Dr. Darrell Salk



TORGHELE: It is October 25th, 2017 and I am here with Dr. Darrell J. Salk at the CDC [Centers for Disease Control and Prevention] Recording Studio in Atlanta. First let me say welcome, Dr. Salk.

SALK: Thank you.

TORGHELE: And thank you for agreeing to participate in the Global Health Chronicles Oral History of Polio Project.

SALK: I'm very happy to do it.

TORGHELE: Before we begin, would you please tell us a little bit about your background?

SALK: It's semi-complicated-- as I was leaving high school, I was planning to go to Stanford [University] and do biological sciences, probably pre-med and I then got an offer for a scholarship for a very prestigious drama academy, acting academy, which surprised me, but delighted me. I had been doing acting for a long time. I had to make a choice-- I ended up going to Stanford and following 00:01:00the medical course. I ended up, after Johns Hopkins [University] doing my training, I ended up in Seattle at the Children's Orthopedic Hospital there, and I got my specialty in pediatrics. I love working with kids--they are just wonderful people. Then I went into a laboratory and worked with the biology of aging in a pathology department, very confusing. And then, after a while, I left and went into the biotechnology industry where I was involved in the development of brand-new products, monoclonal antibodies, gene therapy and so forth. As I approached my 60th birthday, I decided I finally knew what I wanted to be when I grew up so since then, I've been doing some acting.

TORGHELE: Interesting. So, you did some research along the way. Can you talk 00:02:00about that a little bit?

SALK: I will talk about the polio research that I did. I got interested in polio because my generation, which had some of the last smallpox virus inoculations because, in 1971, I think it was, they stopped using smallpox vaccine because the risks associated with it were larger than the benefits. It just worked out that way with how much smallpox exposure people had. So, they stopped it in the United States, kept it up elsewhere in the world and then eventually, were able to--

CDC did a global eradication program and was able to declare that there were no more smallpox viruses anywhere in the world. Well, this total eradication is 00:03:00clearly the best ounce of prevention as opposed to having to do all those cures. So, it's very efficient. It's not there. And this was something that was in my head. And I knew that polio vaccines were working, and I wondered why not do the same thing with the poliovirus, just get rid of it? And this was around 1975-'76 when I was in training.

TORGHELE: So, you began your research on polio then and before you start talking about that research, would you explain the terms you used with the two types of vaccines?

SALK: Yeah, there are two poliovirus vaccines; the first one was developed and 00:04:00started being used in 1955 was the killed poliovirus vaccine. The technical term for it is inactivated, which means killed, and it was given by injection. That was developed by Dr. Jonas Salk and his team, and a huge number of people throughout the country participated in that. The other vaccine is an attenuated vaccine. That means that it is weakened-- the virus is still alive, and it grows once it's been administered orally and it grows and induces immunity. That began to be used in the United States in 1961, 1962 actually. My preference, because typically they've been called IPV [inactivated polio vaccine] and OPV [oral 00:05:00polio vaccine], I got in the habit a while ago of referring--instead of IPV, inactivated, which is not something anybody understands--to killed poliovirus vaccine and live poliovirus vaccine. It's just balanced-- it's clear to me, killed and live, those are the important characteristic differences of the vaccines.

TORGHELE: And when you started your research, what did you know about polio, other than those things? And did you have a specific focus in mind?

SALK: I knew basics about it. When I was in medical school, I heard a number of things that were said, stated by professors that I wondered about because it didn't mesh with my growing up and what I heard. And basically, one time in a lecture, a virology professor said, made a very big point about non-infectious 00:06:00vaccines like the killed poliovirus vaccine are not as good as infectious vaccines like the live poliovirus vaccine. So, I went up to him afterward and just asked for some references, and I went to the library, and I looked those up, and they had nothing to do with the questions--a little frustrating. I was in a pathology work session at one point, which was talking about vaccines and the leader of that session made a statement that was so outrageous, I don't even remember what it was. It was something like, "they stopped using the killed vaccine because it didn't work anymore and started using the live vaccine." I said, "that's not true!" So, I had questions about what the truth was, what the 00:07:00facts were, so I asked my father, Jonas, and he explained a little bit to me, and he sent me a book of all of his reprints, all his publications. So, I started to look at that and gathered, you know, the basics, sort of an introduction, kind of Polio 101. I knew enough to be able to talk to somebody about it. I then went, in my senior year of medical school just before graduation, I went to Atlantic City to visit my dad at an American College of Physicians meeting and it was fun-- it was very interesting. And we had a two-minute conversation on the Boardwalk at one point because I was aware that 00:08:00people like my generation, having grown up with [the] eradication of smallpox and without having what I knew to be baggage from the 1950s and all the controversy that happened, that this was a new generation. And that people would be able to look at information and facts, which is what I was interested in. I suggested to Jonas that he perhaps should get back in because he had moved out of the subject in [the] 1960s, early '60s because it was frustrating to him what happened then. And I thought, I said, "It's about time you got back into this because it's a new world out there, it's fertile ground, it's different." He said, "You know, I know somebody at Science [journal] that might be interested in that." And so that went on to be a story about control of influenza and 00:09:00poliomyelitis with non-infectious vaccines. My father worked on influenza before working on polio. And his basic principle was non-infectious materials can cause a good immune reaction. So, he started writing this paper-- I helped him with, basically, editing. He spent a lot of money to teach me how to--go to school and how to write and so I helped him with that. And as time went on, we continued working. I really learned a lot-- I got pretty well-educated, and I started making contributions of my own to the work, collaborative work.

I was actually probably his most harsh critic because I could say anything I wanted to and you know, if he said something, I said, "You know, prove it. Where are the data for that? Why do you say that?" And because of my experience with smallpox, I said to him, "You know, why don't we say something in here about eradicating poliovirus?" He said, "no, no, no, no, we can't say that." I said, "Why not?" He said, "Because they'll come back at me with you know, well there's natural reservoirs because there are monkeys and all kinds of things and it would be a big--it would be silly." I said, "But what do you think? Is it true? Could it be done?" He said, "Oh, yeah." I said, "Then why can't we say it?" So, eradication of poliovirus, in the 1977 Science article, was mentioned, as far as 00:11:00I know, for the first time.

He also had been using a word as he was working with [Dr.] Charles Mérieux at the Mérieux Institute in France to develop a standardized potency killed vaccine. Together when they talked about things they used--they made up the word "vaccinology" and had a loose sort of meaning, and while we were writing the Science paper I said okay, let's -- so I created a definition for it, you know, a description of it. And actually, like everything else in the Science paper, nothing was recognized really or picked up. My father's papers tended to be ignored by--or whatever--didn't make much impact on others in the field. So, we 00:12:00had this concept of vaccinology, and again, I think that was probably the first place, 1977 in the Science article, that that showed up in the literature.

So, I guess I ended up, after having done Polio 101, I graduated from a higher degree program. And after that, began to ask questions myself and asked the question about why can't we eradicate polio? We can't possibly eradicate it using a live virus vaccine because you're constantly seeding viruses back into the community and the viruses are not stable. They revert to virulence. It's a very well-known phenomenon. So, that's not the way, you know, it's just 00:13:00biologically not possible. So, I wondered, okay, what was the experience in the United States with polio, with both vaccines?

I had been getting the MMWR, the Morbidity and Mortality Weekly Reports, it's a CDC publication about all the important infectious disease things that are happening in the country. And so, I started tracking the data that were reported there on polio, and I went to the library, and I went back through all of the early issues, back before it was the Epidemic Intelligence Service [EIS] it was the National Poliomyelitis Surveillance Unit. And in fact, it was during the 00:14:00polio epidemics and the development of the killed vaccine that that unit was created, which eventually became and grew into what is now the Epidemic Intelligence Service. So, I was going back into all the musty stuff, and I charted what the experience was, what the total incidence of polio was over time. And this was the kind of simple graphic that comes out of it, and that is that over time you can see, killed vaccine was introduced here, KPV [killed or inactivated poliovirus vaccine] and the incidence declined. At this point, live poliovirus vaccine, LPV [live, attenuated poliovirus vaccine] was introduced, but both were being used. And at this point killed vaccine was pretty much 00:15:00stopped being used in this country, so it was only live vaccine. Well, this wasn't really telling much. It was hard--it kind of plateaus here, but you can't really tell what's going on.

So, I decided to see if I could separate out the live virus vaccine associated disease--now today called VAPP or vaccine associated paralytic poliomyelitis--and separate that from the wild virus disease and see what would happen. Well, it turns out that it really wasn't very clear. Live vaccine associated polio kind of went all over the place-- and I realized it was because the CDC used an epidemiological definition for vaccine-associated polio. In 00:16:00other words, there had to be a recognized exposure, a documented exposure to the live virus vaccine for it to be considered vaccine-associated, which makes perfectly good sense, but there were a lot of people who didn't have a documented exposure [to the live virus vaccine]. And as technology improved and the CDC laboratory was able to specify the derivation of different viruses, they could identify viruses that had come from the vaccine--so, vaccine-derived virus--and they could distinguish that from wild poliovirus because of sorts of genetic markers, surface markers. But that knowledge had not ever been 00:17:00translated into the definition. So, I said, okay--I worked through a whole lot of details about what the different antigens were, what it meant and what really is appropriate to decide if it's vaccine-associated. If one doesn't know for sure, it's probably not vaccine associated. And I was delighted to see that when doing that with the revised data I basically created a new definition of vaccine-associated polio and defined the kinds of people who were paralyzed-- recipients, known contacts and indirect community contacts--these were people 00:18:00that were just out in the neighborhood or had no known exposure.

This black line here is wild poliovirus disease. Killed vaccine was introduced here and it went down pretty much in a straight line. This is on a logarithmic graph. Live poliovirus vaccine was introduced here, and it has pretty much a plateau, a continued constant level. I thought, that's an important piece of information because wild poliovirus disease was reduced. It's a logarithmic scale so it may not look like it to you, but this is a 95% reduction between here and here--and it's a straight line, which means it's first order kinetics. 00:19:00It's logical, it makes sense. An individual is either immunized or not immunized and there's no--when live virus vaccine is introduced--there's no change in the slope of this curve. The straight line means that there's no difference in the effect of one vaccine from the other. Killed virus vaccine reduced it at this rate, and when both vaccines were there it continued at the same rate. Whether that was because it was the influence of the killed vaccine or live vaccine doesn't matter, there was no difference in it. This graph also showed that we had essentially eradicated wild poliovirus in the United States in the early-mid 00:20:00'70s. It was gone.

There were occasional scattered cases --they were mostly imported. Well, there was a small outbreak of imported polio in a community which practiced not getting vaccinated at all. But we already had achieved eradication.

That seemed an important piece of information and to confirm it I went to the literature and looked up the European experience. This black line is the total number of cases in the U.S., and it's--as you see, the live vaccine-associated cases are included because this plateau is built in--that was the first graph I 00:21:00showed you. In England and Wales, this pink line, where killed virus vaccine was used for a while and then it was switched to only live vaccine, similar to what happened in the United States, it had the same shape. It makes sense.

In Finland and Sweden [red line], where they never used the live virus vaccine--they only used killed virus vaccine-- there was a straight-line decline. And when you adjust for the different sized populations so that you can compare them, this is wild poliovirus disease, the black line, in the United States. The red line in Sweden and Finland. They're the same. It looks like 00:22:00Sweden and Finland gets--clears off faster, but that's because of the different sizes in populations and the number of people and how it appears on a log, logarithmic graph.

So, that was confirmation of the patterns that I had seen in here, and I again thought that's kind of important. I wonder why nobody's reported this, nobody's talked about it, especially. The concept of eradication, indeed, is possible. We've done it. Scandinavian countries did it. And I wondered why nobody had commented on the straight line, persistent level of vaccine-associated disease 00:23:00that interfered with the, basically, the disappearance of the wild virus. As I said earlier, well, you kept feeding into the population living viruses, which in and of themselves are unstable. And when it passes through the gut--taken orally, the virus grows in the intestines and it's excreted--and when that happens, the attenuated virus that goes in one end recovers some of its wild-type virulence. So, the virus that comes out the other end would not meet the safety standards for release of live vaccine. And so that's why people--both 00:24:00people who received it and people who came in contact with them--would come down with polio. I wondered--this was a very simple analysis and I'm not a genius, I just like putting numbers onto paper--and I wondered why that hadn't been noticed before.

TORGHELE: So, what did you do with that information after you found it?

SALK: Well, I published a series of three papers. As I started to think about it and look at it--

TORGHELE: About what year was that?

SALK: This was in 1979, '78-'79, that I was doing this. And there were 00:25:00discussions throughout the population and among regulators and policy makers about which vaccine was appropriate. This was the controversy of the 1950s, which the media loved because there was a controversy-- Salk versus Sabin. They made a big deal out of it. That was coming on again, to a large extent because my father had started his activities again trying to point out to people that this was what kind of stuff was going on. And he started working with Europeans to standardize and come up with a vaccine that would be as potent as the vaccine he produced in his laboratory, Reference Vaccine A, and move toward tests to see 00:26:00whether it could be potent enough to be effective with a single dose.

So, there was noise about it, and there were several committees that met to evaluate the differences between the two vaccines and what they should do. So, I felt, I can provide some data here, some evidence. You know we now talk about practicing evidence-based medicine. It was not a term when I was in school, but it's an important thing. Don't guess, don't make it up, don't go on the basis of anecdotes or feelings, what are the facts? What is known? And if it's not known, you should know that it's not known and don't pretend that you do know something about it. Well, so I thought I can provide this evidence. I took the first stuff 00:27:00with these graphs and the detailed description of my definitions for the virus and how to interpret it, and I knew--it's boring, it's difficult--but I packed it together in the first of a series of three papers because I knew you had to have that information, otherwise people were going to--scientists were just going to look at it and say-- Ah, they're making it up, wishful thinking. So, I documented it with full, large sets of references and I thought that's a good first step.

I moved on from that subject, having discussed and demonstrated this. Well, the 00:28:00name of the series was The Eradication of Poliomyelitis in the United States, and its subheading was, Live Virus-Vaccine Associated and Wild Poliovirus Disease. So, I described it, I discussed and provided people's comments about it for many, many years-- and then I decided well, let's see what killed vaccine really does. What's really the experience with a killed vaccine in the United States? It was used all by itself from '55 to '61, you know, for six years. They had good data collected. Lots of people studied it, [Dr. Alexander D.] Alex 00:29:00Langmuir and the Poliomyelitis Surveillance Unit at what was then the National Center for Disease Control, the NCDC, had this entire unit created in order to do surveillance. They collected all kinds of information. So, I collected it. I knew what people said about why the live virus vaccine was supposed to be more effective, which I'll go into in just a second, I'll give you a rough idea of what kinds of things those were. So, I went to see what was known. Live virus vaccine discussions happened in autumn, summer and autumn of 1961. The vaccine 00:30:00was brought back, [Dr. Albert B.] Sabin brought it back after doing a large number of mass campaigns--these were studies of the use of a vaccine in the field-- they were not field trials, which are controlled studies, well-designed.

The 1955 field trial for killed poliovirus vaccine, by the way, was just an incredible feat. [Dr. Thomas] Tommy Francis at the University of Michigan pulled it together, and it could never be done again. We could never do a study like that now. It's the gold standard for vaccine trials.

Well, despite the fact that they didn't have as much data when Sabin came back, 00:31:00he pushed to get it used in the United States. And I kind of looked at it, okay, well what were the reasons? Why did that happen? They were saying things like it's administered orally-- that's much easier to do than injection and it's much better accepted by people, so we'll get better immunization rates. It's a live vaccine, so it's going to give lifelong immunity. Everybody knows that a live vaccine, a live virus infection would create a natural immunity, which would be lifelong, whereas a non-infectious material, you know, just wouldn't be as good. 00:32:00And that a killed vaccine was less effective-- we knew it had to be taken and you had to have four doses and then you had to have a booster dose and all of that. A live virus growing in your intestines would give you gut immunity. Everybody knows that the virus is spread by the fecal-oral route, contamination, and therefore, a vaccine given by injection did not stimulate intestinal immunity--it's a special antibody, IgA [immunoglobulin A] as opposed to IgG [immunoglobulin G], and so, it couldn't possibly create a herd effect and the live vaccine could. The live vaccine virus, because it was excreted and passed 00:33:00to other people in the population, had the benefit of increasing the immunization rate. So, people who had not come in and taken a sugar cube were still exposed, and the population would be better protected.

There were a number of things like that, and as I looked at the experience with killed virus vaccine I realized, well, there are data here about its effectiveness. There are data here about the duration of immunity, and it's long. There are data demonstrating that there is indeed a herd effect. So, I wondered why all that happened because every one of the things that was 00:34:00mentioned as a reason, you know, turned out not to be demonstrable. There was no evidence for it. There was no evidence that the killed vaccine was failing in the ways that they said it had to because it was non-infectious. And the things that the live vaccine was supposedly superior at, there had never been any studies of it. It turns out these were all things that were being said and discussed and promoted repeatedly before there was either any vaccine available. And it came from what is referred to as the Pasteurian Dogma-- Louis Pasteur believed that only an infection would induce immunity, that a chemical or a 00:35:00non-infectious vaccination would not induce immunity anywhere nearly as well.

I'll talk more about that later. But that belief became so instilled that by the 1920s, 1930s, it was general knowledge-- "Everybody knew." It was in that time period when my father first wondered about it because he was in a medical school lecture and the professor just--similar to the experience I had said "You know, you have to have an attenuated or an infection in order to develop immunity." And Jonas sat there, and he thought, "But we have diphtheria and tetanus, and 00:36:00these are toxoids--they're toxin which has been modified so it isn't toxic anymore but it's similar enough that it creates immunity to the manifestation of the infection." He said, "So you know, but it seems like it really can." He developed a relationship with Tommy Francis who was studying [the] influenza virus and who believed that a killed vaccine could work and that's what started him on this whole process. So, a lot of the "controversy" the back and forth that happened around the 1940s and 1950s and continued on after that and peaked in 1960 when there was this real kind of challenge--it was about the Pasteurian 00:37:00dogma. It was beliefs on one side and predictions and beliefs on the other side. And there was no information-- and you have the loudest arguments when nobody has any information. The beliefs are very strongly held, and whether they turn out to be right or not, that's where people get quite vociferous.

So that carried forward and it was going on at this 1961 discussion of bringing live vaccine into this country--it was a very powerful influential thing. I had looked at the actual experience in the United States and wondered what was the 00:38:00relative impact of the two diseases, I'm sorry, the two vaccines? This is the entire experience back to the early 1940s. You can see there was a--once it began and caught on, there began to be epidemics until the mid-50s. 1954 was a devastating year. The killed vaccine was introduced in 1955. It was first used in the field trial in '54--over a million children, 1.5 million. And there was this sharp decline, and you can see it's essentially zero down there. The live vaccine wasn't introduced until here. Whereas I mentioned before, on a log graph 00:39:00it's stretched out at the bottom-- this is a linear graph, so that means these are just straight numbers, they are not modified in any way. So, every one of these units is a set number of cases. Well, I looked at this--this looks like--who's really responsible for eliminating poliovirus disease? How can the live vaccine people and the policy makers say that the live vaccine is preferred? I'm now talking about out here, that it's preferred because it is responsible for the elimination of poliovirus disease in the United States. Well, it certainly was being used when poliovirus disappeared, but the impact of 00:40:00the killed vaccine was much more.

Another way to look at this is to look at the amount of vaccines used. The dark bars here are the incidence of polio, cases of paralytic polio, and you can see the average before 1950 through 1954, and the killed vaccine began to be used here, the number of cases went down. Again, this is a linear scale, so it's not stretched out to ask questions about the kinetics, this is just, these are the numbers. This much, the pink area, is how much--the accumulated number of doses 00:41:00of killed vaccine that had been administered. In other words, that's how much had been used in the country that was associated with this decline. At this point, [the] live vaccine became introduced, and this was the accumulated numbers by 1968.

Well, when I looked at this, it's quite clear that in terms of impact on virus in the community there was a heck of a lot more impact from killed virus vaccine. This is overlaid purposely, intentionally, because the live virus vaccine initially was used in people who had already been vaccinated with killed vaccine. So, their reasons for looking at that and saying--I wonder why 00:42:00policies-- I mean, these are just facts, I'm not trying to be biased here. I just went to the literature to see what there was. And as I said, in this time period, the experience with killed virus vaccine in the United States--it was demonstrated about the herd effect, duration of immunity, [and] in fact, the rates of immunization went down when they switched from an injected vaccine to an oral vaccine. No impact whatsoever in terms of actual immunization rates.

So, you know, that was more of this stuff. I published this in the second of that series of three papers and I thought, this is important stuff. I'm really 00:43:00pleased to have pulled together evidence with many, many references on both sides and determine what was supported by the literature and what was based on a belief from the 1930s, 1940s-- I'm sorry, from the 19th century when Pasteur first fought for it. I thought, this is going to be useful because it really will add something to the question of which vaccine should be used because it was apparent to me at this point that there were two vaccines that were both effective. One of them caused disease and one of them didn't. The risk was small, supposedly, with the live virus vaccine-- only 1 in every 3 million 00:44:00doses. So, it was always disregarded as being so small it would be irrelevant, but zero is a lot smaller than that. And in fact, many people who were in the field pointed out that the 1 in 3 million number was a little fishy because it was 1 case of vaccine-associated polio for every 3 million doses of vaccine distributed-- this is what the manufacturers sent out. I don't know how much wasn't even used, you know. It was thrown out because it went past its date, expiry date or whatever, nobody knows.

So that makes it look smaller because more doses per case. And people were--children, infants-- were receiving multiple doses, three or four doses. Well, only one of those four doses are given to a susceptible individual-- they get immunized theoretically after the first dose. Okay and if they didn't, they get immunized after the second dose, but after four doses, you have one individual protected. So that number 1 in every 3 million doses of vaccine distributed is really not a measure of the risk of disease, it's a measure of 00:46:00the rate. A rate which is useful for following trends, you know, it's a number that you say, okay, as time went on this is how the things changed or didn't change. But it didn't address what the risk was to a susceptible individual. That had been pointed out many times.

I looked at it and said, well, primarily the people who are immunized are infants. That's where it's used and there are only 3 million of them born every year. So, those are the number of vaccinated individuals. It's a much more accurate number. And the incidence of live poliovirus vaccine-associated disease is the effect, the adverse effect that you're looking for because those are 00:47:00people who were susceptible. So, the risk to a susceptible person--and this is a risk to any one individual--is not 1 in every 3 million doses, but 3 in a million, which is roughly 1 in 300,000. Okay, that's a small number, but it's a hundred times bigger than the number that was being used as the risk, and that number was used by drug companies, by the FDA [Federal Drug and Administration], by CDC--that was the standard that was used.

As I said, people at CDC and elsewhere, you know, questioned it and pointed it out-- that it really doesn't tell us about risk-- but that's what was there. That's what people were told if they were told anything when they got the vaccine. Actually, shortly after I did that calculation myself--I just kind of 00:48:00made it up--an almost identical calculation was published by [Dr.] Neal Nathanson and his colleagues, and they did the same kind of thing, they took the number of infants, the number of cases and they came up with a number that was very similar. Basically, between two and three cases per million vaccinated infants-- I said it was three per million vaccinated, you know, they made a different set of assumptions. But it was the same order of magnitude and a lot less than 1 in every 3 million.

People can't accept, understand or get a feeling for numbers like that because they're so big. I mean even 3 in a million seems really big. But it was the only disease that was occurring from poliovirus in the United States. It seemed to me that that should be information that was used, as was the case of smallpox--which actually was used for 20 years beyond the time that the risk was greater than the benefit because there was still a chance of exposure to virus coming in.

There were a number of things, other issues in 1961. Really interesting to me 00:50:00when I first found out about it or figured it out. It was not just a question of the scientific debate about infectious or non-infectious, the Pasteurian dogma, it was also--it was a very important one, but it wasn't the only one.

In 1960 we were in the middle of the Cold War and here was a product reportedly better than what we were using in the United States because it was talked up big by those who believed in it. It was tested in Russia in large numbers of people, 00:51:00and it was part of the sales pitch, as it were--we cannot have something that the Ruskies have. So that, international politics, played a role. A very important piece of the discussion at that time was a report that was made by the Council on Drugs of the AMA, American Medical Association. It was very influential. It was never actually published, but it was widely referred to and quoted and it, in fact, is the source of the list of things--that's where they 00:52:00were first pointed out--reasons that the live vaccine is better. And the AMA had never before made a policy statement about an unlicensed drug, an unlicensed product. This was not their place. They would report on efficacy, or whatever, of medicines that they were using, but this wasn't in use. They were advocating for something. Why were they doing that? I mean it was unusual thing for them to do. National politics-- we had just had discussions, arguments, fights about Medicare. This is when Medicare was introduced and the AMA, the physicians, had taken a very strong and public stance against it for all their economic and 00:53:00political reasons. And that's fine, I mean, that doesn't bother me, it's a perspective. But they had gotten themselves a bad name in the public because Medicare did go through and, you know, they had to deal with it and stuff. So, their reputation had suffered as a result of that. And clearly by not only jumping on, but by creating this bandwagon where the recommendation was, the plan was to bring in live vaccine and do mass immunizations, and that would get rid of everything. Get rid of it all at once. It didn't turn out that way because the mass programs revealed the fact that there were cases of vaccine-associated polio.

So scientific politics, international politics, national, international and scientific. And then, of course, there was economics. As always, it plays some role because, well, the AMA was going to be able to have doctors in white coats out administering--giving doses of vaccine very publicly in large mass trials. You know, giving little kids sugar cubes and they can improve their image and thus, their economic status. The vaccine manufacturers, they were perfectly happy. The recommendation was that everybody who had killed vaccine needed to have live vaccine. They just doubled the size of their market.

I'm not pointing at any one of these things as something that was necessarily decided and a cabal in the back room and that kind of thing, but these were factors that all went together. So, realizing that I had information, that this was a period of time in the late '70s when the issue was being addressed again. In 1977, the Institute of Medicine, which is a very prestigious organization, did a very large conference with some discussion, evaluation of the two poliovirus vaccines. So that kind of thing was going on. The ACIP (the Advisory 00:56:00Committee on Immunization Practices), the Red Book Committee of the American Academy of Pediatrics -- they were all looking at the question. So, I had information that would hopefully be helpful in these considerations and, as I said at the beginning, it's a new generation. You know, maybe the people who made the policies a little while ago, 15 or 20 years ago would still have strong feelings, but the rest of the scientific and medical community would be open to it. And so, I wrote a third paper in that series, which was called, Eradication of Poliomyelitis--[not] eradication of poliovirus. I make the distinction 00:57:00because poliomyelitis is a disease and you certainly want to get rid of all of the disease, but eradication of the agent, the virus, is different from elimination [of disease]. So, the "Eradication of Poliomyelitis in the United States, Practical Considerations," and this, of the three papers--unlike the first one, which is full of numbers and laboratory science, the second one was nice and wholesome, but still got meaty things in it--this paper was just addressing the question-- let's compare one with the other, for practical purposes. What's the story? What's going on? And as you can probably guess from 00:58:00everything I had seen up to that point--and this was personal research in the literature, you know, direct. These three papers have a huge number of references in them. The publisher said to me, "Can't you just make this one paper? You know, kind of squeeze it up and get rid of some of those references?" I said, No, I'm sorry, I can't because people are going to look at me and see my name and they're going to assume that I'm biased." As I said, I'm not. I questioned Jonas as much as, if not more than, a lot of people in raising these issues. So, I wanted to make sure that there was a good solid scientific foundation.

In the meantime, the Institute of Medicine, in doing their analysis, came to the conclusion that either vaccine could be used effectively to control polio. They were equivalent-- they used that word, equally effective, you know-- after making all the comparisons, okay? The only difference between the two vaccines was the fact that live poliovirus vaccine could "spread immunity," could move out into the population from a vaccinated person and, you know, get better immunization rates.

Well, that had never actually been demonstrated. No study had ever 01:00:00been done on the actual impact of spread effect. We had documented evidence, measurements of herd effect with a killed vaccine. Let me explain. A herd effect is that when a portion of a population, a herd, is vaccinated or immune, they will not pass the virus--the disease agent--around. So those who are susceptible have a lower risk of exposure. So, herd effect actually is very specifically when (as shown here) actual numbers of cases in 1950 to'54--based on this--one 01:01:00would have expected this much, expected if there had been no vaccine. So that's without any vaccine effect. If the vaccine effect was restricted to those who received the vaccine-- that's what this orange color is here at this second level that's what one can calculate in a reasonable way would be expected if only vaccines were protected. What was observed was this little short pink bar down here that was actually observed and measured. That is herd effect. There 01:02:00was a reduction of disease in susceptible individuals.

Herd effect is not spread of immunity. It's often mixed up and confused and used interchangeably by people who should know better. But the Institute of Medicine made this determination without actually any measurements of it (the spread of immunity) and basically promoted a policy whereby people were being immunized without their knowledge with an unapproved virus, one that would not pass the safety tests of the original vaccine. So, this wasn't "spread of immunity." I 01:03:00mean, I thought a more appropriate term was "involuntary vaccination with a less [than] safe product." I mean, that's inherent in saying-- I want to give this to children so that others who haven't been vaccinated will benefit from it.

TORGHELE: And when you say unsafe, what do you mean? What level of safety are we talking about?

SALK: Oh, well, the requirements--I don't remember exact numbers--but basically, the requirements are when a batch of vaccine virus is produced it has to be demonstrated that its level of virulence or its ability to cause disease is sufficiently low. Okay? Whatever that level is, by that measure, if it comes in at this level, it's not allowed to be released. It fails the safety test. So 01:04:00that's sort of an arbitrary level-- but there was a safety test to do that. And it was well known that the virus that passed through the human intestinal tract would not pass that test. In spite of the fact that it may have been low originally, upon the sugar cube, by the time it got to the other end of the alimentary tract the virus will have gained back some of its virulence. So that's why I say, by definition in a sense, if it would not pass the safety test, then it must be unsafe-- arbitrarily. But we know it was associated with illness as well, so from that perspective, just a practical perspective, it was unsafe. But what I meant, when I was referring to this, was specifically the 01:05:00safety tests that allow for a vaccine to be released and used. And the policy of "spreading immunization" is essentially a policy of using a vaccine that would not pass the safety test.

I wondered how they could do that and sleep at night. This was actually pointed out in 1961 when the discussions were going on-- I'm sorry, 1959 [Dr. G.W.A.] Dick and [Dr. D. S.] Dale in England, pointed out that not since Lady Mary [Wortley] Montagu had introduced the practice of variolation to England from the European continent in the 18th Century--it was a while ago--we had never used, 01:06:00since then, a vaccine, an agent that would spread in the population. The reason variolation was not used was because it was simply taking smallpox virus from a sick individual and giving smallpox-- because they knew that if you survived a smallpox infection, you would be immune. [Dr. Edward] Jenner is the person who made the observation and realized that cowpox virus, which is called vaccinia as opposed to variola, had enough cross-reactivity that milkmaids who got cowpox, 01:07:00never got smallpox. And that's what led to the beginning of vaccination-- vacca (Latin) meaning the cow.

And we were not the only ones. In 1961, many people argued we shouldn't be using something that spreads, that we have no control over. But those voices were buried by the constant refrain of those who believed the Pasteurian Dogma. Another thing that happened in 1961 was that several people-- Alex Langmuir had 01:08:00pointed out a couple of years before-- he said, "We've got this problem licked. Now, this is--we know how to apply it, we know where to do it, we know how to get to, we know we need to get susceptible people immunized, vaccinated-- and that by properly applying it, we will succeed." And this was, like, 1958, I think, and at the 1961 discussions, [Dr.] David Bodian, who was another very well-known polio researcher, said, "You know, it's a real question as to whether polio is even a public health problem anymore. Why are we going to be using mass immunizations, mass campaigns, to solve a problem that isn't there, with an 01:09:00agent that spreads?"

You know, these were great questions. So, I had put all of this together in Practical Considerations. It was a much simpler, a simpler thing, and I thought okay, this will be useful or will help the discussions. It provides references, anybody can check to see where it comes from. I was surprised that I didn't get any feedback about it. One friend at CDC told me about it, he read it and somebody else at CDC congratulated me on this graph, she liked it so much--well that tells the whole story. But I was denigrated only. The publisher, who had 01:10:00been very supportive of me, went to Dr. John [P.] Fox to write a commentary that went with my first publication. I saw it before publication, and I was just astounded because it was full of stuff that--information that wasn't supported.

John Fox was, at that point in time, one of the old guard. He'd been doing polio research since the late '40s and he just discounted this and discounted that and said that "we all know" and it sounded very impressive. And people who didn't know the details were just impressed by that and, of course, you know--the guy's name is Salk, he's biased. The publisher didn't want me to write a response. I 01:11:00asked him, "You know, can I write a response to that to get published at the same time?" He said, "No, we couldn't do it-- you'll have plenty of time to comment later when the letters come into the editor. You'll get to respond to those." I said, "Okay." I then went to John Fox--he was at the University of Washington, where I was--and I met with him. I'm relatively a student at that point and he's a senior professor, and we talked about it. I asked him, "You know, what did you--you know, why did you think this?" And he gave me some generalities again. He said, "There is just no information." I said, "Well, what specifically did you find wrong with [Gabriel] Gabe Stickle's article on the herd effect, that picture I showed you a minute ago was what Gabe Stickle had done--the analysis?" I said, "You know, I'm interested, what specifically is 01:12:00wrong with that analysis?" And he said, "Well, I didn't actually read it."

I don't know--I was speechless for a moment and we finished the conversation shortly after that. But he had said a number of things that were inaccurate, some things that were rude and it was hard for me to believe that a teacher, a professor, would make a comment on something-- I understand where it came from. He knew it all, he brought it all with him. He had been through this discussion before and he merely had the same discussion over again without actually looking at the data or the references that I had pulled together. Okay, he's old guard-- he's carried baggage with him. So, I waited for my opportunity to respond (to 01:13:00letters) because I knew I needed to respond to specific points in that, in order to make it clear to the readers that, you know, what the truth was. And I was quite disappointed when I found out that the next issue of Reviews of Infectious Diseases had come out--and there were not a large number, but there were several, three-four, letters-- and the publisher had John Fox respond to them. Excuse me, what am I? Chopped liver? I did not understand, because he had promised me, and it made no sense for somebody who is not the author to respond 01:14:00to questions about the articles.

It was then that I began to understand some of my father's feelings about what he had gone through. I continued to do research. I wrote papers, some with him, some on my own, about the vaccinology of poliomyelitis--we refined the definition--and herd effect, because that was a weak spot, in a sense, in the discussion I had had, and I had more information. I had lots of stuff. So, I did a very specific study and presented that in Bilthoven in the Netherlands and other things. And nothing happened-- they (my papers) were never referenced in 01:15:00the literature.

This was something that Jonas had told me. It happened to him. He said, "Well they just, you know, they didn't like what I said so they ignored it. And they didn't even put in a reference that I disagreed strongly. It just disappeared." I mean that's my--all of my publications have, in a sense, just disappeared from the discussion because without being referenced, somebody has to actually go back to the library at 1980 and stumble across it or look for it. Things that are referenced in other things, you know, it expands, and you can track things back down. So, I really began to understand at that point why Jonas had pulled out, backed off in 1961. He put up with so much of these non-arguments and 01:16:00couldn't get anybody to listen. I was now having that experience myself, and I was losing the optimism I had on the boardwalk in Atlantic City-- there isn't a new generation, or if there is, it's not paying attention the way I expected it to. So that was really a disappointment for me because I had tried all of the proper channels to get across the materials that I had pulled together and realized were useful, and it just made no difference.

What did I do then? I had been approached several times about acting as an expert witness in cases of vaccine-associated polio. I wouldn't do it. I was a pediatrician. I didn't want to go and say a pediatrician had done something bad by giving this vaccine which he's not given any choice about. Because what he's told by the manufacturers is not accurate. I got to a point where I said, you know, darn it all, I can't seem to make a change or an effect. At least maybe I can help one or two people who have been injured. So, I started doing--being an 01:18:00expert witness. And essentially my message was always about the manufacturer and the stuff that they said. Their response was--but that's what the government tells us to say. And the government policy makers who set this policy and did it--that was where, in fact, change needed to be made. The cases that I testified in and others were becoming very successful from the lawyers' perspective. They were getting good settlements, including an award of--a ten-million-dollar award in Kansas-- two million dollars of damages and eight million dollars of punitive. This was unheard of at the time. And somehow the 01:19:00manufacturer managed to convince the Supreme Court of Kansas to reverse it. This poor guy, who died before this was even all over, had gotten polio from his daughter-- Emil Johnson. Every one of these people had a name. I got to see them. I got to meet them. I heard their stories. There is a wonderful article in the Los Angeles Times from sometime in the 1980s, I forget exactly when, but it was right at the time that I was doing this. And the article made it a point-- in order to--you know, it's not nice to have to sue people and stuff--but in 01:20:00order to make change, that's what you have to do sometimes.

In the meantime, we're getting compensation, some kind of compensation to the people who are injured. From my perspective, I was feeling like okay, I can't change the policy, at least I can try to put pressure somewhere. When you hit somebody in the pocketbook, they tend to go and think about it again. I hadn't realized it until years later when somebody told me that they heard a conversation by the insiders at Lederle [Laboratories], which was the only manufacturer at that time, referring to me as, you know, public enemy number one. I said-- Oh, that's pretty cool. I didn't like doing it. It's not like it was fun or anything, and sometimes the doctors were included in the case and I 01:21:00tried very much to make the point, you know, Doctor so-and-so was doing what is common practice, what everybody does.

An attorney asked me in one case, "Well, have you--you're a pediatrician, have you ever given the oral polio vaccine?" I said, "Well, I don't administer it myself, but I write orders for the nurses to do it." And, you know, do you give specific warnings about it? And besides the fact that there's no killed vaccine available as an alternative, I said "Well, I didn't routinely give warnings--because that was not general practice, accepted practice of medicine at that point." Except on one occasion. I was very comfortable with the hippie 01:22:00type patients--there were a lot of patients that I was less comfortable with--and many of my fellow residents were not so comfortable dealing with a hippie type. Young parents came in with a child and they said, well, we're not going to get vaccinations. This was a long time ago, well before the vaccine deniers or whatever at this point. And I said okay, that's your decision. I said I can understand that. They were being natural. And it was not that great a risk then, except I pointed out to them, I said, but if your baby is not vaccinated then he will be at high risk from getting vaccine poliovirus disease from one of 01:23:00his buddies. I said you know, I can't push you, I can't say terribly much about diphtheria, pertussis, tetanus, okay, and I can understand why one is questioning it, especially because you're not aware that it's around and having problems. But I said, live poliovirus vaccine disease is around. It's in everyday care center-- it's in every kindergarten, it's in every babysitter's setting. So, I just explained that to them. They got the vaccine. I said you know, it's got risk associated with it, a recipient can get disease. I said unfortunately, we don't have an alternative right now, it's only available in Canada. The closest thing that's available is in Canada and they don't supply it for us. But I said you can reduce the risk by giving your child the oral vaccine 01:24:00rather than having your child get that vaccine virus from somebody else. And she said, "Oh, okay, I understand." I told the story to this attorney. I don't think that was what he was looking for. He was trying to catch me up with, well, you do this, you know. And the only time I made a big point out of it was to make somebody take the vaccine, because otherwise it was too dangerous. Interesting.

TORGHELE: So how did the discussion start to change? Or were there other factors that started to change people's minds?

SALK: Yeah, that made people sit up and listen--and the swine flu 01:25:00experience'--and at that point in time people were becoming bothered about DPT [diphtheria, pertussis (whooping cough), and tetanus] and the reactions to it, and autism association. All of that story was beginning then. It all followed one lawsuit in the early 1970s, Reyes v. Wyeth. It was a live vaccine case, live virus case in Texas. You know, I actually, at this point, don't even remember whether--you know, who won, but that was a turning point because that's when people realized, oh, vaccine injury is something that exists. You can get a 01:26:00settlement or whatever. And that--the live poliovirus vaccine--is really the beginning of that whole process of litigation that was affecting it, which was driving manufacturers out of business. I mean, they dropped the business. There was only one left by that time. And going back to Dick and Dane in England, back in 1959 -- they said you know, about Lady Mary Montagu and this is variolation, it's different from Yellow Fever or anything else because this (vaccine) virus is known to move, to spread in a population. They said, and you know, if there's just one occurrence of that it will have a major impact on vaccination programs 01:27:00everywhere. So that was 20 years, 25 years before this time period. So, there were people then who were on board, who understood, who saw the same things.

Eventually, I backed out of the lawsuit business as well--it wasn't a business, but of testifying--to a great extent because cases were settling instead of going to trial. I pretty much moved on in the direction of other things. As I said before, I had continued to publish in polio. I was also doing research in the Pathology Department on the biology of aging and cell culture, and all 01:28:00kinds of other things. And I left the University and went into biotech, so I was doing other things, but I still published every once in a while-- something when it was appropriate--including one that demonstrated the single dose effectiveness of the new (killed virus) vaccine. If you give one dose after the age of six months, it's effective-- I don't remember the numbers--you know, 99+% effective.

TORGHELE: The killed virus.

SALK: Of the killed virus vaccine. It was the one that its potency had been standardized and there were new manufacturing techniques that allowed it to be made less expensively. So, I wrote that. That was important. I was involved a 01:29:00little bit with some studies in Africa on practical ways of giving the vaccine, because it was thought that (A) it's too expensive, (B) you've got to train people to give injections rather than just drops and (C) you needed to maintain frozen material. So, for all kinds of reasons, it was not being used. The live vaccine was always being promoted. And it turns out that in the underdeveloped countries, or countries with warm climates, the (live) vaccine is not very effective. They were having to give four, five, eight, ten doses before somebody would finally convert. There's too much competition with other intestinal pathogens.

And so, they switched from just giving individual ones (vaccinations) to doing mass administrations every, whatever, certain number of years, you know--every year, every two years. They would come and immunize the entire population--that's how we have to do this. Well, when you do that, it seems to me that you end up spending darn near what it would cost for one dose of killed vaccine that would be effective. I mean that study was done in Africa. Yes, it has to be maintained frozen--the live vaccine can be maintained at refrigerator temperature--which is easier to do. Practically speaking, it's not hard to keep 01:31:00something on ice. It's done all the time. But it is hard, with a lack of power and stuff, to transport and maintain "refrigerator temperature." So, you know, I was involved in saying--in pointing out some of these things as well.

And this was the practical part of vaccinology. We initially defined vaccinology as needing to understand the pathogen, the clinical aspects of the disease, the vaccination material that you're using and so forth, in order to get an effective immunization. So, vaccinology was studying and dealing with the vaccines to make them more effective. And it's early 1980, '84 I think it was, 01:32:00Jonas and I wrote a paper called Vaccinology of Poliomyelitis. And at that point, we defined vaccinology as not only all that stuff, but the aspect of practical vaccinology. How do you get it to people? How do you get it administered? How do you deal with cultural problems locally? All of the side issues, as it were, of actually ending up with an immunized child. Because I felt it was really important that that aspect needed to be part of vaccinology, not theoretical, not technical, but practical, because the whole objective of vaccinology is to get an effective immunization. If we can't get the vaccine to 01:33:00somebody, it ain't gonna work. So, I had been doing some of those things along the way, as well. And in a sense, my final--I had moved from being very optimistic to experiencing "What's going on here," to beginning to understand that what's going on here is not really logical. It's clearly emotional, which I had denied before.

In medical school, I went to talk with [Dr.] David Carver, who is a virologist. I worked in his laboratory studying for a while, and one day I said to him, "I'd be interested in chatting with you sometime about the poliovirus vaccines." He said, "No, no, no, I don't want to, you know. Vaccines are too emotional." And I 01:34:00thought to myself--I mean, I backed off, I didn't say anything because it was clear he didn't want to talk about it--but I said to myself, what's emotional about data? That's what I was going to talk to him about. What's emotional about facts and information? Well, I realized that the "problem", the issue, was more on the emotional end of the spectrum, more on the personal end of the spectrum, more the letting-go-of-one-deal-and-moving-on-to-another--sociological, psychological aspects that I just didn't know how to deal with. And you know, I think it would make a fascinating study and I'm sure there are people that study that kind of thing, but to me, it just meant, you know, no need to do that.

Until I got a call from the American Journal of Public Health about a paper that had been written by somebody at CDC, a group of CDC people, that used a decision analysis methodology to address the issue of what would be the risk if we stopped-- if we stopped using live vaccine and used only killed vaccine, because that was being discussed. And I had problems with some of the technical issues. I thought it misapplied the technique. Okay, one can argue about all these kinds of things, but I had what I thought were valid questions about it. And I put that into my response, my article, but the thing that really bothered me was 01:36:00that there--Oh, and I'm sorry. The result of it was-- Oh, we should never do that because the risk would be so great. Four out of the six decision panelists, who were consulted on this, were people who were longstanding live virus vaccine advocates. So that was biased to some extent. But they used it to end up with a specific recommendation about a policy and in my opinion, it was not an appropriate use of that statistical analysis. And that wasn't really the important question. The important question was how policy had been developed. 01:37:00How can you be having a policy of involuntary vaccination in the United States of America with a product that is known to be dangerous when there is an alternative? And I said something about, you know, I was disappointed that that kind of discussion, those issues, weren't brought up in a discussion of policy--polio immunization policy. And the name of my--the title of the article was "Poliomyelitis, A New Challenge for a New Generation." I just realized by that time that the group I thought previously was a new generation was merely an intermediate generation and whatever was going to happen was yet to come. So 01:38:00that's what I-- I ended up, in a sense, my polio career by saying -- people, we should somehow address how policies are made. Where do you get off making these kinds of decisions for people? Somehow it doesn't seem right. And whenever I talk to people who are getting vaccines, you know, lay people, they get it immediately--juries, ordinary people, not experts of any kind. They understand. So, that's what we should be talking about-- How do we set policy?

The authors responded to my technical questions, which is perfectly appropriate, saying well, we think it's valid for this reason or that reason. Okay, that's 01:39:00ordinary back and forth science. They said -- We never intended to discuss social, legal issues, that wasn't part of our study. So, you know, that's the end of that. My point was-- I think it should be part of a study making a recommendation for policy. So, I kind of left it at I can't make any policy change, and I don't understand how to do it, I don't understand exactly why things go the way they do, but I guess I'm going to do some other things instead. It was just frustrating. It wasn't going anywhere. At that point--you asked when things started to change--gradually after that, things began to change.

The WHO organized the Global Eradication Program, never recognizing anything about where that came from or what the difficulties were for the 20 years before that. Jonas used to say something which I thought was amusing until I realized he was speaking from experience, and I was watching it happen. He said, you know, if you do something, first they tell you it's not possible; then they say well, maybe it's possible, but it's not important; and then they say I knew it all along. And what I had been watching for the last ten years or so was many of 01:41:00the things that we had said coming back around again. Right here at Emory [University], there's a vaccinology program-- that term is now constantly used, I'm not even sure how they define it. And I sat in on a conference the other day where they were talking about vaccines and was just amazed at the number of things that Jonas had on his agenda. In the 1950s he was going to, after the polio vaccine project, his intention was to go and look at adjuvants, which are things that are added to vaccines in order to increase the response to them. And it was a touchy subject at the time, 1958, and because you know, people didn't believe it and how are we going to know what--give mineral oil to people as an 01:42:00adjuvant or Freund's adjuvant that's got BCG [bacillus Calmette--Guérin] in it. But he had had experience in influenza demonstrating how much higher response it was with the adjuvant, so he was--wanted to explore it. He didn't get a chance to because he was so distracted by all the brouhaha that went on. I mean, he got a bad rap for that; but anyway, that's how science--so he was unable to do that.

That's now a top topic in vaccinology, now, is an evaluation of adjuvants. After he had been doing the polio studies, he started doing a cancer vaccine--melanoma 01:43:00patients. I don't remember what it was exactly, but he would give them back some of their own melanoma cells or something, and he would have slideshows (at home) at night, and he would show these amazing changes before and after. Okay, it wasn't necessarily long-term and, you know; but he was exploring the immunology of what was going on. Jonas was a virologist, initially, and in the mid-50s he started referring to himself as an immunologist. He said, you know, I'm not just a virologist, I pay attention to the immune system and how it works. That wasn't a typical term in those days. [Sir Frank Macfarlane] Burnet had proposed all 01:44:00about the immune system and everything, but it had not caught on anywhere and so it wasn't an actual field of study. And now it's routine. So, it was fascinating for me to watch that change, that development, and to come to a meeting now, today, having been out of it for a long time and, frankly, hearing exactly the same arguments made about live and killed poliovirus vaccines that came from the pre-vaccine era.

I told you I would come back to Pasteur, the Pasteurian Dogma. In--when was it, 01:45:00the 1980s, 1990s, [Dr.] Gerald Geison published a book [The Private Science of Louis Pasteur]. He had spent years studying the private papers of Louis Pasteur, the laboratory notebooks, which had just then finally been released by the family. And I learned a lot through him, you know, Pasteur's personality, how driven he was, he said he appreciated criticisms, but he would blow up, and his belief in dogma-- infectious versus non-infectious immunization. And what he talked about in here a lot was the taking away of the myth, you know, reducing 01:46:00the myth of Pasteur. But he's not the first, that point has been made ever since early, you know, '20s, '40s or whatever. There were people, historians who do that kind of research that said, you know, he probably wasn't--he didn't, he wasn't the way everybody imagined him, this great, wonderful, glorious hero. It doesn't surprise me that that happened, okay. I mean I'm certainly not blaming Pasteur for it, although, he did make as much of it as he could and promoted himself quite a bit. But what was amazing to me was to discover in reading this, that he really pushed hard on "only infectious agents could cause--could induce 01:47:00immunity." Over and over he stood by that incredibly strongly in public. He (Pasteur) was trying to develop a non-infectious rabies vaccine, he discussed it a lot. His attitude obviously changed in some way. It was like he didn't necessarily still believe what he had said before, but he kept saying what he had said before. And the real surprise was the secret of Pouilly-le-Fort, which was the little village in which he first demonstrated his anthrax vaccine. It 01:48:00was a big impressive thing. He inoculated some sheep with anthrax vaccine and then gave anthrax to--clinical disease--to another set of sheep and mixed them together. And the ones who were vaccinated survived, and the other ones didn't. And this established an important principle that vaccines can work.

It turns out that he did not use, at Pouilly-le-Fort, the attenuated live virus infectious vaccine that he was working on. He used the non-infectious, chemically derived, killed vaccine that was being worked on by someone else in his lab, [Dr. Pierre Paul] Émile Roux. I came across this after my dad had died 01:49:00and I was really sorry because for him, while the vaccine itself, the product, was important and, you know, he was pleased and proud of what his contribution was toward reducing the incidence of disease, saving children's lives, et cetera; you know, all of that part, all of that stuff. It was great. But what drove him from the very beginning was the principle. He wanted to prove the principle, and it was frustrating because nobody would hear it. He did, he proved it in spades, and it turns out that the Pasteurian dogma didn't really 01:50:00exist. The people who were repeating the Pasteurian dogma were carrying forward something that was deceitful at some level. How ironic that was.

He did not--let's move away from science for just a little bit, and I'll put on my son-of hat. I remember as a child seeing what happened at the University of Michigan when the April 12th, 1955 announcement was made. You know, I was a little kid. I loved seeing the displays and everything that was going on. I didn't really follow what people were talking about and certainly not his 01:51:00presentation, but I was pleased that he was up there. And you know, we were all pleased that people seemed excited. But Jonas didn't really understand what [Edward R.] Ed Murrow said to him in a meeting, a TV show, See It Now, that ran live from Rackham Hall [University of Michigan]. He (Murrow) looked at him, and he said, "Young man, a great tragedy has befallen you. You have lost your anonymity." Whoa. He had no idea what that meant at the time. Oh really?

The glorification of Jonas Salk that happened was distressful to him-- he could 01:52:00not get back to the laboratory to do stuff. And he was accused by his peers of encouraging it, wanting to be in the limelight, spotlight, of saying things like during his presentation at that meeting he talked about making a vaccine better. We can make one that is 100% effective. Okay-- he was talking about theoretical, principle issues. He wasn't bragging, he was talking about the principle that he wanted to make. And something else happened during that talk, which was that he failed to recognize any of the people in his laboratory. This is a dumb mistake. 01:53:00No excuse for it, okay, but I do know that he was focused on-- what am I going to say? I have to prepare a speech-- I don't know the results of this trial yet. I'm pretty sure it's going to be some effect, but what if it's only, you know, 40% effective? So, he was really focusing on that. My mother said, at that time, she said, "You know, I didn't see his talk ahead of time. I didn't see the draft," she said, "I wish I had because I would've pointed that out to him, that he was missing that." So, his own personnel were disappointed to some extent. Some of them were fairly embittered by that. I get it. It's insulting, et cetera. It's the one time you get somebody to say thanks, what a contribution! 01:54:00But he also didn't recognize any scientist on whose work he had built. Okay, this is against scientific ethics. This great big media circus, which in fact was put on by the March of Dimes--he had nothing to do with it, I mean he was bothered by all of this stuff being done--he got dinged by his peers for that as well. So, his peers--he never got what he really wanted, which was recognition that the principle he espoused was good. That he did good work as a scientist, you know-- just ordinary things that happen in science.

And that day, April 12, 1955, it all changed. Not only did he do these terrible 01:55:00things with media and being friendly to people, being nice to people. He didn't know what the heck to do. People would come up to him and want to touch him and shake his hand and crowd around him. I mean he couldn't walk down the street without that happening. It took a long time for him to learn how to be this and do this. But he was just being polite-- he wasn't trying to encourage or grab the spotlight or build on fame or something like that. He was just being polite to people. What else could he do? Go away, don't bother me? He would never have done that. So, there are lots of pictures of him smiling and talking to people and shaking hands and letting people touch him and, you know, the whole thing. 01:56:00Except for the fact that he was a nice guy, he got a bad rap from his peers on all of that.

I mean it still appears--I mean, it's been the focus of several books, not the first one, Breakthrough [ Richard Carter] was really very good, very balanced. But after that, it was like people needed to find something that they could sell, and so the controversy was built up and the tearing down of Jonas Salk or revealing Jonas Salk's bad side or something was something they could get their fingers on. So that went on and, you know, his friends knew this--the people who 01:57:00really knew him. And it just hurt, meaning in the sense to see the negative impact it all had on him. He didn't get back to the laboratory. He moved on to something different, he moved on to the Institute [Salk Institute for Biological Studies], creating this Institute. He has not gotten credit for the real contributions that he has made, the principle. You know, there are techniques and technologies that he developed while working on polio. I was amazed to read in a publication, one of his early publications, that they created out of plexiglass a 96 well plate, which is in research--it's always used. I mean it's in lots of places because 96 little wells, you can put a little stuff in each one. And I was astounded to see this publication that he said, why don't we do 01:58:00this? You know? That, and then there were other technological things that he created. And in fact, I was surprised when I actually started reading his papers. He did good work. I mean he was careful. He would make an intuitive leap-- this means that. maybe such and such. And his peers, who already started out not being comfortable with what he was doing, said-- ah, he's just wishful thinking. He makes these jumps, and it doesn't make any sense whatsoever-- you can't conclude that from what's happened here. Well, he would take that criticism and go back to the laboratory and then would publish a paper filling 01:59:00in all of the gaps, showing that in fact, he was right, and you could fill in the gaps. He would just leap to a conclusion, which helped him go other ways. I saw those papers and I saw that every single time, he responded. But that never changed what the reaction had been. And this business of losing your anonymity was not a small thing. That had huge impacts, well, on all of us to some extent, but, you know, it changed his career. To some extent because of the lack of recognition for the science among his peers, et cetera, and the disdain with which he was held.

Albert Sabin referred to the polio project as kitchen science-- I'll comment on 02:00:00that again in a minute. But he got to the point where he began to realize that the fame opened doors for him, it was a kind of political capital. It would get him to be able to do things for people, with people. And I'm totally aware of it, because when he died, it went away, you know. Peter, Jonathan and I were suddenly out there with nothing. I felt like I had lost my mouthpiece because I would talk with him about science or something, AIDS [acquired immunodeficiency syndrome], whatever he was working on and give him ideas or I'd raise questions 02:01:00and stuff and he would go off and-- Now, if I said that to somebody else where it was important to use, they wouldn't listen to me anymore. Albert Sabin was very much like Louis Pasteur in his personality, which I discovered by reading this book on what Louis Pasteur was like. He was a self-promoter-- he was an orator, which is in common about Louis Pasteur. I saw him (Sabin) many times, and he would stand up and make a presentation--like this-- and be very convincing and insistent and stuff and disparaging. Literally, disparaging of other people and stuff. And I mean, I'm perfectly comfortable saying that now because I'm not just, "Oh what a nasty guy-- he didn't like my father", you 02:02:00know, I observed him-- I saw him. And most interestingly, after my father died, I went to a meeting in his place. They asked me to please come. I said I didn't want to come all the way to France. It was for Charles Mérieux-- a meeting that he was putting together--and they were very good friends. He was very important. I said okay, I will do it to be supportive of Charles. At this conference--which was about the 100th anniversary of Pasteur something and the 150th of Jenner's, you know--there were a number of people who were recognized with little plaques or something for their work and contribution to vaccine development. It was to be my father and [Dr.] Hilary Koprowski and Maurice [R.] Hilleman? No. 02:03:00Oh--anyway, these were much older than me and very respected and very strong advocates for live poliovirus vaccine. I mean they were in Sabin's "group." And Sabin's wife was also there, and I stood in for my dad. And I'm standing around and having a conversation and these two or three guys, who had worked with him (Sabin), grown up with him. They laughed. I mean, it was something about-- "Oh, he was not always the nicest person." And the other one said, "Yeah, even his best friends didn't like him." I thought, I don't think you wanted me to be standing here to hear that. But it was such a wonderful and succinct picture of 02:04:00what I had seen. (Sabin) was a good scientist and all of that, but to ding my father for doing "kitchen science!" What's wrong with kitchen science? The kitchen is where everything starts. You get new ideas and breakthroughs by using what you already have or applying them in a different way for a different purpose. He implied that there was something bad about it, that it was, you know, it's denigrating. It was-- you don't know what you're doing-- it's unimportant. Maybe it's true, but it's not important. But Sabin's--this reference to kitchen science surprised me because the work that Sabin was doing 02:05:00was culturing polioviruses and passing them in tissue culture--I know how to do that--repeatedly until nature made the virus weaker. Important stuff, but he was essentially following a recipe out of Pasteur's cookbook. That was exactly what Louis Pasteur was doing. So that didn't sit well with me that somebody would try to make a point like that.

Jonas got dinged for not giving credit. I absolutely agree that that happened at Rackham Hall on April 12th, 1955. I don't apologize for it, but I think I have an explanation for it. He got along so well with his subordinates. He gave 02:06:00people credit just being there all the time. I've seen him be approached by one of the maintenance workers, who got into a conversation with him about the cousin he had told him about before, who was ill, and what should he do about it? Or, remember last week when I talked--oh, I know, Jonas would say, "How is your foot?" And they were very loyal to him. This is the nice guy reference I made, and he really respected them and appreciated the loyalty and stuff. He wasn't the world's best expresser of that kind of thing, but the degree of loyalty that we saw-- We went to the extent of adding a dedication at the 02:07:00University San Diego Library. My brothers and I donated his papers. It's an incredible collection, another major contribution. He saved everything. And Lorraine [C.] Friedman organized it.

TORGHELE: His secretary.

SALK: Yeah, longtime secretary, right from--back in '49 or something. And she went out to California with him and she was very, very careful. Everything was filed, everything is beautiful, and the librarian saw this. And Barbara [L.] Robinson, who came along later, was also involved in all of that administrative stuff and record keeping and stuff. She, after his death, she organized the stuff that hadn't already been organized-- by Lorraine, you know-- the stuff 02:08:00that had collected over a bunch of years. And the librarians received this, and they said, "Gee, we don't have to do anything. It's all organized. Usually, we get boxes out of a basement and not only are they smelly, but they are all mixed up." So that collection, for historians, it's really, really an astounding piece of-- collection. I mean it drove me crazy that he would not throw anything out or Lorraine would not throw anything out. They moved from Pittsburgh out to the Institute right around 1962 and somewhere when I was already living in Seattle, you know, I was an M.D., I opened her desk drawer and there was a three-cent stamp that had been recovered from an envelope because it hadn't been 02:09:00postmarked. And I knew it was from a long time ago because I remember when postage was three cents. And Barbara's loyalty and the efforts she put in, I wanted to recognize his appreciation of all of that, as well as recognize Lorraine for starting it and Barbara for finishing the collection. I have a piece of that I'd like to read to you, because it's kind of revealing. You know, something that my brothers and I are very aware of and it's not usual to put a dedication on a gift like this. But we said, you have to put a long version of this in the finding document itself so that people will stumble across it.

And in the catalog, you know, we want a short version so that people know this, that somebody cared about this aspect of him. "The collection of Jonas Salk papers is dedicated to the support staff who worked with Dr. Salk during his more than 50-year career. He shared with them lasting relationships of mutual respect and admiration. Special recognition is given to Lorraine C. Friedman and Barbara L. Robinson, whose personal efforts and dedication are primarily responsible for the existence, quality and extent of this collection". That's the brief one, there's a longer version. I saw him behave, act out, all of that. I got responses when he was no longer around, and I stood in his place for some 02:11:00things or was doing something. I was visiting the Watson Home [D.T. Watson Home for Crippled Children]--I was a trustee at the Watson Home for a while, which is where the original studies were done--and they had a social gathering. A guy came up to me and he said, "I want to say hello. I wanted to introduce myself. I want to shake your hand. I worked on building the animal cages in the [Pittsburgh] Municipal Hospital, the ones where the monkeys were kept." And he then talked about how difficult it was or something or other, and something about your father was a nice guy, supportive and stuff. I was working with a roofer-- it happened to be on my dad's house after he died because it needed some work--and one of the guys came over to me and said, "I just want you to know, I worked on the waterproofing in what's now the basement of the Institute 02:12:00building." He said, "You know, your father would stop by all the time to see what the progress was, what was going on." That was-- I learned something about-- I mean I had seen it myself--but I learned something about the impact he had on people, just his presence. And then, there was the other aspect of what happened to me after he died, and I stood in for him. I was a little kid at the time of the development of the vaccine. And you know, for me, I didn't know what was going on and in fact, we didn't even talk about polio, it was not one of those scary things in our family. And people would come up to me and want to 02:13:00touch me because it was the closest thing--they felt in connection with him. It was the experience they'd had, you know, back in the '50s when this great relief happened, and church bells rang and stuff. I just learned the depth of the importance to people of that generation. They would thank me. Oh, I didn't do anything. And I know from comments by some of the technicians in his laboratory who moved from Pittsburgh with him out to La Jolla, and they'd comment on what an incredible time it was in the laboratory then, working on that project. It 02:14:00was like a war was going on, the focus, the work, the energy-- you know, this team, teamwork. And that happened everywhere in the country related to this--well, what later became a moon project. But this project to fight polio, just like today's fight against cancer, breast cancer, involved everybody. Everybody had a piece of it, you know--women who marched for dimes, the nurses who volunteered to take part in the program, the scientists who were working on other aspects of it. I hope someday to post an acknowledgment that I prepared 02:15:00for a display one time that didn't get used. But I knew, okay everybody says he doesn't give credit, but do you know who does deserve credit? Do I have it? Where did I put it?

"Contributors to the development of the killed poliovirus vaccine." It started with medical and scientific researchers--hundreds of physicians and investigators who were staff and colleagues--contributed to the basic understanding. Dozens of lead scientists, whose contributions of breakthrough studies provided tools and knowledge. The virus research laboratory a list of 02:16:00the names of the specific individuals, numerous other laboratories, glassware, and animal care technicians and assistants. University of Pittsburgh Administration and facilities support--all of these people. And it goes through other research colleagues; the National Foundation [for Infantile Paralysis]-- administration of it, administrators--Basil O'Connor, administrative staff-- thousands of volunteers, millions of donors. People were so pleased when it worked. Their dimes had created this magical miracle thing. Early human studies, a list of people who were involved in those, you know, their names. And it gets 02:17:00to groups that are farther and farther away and bigger and bigger. The 1954 field trials, of course-- the Vaccine Evaluation Center, University of Michigan, Tommy Francis and all the people who were in it, the field personnel, 311 state and local health officials, 64 physical therapists, 22 CDC Epidemic Intelligence Service Officers, 39 laboratory investigators, 17 members of the Advisory Committee, thousands of participating medical personnel and volunteers. Pharmaceutical companies--it lists seven of them here that were involved in the early work. The Polio Pioneers, which was the little badge they got when--the 02:18:00kids in the field trial-- 1,829,916 first, second and third grade children who participated in the trials. Approximately 3 and a half million parents who bravely consented to let their children participate in a double-blinded study with no guarantee of receiving the test vaccine and no certainty of any benefit even if they did. I'm a parent now-- it wasn't just, you know, almost two million little kids-- double that number of parents made the decision to be involved. So that's why there was such an incredible coming together and 02:19:00appreciation. You know, unfortunately, from my father's perspective, he ended up being the icon, the center which they all insisted-- they needed a hero. But there were also major technical and social advancements during the development of this project. The Bureau of Biologics created the whole idea that is now a byword in FDA-- The process is the product. Before this they were having to approve drugs that, "Okay, here it is, let's analyze it and see if it's what it's supposed to be."

You can't do that with a biological product. You can have safety tests, but this was a point that Jonas made-- look, if you follow the procedure that I've done here, you'll be okay. And so, it's the process that's important don't go and wing it with various things. He said, "I don't know what happens, I just know that this one works." Vaccine manufacturers-- just the whole process--and the things that they learned about the regulatory stuff that was going on. Fundraising-- the incredible feats and advances in fundraising techniques with the March of Dimes, you know--it was involved with it and created it. Pet food-- I spoke to somebody who had been involved in creating the monkey chow (used in 02:21:00the laboratory) those years. There are more, you know-- legal issues, standards. These were big changes that happened in this period of time that I had no idea about. So, for me, it was kind of astounding to realize what it was like-- I mean, we had just come out of World War II and now it was [the] war against polio and everybody pulled together, and everybody was involved. And everybody made contributions, you know, including all the people who made the technical advancements I'm talking about. And when I realized-- That was when I thought 02:22:00about who really contributed--and Jonas knew his place in it. He was pleased and deserves credit for focusing on the principle and getting it done and organizing a team and all that stuff, but the product was a result of all this other stuff that was the product. As I said before, he was pleased with it, but he didn't feel like he owned it-- everybody owned it. It was part of everybody. Ed Murrow asked him, in that same interview, "So who owns the patent on the vaccine?" Jonas was taken aback, he said, "Well, the people I suppose. Can you 02:23:00patent the sun?" And by that he meant the sun belongs to everybody, you can't patent that. He was a novice at public things to say, and it never occurred to him that the way it was taken by peers who didn't like him was that he was comparing himself to the creator of the sun, you know. It was a title of a book and that was the point of having it as a title. And that was one of the first books that presented Jonas in this sort of negative light about all kinds of little stories and things. And of course, the scientists who didn't get along with him were happy to talk about things.

I've covered a lot. I haven't thought about it for a number of years, so it surprises me how much there really is there. It's an incredible story, both back in the 1940s and '50s and then this whole issue of live versus killed. It's so much more than just a front-page story and a headline, an opportunity for scuttlebutt or whatever. It raises really big questions on immunization policy, on public health methods. I don't know what to do with it, but I am hoping that somebody sits down at a conference and says how come? I've always wondered why. 02:25:00This stuff that was pretty obvious, why didn't it have an impact? Where did we go wrong? Where did we go right? [It's] not my field.

TORGHELE: You have presented such a wonderful and complete picture of the polio work and of your father, and you and I can't think of anything else that we could add to make it any better. It's wonderful the way you did it.

SALK: Okay. I could probably come up with a story.

TORGHELE: All right.

SALK: What do you do when somebody comes up to you and says--"Salk? Are you related?" My mother, back in 1955, handed a charge card--at that time it was a 02:26:00little metal plate--handed it to a salesperson and she looked at it--and everybody knew the name right then, okay--like, (gasp) "Oh, are you related to Jonas Salk?" And she said, "Only by marriage." She was sharp. So, I honor her when people ask me. I often say, "Well, yeah, he's my father," and they say "Really?" And I say, "Really--well, that's what my mother tells me, and I have to take her word for it."

TORGHELE: That's a great way to end.

SALK: Yeah, okay.

TORGHELE: Thank you so much for being here and sharing all that with us.

SALK: You're welcome. Thank you so much for the opportunity to revisit a subject that confused me while it was going on.

TORGHELE: And thanks for your own contributions.

SALK: Thank you. Did I say that I suspect my greatest contribution to the whole thing was that two-minute conversation on the Atlantic City Boardwalk? It instigated him to get back in it.

TORGHELE: You talked about it towards the beginning, yeah.

SALK: But in retrospect, I think that was really an important contribution.

TORGHELE: That was yours, for instigating it. Thank you for that too.

SALK: Thank you.