How past vaccine races can help win this one

“The vaccine works. It is safe, effective, and potent.”
In 1955, those were the words that told the world US scientist Jonas Salk’s polio shot was a success. It was news greeted with popular jubilation, ringing church bells and boldface banner headlines. The sort of heartfelt relief that most of us can readily identify with, more than a year into a coronavirus pandemic that has now killed 2.5 million people.
In an age when rich countries have largely forgotten the ravages of infectious disease, we have spent the past months grappling with the impact of a highly contagious illness that does not discriminate. We now hope our technological and medical advances can accomplish in months what it took decades to achieve in the past with poliovirus, smallpox or measles. As those rejoicing at Salk’s victory soon found, the first vaccines are the end of the beginning — not quite the beginning of the end.
The two viruses are very different. Poliomyelitis is primarily spread through contact and infected fecal matter, while Covid-19 is usually transmitted through respiratory droplets. The first tends to affect young children, and can invade the nervous system.
The second appears to hit the elderly hardest. Polio has triggered no pandemics, no economic crashes. Yet the large-scale campaign against what was once called infantile paralysis, and the fear that preceded it, is arguably the closest precedent to today’s effort.
There’s good news in that. Past inoculation successes are reminders of what is possible: We know that vaccination works. There were also painful mistakes that stand as salutary reminders for modern policy makers that ending viral nightmares requires sound judgment, investment and trust.
Records of polio cases date back centuries, perhaps as far back as ancient Egypt, but epidemics only became a serious scourge in Europe and the United States as the last century dawned. The first recognised US outbreak was in Vermont in 1894. Others followed. In 1916, a devastating summer in New York brought death, lockdowns, anti-immigrant prejudice and culls of cats. It left a trail of dread. The annual number of US cases peaked in 1952 at nearly 60,000.
Many more children died in accidents or from cancer over these years, but panic was widespread. Images of patients in iron lungs, huge metal chambers designed to help patients breathe, terrified. So did young children in leg braces. By the 1950s, the only thing Americans feared more than polio was the nuclear bomb. Ending that
took a crusade. President Franklin Roosevelt, who contracted polio in 1921, helped turn a rehabilitation charity into an unprecedented national campaign that touched nearly every American, encouraging them to give just one coin for research. They did, sending them in such large numbers the White House could hardly cope. The March of Dimes began in 1938, transformed fundraising and collected hundreds of millions of dollars.
Then, success. Salk got to the finish line first with an inactivated virus vaccine, earning him popular adulation, though not necessarily the respect of his peers. Albert Sabin, a bitter rival who developed a different, live virus oral vaccine approved a few years later, dismissed it as “kitchen chemistry,” arguing the University of Pittsburgh scientist had simply put together findings others had made. Still, thanks to both, cases plummeted.
After a year or so of Covid-19, we have vaccine breakthroughs, but we’re not yet near the finish line; eradication is distant. There are too many unanswered questions. We don’t know enough about how immunity works after illness or vaccination, nor do we fully understand transmission. Cases go untraced. The goal of today’s shots is to bring down mortality rates, and to keep health systems running. Children will not be immunised for months.
Eventually, though, the target will shift. Victory will require mass and even routine inoculation while tackling significant skepticism. As that happens, it’s worth considering that the world has been here before. There are lessons to carry into the 21st century.
At the most basic level, it’s clear that central government-led policy — leadership — is crucial at every stage, from supporting vaccine development to dissemination. The official decision to get behind polio inoculations didn’t guarantee a cure, but without support would have taken far longer. So too with Covid-19. In the US, Operation Warp Speed, a $12 billion-plus effort to fund vaccines, was a rare bright spot in the Trump administration’s otherwise dismal handling of the outbreak. Investment in manufacturing may have saved months. It’s a pity so much time was wasted by the same officials, failing to plan adequately for the actual injections.
A sound strategy will have to include insuring that even the least-affluent countries have the necessary healthcare structures, without which routine immunisation, cold chains to preserve vaccines, timely testing, monitoring and oversight — the basics for control of Covid-19 and any subsequent viruses — will be impossible. It’s a priority that has been neglected for too long already.
While good governance helps, poor decisions create disproportionate and lasting damage. In the US campaign against polio, not unlike Covid-19, the first hiccup was dissemination. President Dwight Eisenhower’s administration simply did not see distribution as its role. That was “socialized medicine,” opposed by the then secretary of health, education and welfare.
One official quoted in David Oshinsky’s “Polio: An American Story” suggested that an allocation program would “constitute an undesirable precedent.” Shortages plagued the early years of the campaign, as did inequities in access at a time when US schools were only just being desegregated.

—Bloomberg

Clara Ferreira Marques is a Bloomberg Opinion columnist covering commodities and environmental, social and governance issues. Previously, she was an associate editor for Reuters Breakingviews, and editor and correspondent for Reuters in Singapore, India, the UK, Italy and Russia