I’ve been using the Chirp App for listening to the Recorded Book called Polio: An American Story by David M. Oshinsky (1). This author has been triggering my thoughts about the experience of working in biomedical research. These thoughts have been about a new understanding of how investment in research has changed from private philanthropy grants to, as for my personal experience, government grants. I also have been reminded of the many ethics questions related to research in animals and humans, and how this changed over the 20th century. Finally, what I’d like to cover in this blog, the interesting complexities of public relations about major research efforts.
Oshinsky does a great job of developing the story of the development of a polio vaccine to the point of nearly eradicating this disease throughout the world (2). He won a Pulitzer Prize for this book, Polio: An American Story (3), and many of his other works have been duly noted as New York Times Notable Book winners (1). I was struck by his tale of the announcement about the largest public health study ever done funded at $17.5 million (4) that proved the effectiveness of the Salk-developed “killed-virus” vaccine. Issues addressed were i.) the approach of Thomas Francis, the principal investigator of the human vaccine study, in making the announcement about the study leaving many questions; ii.) how Jonas Salk followed up that presentation slighting both Francis and his own laboratory staff; iii.) the reactions of his competition – primarily Albert Sabin, advocate for a
“live-virus” vaccine; and iv.) the reactions of the scientific community to the announcement and the man behind it – the newest superhero scientist. I’ll follow a discussion of each of these issues with some thoughts I have about public relations campaigns…not that I’m an expert but this experience is certainly instructive.
After obtaining approval from a panel of virology experts on a vaccine advisory committee, and fighting against publicity that warned of the dangers of participating, Thomas Francis from the University of Michigan completed the first and still largest double blind national clinical trial including 1.8 million people which included 650,000 children who received a “Salk vaccine” or a placebo vaccine between April and June of 1954, and 1.2 million who received nothing and served as control for both treatments. Francis ran the trial with great attention to detail, as well as secrecy, even keeping the results from Salk and the study funding agency, the March of Dimes. A year after the trial began – on the same day that Franklin Roosevelt had died in 1945, April 12, Francis’ 98 minute announcement that made it clear that the vaccine was 60-70% effective against the cause of most parasitic polio myelitis – Type 1 (1). Press releases were more bold, stating the studies proved 80-90% effective (6) apparently focusing on the less troublesome strains of the virus – Types 2 and 3. This left many questions about the work, but clearly showed a way to change the number of people infected with a dreaded disease.
The Jonas Salk Follow Up
Standing up after the announcement, Jonas Salk began to laud the outstanding work of Thomas Francis, and then Harry Weaver, director of research for the March of Dimes, scientists at Connaught Laboratories who were one of the central producers of the vaccine, Tom Rivers and the vaccine advisory committee, the March of Dimes and Basil O’Connor, people of the D.T. Watson Home and the Polk School, and various deans and trustees from the University of Pittsburgh where Jonas Salk had his appointment. He failed to recognize the people in his own lab as he had done with papers and other opportunities to recognize his laboratory in the past, and this would come back to haunt him the rest of his career.
He then belittled the current results by saying that he had a new better vaccine than the one just tested. He stressed two ways the vaccine could be improved, which, though answering questions about the 60-70% effectiveness of the current vaccine, would be seen by Francis as insulting. Salk boosted that his methods may lead to 100% protection against all forms of the virus. Tom Rivers who had risked his career to gain approval of the vaccine study, was also angry at Salk for undermining the results of the study, and for failing to give Francis the kudos he deserved for the superbly run vaccine trial of an unprecedented scale.
Nonetheless, the news came out that the Salk vaccine was “safe, effective and potent”. The message that the March of Dimes certainly wanted in full press.
Albert Sabine’s Reaction
Albert Sabine was a member of the polio vaccine advisory committee who had to approve the protocol for the study to prove the effectiveness of the Salk vaccine, and also was a competitor of Salk, as Sabine was developing a live polio vaccine, and would eventually in 1961 obtain approval for this vaccine six years after the Salk vaccine started to be used for vaccinations in the U.S.A. and around the world.(5) Sabine struggled to sign the approval of the vaccine for licensing by the new Federal Department of Health, Education and Welfare – he could do nothing else than sign it or be seen as an obstructionist.(1)
Scientific Community’s Reaction
Jonas Salk had been struggling for recognition in the scientific community, having staked his career with a position at the University of Pittsburgh, he was not seen as being at a highly respected institution. The announcement did not help his reputation, because scientists frown on publicity before peer review. The scientific community considered this hyping the work, and certainly many were probably jealous of the recognition now given to Salk, when, from their perspective, he hadn’t done anything to deserve it. In fact, supporting this argument was Salk’s own effort to convince patent attorneys representing both the University of Pittsburgh and the March of Dimes that the Salk vaccine could not be patented because it represented only based on prior work, disclaiming any novelty.(1) Even today, scientists prefer peer review prior to publicity, even when, as in the case of this polio vaccine trial result announcement, it is not possible to wait the months for such reviews to be completed.
Some Thoughts About Public Relations Campaigns
Competition, status and prestige are an important part of being an academic, men and women who would not have gotten into these high visibility jobs without their drive to succeed in each step in their careers. Of course many are exceptionally good with the detail necessary to complete complex laboratory and clinical studies, and others are exceptionally good with the administrative logistics needed to organize, fund and promote large national research projects, but drive is probably the most important skill among those academics that achieve the pinnacle of their profession as did Francis, Salk and Sabine.
My approach to an announcement of this scope and importance would have been more collaborative and communicative. Where Francis kept quiet to the point of making an announcement that even Salk did not know before the announcement, as public relations lead, I would have insisted that Francis and Salk coordinate their pieces of the announcement. I would have Francis and Salk discuss, with me, the best way to make their presentations before getting in front of the public where it will be impossible to change the perceptions they create. For public relations impact, I would assure the announcement objective of positive perception about the trial, without inaccuracy. Also the more collaboration participants who were included in the discussion about the announcement, the better for ensuring the best outcome.
As for the reputation with the scientific community, I would attempt to have a paper in submission after being reviewed by the Vaccine Study Advisory Committee Chair before the announcement, having addressed all the concerns in preparation of the paper. Possibly, I would have the paper approved prior to the announcement, though I would try to do this in parallel to completing the necessary work to license the vaccine and scale up production for distribution.
This blog has been about only a portion of this book that stimulated some of my thinking, and other important information provided by Oshinsky in Polio is worth talking about in a separate blog including the evolution of ethics and protocol in clinical research, and Federal support of nationally-important vaccine distribution such as Polio, as a great learning opportunity for the upcoming COVID-19 vaccine. Look for these blogs in the future.
- “Recorded Books – Polio.” Accessed May 29, 2020. https://www.recordedbooks.com/title-details/9781428129856.
- “Polio Rates Over Time – WorldAtlas.Com.” Accessed May 29, 2020. https://www.worldatlas.com/articles/polio-rates-over-time.html.
- Klein, Christopher. “8 Things You May Not Know About Jonas Salk and the Polio Vaccine.” HISTORY. Accessed May 29, 2020. https://www.history.com/news/8-things-you-may-not-know-about-jonas-salk-and-the-polio-vaccine.
- “Thomas Francis Jr.” In Wikipedia, April 9, 2020. https://en.wikipedia.org/w/index.php?title=Thomas_Francis_Jr.&oldid=949888373.
- “U-M School of Public Health Polio Vaccine.” Accessed May 29, 2020. https://sph.umich.edu/polio/.
- “Polio Vaccine.” In Wikipedia, May 28, 2020. https://en.wikipedia.org/w/index.php?title=Polio_vaccine&oldid=959418631.