some of that to a shift in American journalism, a “regrettable loss of objectivity,” he said, where “we have papers on the left and papers on the right reporting things that are their opinions rather than what is factual.” Newspapers and radio news did not used to be as partisan as they are today, he pointed out. But the biggest problem is lack of leadership and trust.

“We need people whom the public will trust regardless of their political affiliation, and we don’t have that,” Plotkin said. “People are not accepting advice from the same source. They’re accepting advice from the sources they trust and ignoring the sources they don’t trust.”

The confluence of rampant misinformation, political division and a confusing media landscape make it incredibly difficult for Americans to heed the biggest lesson the polio era has to offer: it takes everyone working together toward a common goal to overcome a foe this big.

“The main thing that strikes me, looking back to the polio experience, was the unity that existed in the public’s mind,” Salk said. “For the most part, it was a shared experience. People were terrified; polio was deeply ingrained in the public’s consciousness.”

That’s what enabled the March of Dimes to raise the funds necessary to fund the polio vaccine trials. “It was the American public that rose to the occasion,” he said. The April 1955 announcement that the vaccine was safe and effective led to jubilation that had been welling up for years while the public remained riveted on the vaccine’s progress.

At first, Salk thought that might happen again.

“In those early days with the lockdown, I just was so pleased and impressed with the American people,” he said. “It was remarkable how people were cooperating, working together, acting together, faced with this thing that was spiraling into a critical situation.”

He recalled an article noting how many cases were prevented with lockdowns across the world and “how extraordinary it was that there’s never been a moment in human history where we made such a difference in such a number of lives than in those first weeks of the pandemic.”

And then “things started to rear their ugly head,” he said. Here came the armed lockdown protesters, the pressure to reopen states before it was safe, the devastating effects of the lockdowns on businesses and people’s incomes, the resistance of people to wearing masks, misinformation running wild…

“It was devastating to me internally to experience that level of discord,” he said. “Then, even before Memorial Day, I was feeling sick inside” knowing how cases would start climbing. Salk doesn’t know how it’s possible to recapture that sense of unity the US had in the 1950s. “Can you translate that to today?” he asked. It’s too simplistic to say we should just all come together like we did back then while powerful power today are “fanning the flames of discord with the objective to divide and conquer, to fracture the unity of consciousness in the country, not bring people together,” he said.

Hussey also remembers a more community-minded America, not the “me society” she sees today, and is baffled at those who won’t wear masks. “Please listen to the scientists and the public health experts,” she said. “I pray when the vaccine does come out, that people don’t fight it.”

“One of my concerns is that once there are vaccines, if substantial number of people won’t get vaccinated, we won’t have the herd immunity effect that we get with other vaccines, and obviously that could mean that the virus would persist circulating in the US,” Plotkin said.

That concern may be premature when so many other challenges—manufacturing, distribution, prioritization of vaccine recipients—lay ahead, but the general unease so many feel about how a vaccine will be received is perhaps the most meaningful difference between the polio era and today.

But it’s also a difference that can be changed.

Hussey, a Rotary club member who has volunteered in 30 National Immunization Days in India, Nigeria, Chad, Somalia, Egypt, Bangladesh and Pakistan, is hopeful. She described the resilience she saw in places like Africa when it came to acting together for public health.

“They’re more willing to stay home, more willing to follow the orders of the doctors because they’ve lived through more disease outbreaks,” she said.

It’s still unclear how long the pandemic will drag on and how long it will be until a safe, effective vaccine is widely available to anyone who wants it. When we think back on the polio era, it was truly an era, with years of fear that built up, summer after summer, and the maimed and dead children it left behind a constant reminder of its devastation. Perhaps we’re asking too much to ask a country as headstrong, diverse and independently minded as the US to come together just six months after the virus. Maybe, frustratingly, it will take more suffering.

“Even these number of months later, the populace is still in shock,” Salk said. “We don’t have our bearings. We don’t know what we’re experiencing.” Perhaps, when the shock subsides and everyone has begrudgingly accepted the reality of this disease and what it can do, maybe, just maybe, history could repeat itself.

Originally published at forbes