Women’s Work: Vaccinating America Against Polio — A Story of Trust, Mothers, and Mistakes

For nearly a year, mothers around the nation had offered up their children to science. In 1954, as polio raged, nearly two million children lined up in their schools, letting themselves be stuck with needles to test a vaccine that might prevent them from getting poliomyelitis, a virus that in some cases could cause paralysis, or even death. In 1952 alone, there were more than 21,000 paralytic cases in the U.S.

As this massive drug trial proceeded, every mother wondered if the vaccine would work, and whether their child would receive the real vaccine or the placebo. A 1954 Gallup poll showed that more Americans knew about the polio field trials than could give the full name of the President.

On April 12, 1955, the nation found out: Scientists gathered at the University of Michigan to announce Dr. Jonas Salk’s vaccine trial was successful. After a press release that morning, epidemiologist Dr. Thomas Francis Jr. divulged the full results in a nearly two-hour lecture to 500 doctors and scientists. At 5:15 that afternoon, Surgeon General Leonard Scheele and a small number of staff were on hand to witness the pivotal next step: Oveta Culp Hobby, Secretary of the Department of Health, Education, and Welfare, signed the license approval for six manufacturers to make and distribute the polio vaccine. Hobby called it “A great day. It’s a wonderful day for the whole world. It’s a history-making day.”

This important day was made possible by millions of women nationwide. Since 1950, annual “Mothers March on Polio” events had raised $250 million for the National Foundation for Infantile Paralysis (NFIP), funding the trial that enabled vaccine approval. These mothers, desperate to protect their children, also pressured Hobby and the government to deliver.

American mothers, deeply invested in fighting polio, became Salk’s primary audience in the spring of 1953. After several years of testing, Salk, working with the NFIP, announced a national trial targeting school children in grades one through three. The 1954 trial children earned the nickname “Polio Pioneers” for their role in the double-blind placebo study. The Jackson Advocate newspaper, covering the first injections in Mississippi on May 1, 1954, noted that eight-year-old Mary Duckworth received the first vaccine. She was followed by about 170 classmates, and the paper was careful to note that “Children of both races are being inoculated.”  By the time of the April 12 announcement, nearly two million children in the United States, Canada, and Finland had participated in the trial. The trial also included thousands of teachers, medical professionals, and other volunteers.

After April 12, 1955, the federal government quickly mobilized for vaccine rollout. On April 14, President Eisenhower tasked Hobby with a study focused on supply and distribution. Expectations were high for millions of Americans, but production would take time. Hobby found herself at the center of this national effort. Public health responsibilities, including vaccine distribution, fell to the United States Public Health Service, which Hobby’s department oversaw in the absence of a centralized agency like today’s Centers for Disease Control and Prevention.

Never before had anyone conducted such a massive public health campaign. On April 22, experts gathered for a conference on the Salk vaccine, focusing on future vaccine availability. Hobby reminded attendees: “The ultimate purpose all of us have, of course, is to confer the greatest good on the greatest number of people to whom polio presents the greatest threat.”

Yet, just ten days since the announcement of the vaccine’s success, Hobby told the conference attendees that  “confusion, misunderstanding, and anxiety” were evident. Americans wanted to know how soon the vaccine would be available, and how they could access it. By April 13, the Washington, D.C., Evening Star newspaper reported that doctors were “being bombarded with requests from parents for the vaccine.” However, journalist John McKelway noted, America’s doctors “know little more than the public does about the vaccine.” In a separate article on the same page, the Associated Press reported that vaccines had already been shipped out to states, and immunizations would begin that week. Such publicity was why, on April 22, Hobby stressed to the attendees that navigating this process was an important public service. The conference led to the creation of a National Advisory Committee on Poliomyelitis Vaccine to help with the rollout.

A week later, on April 29, vaccine rollout dominated a cabinet meeting with President Eisenhower. Members discussed the proposed distribution plan, prioritizing children aged five to nine, then one to five. As discussion moved to costs and production, Hobby called the rollout one of the most complex medical advancements ever seen, emphasizing “we must never speed up production at the expense of quality.” The meeting also addressed a novel concern: Doctors were wrongly telling mothers that the government controlled vaccine distribution. Cabinet members were then tasked with publicizing the opposite: that the government was not at all controlling vaccine distribution. Rather, Hobby and her office were establishing guidelines for who should receive the vaccination first. It would be up to individual states to set distribution themselves, although President Eisenhower did not clarify the process until the end of May.

Notably, the Cabinet did not discuss a related issue from their April 29 review paper: According to the document, which Hobby prepared in advance of the meeting, something was amiss with Cutter Laboratories vaccines. As of April 27, 11 new polio cases had emerged, all from Cutter vaccinations. According to Hobby’s document, Surgeon General Leonard Steele asked Cutter to temporarily remove its vaccine almost as soon as he learned of these cases. State health departments across the country were informed. As the first government official to authorize the vaccine’s release, Hobby now found herself at the symbolic center of a crisis she couldn’t directly fix.

Initially, the news was a concern, not an alarm. While the President’s Cabinet met, Scheele was also meeting with polio and immunology experts to further investigate what was happening at Cutter Laboratories. In an April 30 press release, Dr. Steele emphasized the new vaccine wasn’t 100 percent successful, even while disclosing that out of 29 new polio cases, 26 were connected to Cutter vaccines. Health department officials remained optimistic; the Surgeon General pointed out that four million children had already received vaccines, suggesting that 29 was a small number in the larger picture. Yet less than a week later, the New York Times announced “U.S. Halts Flow of Polio Vaccine Pending a Study.”

The Cutter vaccines had gone through required safety testing, but the protocols had changed once the trial finished and the government signed off on licensing the vaccine. During the trial, there had been three layers of testing to ensure no live polio virus went into the vaccine. But after April 12, the companies themselves were solely responsible for the testing, and the government did not have the capability, staffing, or money required to test every single vaccine batch produced across the nation. It turned out that Cutter Laboratories had struggled to inactivate the live polio virus and had not disclosed the high number of faulty batches they had discarded or reformulated, which gave some indication of their production issues.

Although the government paused the vaccine program rollout, it was too late to stop the spread of polio from the Cutter vaccines. In just two weeks in April, 380,000 children received the Cutter vaccine, according to Dr. Paul Offit, author of The Cutter Incident. About one in three of those doses was contaminated. Offit estimates that ultimately, the Cutter vaccine led to at least 220,000 polio infections and ten deaths. Three-quarters of those who contracted polio from the Cutter vaccine remained paralyzed for life.

The month of May brought greater confusion over the vaccine. On May 22, The Washington D.C. Sunday Star announced that “Government Holds Up ‘Safe’ Vaccine.” Americans had been told that a cure for polio had arrived, but now that cure had been called into question. The Surgeon General, the Star pointed out, “said the vaccine was entirely safe. Then he ordered the vaccination program suspended.” By this point, 80 children had acquired polio after vaccinations, most of which came from Cutter Laboratories. “The Public Health Service,” the paper noted, “seemed to think the only thing to do is restudy, recheck, and re-examine.” Salk himself called the polio cases “coincidental” in the same article and reminded Americans that the vaccine “was never announced as 100 per cent effective…but people seemed to expect it to be.”

In the midst of concerns over vaccine safety, members of Congress made Hobby their first target. Even as Congress debated funding and scientists discussed safety protocols, political voices accused her of mismanaging public trust. Senator H. Alexander Smith (NJ) introduced funding legislation, while headlines blared that Oregon Senator Wayne Morse suggested Hobby be fired for “gross incompetency.” New York Congressman Emanuel Cellar claimed that Hobby “has stirred up a witches’ brew of uncertainty and confusion.” Missouri Representative Richard Bolling accused Hobby of hiding behind Dr. Steele.

On May 29, the New York Times announced that the scientists were taking over the next steps in the roll out. The government formed a permanent committee on polio vaccine testing and release, clarifying federal manufacturing standards. The article noted that “Among other things the vaccine must now be tested after, as well as before, it is bottled.” These changes improved safety, but also raised concerns that there would not be enough vaccine supply for Americans that summer.

By mid-summer, Hobby’s early leadership was receding. On July 13, she announced her resignation. Oveta Culp Hobby’s tenure as the first Health, Education, and Welfare Secretary ended just three months after authorizing the polio vaccine’s release. She resigned due to her husband’s health, though the rollout’s strain and early failures had marked her time in Washington.

But despite the controversies in the spring, a national survey conducted by the National Opinion Research Center at the University of Chicago suggested that American fears were short-lived. This survey, conducted during the summer of 1955, showed that about 17 percent of respondents did express fears over the vaccine. However, those interviewed earlier in the summer tended to admit to having fears more often than those interviewed late in the summer. “It has been suggested,” the authors of the study wrote, “that during the latter part of 1955 the public in certain sections of the country showed little apparent interest in obtaining the Salk vaccine. The survey data indicate that where such apathy existed, the major reason did not lie in fear or hysteria about the safety of the vaccine….as the outbreak of polio cases following some of the vaccinations in April receded into the past, fear of the vaccine’s safety became characteristic of only a small minority.”

On January 1, 1956, the New York Times reported that ten million American children had received the polio vaccination to date. That year, polio cases dropped by one half in the United States, down to fewer than 15,000 cases. In 1957, polio cases fell by another two-thirds, down to the lowest rate of polio since 1942, just under 6,000 cases. In 1961, only 161 Americans contracted polio, according to the World Health Organization.

Today, the Cutter incident remains an important case study in vaccine safety. In the summer of 1955, it served as a lesson in federal visibility, scientific trust, and the public burden placed on one of America’s highest-ranking women. The federal government learned then how much public trust depended on scientific rigor and steady leadership.

In 1964, Congress created the Advisory Committee on Immunization Practices to provide expert advice to the Centers for Disease Control (CDC) and the Secretary of what was at that time the Department of Health, Education, and Welfare – now the Department of Health and Human Services. The committee formed after nearly a decade of experience from the polio vaccine rollout in 1955, later oral polio vaccines in 1961 and 1963, and the measles vaccine in 1963. Rather than having to convene a special group to consult on every important vaccine, this standing body could consistently offer advice. The committee members have historically provided recommendations on who should be vaccinated and timing of vaccinations. This month, the Secretary of Health and Human Services fired all 17 committee members and began announcing replacements, some of whom have far less experience with vaccines, according to Science magazine.

As vaccine oversight transitions today, those lessons remain relevant: The challenge then was responding to manufacturing failure; now, it may be preserving public confidence in prevention institutions.