As many of you know, I am a community health nurse. I started my nursing career working on a post-operative care unit at a community hospital, but I was always more interested in the communities my patients came from, the homes they were going back to after discharge, and the impact of their environment on their recovery.
After three years in an acute-care hospital, I chose to study community health when I went back for a master’s degree. At the time, I believed, and still do, that the future of health care was going to be in the community.
In my master’s program, I was assigned a book to read about the polio epidemic in the United States, which started at the very end of the 1800s and continued through the first half of the 20th century. The story was a compelling one for me because, as the youngest of four children, my mother shared stories of children in the age groups of my older siblings she had heard about whom were stricken with this terrible disease. For parents living through that frightening epidemic, not knowing what the cause of the disease was, how it was spread, and if their child would be the next one who would contract this disease must have been harrowing. In 1916, there was a significant polio outbreak in New York City which spread to the adjacent states and resulted in significant death and disability of which the majority of those affected were under five years of age.
As with many crises, we somehow figured out ways to come together to improve our society. Out of this epidemic came the creation of the March of Dimes (originally called the National Foundation for Infantile Paralysis) which provided support for children with polio and their families. It was also a time of significant scientific breakthroughs. Even though there was so much the scientists didn’t know, it was through science and experimentation that our country made significant strides against the polio virus. Dr. Jonathan Salk created the first vaccine from the “killed” polio virus and began clinical trials with monkeys in 1949; by 1954, 1.3 million children had received the Salk polio vaccine. The Sabin vaccine was also developed, this time with “live” polio virus, which was administered to over 10 million children in Russia. Between 1956 and 1958, the number of polio cases worldwide decreased more than 75%. Polio still exists today but only in three countries (Pakistan, Afghanistan, and Nigeria). In 2017, the total number of cases was 22.
I have been thinking about that book on the polio epidemic for many months now because when I read it, I never thought I would be living through a similar experience. In the early days of COVID-19, we knew very little about how the virus was transmitted, what it would take to reduce the spread, and who was most vulnerable. Unlike polio which affected mostly children, we learned this virus targeted the elderly and those with pre-existing conditions far too late to protect our nursing home residents and the elderly in our communities. At the beginning of the pandemic, we were told masks were not necessary but soon realized the importance of face-covering to reduce the spread. Handwashing, social distancing, and wearing a mask became routine parts of everyday living.
And now we are facing another serious public health decision point. As the vaccines for COVID-19 enter the market, will there be sufficient trust in their safety and efficacy so the public takes them? A safe and effective vaccine will have the biggest impact of all the prevention measures we are currently using to minimize the number of new cases. I suspect those parents who were asked to join the millions of people immunizing their children against polio more than 60 years ago felt that same level of anxiety that we are feeling now.
There is a TV commercial that says something like the way back to normal is through science. I continue to have faith in our scientific infrastructure as it examines the development and testing of vaccines through clinical trials. Every one of these trials has an independent, non-governmental Data Safety Monitoring Board (DSMB) which is charged with reviewing the safety data and making a determination about whether the trial continues on or is halted. Currently, the DSMB is the only body that has access to the trial data. Once these trials are complete, or the DSMB is satisfied with the safety and efficacy data, the FDA will have to approve the vaccine for use in the general population. Vaccine manufacturers can apply for an emergency use authorization, but the FDA has signaled they will have certain restrictions in place for obtaining this type of authorization.
So for me, the jury is still out. I will continue to watch the science and the scientists to make my own determination of how safe and effective the vaccine is. I will watch how the FDA takes on the application process for these vaccine manufacturers and I will listen to scientists I trust, like Dr. Fauci, to point me in the right direction with regard to this vaccine. I believe in the importance of vaccines and I have seen the changes in the world’s population for those diseases for which we have a vaccine and for those diseases in which we don’t. Just look at the world prevalence (number of existing cases) of HIV (38 million) compared with that of polio (22). I believe in the power of science to get us back to a more normal life. I hope you join me in this critical analysis as we each make our own decision about vaccination.