Ten months after the COVID-19 pandemic abruptly changed our lives, a weary United States is seeing the long-awaited light at the end of the tunnel. Hundreds of thousands of deaths later, a vaccine is now within reach.
But history shows us that the development of an effective vaccine is not necessarily the end of the story. Making sure that the vaccine gets to everyone who needs it can be a long and complicated process.
In 1955, when the polio vaccine became widely available in the United States, it was the news the nation had been waiting for. The disease had taken the lives of thousands, and left thousands more with permanent paralysis. Children were particularly affected, but beyond that, polio did not discriminate. It affected all races and income levels equally.
“There were summertime epidemics every year,” said William Petri, MD, PhD, chief of the Division of Infectious Diseases and International Health at the University of Virginia. “In 1916, there were 2,000 deaths in New York City alone.”
When a vaccine was finally ready, the first flood of doses went out in 1955. As researchers had hoped, the number of polio cases dropped dramatically across the country.
But by 1958, there were reports of new polio cases arising in some parts of the nation—particularly in areas with a large Black population.
This clip from “ The Future of America’s Past” takes a look at where the U.S. polio immunization program went wrong:
Because there was no federal vaccine program, the first doses of the vaccine were paid for by charity organizations. After that, the responsibility fell to states and localities to handle the cost and distribution. Some states were able to distribute their doses more thoroughly than others, and some communities were overlooked completely.
“We still see this in parts of the world where polio has not been eradicated,” said Dr. Petri. “Political unrest in places like Afghanistan and Pakistan has made it difficult to reach every segment of the population.”
These pitfalls mean that even a widespread wave of relief can be followed by another surge of infections and deaths.
“Vaccines are only as good as their method of delivery,” said Jeffrey Donowitz, MD, a pediatric infectious disease specialist with Children’s Hospital of Richmond at VCU. “Lapses in coverage create an environment in which more cases can come up, even after the vaccine has had great success.”
Because of this painful lesson, the research community has made equitable distribution an important part of the conversation as the COVID-19 vaccine is developed.
“And not just equitable distribution, but also strategic distribution,” said Dr. Petri. “The first doses will need to go where they will have the greatest impact.”
For that reason, the Centers for Disease Control and Prevention (CDC) has recommended that the nation’s healthcare workers come to the front of the line for vaccines, along with residents of long-term care facilities. Both groups are at exceptional risk of exposure to the virus, and have suffered some of the highest death counts from it.
Along with logistical issues, skepticism of the vaccine’s safety or efficacy may present another roadblock. Sadly, that too may be a consequence of past mistakes: Distrust of the vaccine is particularly high in Black communities, where suspicion of the medical community has been fed by a horrific history and may have contributed to disproportionate suffering from COVID-19.
Whatever roadblocks arise, it will be a months-long process to get the vaccine distributed and begin our post-pandemic lives. In the meantime, there’s another lesson to be learned from the polio pandemic: Before the vaccine eventually stopped its spread, many families kept the virus at bay by following the advice of public health officials in their homes and their personal habits.
The complexities of this pandemic bring reasons for optimism and caution alike, according to Anthony Fauci, M.D., whose expertise in infectious disease has made him a household name this year.
“[The vaccine] is not going to do it alone,” he said in a recent NPR interview. “This should not be a signal to pull back on the public health measures that we must continue to implement.”