Biographies always overlook people, especially the people who enable a subject’s life. “The help,” as they are often reduced to, are erased from the narrative. This is so true in stories of groundbreaking medicine, where rounds of anonymized clinical trials necessarily obscure the identities of people that medicine is tested on. Jonas Salk did incredible things for our world, revolutionizing medicine by helping to create the flu and polio vaccine and transforming vaccine preparation in general. But he also tested those vaccines on unconsenting subjects: People institutionalized in mental facilities. It was standard medical practice at the time, but the ethical problems seem obvious to us in hindsight. When his story is told, these people are often treated as an uncomfortable subplot.
When I wrote Unruly Figures, I wanted to focus on historical people who often get overlooked, or whose story is only framed one way. That included acknowledging the darker sides of what some of those figures did, and how those decisions can reverberate through time. Though informed consent became standard medical practice in the 1950s, there are still populations vulnerable to coerced clinical testing, namely incarcerated people. I chose this excerpt because I wanted to take another look at how Salk and others let the desperation of World War II blind them — but also at how they became more compassionate over time.
Unruly Figures was written as a celebration of how people bucked convention and changed their world. The people they met along the way mattered too, even when their names are lost to time.
Jonas Salk intended to go into research and [after] his first year in school, he landed a prestigious fellowship to work in the laboratory of his professor, R. Keith Cannan. There he made his first scientific discovery: a new way to separate bacteria from the culture broth they were grown in. The old process was cumbersome and slow; Salk realized that if he added calcium phosphate, the bacteria stuck to it and sunk to the bottom. His new method allowed scientists to harvest bacteria nearly seven times faster than before. At just twenty-two years old, he published his first scientific paper.
Cannan, realizing what a bright scientific mind he had on his hands, encouraged Salk to follow the PhD path instead of the MD path. That would allow him to focus more on research. But Salk declined because he “perceived how easily one could become absorbed in some chemical puzzle and lose sight of the human element. And that is what drove him.”
After his fellowship with Cannan, Salk sought the mentorship of Thomas Francis Jr., who was famous for his work on influenza viruses. He began working in Francis’s lab, where he realized that, despite prevailing medical wisdom, a killed virus could be used to give someone immunity. Proving this would become a dominating mission for the rest of his life.
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On December 7, 1941, World War II barged onto America’s doorstep in the bombing of Pearl Harbor. National discourse around going to war was overshadowed by memories of the 1918 flu epidemic, which had killed almost as many servicemen as the actual conflict had. Henry L. Stimson, the US Secretary of War, was “concerned about the repetition of such a military disaster,” so he formed the Commission on Influenza with Francis as director. Francis was the ideal person for the job—he had been the first American to successfully isolate an influenza virus and identify different influenza strains.
Salk joined the team in April 1942. Its main task was to create a vaccine that could be used to protect soldiers from influenza while living in cramped quarters. But viruses proved trickier to study than the bacteria he’d worked with in medical school because they require live tissue to grow; for an organism that can be so devastating, viruses can be surprisingly delicate once outside their hosts. Scientists usually used fertilized chicken eggs to grow viruses. As he had with bacteria cultures in Cannan’s lab, Salk quickly established a more efficient way to extract live virus from the eggs: by exposing them to red blood cells, which would cause the virus cells to clump together. Once the clump of virus cells was removed from the egg, he could wash off the blood, kill the virus, and store it in a sterile vial. That was the basis of the Commission on Influenza’s vaccine.
Testing was initially performed on people permanently housed in Ypsilanti State Hospital and the Eloise Psychiatric Hospital outside Detroit—“the place of last resort of the mentally ill.” Without telling the patients, the team inoculated half the residents and gave half a placebo, then exposed them all to influenza using a nasal spray. Involuntary medical testing on institutionalized people was still considered acceptable at the time; only since the 1950s has informed consent been the scientific standard. The inoculation worked. Only 16 percent of the patients with the vaccine got sick.
Armed with that knowledge, the commission began vaccinating thousands of men in the Army Specialized Training Program at different universities. During an influenza outbreak in 1943, only 2 percent of vaccinated people got sick. The vaccine was a resounding success — and it had been made with a killed virus.
Scientific dogma declared that only live viruses imparted immunity for a significant length of time. Most virologists believed that a killed-virus vaccine could impart immunity only for a few weeks at the most. But Salk believed it could last longer, so he revisited his test subjects at Ypsilanti and Eloise and showed that they retained elevated levels of antibodies a year after their inoculations. In fact, there were no known cases of influenza among the vaccinated people.
Salk made another startling discovery: incidence of influenza was significantly lower on the campuses where people had been vaccinated, even among unvaccinated people. More vaccinated people had meant fewer sick people to spread the virus, so even unvaccinated people were protected; Salk had accidentally discovered herd immunity.
Despite Salk’s successes, his work weighed on him.He began spending nights and weekends in the lab, working feverishly.He felt that he had too much to do and not nearly enough time to do it.The pressures of safeguarding the health of the entire US military during a dangerous international conflict left Salk with chest pains and unable to sleep at night.
Moreover, while Salk did much of the work, Francis got all the public credit. Soon, he and Francis began to butt heads.Salk had begun developing relationships with the press and pharmaceutical companies, which was seen as unseemly for a professor and academic. Salk, however, didn’t see himself as an academic, and he recognized the power of the press in spreading pro-vaccination messages. After five and a half years in Ann Arbor, Salk and his family moved to Pennsylvania, where he headed up his own lab at the University of Pittsburgh. He took with him increased celebrity, thanks to his part in developing the flu vaccine, and a better understanding of virology.
His early days in Pittsburgh were frustrated by controversy around his recommendation to add adjuvants like mineral oil to vaccines. (Adjuvants are any ingredient added to a vaccine in order to “stimulate and enhance the magnitude and durability of the immune response” by making the body react more strongly to the vaccine.) Years ahead of his peers, Salk was convinced that adjuvants could boost efficacy while also reducing volume, meaning more strains of influenza could be added to each vaccine to improve chances people would be protected.
The cliquey world of virology rejected his ideas outright, claiming that adjuvants would cause cancer or deformities without any evidence this was the case. Salk later proved that he was right, but the potential for lawsuits linked to adjuvants had been implanted in the minds of pharmaceutical directors. They wouldn’t add the adjuvants to their formulas. (Today, adjuvants are standard in influenza vaccines and many others.)
In the mire of this frustration, Salk was approached by Harry Weaver, director of research at the National Foundation for Infantile Paralysis (NFIP). Weaver’s pitch was simple: help determine the different strains of poliovirus so it could make a vaccine and receive generous funding in exchange. Salk, like all academic scientists, needed funding, so he said yes despite having very little experience with polio.
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In 1952, Salk began trying to develop a polio vaccine. He once again faced dogmatic resistance to killed-virus vaccines. Among most scientific circles, there was “an almost religious fervor” that killed vaccines couldn’t impart lifelong protection. Salk, aware of how well they had worked with influenza, set about trying anyway. In just three months, his team developed a killed-virus vaccine from scratch. They tested it on monkeys, and it prevented paralytic poliomyelitis in every single trial.
But the NFIP Committee on Immunization wasn’t having it. Despite the many times Salk had already been proven right, it refused to move forward with killed-virus vaccine testing on people.
So Weaver, the director of research at NFIP who initially approached Salk about working on polio, encouraged Salk to pursue testing on his own. Using his University of Pittsburgh contacts, Salk started testing children who had already survived polio once because he wanted to prove the safety of the vaccine itself, not its effectiveness in preventing polio infection. (This time, the test subjects’ parents signed consent forms.) When that test worked perfectly, he gave the vaccine to children who hadn’t had polio, to test its safety for them. None of them had adverse reactions, proving again that the vaccine itself was safe.
But Salk wasn’t going to expose the children to the virus—if the vaccine didn’t work, he risked killing them. Instead, he took samples of their blood to get their new antibodies, injected blood into cultures of monkey kidney cells, and then infected that. Only when those kidney cells thrived was Salk sure he’d done it: the children’s blood—and therefore the children—was immune to polio. He called it “the thrill of my life.” Confident in the results, Salk administered the vaccine to himself, his wife, and their three sons.
From Unruly Figures by Valorie Castellanos Clark. Copyright © 2024 by Valorie Clark. Reprinted by permission of PA Press, an imprint of Chronicle Books.
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