Scene from a hospital room where many, many children are in line to be inoculated.
This book skates along many thin lines, somehow managing to stay on the right side of the boundary in every case. It could easily be hagiographic about Drs. Jonas Salk and Albert Sabin, inventors of the primary polio vaccines, but it is honest and fair about both of them: Salk’s killed-virus approach to ending polio probably was the safer one, but Sabin’s mostly won the battle over the span of forty years. Moreover, Oshinsky could easily have treated Salk and Sabin as lone pioneers, locked in a gritty man-to-man war, but he doesn’t; he’s well aware — and spends most of the book explaining — that beneath the two scientists sits a vast scientific enterprise and a vast financial apparatus that put money in the men’s hands. Cosma Shalizi remarks somewhere that every scientist is an institution in miniature, and nowhere was it truer than in the race to find a cure for polio; Salk and Sabin by no means stood alone. Behind each was a veritable public-health Manhattan Project.

There was also a lot of PR magic involved in drumming up the funding that paid for the Manhattan Projects. It certainly helped, if that’s the word, that FDR developed polio in the prime of his life; he became the public face of the disease and of the organization that he promoted to end it, namely the National Foundation for Infantile Paralysis, commonly known as the March of Dimes. (Did you know that that’s part of why Roosevelt is on the dime? That’s a fun trivia fact that I only just learned from Oshinsky’s book. And I’ll be honest with you: I didn’t know that was FDR on the dime until just the other day. I always thought it was Truman.) Without the funding, none of the other magic could have happened. And without convincing Americans that poliomyelitis could strike at their children at any time — that everyone was vulnerable — the funding would likely have dried up.

What I find perhaps the most fascinating about the whole anti-polio enterprise is the sheer mass of boring but utterly essential logistics that made it run. Consider the amount of labor, and the amount of crushing detail, required to conduct a massive program of inoculation for a disease that didn’t victimize all that many people: at its peak in 1952, there were 21000 paralytic cases. That’s not nothing, but even in 1952 the U.S. had well over 150 million people. So now imagine trying to figure out whether your vaccine stops the disease; you’d ideally want to give the vaccine to one group of people, not give it to another group of people, and see whether the first group gets less of the disease than the second group. But since the disease is rather rare to begin with, you’d need to vaccinate a lot of children (and monitor a lot of other unvaccinated children) to see any significant differences between the groups.

So you’re studying many hundreds of thousands of children. Now just think of the difficulties in running an experiment that large. First of all, let’s imagine that people believe your vaccine works; then you can expect doctors who know which vials contain vaccine and which don’t to reserve the vaccine-filled vials for their families; this and many other reasons dictate that doctors must not know whether they’re administering vaccine or placebo. But exactly because the drug was believed to be effective, it’s unethical to deny it to vulnerable populations. Yet rigorous science demands that the drug trial be controlled (some people get the drug; some don’t), and that it be doubly blinded (patients don’t know whether they’re getting vaccine or placebo, and doctors don’t know which they’re administering). Cutting that particular knot is at the intersection of politics, ethics, and science.

In a complicated vaccine schedule like the Salk one, which required three separate shots over a span of time, you can expect some people not to come back for their followup shots. In a pre-computer era, the record of who got which shot would go onto a piece of paper, and lots of those pieces of paper would end up in the mail to a central processing facility. Some of the pieces of paper will be lost, some of the patients will be mis-coded, etc.

These details are, indeed, all mind-numbing. So it would have been necessary to build process upon process around these forms, in the expectation that the people executing those processes would get bored and let their minds wander. Essentially, the process of testing a vaccine on millions of people would require hierarchical organization and a bureaucracy. The scientist’s work embodies a scientific community in miniature.

You can think about the experiment — with all its various protocols — like the deployment of a complicated piece of software. Eventually someone is going to find a bug in the protocols — an edge case that someone didn’t quite prepare for, where the code didn’t fail appropriately. That’s exactly what happened in the Cutter incident. Imagine being Jonas Salk, his reputation hanging on the vaccine that indelibly bears his name, during the nail-biting months after all those children were shot full of his vaccine. Any of those “protocol bugs” is yours; it has your name written on it. When children die after agonizing paralysis, their deaths are unavoidably thought to be your fault.

All of this — the logistics, the personal agony of Drs. Salk and Sabin, the lab work to produce live polio virus outside of neural tissue, the petty battles between scientific personalities, the PR, the financing — is covered in David Oshinsky’s absolutely gripping [book: Polio]. You couldn’t ask for a better work of scientific journalism, yet it has the scholarly rigor that you’d expect from a longtime history professor. It has a nearly staccato rhythm that pulls you unstoppably along. It is a great achievement.