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Polio was once one of the most feared diseases in America. Now it's on the verge of eradication. Cases of the paralytic disease, which is spread mainly through infected feces, have dropped from hundreds of thousands a year in the 1950s to just a few hundred today. And the virus remains endemic in only two parts of the world - northern Nigeria and the Afghanistan/Pakistan border. Now the decades-long fight against polio has reached what public health officials hope is a final showdown.
For our series Chasing Down Polio, NPR's Jason Beaubien looks back at that fight and the vaccines that helps turn the tide.
JASON BEAUBIEN, BYLINE: Polio been around for centuries. But it gained momentum in the early part of the 20th century. The first major polio epidemic in the United States hit Vermont in 1894. A larger outbreak struck New York City in 1916. As the number of polio cases grew, the paralytic disease changed the way Americans looked at public health and disability.
In 1921 Franklin Delano Roosevelt contracted polio. Twelve years later, he was inaugurated as president.
PRESIDENT FRANKLIN DELANO ROOSEVELT: I, Franklin Delano Roosevelt, do solemnly swear that I will faithfully execute the office of president of the United States...
BEAUBIEN: FDR concealed the extent to which he suffered from polio but he acknowledged having it. His presidency put polio front and center on the national stage. In 1938, Roosevelt founded the National Foundation for Infantile Paralysis and he spearheaded the March of Dimes for polio research. Tens of thousands of people all across the country were being paralyzed each year by the disease. Special hospital wards were set up with iron lungs to keep polio victims alive.
In the wake of World War II, President Harry Truman declared polio a threat to the United States and called on Americans to do everything possible to combat it.
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BEAUBIEN: By the early 1950's polio was a leading killer of American kids. Dr. John L. Sever spent decades working as part of Rotary International's global campaign against polio. Sever remembers when he was growing up in Chicago how terrified people were of the disease.
DR. JOHN L. SEVER: It was really feared.
BEAUBIEN: Rich kids as well as poor were being left paralyzed. Late summer was dubbed polio season. Public swimming pools were shutdown, insurance companies even sold polio insurance for newborns.
SEVER: The fear of having your child get this and being paralyzed for life, possibly dying of polio, was a fear of parents throughout this country.
BEAUBIEN: Early attempts to develop a vaccine against ran into numerous hurdles. A vaccine tested on 10,000 kids by two researchers at New York University provided no immunity and left nine children dead. Other vaccine trials injected volunteers at mental institutions with potential polio vaccines. Scientists were struggling to cultivate the virus in laboratory settings.
Jonas Salk, from the University of Pittsburg, launched what was then the largest human vaccine trial in history, involving nearly two million American kids.
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BEAUBIEN: Salk was hailed as a humanitarian hero. Famed CBS newsman Edward R. Murrow asked Salk who owned the patent to his miraculous vaccine. Salk replied, there is no patent. Could you patent the sun?
The battle of science versus disease, however, wasn't as smooth and as simple as newsreels from the time depicted it. A production mistake at a lab producing Salk's vaccine exposed thousands of children to the live polio virus, paralyzing dozens of them and killing five. Salk's main rival in the vaccine race, Albert Sabin, at Cincinnati Children's Hospital, had to go to the Soviet Union at the height of the Cold War to test his polio vaccine.
Both Salk and Sabin's vaccines are still used today but Sabin's version, which requires just two drops in a child's mouth, proved much easier to use in mass immunization campaigns. And Sever, with Rotary International, says the simplicity of Sabin's oral vaccine was key to wiping out the disease in much of the developing world.
SEVER: After all, if you could count to two, you could be an immunizer.
BEAUBIEN: The last U.S. cases of polio occurred in 1979 among isolated Amish communities in several states. And then efforts to eradicate polio globally began in earnest.
CIRO DE QUADROS: Yeah, my name is Ciro de Quadros and I'm the executive vice president of the Sabin Vaccine Institute here in Washington, D.C.
BEAUBIEN: De Quadros led the World Health Organization's drive in the 1980s to eliminate polio from the Americas. And the last case in the Western Hemisphere was reported in Peru in 1991. De Quadros also led the campaign to wipe out smallpox. He says smallpox was easier to tackle.
QUADROS: You know, smallpox was a disease that you could see in the face of the people. You don't need to have a sophisticated laboratory, you know, and transport of specimens here and there. Then you had a vaccine which was heat stable. You could put your vaccine in the pocket and go around and vaccinate.
BEAUBIEN: Polio, on the other hand, can be a complicated diagnosis. The polio vaccine isn't nearly as effective as the one for smallpox. And it needs to be kept refrigerated or it's useless.
QUADROS: Polio vaccine, you know, is a vaccine that has interference with other enteroviruses in the environment, so that you need to give several doses, you know, until you reach a good level of immunity. You need to repeat that again, again and again, both in the routine (unintelligible) and through mass campaigns. And you can imagine that it's totally different than the smallpox.
BEAUBIEN: Smallpox was declared eradicated in 1980. In 1988, the World Health Organization set a new goal of doing the same to polio by the year 2000. That target obviously was missed. Groups such as UNICEF, the World Health Organization, the Bill and Melinda Gates Foundation, and Rotary International have poured billions of dollars into the effort to rid the world of polio and the are very close to their goal. So far this year, there have been fewer than 200 polio cases globally.
Joel Breman, at the National Institutes of Health, however warns that the intensive immunization efforts against polio right now can't let up at all.
JOEL BREMAN: We've seen what can happen when there's any break in the chain. About 2003 and '04, northern Nigeria stopped vaccinating even though they had endemic transmission - and boom, 21 other countries that had proven to have eliminated polio became re-infected all over.
BEAUBIEN: Nigeria, Afghanistan, and Pakistan are the only countries where polio still has a foothold. And the final history of this terrifying disease could hinge on whether the virus can be eradicated in one of Africa's most chaotic nations.
Jason Beaubien, NPR News.
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