The Death of a Disease: A History of the Eradication of Poliomyelitis

9. The Race for an Oral Vaccine

78 The Death of a Disease 78 9 The Race for an Oral Vaccine United States, 1950–1960 On February 27, 1950, an eight-year-old boy from Letchworth Village, New York, received a prototype of the oral polio vaccine Hilary Koprowski had developed using the live, weakened (attenuated) virus. The boy suffered no side effects and Koprowski enlarged his experiment to include nineteen other children. At the time Koprowski was a scientist at Lederle Laboratories , a fast-growing pharmaceutical company. Since 1948 he had been working on a viral attenuation process: A spinal cord suspension infected with Brockman’s virus was adapted through successive passages on the brains of Swiss albino mice [. . .]. By the seventh passage , the vaccine was safe; it could be injected without harm to the monkey brains. The virus made for mice then underwent passages on rats. After one to three passages, the vaccine was ready.1 The Race for an Oral Vaccine 79 Later Koprowski realized that this strain, which he believed to be type 1, the most common type, was actually type 2. He renamed it TN. As he would write forty-five years later, “We had taken the path that would lead us to polio eradication.” His results were excellent. The virus was found in the stools of everyone who received the vaccine, which indicated it had reproduced in their digestive systems and triggered the production of antibodies. When the immunized children received the vaccine a second time, they were not reinfected, evidence that they were protected. The findings were so spectacular that when Koprowski presented them to a meeting of the NFIP’s Immunization Committee, the committee members greeted them with skepticism. All of these events took place four years before the Francis Field Trial of the Salk vaccine, but the oral polio vaccine would not be ready for use until five years after the injectable vaccine reached the market. Strong teams were competing to make an oral polio vaccine , including one led by Albert Sabin of the Children’s Hospital Research Foundation in Cincinnati as well as the one led by Hilary Koprowski of the Wistar Institute in Philadelphia , which he joined in 1957. Obtaining attenuated viral strains was an arduous task, which Koprowski likened to Hercules cleaning the Augean stables. Koprowski wrote that while his chore was less difficult, it was much more time-consuming because the same process had to be repeated again and again. In 1951, Koprowski tested a prototype of the vaccine containing attenuated strains of types 1 and 2 on a group of sixty-one children in Sonoma State Home, an institute for mentally retarded children. The type 1 strains had been attenuated by twenty-seven passages inoculated intraspinally 80 The Death of a Disease in mice. Later, cell cultures would be used for virus attenuation .2 Herald Cox, who first hired Koprowski at Lederle, had a falling-out with him in 1952 and became one of his rivals. According to Roger Vaughan, Lederle invested an estimated $13 million in the development of a live attenuated polio vaccine. Albert Sabin, who was also working on live attenuated strains, paid a visit to Koprowski’s lab at Lederle. In the words of Koprowski, the purpose of Sabin’s visit was “to bury the hatchet and exchange samples of viruses. So I sent him some of my samples. But I never received any of his samples from him.” Maurice Hilleman, a major figure in vaccine research in America and director of the Merck Institute for Therapeutic Research, explains tersely that Sabin, “a selfpronounced genius, went in and took over Cox’s and Koprowski’s ideas.”3 According to John Paul, Koprowski would later complain that the polio vaccine he had discovered became known as the Sabin vaccine. Many people were surprised at the viciousness of the disputes surrounding the discovery of the AIDS virus in the late 1980s. Those controversies were, however, no more characterized by dissension than the controversies surrounding research to develop a polio vaccine. In addition, they were confined to competition between two teams: Robert Gallo’s team at the National Institutes of Health, and a team of Parisian physicians and virologists working with Luc Montagnier. Whatever his actual contribution, Montagnier got far more limelight than any of his colleagues following the isolation of the AIDS virus.4 Sabin wasted no time. In 1954 he wrote his first article about research on attenuated...