G.G. Proves Itself

The biggest breakthrough in the long stalemated war against polio was announced last week.

Dr. William McDowell Hammon, Pittsburgh epidemiologist, told the American Public Health Association in Cleveland that "significant protection" against the paralyzing effects of polio can be given by inoculating children in epidemic areas with gamma globulin.

Who Got Which? Dr. Hammon was reporting on results of the $1,000,000 tests (paid for by the National Foundation for Infantile Paralysis) in Provo, Utah, Sioux City, Iowa, and Houston (TIME, July 14). In all, 54,772 children aged one to eleven got inoculations while polio epidemics were raging. Half the children received shots of gamma globulin, the small fraction of human blood which contains protective antibodies. The other half received useless (but harmless) gelatin. Nobody, not even the doctors, knew at the time which child got which shot.

After the mass needling was over, small teams of experts stayed in each area and studied new cases of polio. If the victim was one of the inoculated children, they recorded the code number of the syringe with which he had been inoculated. Then the doctors followed the case to see whether the child's illness developed to the paralytic stage. If so, they noted how severe the paralysis was, and how long it lasted.

When all these facts were known, the records went to the foundation, which checked each victim's syringe number against the manufacturer's list to see whether the child had had G.G. or gelatin. The results reported by Dr. Hammon were heartening: of more than 27,000 children who received gamma globulin, only 2 developed paralytic polio; of an equal number who received gelatin, 64 suffered some paralysis. And, Dr. Hammon added, it looks as though the attacks were milder and shorter-lived for children who had G.G. than for the others.

Active and Passive. For Dr. Hammon, the progress reported marked a hilltop on a long, hard road. Ohio-born, he took mission training in Pittsburgh and supplemental work in Brussels, then shipped to the Belgian Congo for four years as a medical missionary. Not until he was 28 did he enter Harvard Medical School. Many of his recent years as an epidemiologist have been spent in trying to persuade his colleagues (including those at the National Foundation) that gamma globulin was worth a major trial. Lately, and in the tests themselves, Dr. Hammon has had great help from Philadelphia's Dr. Joseph Stokes Jr. (TIME, Nov. 5, 1951) who tried to use the antibodies in blood against polio 20 years ago.

For all his evident missionary zeal, Dr. Hammon was quick to point out that gamma globulin is far from being the weapon of final victory over polio (that is likely to be a vaccine). Its chief drawbacks: P:It gives only "passive," short-lived immunity (five weeks' protection from an average dose). "Active," permanent immunity must still be developed by each individual in fighting off a mild attack by the polio virus--the kind of attack that often goes unnoticed or is mistaken for a cold.

P:For best results, G.G. must be given very early in the incubation period after exposure to polio. There is no sure way of telling when this is. P:It is no preventive against polio--only a partial protection against the paralysis caused by polio.

Supply & Demand, The worst drawbacks, however, have nothing to do with G.G. itself. They are matters of supply & demand. It takes almost a pint of blood to make an average shot of G.G. (7 cc). To give protection for a single polio season to all the 41 million U.S. children under 15 might take 100 million shots or more, and there simply is not that much gamma globulin available, nor the blood or plasma to extract it from.

Worse yet, even if the blood were available, the three U.S. plants producing G.G. could not handle the extraction job, and such plants are expensive to build and operate. Finally, G.G. itself is costly: at present prices, a season's four shots for a 50-pound youngster would cost $70, and more than $100 for a 100-pounder, because the amount used goes up with the subject's weight. Mass production might halve these costs.

At first, public health authorities were horrified at the thought of the problems they will have to face. Said one: "I shudder to think of next summer's mass hysteria among parents who know of gamma globulin." He foresaw all kinds of abuses: bootlegging in G.G., racketeering with worthless substitutes, faking measles to wangle a shot of G.G. in areas where it is not being given-for polio. This expert's solution: declare a national emergency, giving the Government a monopoly of blood and blood products; allot G.G. only to areas with the worst epidemics; let a public authority (not pharmacists) dispense it for doctors to inject.

The A.M.A.'s Dr. Paul L. Wermer doubted that the Government would have to step in so far. He was glad that the news had come out at the end of a polio season. "It gives us time to prepare," he said, "and time to think it over soberly without a background of emotion and hysteria." Dr. Wermer admitted that reserving G.G. for areas with proven epidemics means that the first children stricken in any region will be denied its benefits.

Actually, though the coming boom in G.G. creates problems for the National Research Council's Blood Committee, it may end the shortage which has had all defense authorities worried. Parents who have never bothered to give blood for the wounded in Korea might gladly give buckets to get shots of G.G. for their own children. Blood banks might give a credit of one inoculation for every pint of blood that the family donates. But the bottleneck in processing, the wrangles over distribution, and the high price of G.G. will remain to plague the authorities.

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