One-Swallow Vaccine

An all out drive by backers of oral, live-virus vaccines for the right to succeed the Salk killed-virus injections as the first line of defense against poliomyelitis reached the U.S. last week. Biggest offensive was launched in Miami and surrounding Dade County, where the entire under-40 population, estimated at 520,000, was marshaled in an effort to show that a single swallow of the three-way vaccine is not only safe but superior to Salk. By week's end the campaign's sponsors tallied more than 75,000 who had taken the vaccine. They hoped to run the total close to the half-million mark before April, which would make this the biggest test of any live vaccine in U.S. medical history, and surpass the figure of 440,000 children covered by the 1954 trials of Salk vaccine.

Paper Cup. From the skyscraper hotels and high-life restaurants of Miami Beach to country schools and community centers back in "the 'Glades," adults and children lined up from morning until night. It was all free. New York's Lederle Laboratories donated the vaccine. Physicians, nurses, and a host of assorted volunteers gave their services. Paper work was at a minimum. For each person to be vaccinated, there was a short form listing how many shots of Salk vaccine he had had, and for minors, a form for parental consent.

Even for the busy workers, everything was gratifyingly simple. The vaccine, colored the faintest of pinks by cherry flavoring, arrived in 1,000-cc. bottles (about a quart), enough for 500 doses. A nurse drew 2 cc. (half a teaspoonful) at a time with a bulb-type dropper, put it in a tiny paper cup. Another worker added about a tablespoonful of water--distilled, to guard against the possibility that chlorinated tap water might reduce the vaccine's potency.

Adults and schoolchildren downed the mixture at a gulp. For infants, the vaccine was usually put in a plastic teaspoon, sterile from a fresh pack. The teaspoon was thrown away after use.

This straightforward procedure contrasted sharply with the complications of needle sterilization and alcohol swabbing with the injected Salk vaccine. And it was free of pain and the slight risks of needle jabs. Though a few vaccine swallowers (including adults) made wry faces, they need not have; the almost imperceptible flavor was pleasant. (But one pediatrician, knowing his clientele, took the added precaution of mixing the vaccine with a cola drink.) 700 an Hour. Almost 200,000 requests for the vaccine were in before the test began, and the biggest problem was getting the stuff to all who wanted it. Tourists were not invited, but a few horned in at a mobile unit set up in front of a Collins Avenue restaurant to take care of hotel personnel. In the elementary schools, classes of 30 or more children all took their medicine in elapsed time as short as seven minutes. At Sunset Elementary School, just south of Miami, 732 children ran through the line in less than an hour.

At Homestead A.F.B., home of the Strategic Air Command's 823rd Air Division, corpsmen and nurses carried the vaccine out to flight crews and ground crews in the alert areas to avoid any break in their availability.

Jointly sponsoring the massive campaign were the Dade County Medical Association, the county Health Department, and the University of Miami's School of Medicine. Prime mover in getting it rolling was Dr. Turner E. Cato, 56, the county's veteran health commissioner, who was inspired by the grandiose and seemingly successful anti-polio program launched by the Russians with Dr. Albert Sabin's live-virus vaccine (TIME, Nov. 2).

Despite cajoling by him and fellow physicians, too many Dade County residents had neglected to take Salk shots, so that in 1959 the county had 46 cases of paralytic polio. Still more disturbing, seven victims (including two who died) had had three Salk shots. The county medical association, led by incoming President Franklin J. Evans, abandoned organized medicine's traditional opposition to free medication as socialistic and decided to support an all-out test of oral vaccine to be given free. The university's professor of preventive medicine, Dr. M. Eugene Flipse, became program chairman.

Can It Revert? The time was right.

Although three U.S.-made vaccines containing live but attenuated (weakened) viruses have been widely tested overseas, the U.S. Public Health Service will not license any for general use until rigorous and extensive tests on home grounds indicate their safety. Main concern: the fear that a weakened or modified virus may revert, after multiplying in vaccinated subjects' guts, to a disease-causing form.

Evidence on this, which has alarmed some experts, is that this recovered virus sometimes causes paralysis when injected directly into the brains or spinal columns of monkeys.

Herald R. Cox, Sc.D.,* 53 next week, who developed the vaccine for Lederle, insists that his polio virus strains have been so modified that they cannot again cause disease after growing in their natural habitat, the human gut. They have an added safety factor of a million, he said last week. And since even "wild" polio virus causes detectable disease in only one out of a thousand of the people it infects, he argued that the chance of getting disease from this vaccine is one in a billion.

From tens of thousands of blood samples, the Florida campaign's sponsors expect to have answers within a few weeks on the vaccine's potency and safety. Eventually, they hope to eliminate wild polio virus entirely from Dade County--which no killed-virus vaccine could ever do. By the end of the 1960 polio season, Dr. Cox is confident, his vaccine can be licensed. Meanwhile, the National Foundation (TIME, Jan. 18) grantees are testing the Sabin vaccine. The struggle for the right to supplement and eventually supplant the Salk vaccine will become increasingly bitter as the year advances. But until a live-virus vaccine is approved, all authorities continue to recommend Salk shots.

* One of the U.S.'s doughtiest virologist. Working against Rocky Mountain spotted fever in 1938, he caught the disease, believes that he would die if he had not previously taken his own new vaccine.

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