Hektoen International

A Journal of Medical Humanities

The history of polio and cigarettes, and the need for a COVID-19 vaccine mandate

Daniel Gelfman
Indianapolis, Indiana, United States

Polio Vaccine and Fundraising Matchbook. Photograph at the Science History Institute, Philadelphia. Photo Credit: Daniel Gelfman, July 3, 2021.

Depicted in this display (Picture 1) at the Science History Institute in Philadelphia are technologic marvels. The first is a box that contained early vials of Dr. Salk’s formalin inactive polio vaccine (with supplementary irradiation). The second is a matchbook, originally invented in the 1890s, that made another technologic marvel easy to use: the machine-rolled cigarette. The matchbook was used to promote donations to the March of Dimes to fund research in testing the Salk polio vaccine in 1954. Matchbooks were commonly used in advertising, and it is not surprising that they would have been used in the 1950s to promote health-related research. These products of technology have many similarities and their histories have an important message that is relevant today.

Before the introduction of immunization in 1955, poliomyelitis was feared by parents as it indiscriminately caused paralysis and death of otherwise healthy children. The March of Dimes was founded in 1938. It was originally called the National Foundation for Infantile Paralysis (poliomyelitis) and was founded by President Franklin D. Roosevelt, who was himself thought to have been a victim of polio. FDR tasked his former law partner and philanthropic friend Basil O’Connor with the position of president of this non-profit organization. O’Connor developed a new nationwide program that encouraged donations as small as a dime, coupled with local membership. The program was vastly successful and raised millions of dollars. It was clear that vaccination was needed to stop this disease. Both Drs. Salk and Sabin received research grants from the March of Dimes.1

The dangers of smoking were first recognized in the 1950s but were not taken seriously by most, as cigarette smoking was still considered glamorous. It required decades to change this image, even after the original Surgeon General’s warning in 1964. Per capita cigarette use did not start to decline until 1975. With an additional warning from the Surgeon General in 1986 concerning the dangers of secondhand smoke, followed by bans on smoking in most public places by 2012, cigarette use in the US has fallen to a current low of about 14%, down from 47% of adults in 1953.2

Surprisingly, there were significant delays with vaccinating the public against polio in the US. Production, testing, and, most importantly, inoculation with this vaccine was difficult. Approximately 1,500 monkeys were required to produce 1,000,000 Salk vaccines.3 Public support for the Salk vaccine was significant, with hundreds of thousands of parents allowing their children to be participants in clinical trials. They were called polio pioneers. Once the vaccine was declared “safe, effective, and potent,” there was a rush to have children immunized. Public support for the Salk vaccine remained high, even in the face of one early production facility, Cutter Laboratories, improperly inactivating the vaccine, resulting in 260 cases of polio and ten deaths. (This explains why the pictured Salk vaccines had the additional unnecessary step of using supplementary irradiation.)

Rates of polio immunization were initially high and cases of polio plummeted in 1956 and 1957 in the US, but then started to rise in 1958 with over 1,000,000 doses of vaccine unused that year and, according to the CDC, only half of the country’s 24,000,000 children under age six fully immunized.4 Although immunization did finally increase and polio cases declined by 1961,3 it was not until about 1980 that polio was eradicated in the US, although it was still possible to be brought in from other countries. What is significant about 1980 was that this was the same time that all states had enacted and enforced vaccine mandate laws necessitating polio vaccination for children to enter school.

It is of interest that both the development of the polio vaccine and the recognition of the health risk from smoking were discovered at about the same time, in the 1950s, and that the full benefit of this knowledge was much slower to realize than one would have expected. It is both understandable (fear of vaccination and, unfortunately, apathy5) and yet difficult to explain why it took so long to vaccinate enough people in the US to eradicate poliomyelitis. It required public education coupled with state mandates that resulted in significant non-criminal consequences. Persistent cigarette use is more understandable. Smoking offers something many find relaxing, helpful for weight loss, and extremely addictive, which for some decreases their concern of the health risks from smoking to oneself and the loved ones around them. Changing behavior to markedly decrease smoking required public education concerning the dangers of smoking and of secondhand smoke. It also required mandated limitations on where smoking was allowed, which made it difficult to smoke in public places.

The objects in this showcase remind us of the history of modern technology with its potential benefits and dangers. They also remind us that even when it is known what products of technology we should and should not utilize for our own good, human behavior is hard to change. Today this is most recognizable in the hesitance to obtain necessary COVID-19 vaccination. With the highly infectious variants and the lower number of vaccinated younger individuals, we are again seeing hospital beds fill with younger patients as happened during the reign of polio. It is up to all of us to encourage, by example and with gentle persuasion, the use of health-promoting products of modern technology and discourage, in the same fashion, those that are dangerous. But if we really want to be successful in changing behavior and getting most of the population vaccinated, we need to look at what history has shown is necessary to accomplish this. History has demonstrated the necessity of mandates that make not following consensus recommendations inconvenient and tiresome.


  1. A history of the March of Dimes. Accessed August 11, 2021. https://www.marchofdimes.org/mission/a-history-of-the-march-of-dimes.aspx
  2. Cummings KM, Proctor RN. The Changing Public Image of Smoking in the United States: 1964–2014. Cancer Epidemiol Prev Biomark. 2014;23(1):32-36. doi:10.1158/1055-9965.EPI-13-0798
  3. Baicus A. History of polio vaccination. World J Virol. 2012;1(4):108-114. doi:10.5501/wjv.v1.i4.108
  4. Paralytic Polio Rises; More Than Half of Population Is Still Unvaccinated. Accessed August 9, 2021. http://timesmachine.nytimes.com/timesmachine/1959/03/01/91417883.html
  5. Rise in Paralytic Polio Tied to Public Apathy. Accessed August 9, 2021. http://timesmachine.nytimes.com/timesmachine/1959/03/13/80765732.html

DANIEL GELFMAN, MD, FACC, FACP, is a Clinical Professor Emeritus of Medicine (Cardiology) at The Marian University College of Osteopathic Medicine. He remains active teaching clinical medicine, working as a volunteer physician, and pursuing scholarly activities at Marian University. His research interests currently include developing effective teaching methods and combining the humanities with medicine. Recent publications include, “The David Sign,” published in JAMA Cardiology, and “The importance of ‘The David Sign,’” published in Hektoen International, which reveal and discuss previously unrecognized illustrations of cardiovascular physiology in Michelangelo’s sculptures.

Summer 2021



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