In response to the backlash that erupted after his mandate of the cervical cancer vaccine Gardasil last month, Gov. Rick Perry compared it to another vaccine.
"I look at this no different than vaccinating our children for polio," he said.
David Oshinsky, chair of UT's history department, disagrees with the governor.
"It was very different," said Oshinsky, who won the 2006 Pultizer Prize in history for his book on the American polio epidemic.
The comparison between the two vaccines stems from Perry's recent mandate, which states that all Texas girls ages 11 to 12 who are entering the sixth-grade must be inoculated against the human papillomavirus, a sexually transmitted disease that can cause cervical cancer. The mandate would go into effect September 2008.
Though several parallels can be seen between the polio vaccine's emergence and today's situation surrounding the HPV vaccine, Oshinsky said there is really only one reason Perry would compare the two - polio's success.
"It was this enormous national effort that saved millions of children from death or paralysis," he said. "I think they keep bringing it up, because polio is the great success story."
Deadly diseases
Poliomyelitis is a virally induced infectious disease that spreads into the body through the bloodstream and into the central nervous system. Early symptoms are described as flu-like - aching sensations, fatigue and fever - but the ultimate effects include muscle weakness and often paralysis.
In the early 20th century, the U.S. experienced a dramatic increase in polio cases, striking young children and throwing the country into a panic. The first major epidemic was documented in 1916, and the worst one would occur 36 years later, marked by more than 57,000 documented polio cases in one year. Oshinsky's book, "Polio: An American Story," chronicles the nationwide frenzy about the disease and the efforts to find a successful vaccine.
Between 1952 and 1955, scientist Jonas Salk and his team developed a potentially safe injectable vaccine against polio and tested it. The trials were the largest in U.S. history, involving an estimated 1.8 million children.
"There had been some human testing, though informed consent was not what it is today," Oshinsky said. "Mostly testing in orphanages, mental hospitals, places like that."
The amount of testing that was conducted for the HPV vaccine is a major issue among critics of Perry's mandate. The Centers for Disease Control and Prevention reports that Merck and Co., the pharmaceutical company that produces Gardasil, performed testing on the vaccine for five years before it was legalized. Gardasil was tested in various countries, including the U.S., on more than 11,000 females between the ages of 9 and 26. Reports show the vaccine is safe and has no serious side effects.
Joy Penticuff, a UT nursing professor, said the short amount of time allowed for testing Gardasil leaves much room for doubt.
"The question remains about two things. One, what are the possible long-term effects, which have not been studied? And two, will the vaccine actually maintain a person's immunity over a period of time?" she said. "They just don't know."
The polio vaccine administered today is not Salk's discovery, but that of Albert Sabin, Salk's competitor, according to Oshinsky's book. While Salk's vaccine used a form of the killed polio virus, Sabin used a weakened form of the live virus, resulting in a stronger vaccine. He began testing on his version of the polio vaccine in 1957, at first in other countries that included the Soviet Union and Eastern Europe before testing a strain in the U.S. The vaccine was licensed in 1962 and quickly became the vaccine of choice because of its cheaper cost and because it was taken by swallowing, not in an injection.
Merck's HPV vaccine Gardasil, on the other hand, is known as a prophylactic vaccine, made from non-infectious HPV-like particles taken from the outer coat of the virus.
Human papillomavirus infection is the most common sexually transmitted infection in the U.S., infecting roughly 6.2 million people a year, according to the Center for Disease Control and Prevention. It can cause genital warts as well as warts in the upper respiratory tract. Most HPV infections don't have symptoms and are resolved without treatment, but about 10 percent of women with HPV will develop a persistent HPV infection, and every year an estimated 10,000 women get cervical cancer as a result of the virus. Of those 10,000, about 3,700 die from it.
"Cervical cancer is not on the radar in the way polio was," Oshinsky said. "There's this similar sense that you have this vaccine that can prevent a terrible disease, but that's about it."
'A crisis point'
Perry's HPV vaccine mandate calls up questions of parents' rights to make decisions for their children, a far cry from parental reactions to Salk's polio vaccine in 1952. A mandate was unnecessary then, said Oshinsky, because the government had little to do but sit back and watch the volunteers spill in by the thousands.
"People were not sure what the outcome would be, but I think it speaks for just how afraid of this disease they were that they were willing to risk their children," he said.
Salk's celebrated polio vaccine was licensed in 1955 and was not immediately required by any state, while Perry mandated Gardasil eight months after it was legalized.
"There were children getting polio all around the country. You could see the impact of polio in the way the whole nation was united in the attempt to develop a vaccine," Penticuff said. "With [Gardasil], it's quite a while before a young girl would develop into a young woman or a middle-aged woman and run the risk of cervical cancer."
Today, polio spreads particularly in large and densely packed populations with poor sanitation and even poorer records of routine immunization. In 1998, when the World Health Assembly voted to eradicate polio by 2005, 50 countries were polio-endemic. Today, only four remain: India, Nigeria, Pakistan and Afghanistan. The wild polio virus has long been eliminated in the U.S., largely thanks to Sabin's vaccine. However, a lingering effect of the success of this vaccine is the growing public doubt about the need for vaccinations in general.
"We're reaching a crisis point with vaccines in this country," Oshinsky said. "There's a growing sense that vaccines are more dangerous than they are helpful."
UT social work professor Cynthia Franklin confirms the idea.
"There are all these claims that vaccines have caused all kinds of problems, from mental health illness to autism," Franklin said. "There are all kinds of individual thinkers, all kinds of different beliefs."
Oshinsky credited this sense to the fact that because the vaccines have worked so well, people are unaware of what they are being protected from.
"Some people don't even remember what polio is," he said. "They should remember. We all should remember."
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jeffrey.dorfman@uct.ac.za