When Elvis Helped to Conquer PolioDecember 20, 2020
As the star of the year—Elvis Presley—prepared for his breathlessly anticipated appearance on the highest-rated variety show of 1956, the United States was in the throes of a medical crisis. The Salk polio vaccine had been available for just over a year, creating hope for eradicating a virus that had haunted communities for decades. Despite scant government safety oversight, the vaccine had been embraced by much of the public as a long-awaited salvation. But one early batch of bad shots had sickened, paralyzed and killed children.
Those shots were recalled, the drugmaker expelled from the polio program. Vaccinations resumed, but some people remained hesitant. Teenagers, especially, balked at getting inoculated, because of a mistaken belief that immunization for a disease also known as Infantile paralysis was only for little kids and babies.
The March of Dimes—an extraordinarily high-profile organization at the time, closely identified with the long war on polio—sought someone who could rev up immunization, giving it a jolt of attention and excitement, the perfect marriage of science and pizzazz.
So on Oct. 28, 1956, backstage at “The Ed Sullivan Show,” the 21-year-old Elvis Presley—the smooth-faced, pouting, swivel-hipped hero of American youth—extended his left arm. In went the needle. Off went the flashbulbs. A polio star was born.
And then he went on stage to wiggle, wink and wail. “Hound Dog.” “Love Me Tender.” “Don’t Be Cruel.”
Now, the first coronavirus vaccines are being given to high risk health care workers; nursing homes are next. Over the coming months, the vaccines will begin reaching the nearly 330 million people in America, including underserved and minority communities with tenuous faith in the U.S. health care system. But even with far stricter government oversight than in the ’50s and no reports of serious side effects, there’s widespread fear and uncertainty about injections that draw on unfamiliar technologies, developed with record-breaking speed amid the most polarized political environment in memory.
Vaccines can’t stomp out pandemics if large numbers of people shun them. Rebuilding trust—in science, in medicine, in political leaders, in common purpose—is fraught and complex, as a new presidential administration is starting to realize.
And there’s no Elvis to unite America.
By the standards of coronavirus, polio was more of a looming threat than a deadly pandemic; from 1950 to 1953 there were 119,000 cases of paralytic polio and 6,600 deaths, according to the Centers for Disease Control and Prevention. But that didn’t begin to capture the sense of dread that surrounded a disease that, seemingly out of nowhere, struck tens of thousands of healthy children per year and left some of them dead and many others unable to walk, or breathe on their own.
There was no White House Operation Warp Speed to hasten a vaccine, but the challenge nonetheless spurred an epic rivalry between the two brilliant, driven scientists, Jonas Salk and Alfred Sabin. Salk’s vaccine was the first to arrive. His was what’s known as a “killed virus” vaccine—but as it turned out, killing every drop of the powerful polio virus in a factory wasn’t as easy as painstakingly crafting smaller batches in Salk’s lab. Sabin’s vaccine, which used an attenuated or weakened virus, came on the scene a few years later, and for a time eclipsed Salk’s.
The Salk-Sabin feud was only part of the drama surrounding the polio vaccines, a legacy that haunts immunization campaigns today. While coronavirus came upon the world suddenly and calamitously, polio arrived stealthily, through mysterious outbreaks in the late 19th century. The first polio epidemic recognized in the United States was in Otter Creek Valley, Vermont, in 1894. The big outbreak that awakened prolonged public fear came in 1916. From then on, polio outbreaks were seemingly more frequent and more terrifying with each passing year. Each summer, movie theaters (sometimes the only place in town that had air conditioning) and swimming pools were closed. Schools and places of worship were shut. Playgrounds and birthday parties were deemed unsafe. Families pulled their children close and cowered.
The sheer horror of the virus itself dispelled any doubts about its seriousness; no one looked at a child trapped in an iron lung and called it a hoax. But baseless theories about transmission raged, filling a void in medical understanding.
The search for treatments or a vaccine intensified in the 1930s after Franklin Roosevelt, afflicted by polio in 1921 at age 39, founded the Georgia Warm Springs Foundation and, in 1938, the National Foundation for Infantile Paralysis, which in turn created the March of Dimes.
Roosevelt lent the fight against polio an intensity and a panache: He drew a roster of Hollywood celebrities to the cause, including hugely popular early- to mid-20th-century crooners Eddie Cantor, Bing Crosby and Rudy Vallee. In 1940, the young Nancy Davis—later Nancy Reagan—appeared in a foundation-sponsored short film called “the Crippler.” Polio would remain star-studded until its extinction; historian David Oshinsky, who wrote a Pulitzer prize-winning history of the disease, recalled finding a photo in the archives of the Waldorf-Astoria of a 1950s benefit involving the odd celebrity trio of actress Grace Kelly, song lyricist Oscar Hammerstein II and surrealist painter Salvador Dalí.
The first two vaccines were developed in the 1930s. Shockingly, there was no real federal oversight of vaccine clinical trials at the time, no data checks by independent experts, no Institutional Review Boards at medical schools. One was a precursor of Salk’s killed-virus vaccine; the other an early stab at a Sabin-style weakened virus. In both cases, the scientists recruited families by proffering a whiff of hope that their children could be protected. Both vaccines, primitive by today’s standards (one was made in a bathtub), were widely publicized. Both failed. One killed at least nine children; the other caused a form of encephalitis. One of the scientists would die within a year at age 36, in what was widely suspected to be a suicide.
The children of the ’30s were the parents of the ’50s. When Salk’s vaccine was ready for testing, there was a lot of skepticism among scientists, particularly from Sabin and his allies. Some of that foreboding stayed within scientific circles but some made it into the press. Among the media giants who railed against the Salk vaccine was the highly influential gossip columnist and radio personality Walter Winchell. If YouTube had existed then, he’d have been right up there with the Jenny McCarthys of the anti-vax world. The experimental vaccine, Winchell warned “may be a killer.”
The National Foundation, the nonprofit created by FDR that sponsored the vaccine trials, actually got a lot right in launching the Salk vaccine. It created a template that would be adapted by the Trump administration’s coronavirus vaccine accelerator. The foundation ordered big batches of the vaccine, willing to discard it if it failed but eager to start injecting kids as soon as possible if the clinical trials worked. The early purchases helped to mitigate the huge financial risk of bringing an uncertain product to market. “It was Warp Speed One,” said Paul Offit, a leading vaccine researcher at Children’s Hospital of Philadelphia and the author of several books on polio and other vaccines. “They paid for the trial. They paid for mass production by five companies. … They took the risk out.” That’s a lot of what Donald Trump’s Operation Warp Speed is doing with coronavirus.
In 1954, nationwide testing of Salk’s polio vaccine commenced. The country embraced the massive experiment, involving injecting a brand new vaccine into the arms of nearly 2 million school children. They were sometimes called America’s Polio Pioneers. The vaccine was licensed to five companies in 1955. For the public overall, “the risk of an unknown vaccine was virtually nil compared to the fear of the disease itself,” said Oshinsky.
But the Salk vaccine was not easy to make. The multistep process used formaldehyde and special filters to inactivate, or kill, the live polio virus without obliterating it so forcefully that it couldn’t produce the immune response needed to make the vaccine work. And then one of the five companies seeking to replicate the vaccine made a mistake.
Cutter Laboratories, which was later bought by Bayer and is probably best known today for an insect repellent, wasn’t as well-known as some of the other licensees, but given its experience with veterinary and early human vaccines it wasn’t an obviously bad fit. Government regulation was flimsy; President Dwight Eisenhower thought too much federal oversight would be “socialized medicine.” Cutter dutifully submitted to the government the required paperwork on the batches that were fine—but it never reported on the batches that it had to discard when it failed to kill the virus. In the spring of 1955, Cutter shipped out shots containing live polio virus to California and Idaho. Children began to get sick. And since polio, like the novel coronavirus, can be asymptomatic, children infected from the bad vaccine spread the disease, seeding infections across the country. Offit, in his book The Cutter Incident, estimates that a total of 220,000 people were infected, 70,000 developed muscle weakness and 164 were severely paralyzed. Ten died.
“It was a mass tragedy,” said Offit, who sees it as part of the origination story of vaccine fears of today.
Cutter was kicked out of the polio game. And vaccination resumed—with surprisingly high levels of acceptance. The swift and decisive federal response to the Cutter incident helped to restore faith, particularly in a 1950s world that was more trusting of authority and experts.
“It was front page news—unwittingly, individuals had been injected with live polio virus, “ said Jason Schwartz, a historian of science at Yale University. “Think about how catastrophic an event like that would be for the successful promotion of the safety of the Covid vaccine.”
Nobody was polling people back then about the extent of vaccine resistance, so it’s hard to know precisely how much fear lingered. But pockets of the population were scared off, or at least apprehensive—or unable to pay for the shot and multiple boosters for all their children. “Cost, apathy and ignorance became serious setbacks to the eradication effort,” said Stephen Mawdsley, a British historian who made a short film about polio in the United States. Thousands of people, mostly young, were still falling ill.
The young man already known as the King did three appearances on Ed Sullivan between September 1956 and January 1957—the final one when he was famously shown from only the waist up. The first one alone reached an estimated 60 million people—more than a third of the entire national population of 168 million. No entertainer today commands anything close to that audience. And his fans—the swooning, half-crazed, first-generation rock and rollers—were from an age group in need of the vaccine.
Elvis’ polio vaccination came right before his second “Sullivan” appearance, as his megahit “Love Me Tender,” released one month earlier, was climbing the charts. A 40-foot cutout of Presley and his guitar, campy by today’s publicity standards, adorned the theater’s brick facade on Broadway. Back stage, as journalists looked on, New York City Health Commissioner Leona Baumgartner held Presley’s left arm as her assistant commissioner, Harold Fuerst, hit the plunger.
“Hey kids can I talk to you? This is Elvis Presley,” he said in a March of Dimes PSA recorded around then. “If you believe polio is beaten, I ask you to listen. The fight against polio is as tough as it ever was.”
Later accounts probably overstated Elvis’s role in jacking up the vaccination rate, but he had undeniable impact amid a broader effort to boost teen immunization, including “Salk Hops” and a campaign to get teenage girls to spurn dates from unvaccinated teenage boys, according to Mawdsley.
Presley would stay involved with the March of Dimes, visiting kids struggling with polio and being photographed with March of Dimes poster children. He even purchased FDR’s former yacht for the then-considerable price of $55,000 to donate it to the charity—though when March of Dimes was unable to accept it, he turned it over to the Coast Guard.
In the decades since the Cutter incident, both anti-vaccination forces and vaccine hesitance—related, but not identical—have spread and transmogrified. There is no one type of vaccine opponent, no single rationale. Objections come from the left and the right, from people who don’t want the government to tell them what to do, those who think pharmaceutical companies are engorging themselves on toxic products, and assorted other beliefs and philosophies, religious or otherwise.
Experts on public health messaging and the anti-vaccination movement don’t think many of the hard-core vaccine opponents will change their minds and accept the coronavirus vaccine, no matter how much public education and messaging initiatives are unveiled. However, the so-called “vaccine-hesitant”—people who oppose or fear vaccines but not so militantly—can be reached with the right message. But it’s hard.
“There’s no one Elvis,” said Adam Berinsky, a political scientist at MIT who studies language and messaging in public health. The challenge today is to find “the right Elvis for the right community.”
Maybe that will be Oprah Winfrey or Tom Hanks or Dolly Parton.
But messaging is more complicated than in the trusting 1950s, when Elvis vamped for the camera and President Eisenhower’s little grandson David was filmed dutifully waiting in line for his polio vaccination and then fishing with his grandpa. The ’50s weren’t the idyllic era sometimes depicted; but it was a whole lot less polarized, less distrustful than today. Now, there is a whole new category of vaccine hesitancy—people who normally trust vaccines but are alarmed by Trump’s exaggerated timetable and pressure to get a vaccine out before the election, when his own public health appointees were cautioning that it would not be safe.
Some polls suggest that apprehensiveness is subsiding postelection, with the Food and Drug Administration having resisted Trump’s pressure and standing its ground on vaccine safety. It may not have hurt that the head of Operation Warp Speed, Moncef Slaoui, has outed himself as a Democrat and said he has “more affinity” for the incoming Biden administration than for Trump.
The branding of the vaccine has been problematic, however.
“‘Warp Speed’ was not the right way to put it,” said Oshinsky. The public “doesn’t know what it means. They know it’s coming out at tremendous speed and they don’t know what’s behind that.”
Berinsky put it this way: “Trump pushing the vaccine—speeding it up—created distrust.”
Having the drug companies—another source of suspicion—attest to the vaccines’ safety won’t cut it either. Broader transparency, about the research and who is evaluating that research, will help, if people who are broadly trusted, like Anthony Fauci, can vouch for it. But data transparency only goes so far, since ordinary people can’t assess it on their own.
And for some communities, skepticism has been decades in the making, particularly among minority groups who have ample reason to distrust the health care system from decades of being underserved.
President-elect Joe Biden picked a Yale health equities researcher and physician, Marcella Nunez-Smith, to play a prominent role in the incoming administration’s pandemic response, focusing specifically on these challenges. She’d been advising him since August, and says assuaging minority communities’ vaccine fears has been a priority from the get-go, particularly as these are the communities hit hardest by the pandemic and its economic fallout.
“The work of truly engaging community leaders—writ large, not limited to communities of color—involves partnerships,” she said in a POLITICO interview soon after Biden named her to his team. Messaging has to come from scientists—but also “neighbor to neighbor, friend to friend—the community.”
Having scientists who are themselves part of the community vouch for the vaccines will help, said Lisa Cooper, a physician who directs The Johns Hopkins Center for Health Equity. Given her own experience, she can tell apprehensive people, “I have served on a data safety and monitoring board”—in her case, for an Ebola vaccine. “I know what people have to go through in order to decide when something is safe to be administered.”
The FDA also required the clinical trials for these coronavirus vaccines to include a cross section of the population, another trust-building ingredient.
But white coats, no matter who is wearing them, aren’t enough, Cooper and other experts on health disparities and public health outreach recognize. Messaging will have to be multifaceted, multilayered, multilingual and multimedia. It will have to be national and local, political and apolitical, involving doctors, nurses and pharmacists, church and other faith groups, community organizations—and athletes and celebrities. Trusted figures have to say not only that you should get the vaccine but that they themselves are getting it. Former Presidents Barack Obama, George W. Bush and Bill Clinton have all offered to pitch in.
And that has to be layered on transparency—and empathy. Kenzie Cameron, a Northwestern University expert on health care communication, said that means being frank about both what is and isn’t known about the brand new vaccines. Data will be collected for months to come, as scientists learn more about how long and how well the shots protect people, and whether any safety problems emerge as hundreds of millions of people get inoculated around the globe. And empathy means talking through people’s fears, not just cutting them off and saying “No. You are wrong.” That’s true in community-based messaging, as well as in a doctor’s office.
“Personal narratives are incredibly strong,” Cameron said. “Someone is saying ‘I am not telling you to do something that I’m not doing.’”
Drawing on community health workers, or other trusted local people connected to health is also a good strategy—and it helps if they can speak the language of the community, said Sandra Hernandez, president and CEO of the California Health Care Foundation. A physician with roots in both the early HIV/AIDS crisis and Latino communities, she said contact tracers working on coronavirus at the community level may be good vaccine messengers.
“We’ve got five organizations in the Mission [District in San Francisco] doing contact tracing. They are trained, they are local, they are young, they are people of color,” she said. “They may end up being a workforce that is primed to be able to help.”
“The operative word is trust,” Hernandez added.
Given that even celebrities and athletes can be polarizing these days, there will have to be a mix of famous faces, some to address specific communities, others as part of national campaigns. A celebrity-laced Trump administration ad campaign to “lift spirits” before the election was canceled; a less politicized version is being revived. Cooper said she’s already engaged with the National Football League on how they can figure into a vaccination campaign. At least two Republican senators from Trump-backing states, Rob Portman of Ohio and Steve Daines of Montana, have disclosed that they volunteered in vaccine clinical trials—a helpful message to conservative voters who are skeptical of the coronavirus itself, not just the vaccines.
Messaging isn’t one and done. People will have to be reminded to get both doses. They will have to be reassured that having mild side effects doesn’t mean they have Covid—or that they shouldn’t get the second dose. If they have a friend or relative who gets the shot and still gets sick, they will have to be reminded that it takes two doses plus a couple of weeks to build resistance. Waves of misinformation are inevitable; waves of truth will have to combat them.
Yet there are also signs that the fear is abating, that the calculus for a Covid vaccine is different. People who shun a flu shot or don’t vaccinate their kids against measles may think differently about the risks and benefits of a Covid shot, noted Schwartz, the Yale historian. This is a vaccine meant to end the worst health crisis in a century, a global disaster that has upended the economy, separated loved ones, shut schools, and effectively ended theater, travel and dinner parties. It has killed more than 300,000 Americans.
Back when Ebola struck, doctors encountered people who wouldn’t get a flu shot but were frantically demanding Ebola vaccines—even though Ebola was not spreading in the United States and there was no shot at the time. For everyone who is now asking of this new vaccine “Is it safe?” many more are now asking “When can I get it?”
And once thousands, then millions, then tens of millions get vaccinated, Americans’ confidence will rise.
“They will get this,” predicted Offit, the vaccine expert and polio historian. “They will want it.”