2023/01/01 by Naomi Rogers · 1 voice
Medicine · Social Sciences · #Historical Medical Research and Treatments #Vaccine Coverage and Hesitancy
paper · doi:10.5325/nursinghistory.31.0080
openalex publication_date 2023/01/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/03
In 1955 women with their children in strollers marched outside a city mayor’s office shouting “our children must be protected against polio” and denouncing city officials for not providing enough vaccinations.1 One year later a woman accused city officials of having “deliberately . . . maliciously, recklessly and forcibly” vaccinated her seven-year-old son in defiance of her written instructions and despite the boy’s protest that “my mother doesn’t want me to have this.”2 Clearly, the public had conflicting responses to the new Salk vaccine when it was first introduced in the United States in 1955. This article revisits the rollout of polio vaccination during the 1950s, arguing that the vaccine hesitancy and outright resistance to vaccination that we see today in the COVID pandemic are not new. And now, as was true then, public response is complicated by social injustice, community suspicion, and confusing public health messaging.In April 1954 the March of Dimes, America’s largest disease philanthropy, organized the Salk Vaccine Clinical Trial to combat the dreaded polio epidemics that had plagued the United States since the early 1900s. The Salk Vaccine Trial, the largest clinical trial in history, was a massive operation that included millions of children as well as their parents and teachers. Using public schools as vaccination sites, doctors and nurses injected second-grade children with either the Salk vaccine or a placebo, kept careful records to ensure confidentiality, and sent those records for analysis to virologist Thomas Francis at the University of Michigan. During the next few months this process was repeated twice more, so that every child in the trial received three spaced injections.3 In April 1955 Francis announced that the Salk vaccine was both safe and effective. In America and around the world parents rejoiced that the threat of polio was over.Not everyone was thrilled with the prospect of the vaccine, however. The rollout of the polio vaccination process was bumpy, and arguments by anti-vaccinationists strengthened public skepticism during the trial period and later as the vaccine was distributed in public schools, doctors’ offices, and health departments. The confusing and conflicted public response reflected Cold War health politics and the emerging civil rights movement, as well as the powerful role of the March of Dimes, racial segregation in health care, and the inequities resulting from the fee-for-service medical system. Despite a widespread admiration for scientists like Jonas Salk, some Americans remained skeptical of public health officials’ expertise.Throughout its history, the March of Dimes had consistently sought to ensure the good will of the public by not challenging the structure of the medical institutions on which it relied. The organization focused on raising funds for its campaign against polio. These funds were used to train doctors, nurses, and physical therapists in the latest polio techniques, as well as in the care of patients paralyzed by polio.Since its inception in 1938, the March of Dimes had based its strategies for dealing with racial segregation in medical practice on the model of the New Deal programs used by President Franklin Roosevelt’s administration. In expanding America’s social welfare network, the Roosevelt administration had deferred to powerful Southern Democrats by allowing local “customs” to prevail in the implementation of new federally funded services. As a result, hospitals, doctors’ offices, and health departments continued to offer racially segregated medical care.4 Thus, when the March of Dimes was unable to overturn the policy of segregation at Warm Springs (the nation’s leading center for polio rehabilitation), it opened a separate, small polio hospital at the Tuskegee Institute for African American patients and health professionals.5 Later, the March of Dimes hired African American educator Charles Bynum in 1944 as its first “interracial” official to direct fundraising efforts to middle-class Black communities. After World War II, the organization featured African American children as part of its poster child campaign but without depicting Black and White children together.6The March of Dimes polio poster campaign in the 1950s reflected the racial separatism of medical care that was typical in mid-twentieth-century America, adhering to the widespread acceptance of “separate but equal” despite growing protests by civil rights activists.7 These policies allowed the March of Dimes to work cooperatively with hospitals, state agencies, and civic groups around the country and to entice conservative leaders of businesses and professional groups to become members of the March of Dimes’ local and state chapters.The 1954 vaccine trial was set up on the basis of racial separatism. Using schools as its point of contact with children, including the many schools that were segregated by race, the March of Dimes made sure that African American children participated in the trial either by bringing the vaccine to their separate schools or by bussing them to a White school to receive the vaccine. During the trial Black physicians and nurses gave vaccinations in segregated clinics and meeting halls. March of Dimes officials extolled the opportunity for African American children to become “Polio Pioneers” as a sign of the trial’s race-neutral achievements. However, in May 1954 the Supreme Court’s decision in Brown v. Board of Education made the public aware of the damaging effect of racism in elementary schools. Photographs of children of color being vaccinated on the lawns of White schools but forbidden to use the schools’ restrooms or even to enter the schools through the same door as a White child were now disturbing, not neutral.8 The public began to question why the March of Dimes’ trial had been organized in these starkly inequitable spaces.The March of Dimes defended the central role of public health doctors and nurses during the vaccination rollout as a critical sign of support for the nation’s commitment to test and then deliver this new, longed-for weapon against polio. Until this time the March of Dimes had largely avoided fights with physicians and the American Medical Association (AMA). In fact, during the 1930s and 1940s Basil O’Connor, director of the March of Dimes, had lobbied extensively against federal funding for polio research as “a Communist, un-American scheme,” and his conservative attitude had suited AMA leaders similarly suspicious of Democratic proposals for federal health programs that might undermine private practice.9By the mid-1950s many medical societies saw providing vaccinations at public schools and public clinics instead of in doctors’ offices as a “dangerous precedent.” They used language drawn from the AMA’s massive campaign against what it called “socialized medicine,” a campaign that had soundly defeated Truman’s national health insurance plan a few years earlier.10 Republican physicians, aware that O’Connor had been part of Franklin Roosevelt’s inner circle since the 1920s, were also unhappy with what they believed was O’Connor’s deliberate choice of the ten-year anniversary of Roosevelt’s death to announce the Salk vaccine trial results.11 After the federal government licensed the Salk vaccine and the March of Dimes began to provide millions of free vaccine doses for elementary school children, physicians grew fearful that the public would begin to rely on a free vaccination program that would exclude the family doctor and America’s fee-for-service medical system. Pressured by medical societies and the AMA, President Eisenhower and a number of congressmen reiterated their support for the private doctor’s role in any vaccination program.12 After the trial, Hart Van Riper, the March of Dimes medical director, acknowledged that methods of distributing the vaccine “must be settled at the local level” and that even the immunization of “medically indigent” patients was “entirely a local problem to be solved administratively in terms of customs, tradition, and practice in the community.” He hoped that physicians would cooperate “in developing and carrying out local programs of vaccination,” arguing that this was “a medical emergency” and not “a precedent for the future practice of medicine.” He also assured physicians that once the majority of America’s children were vaccinated in this initial campaign, they would receive the polio vaccine as part of their routine pediatric care.13Along with immunizations against smallpox, diphtheria, whooping cough, and tetanus, American physicians began to offer polio vaccinations in their private offices.14 But soon glaring gaps in the nation’s medical system became visible due to the extensive mobility of American families in the decades after the war. America’s scattershot system of medical records led one nurse, a major in the Army Nurses Corps, to complain in a letter to the American Journal of Nursing. She explained that a mother had brought her children to the clinic for vaccinations, saying that the two-year-old was supposed to have his second polio shot and the six-year-old a DPT booster. Her toddler had supposedly had his first polio shot and a couple of DPT shots at a civilian doctor’s office in California. Her daughter had been immunized at a military base where the family had lived for a while and later had three polio shots from a civilian doctor. No one had given the mother any records.15 Children whose families were migrant workers posed an even greater challenge. Herbert Hill, the NAACP’s labor secretary, urged Oveta Culp Hobby, President Eisenhower’s Secretary of Health, Education and Welfare (HEW), to intervene so that children of the thousands of migrant farm workers—many of them “colored”—would be able to have access to polio vaccination. The federal government, Hill argued, must make sure that “the nation’s forgotten children” were offered the same medical care that America’s suburban children were given.16 Hobby, however, believed that most federal medical programs would bring socialism through “the back door.”17Officials were surprised when a number of communities declined the opportunity to participate in the trials and have their schoolchildren become “Polio Pioneers.” Social scientists conducted a series of investigations to try to explain the reasons for this visible group of the “unvaccinated.” During the vaccine trial Thomas Francis requested a special survey of a sample of communities that had been offered the placebo vaccine. After interviewing 11,200 families—including 381 who had refused to participate—the researchers found that the non-participants’ children were less likely to have received regular smallpox, diphtheria, and whooping cough shots; lived in less well-kept homes in poorer neighborhoods; had mothers who were more likely to have left high school without graduating; and had lower family incomes.18 These entangled factors of economic inequity and unequal access to medical care continued to haunt polio vaccination campaigns into the 1960s.One clear reason for families’ reluctance to participate in the trials was the shocking announcement by radio commentator Walter Winchell in April 1954. The polio vaccine “may be a killer,” Winchell declared dramatically, noting that some batches of the Salk vaccine contained evidence of the live polio virus. His claim led to the withdrawal from the trial of an estimated 150,000 children.19 Two sociologists from the National Institute of Mental Health and a psychologist employed at the March of Dimes Public Education Department conducted a study of mothers in one Virginia county who refused permission for their second-grade children to be part of the trial. In this study the researchers found that many parents had ignored counterarguments by the local health officer, the head of the medical society, and editorials in major newspapers. Even before Winchell’s report was aired, four surrounding communities had already refused to participate in the trials; after the broadcast another city and a nearby county also refused. In the Virginia county under study, two-thirds of eligible children from two rural schools and three urban schools (one a “Negro” school) did agree to participate. The 74 (out of 175) non-consenting mothers explained their refusal based on the physical condition of the child, their belief that the shots were unsafe, their opposition to “experimentation,” their awareness of controversy over the program, and the lack of proof of the vaccine’s effectiveness. Consenting mothers were more likely to have completed high school and some amount of college (32 percent and 47 percent) than the non-consenting mothers (25 percent and 27 percent). The non-consenting mothers were also more likely to have relied on radio and television broadcasts than on newspaper articles for information and were less likely to have consulted a physician. The researchers suggested that county officials might have mitigated these responses if they had described the trial as “a frankly experimental program aimed at preventing disease.” While the researchers acknowledged that suggesting the trial involved “trying something out without promising whether it will work” could “cause distrust, particularly among those unfamiliar with the scientific method,” they nonetheless believed that a frank discussion of the trial’s complex nature “in terms of the experience of the participants” could help achieve “conviction which will withstand emotional attacks.”20Hart van Riper vigorously rejected this argument. To say that “science is infallible” and “that nothing new should be clinically tried before it is 100 per cent fool-proof,” he protested, was more damaging “to scientific progress and human welfare than occasional, though tragic and regrettable, errors.” He acknowledged well-known examples of “mistakes”—a word he placed in quotation marks—such as the deaths of infants given a contaminated BCG anti-tuberculosis vaccine in Lubeck, Germany, in the early 1930s and the large hepatitis epidemic caused by a contaminated 17D vaccine against yellow fever given to U.S. Army troops in 1942. “Viewed in retrospect,” he argued, such “mistakes” did not “discourage progress toward the prevention of disease.”21Polio scientists and health officials should have been less surprised by this public skepticism. In the early 1950s vocal anti-vaccinationists such as Duon Miller, a cosmetics manufacturer based in Coral Gables, Florida, had written to Basil O’Connor, Jonas Salk, and other prominent officials warning them that “thousands of little white coffins will be used to bury victims of Salk’s heinous and fraudulent vaccine.”22 In his 1954 radio announcement Winchell had used, without attribution, Miller’s phrase “little white coffins.”23 Miller’s pamphlet Double Polio Challenge challenged the March of Dimes to compare the skills of its professionals with two chiropractors to show who could treat polio paralysis more effectively. He also offered to be a human guinea pig by injecting blood from a new polio patient into his veins. The children who were participating in the 1954 trial, he warned, would have “their life’s blood polluted with Dr. Salk’s fraudulent vaccine” for “all vaccines against all diseases have always left in their path Death and ill health.” Polio, he was convinced, was not a viral disease but a sign of poor nutrition: it only affected children who were fed candy and soft drinks.24 A wider anti-vaccine movement expanded these arguments, describing the “serum trust” which had forced President Eisenhower to tell everyone to get three polio shots and Britain’s Queen Elizabeth to agree to have “her two children’s health interfered with by polio shots—amid a fanfare of press and radio hokum.”25 Anti-vaccinationists were part of a broader anti-science movement which included criticism of the efforts to introduce fluoridation into public water supplies. Members of Congress heard their testimony in various hearings throughout the 1950s warning that fluoride was a dangerous poison and that fluoridation was only the first step in the expansion of government control over an individual’s life which would lead to socialism or totalitarianism.26In July 1955, Hobby had to resign her position as HEW Secretary. As a staunch critic of government intervention in medicine, Hobby, in early May, had awkwardly defended the federal government’s inability to alleviate the nation’s shortage of vaccines, telling a Senate committee “no one could have foreseen the public demand” for the vaccine.27 Far more devastating to her position was her tepid response to the serious crisis caused by contaminated batches of the Salk vaccine produced by the Cutter Laboratories in Berkeley, California, which led to paralysis in seventy-nine children and one hundred and five of their friends and family members, as well as eleven deaths. The repercussions of this contamination were great. In May 1955 the Surgeon-General briefly halted the entire vaccination program and then resumed it only after receiving clear assurances from senior polio virologists. The National Institute of Health took charge of vaccine testing and the March of Dimes was blamed for its inadequate supervision of vaccine production. Albert Sabin, a virologist who had been developing a live-virus oral vaccine, was featured on the cover of Time with the headline “Next: Live Vaccine.”28The Cutter incident clearly contributed to public sympathy for anti-vaccination arguments. African American were to get vaccinated Charles Bynum with in children and mothers are not of the Salk In the of epidemic polio in of the were African In Americans under were not including some health The of the American Journal of that are not to polio we are nurses, and are workers and was urged to the members of her family and her friends to have these The a Black that vaccination reluctance was the of “the that communities when polio epidemics on the as well as “the polio the of children, the schools and . . . polio and problem of the polio was when the federal government licensed oral vaccine in A vaccine that could be in a instead of by was more to the public and less health In the of health officials used the oral vaccine to an epidemic in New the help of local doctors, nurses, and around a community they offered the vaccine in hospitals, doctors’ offices, and at charge to the set up clinics at public schools and that two nurses and to could two hundred and an Thus, in one they four hundred anti-vaccinationists did not with the widespread use of the oral vaccine, the powerful of the and health officials to that other members of the community were protected from polio even if they had not been The broader around the health care system and its inability to poor and the and of the Salk and vaccine with are only with the campaign of the COVID to and for their help in and out and to and for their and