Opinion | The Forgotten Toll of Polio

In part 1 of this exclusive video interview, MedPage Today‘s editor-in-chief Jeremy Faust, MD, talks with Perri Klass, MD, of NYU Grossman School of Medicine in New York City, about the forgotten toll of polio and how public health transformed childhood survival.

The following is a transcript of their remarks:

Faust: Hello, I’m Jeremy Faust, medical editor-in-chief of MedPage Today. I’m so excited to be joined today by Dr. Perri Klass. Dr. Klass is a professor of journalism and pediatrics at New York University. Her book, A Good Time to Be Born: How Science and Public Health Gave Children a Future, was published in 2020 and is now out in paperback under the new title, The Best Medicine. It’s more relevant than ever and I’m so glad to have Dr. Klass with us today. Dr. Perri Klass, thank you so much for joining us.

Klass: A pleasure to be here.

Faust: Today, I opened the New York Times and I see that the nominee to run HHS [Department of Health and Human Services] is going to request that the polio vaccine be taken off the market. You’re the perfect person to ask about this. What’s your reaction to that?

Klass: I think that we have collectively forgotten and are in danger of really, really forgetting what suffering these diseases meant. How much pain, how much agony, how much misery, and say — I’m a pediatrician — even within our field, how they were dreaded not just by parents, but by pediatricians. And it’s almost like — and this has to be true of anybody who’s talking about taking away the vaccine — it’s almost like the name of the disease has no longer resonates for people.

Faust: I don’t think people know what the March of Dimes was really about. I don’t think that they really know what an iron lung is. Could you just tell people about those things?

Klass: So polio was a disease that was really dreaded in the ’20s, ’30s, ’40s, ’50s. I grew up with parents who had very clear memories of the summer polio epidemics. They grew up in Brooklyn, and what their memories included was not just the fear and the anxiety, but the truth that every year there were empty seats left in classrooms; that there were children who ended up — the iron lung was what was available to help a child breathe when a child got paralytic polio and the paralysis extended to the respiratory muscles — it didn’t have the technology or the ability to ventilate, so they would put the child in an iron lung, a sort of big metal cylinder, which would use positive and negative pressure to try to keep the child breathing.

But polio, that paralysis did not generally resolve. Children spent — some of them years and some of them their whole lives — in those iron lungs. I have heard stories in pediatric history of residents being asked to experience the iron lungs so that they would understand what was being asked of the children.

And you mentioned the March of Dimes because there was this huge campaign on the part of the public, on the part of parents, on the part of the charity. That was the March of Dimes, to raise the money for research. And it was originally done by asking people to send in dimes. And it was a huge example of the power of popular fundraising. But it was so popular because this was such a universal terror for parents every place in the country, every social class.

Faust: And zooming out your book, really the central thesis of the book is that sometime during the 20th century, something changed or enough changed that surviving childhood became the norm. And there’s a graph on page 294 of your book, which I’ve seen a million times, and it just shows the infant mortality rate from I think the 20th century up until recently. And you see that we started at a death rate of a 100/1,000, 10% of infants were dying. And then of course many didn’t survive childhood. Today it is 95% lower than that. How do we get there? Vaccines? What’s the secret sauce?

Klass: It’s a lot of things. And what I’m arguing in the book is that human beings, we get a lot of things wrong. We make a lot of messes. This might be the best thing that we ever did collectively as a species. If you go back through human history, you’re probably losing 30%, even 40% of the babies born alive don’t make it to the fifth birthday. You’re talking about infant mortality in the first year of life, but you’re not talking about who gets diarrhea at the time of weaning or who dies of the complications of measles at the age of 1 or 2 [years]. And those are ailments which were especially likely to hit you when you were [age] 1 or age 2, or who gets diphtheria or who gets polio.

So we are talking about all through human history, probably losing 30%, 40% of the children born, by the fifth birthday. So that means that every family, every city knew this grief. And look what we’ve done. I’m talking mostly about the part of it that we’ve seen in the last hundred, 150 years just because it’s so close.

If we go back 100 years to the 1920s and we think about, say, my grandmothers who were pregnant with my mother and my father, one out of every 10 babies born died by the first birthday. Nevermind the 2-year-olds and the 3-year-olds and the 4-year-olds. It means if you gathered a group of people around the table, even if they ranged from the poor to the rich and powerful, everyone would have lost a child, lost a sibling, seen this happen to neighbors, to friends. It was just part of being a parent. And it was obviously also part of being a pediatrician, because the polio epidemic would come or the infant diarrhea would come and there was nothing you could do.

Vaccines had a huge amount to do with this, but so did sanitation, so did public health measures, so did parent activism. There’s a lot of different pieces. I don’t want to think of it as one campaign, but we did it. We got to a place where if you have a child today, you can and you should be able to expect that, barring terrible and unexpected and very rare tragedies, you’re going to watch your child grow up.

Faust: It also changed the interaction between parents and children because, and this is something where you talk a lot about, you want to read to your children and you want to do other things that enrich them. But if you have so many kids, because half will die and there’s an emotional detachment, I think there’s an argument to be made that it didn’t just change the death rate, but it changed the kinds of lives kids have.

Klass: Well, it’s a really interesting question because one of the things you have to think about when you think about this topic is how did parents live with it? And I think one of the things that’s a little, that’s more than a little heartrending, is actually parents love their children, they bonded with their children. They grieved and mourned for those children who died. We have so many traces in history if we start looking for them.

And yet that was part of the deal. If you were going to be a parent, and I think I quote Charles Dickens to this effect, and many other writers said, this is part of being a parent. You know that there is this grief and you have to manage it. And many of the women are grieving while they’re pregnant again, and I can’t always understand how some of them managed and how they survived. I think they did love their children, but I think they loved them the way that you love somebody who you know is precarious.

Faust: Right, there’s a distance or there’s a bargaining that happens and it’s a thing that we don’t associate it today with childhood, we might associate that with how we deal with the end of life for loved ones. And I see that detachment.

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