Skolnik: COVID-19 – Looking Through A ‘Polio Lens’

Los Alamos

When we look at the present pandemic through the lens of US efforts to eliminate polio in the 1940s, ‘50s and ‘60s, we should be deeply concerned at some of what we see. Most notable is the lack of social cohesion around COVID-19 compared to the remarkable cohesion the US displayed in combatting polio.

One of the prevailing strengths of the US effort to discover and deploy a vaccine against polio was the remarkable amount of social cohesion around this work. The first successful search for a vaccine was supported by a private organization, headed by a trusted counselor of President Roosevelt. The president, who suffered from polio, completely backed this effort. Large parts of society supported the March of Dimes, most famously with the “women’s marches”, which collected dimes to send to the president from people all over the country to support the battle against polio.

American attitudes after World War II further enhanced the willingness of people to work together toward a common good. This was also a period in which the US saw investing in new technologies as central to maintaining its pre-eminence as a world power. It is also important to understand that people were terrified that someone in their family—especially their children—might get polio, become paralyzed, die, or wind up in an iron lung. This overwhelming fear also greatly added to American interest and urgency in the fight against polio.

The clinical trial for the Salk vaccine included 2 million children. The announcement that the vaccine was effective was a monumental day in US history and Jonas Salk was treated as a national hero. While there have always been people who are vaccine hesitant, I can remember well how every family that I knew took their children to be among the first to stand in line at schools and get the vaccine. Several years later, they did the same for the Sabin vaccine, which was given on a sugar cube.

Interestingly, however, is the fact that the numbers of people in the US who were paralyzed or killed by the disease was fewer than most people think. The largest number of people killed by polio in any year was just over 7,000 in 1916. Polio caused about 15,000 cases of paralysis a year and the largest number who suffered mild to disabling paralysis from polio in a single year was just over 21,000 in 1952. Of course, the fact that polio came back every year until eliminated by vaccination increased the total number of infections and deaths and further heightened people’s fears and their hope that the disease would soon be eliminated.

By contrast, COVID-19 took about 500,000 US lives in 2020 and more than 20 million Americans had confirmed infections that year. Yet, social cohesion around the fight against COVID has been limited. President Trump and much of his team often downplayed the outbreak, despite the president’s having been infected. That same leadership, joined by many at the state level and amplified by social media, often decried and worked against the disease-fighting measures recommended by public health authorities. Related to these actions, many people either continue to deny the existence of COVID-19, believe it is “no worse than the flu”, or see vaccine refusal as a symbol of political solidarity. Many public health authorities have faced harassment and mask mandates have been contentious. Despite the remarkably rapid development of safe and effective vaccines, there are 16 states in the US in which less than 50% of the population above age 18 have been fully vaccinated.

Many of the great advances historically, in the US and elsewhere, have come as a result of public health measures, including many that enjoyed widespread public support. I don’t pretend that we can return to the social cohesion of wartime or post-wartime America. Nor will I pretend that COVID can produce the universal fear that America had about polio. Nonetheless, I do believe that our present lack of social cohesion around public health is a grave threat to all of us—not only in the face of the pandemic but also as we look forward in the health, social, and political arenas.

Editor’s note: Richard Skolnik is the former regional director for health for South Asia at the World Bank. He was the director of an AIDS treatment program for Harvard and taught Global Health at the George Washington University and Yale. He is the author of Global Health 101 and the instructor for Yale/Coursera’s Essentials of Global Health.

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