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Gareth Millward | 28 October 2019
◇ British History | Medical Humanities | Modern History
Jonas Salk would have been 105 today, 28 October. He is remembered as the inventor of the polio vaccine who, when asked how much money he stood to make, declared: ‘There is no patent. Could you patent the sun?’
Of course, “it’s more complicated than that”. Salk was part of a multi-national, multi-agency project to develop prophylactics. Without the use of “his” injectable vaccine and the oral vaccine developed by rivals on the other side of the iron curtain, humanity would not be on the verge of eliminating polio. (For more on that story, see the excellent book by Dora Vargha.)[1] And one of the reasons Salk didn’t patent the vaccine was that it was unpatentable.
But let’s not be uncharitably pedantic. It is, after all, his birthday.
In the wake of recent reports of resurgent infectious diseases – including polio – vaccination is back in the news. (If, indeed, it ever went away). Matt Hancock, the UK’s Secretary of State for Health and Social Care, has suggested the government might consider mandatory vaccination. Public health experts have cautioned against this, using (in part) historical evidence. In the nineteenth century, compulsory vaccination generated a well-organised, vocal and occasionally violent anti-vaccination movement,[2] the effects of which still haunt Britain’s public health authorities.
Public health has taken its lessons from high-profile examples of crisis – smallpox, pertussis or measles to name but three.[3] But not all problems come from rejection of vaccines. With polio in the 1950s, the problem was the government’s inability to meet demand.
Salk’s vaccine (yes, we’ll give him credit here – after all, contemporaries referred to the inactivated poliomyelitis vaccine simply as “Salk”) became commercially available in 1955. The British government announced with great fanfare that it would provide the vaccine for free to all children and young adults. There was clear demand for it. This invention – in the same vein as space exploration and penicillin – was a marker of modernity, the power of science to solve once-intractable problems.
Unfortunately, there was not enough to go around. In 1955, a manufacturing defect by Cutter Pharmaceuticals resulted in the accidental infection of hundreds of American children. As a result, the British banned American imports and chose to use domestic factories to produce a “safer” form of the vaccine.[4] But Britain didn’t have the capacity to produce enough doses in time. Shortages created complaints from the British press and parents, and – despite the demand – few registered for the vaccine because of the long waiting lists and inconvenience.
As proof of the demand for the vaccine – despite the Cutter incident – local authorities were swamped with requests when high-profile cases made the news. The death of professional footballer Jeff Hall showed even fit, young people could be affected and created a surge in numbers of younger adults presenting themselves and their children for the jab. In the ensuing shortages, the health minister blamed people for their apathy – if they’d just done as they were told when they were told, the government could have better distributed the vaccine over the course of the year. This did not go down well as a public relations exercise.
This crisis was eventually overcome through the introduction of the oral polio vaccine in the early 1960s. Taken on a sugar cube, parents were much more willing to present their children. It was a quick process that could be done anywhere; it didn’t hurt (though its taste was somewhat to be desired); and it could be manufactured so easily, and in such volume, that there was no need to wait around for months for the next batch to become available.
Of course, all historical circumstances are different. Anti-vaccination literature is certainly more visible than it was in the 1950s. Populations are more mobile. The immediate memory – even fear – of certain infectious diseases has faded.
At the same time, the intriguing part of this history – at least to this historian – is not why people don’t vaccinate their kids. It’s why so many do.[5] The vast majority of children receive some form of vaccination – upwards of 95 per cent – even if they do not always complete every course in the recommended time frame.
The great improvements in vaccination rates over the past 70 years have come from better administration. Easier-to-administer vaccines. More-robust procedures for following up on missed appointments. Advertising. Having local health professionals answer the specific questions and concerns individual parents might have. Following up with patients who might otherwise slip through the surveillance of public health authorities (such as those who do not speak English, regularly change addresses, have other acute social care needs). All these things required resources which have been squeezed significantly since public health was reintegrated into already-struggling local authorities.
It would be unwise for a historian to say that this is the cause of the problems, or that extra funding will provide a magic-bullet solution.
It is, however, worth reminding ourselves that crises in vaccination policy are not new. We have experienced them before. And not all of them have been due to a lack of demand or fear of a particular vaccine. The 1950s polio example shows us that more practical issues can be at play, and that the public and its collective behaviour are not necessarily at the root of them.
Gareth Millward is a Wellcome Research Fellow at the Centre for the History of Medicine at the University of Warwick. He has worked on the history of disability, public health, vaccination and most recently sick notes. His book Vaccinating Britain was published in January 2019 by Manchester University Press.
Notes
[1] Dora Vargha, Polio across the Iron Curtain: Hungary’s Cold War with an Epidemic (Cambridge: Cambridge University Press, 2018).
[2] Nadja Durbach, Bodily Matters: The Anti-Vaccination Movement in England, 1853–1907 (Durham: Duke University Press, 2005).
[3] Stuart Blume, Immunization: How Vaccines Became Controversial (London: Reaktion, 2017).
[4] Hannah Elizabeth, Gareth Millward and Alex Mold, ‘’Injections-While-You-Dance’: Press advertisements and poster promotion of the polio vaccine to British publics, 1956-1962’, Cultural and Social History 16:3 (2019): 315-36.
[5] Gareth Millward, Vaccinating Britain: Mass Vaccination and the Public Since the Second World War (Manchester: Manchester University Press, 2019), p. 1.
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