Ask Not What Your Vaccination Can Do For You

But What Your Vaccination Can Do For Your Community

I have had a fair amount of experience with polio, but most US-practicing clinicians know little about the disease unless they trained in another country.

I was born in 1947, so I remember the fear before the introduction of the Salk injectable vaccine in 1955. I grew up in Danvers, MA, where there was a swimming area known as Paradise Park. My parents called it “polio park” and would not let my sisters or me swim there because of their concern about polio. I also remember the day that my classmates and I lined up for our first polio vaccination at school. No parents refused the “jab”.

My future brother-in-law, W. Robert (Bob) Wonkka, was a star athlete at Leominster, MA High School. He played halfback in football, and I was told that he once scored five touchdowns in one game. The top cartoon shows “Wonkka” in the end zone when Leominster beat Dury 28 to 0. But Bob contracted polio during the 1946 football season and polio epidemic. He spent months in the hospital and was left with a permanently paralyzed left leg. He wore a full length, metal leg brace for the rest of his life. The second cartoon shows a misspelled “Wankka” sitting on the bench with the polio bug running for a touchdown at the bottom of the cartoon. He was so well regarded in Leominster that the community took up a collection to pay his college tuition to Wesleyan. And despite his left leg paralysis, I never heard him complain. He became a teacher and coached girls’ and boys’ basketball at Peacham Academy in Vermont.

I also had some clinical experience with polio. As a medical student assigned to Lemuel Shattuck Hospital in Boston, I saw a man who lived in a “rocker bed”. This was a bed that rocked from flat to upright and back about every 3-5 seconds, fast enough to give him a respiratory rate of 12 to 20 breaths per minute. The breaths were created by the abdominal cavity pressing against his diaphragm when he was flat, and falling away when he was upright, creating an exhalation and inhalation, respectively. His phrenic nerve was affected and his diaphragm was paralyzed. The rocker bed allowed him to live outside an iron lung.

I also participated in the care of a high school student with polio. In 1972, 12 students at a Christian Science prep school in Greenwich, CT contracted polio. (1). Christian Science teaches that the spiritual understanding of Christian principles can cure disease, and that medical treatments are not required. None of the 12 students had been vaccinated, and three developed paralysis. One of the students returned to his home near Cambridge, MA, where I met him during a fourth-year pediatric rotation at Mount Auburn Hospital in Cambridge.

These experiences have made me watch the polio literature over the years, although I am clearly not an expert. I do think there would be less vaccine skepticism if more people saw both the ravages of the disease and the rapidity with which it was controlled with vaccination.

Wild polio was considered to be eradicated in the US in 1979. The last case of wild polio occurred in 1993, although there was a case of paralytic polio in 2022. This occurred in an unvaccinated individual and was caused by vaccine-derived polio. Such vaccine-related cases have been cited by anti-vaxxers to argue that polio vaccination is dangerous.

There are two forms of polio vaccination. The “Salk vaccine” uses injected, inactivated polio virus. This vaccine prevents paralytic polio, but does not prevent intestinal infection and intestinal shedding of the virus. The US has used only this form of the vaccine since 2000 for reasons presented below. In contrast, the oral or “Sabin vaccine” administers weakened live virus. The oral vaccine prevents infection of the intestinal endothelium, so is preferred for managing epidemics in unvaccinated populations because it prevents replication of the virus in the intestine and thereby reduces fecal-oral spread of the virus. The problem is that some of the live oral virus can be excreted in the stool, and infect other unvaccinated individuals. With repeat passage among unvaccinated individuals, the virus can strengthen and ultimately can cause paralytic polio. So, even though the oral vaccine decreases spread in epidemics in unvaccinated populations, it can cause paralytic polio among the unvaccinated if passed enough times among a population. And for that reason we only use the injected vaccinations in the US.

It behooves clinicians to know something about these “eradicated” diseases so that we can address patient concerns when they arise.

There is presently a rehash of the myocarditis that occurred primarily in young males who received the COVID-19 vaccine. Cases clearly occurred, but we have written that they may have been over-diagnosed, especially in athletes because strict criteria for the definition of myocarditis were not always used.(2) The risk of COVID-19 to the population is less now, but those now second guessing the immunization of children during the epidemic on the basis that the vaccine-caused myocarditis must have forgotten that we had to use refrigerated trucks in New York City to store the COVID victims’ bodies.

There is something else to remember that many people forget. Vaccination is something that an individual does not only for themselves, but for the community. Vaccination protects others because it prevents the spread of the disease, and thereby helps protect those who are medically vulnerable or who cannot be vaccinated for legitimate medical reasons. I will always remember President John F. Kennedy’s inaugural speech in 1960 when he said, “Ask not what your country can do for you, but what you can do for your country.” Such an attitude is presently rare, but perhaps we in medicine need to say, “Ask not what your vaccination can do for you, but what your vaccination can do for your community.”

1. https://www.nytimes.com/1972/10/26/archives/12-pupils-are-stricken-by-polio-at-private-school-in-greenwich.html

2. Patel P, Thompson PD. Diagnosing COVID-19 myocarditis in athletes using cMRI. Trends Cardiovasc Med. 2022 Apr;32(3):146-150. PMID: 34954013