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rsenal Elementary School’s gym was set up with three tables and several medical workers standing behind them that February morning. About 20 newspaper reporters, two news photographers and a TV video cameraman hovered in the background.

Dr. Jonas Salk prepares to draw blood from Arthur Donahoo of Washington, Pa., as part of the polio vaccine testing in the early 1950s. (Post-Gazette Archives)

Second- and third- graders filed up to the tables, first-graders trailing behind. At one table, a wide-eyed boy offered his arm. A doctor and a nurse, both women, spoke soothingly as they found a vein, took blood from his arm, then injected him with a red liquid. He didn’t shed a tear or make a sound.

Then, giggling with relief, he pressed a wad of cotton to the spot where the needle had pierced his arm and walked to a screened-off recovery area.

 Most of the older children kept quiet when their turns at the tables came. But some of the first graders began to shriek when they felt the needle.

So began the first widespread trials for a vaccine to fight the dreaded poliomyelitis virus, as described in a front-page story Feb. 24, 1954  in the Pittsburgh Post-Gazette. The 1954 trials were the largest of that kind up until then — “unprecedented in its scope and magnitude,” according to a Salk vaccine subject guide from the Center for the History of Medicine at the University of Michigan Medical School.

As the world now works through the challenges of rolling out vaccines to fight COVID-19, it’s clear that efforts involving massive amounts of supplies, millions of people and newly approved products are complicated. The U.S. last faced such a logistical challenge of such a mass vaccination program in 1955, and Pittsburgh was at the heart of it.

Until that point, polio had been a deeply feared disease with no cure. Spread through contact with infected human waste and, occasionally, through contact with droplets from an infected person’s sneeze or cough, it had become many parents’ worst nightmare.

With news of a 10-year-old girl and her aunt, 17, being hospitalized for polio, Canonsburg health officials closed the borough public pool in July 1948. (Post-Gazette Archives)

The polio virus existed on a small scale for possibly thousands of years, but in 1900, epidemics broke out in the U.S. and Europe. Experts believe that before then, mothers who survived the virus passed some immunity to their children in the womb or through breastfeeding, according to “Polio: A 20th Century Epidemic,” a 2018 article from London’s Science Museum.

Better sanitation in the 20th century meant fewer people were exposed to polio in their early years and fewer built up immunity. Women were less likely to give immunity to their babies. Ironically, better sanitation led to higher incidence of the disease.

After 1916, the disease began a cycle of surging every summer in the U.S., with the most serious attacks coming in the 1940s and 1950s. In 1952, the U.S. reported 57,879 cases and 3,145 deaths, according to a 2017 article by Sophie Ochmann and Max Roser published on Our World in Data.

Some swimming pools, such as the one in Canonsburg, were closed as a precaution, according to a July 28, 1948, article in the Pittsburgh Sun-Telegraph.

About 4% of people exposed to the virus suffered fever, sore throat, headache, vomiting, fatigue, back pain or stiffness, pain or stiffness in the arms or legs and muscle weakness or tenderness. A small percentage experienced more severe symptoms.

In a rare photograph showing President Franklin D. Roosevelt in his wheelchair, the president poses in February 1941 on the porch at Top Cottage in Hyde Park, N.Y., with Ruthie Bie, the granddaughter of the caretaker of the cottage, and his dog, Fala. (Franklin D. Roosevelt Presidential Library & Museum)

Within a week, the sufferer suddenly had no reflexes, the muscles ached severely and limbs were loose or floppy. 

In extreme cases, extremities, usually the legs, became paralyzed temporarily or permanently. The patient had to rely on leg braces or wheelchairs. In permanent cases, legs could atrophy and feet could become deformed. Temporary paralysis could last a year. According to the World Health Organization, about 1 in 200 polio infections leads to permanent paralysis.

In up to 10% of permanent paralysis cases, the disease destroys the ability to swallow or breathe, leading to death if the patient receives no automated assistance. The first machine to help patients breathe was called an iron lung.

Franklin D. Roosevelt, U.S. president from 1932 to 1945, famously contracted polio at age 39 and lost the use of his legs. For public appearances, he used a cane and heavy leg braces and leaned on a son or adviser for balance as he swung his legs forward, making it appear as if they worked.

Other well-known polio survivors include KDKA-TV news anchor Stacy Smith; retired professional golfer Jack Nicklaus, who believes his sore joints might signal post-polio syndrome; film director Francis Ford Coppola; singers Judy Collins and Joni Mitchell; and actors Alan Alda and Donald Sutherland. All of them as children spent lonely weeks or months in bed recovering.

The first effective vaccine came from virologist Jonas Salk’s laboratory at the University of Pittsburgh. And that put the Steel City on the front line of testing and rolling it out.

The National Foundation for Infantile Paralysis in 1951 granted Salk $200,000 a year, according to the 2005 book “The Cutter Incident,” for three years to develop a vaccine. 

Salk tested variations of his vaccine in his first subjects — a pilot group of 43 children, with parental consent — in 1952 at the D.T. Watson Home for Crippled Children in Leetsdale. These children already had polio, but there was  a risk that they could catch a different strain. The vaccine, however proved safe and boosted their antibodies to polio.

The Salk vaccine then was given to the adult staff at Watson, about 50 people.

The Polk Center in 2019. (Steve Mellon/Post-Gazette Archives)

The original Watson Home no longer exists. The organization is now the Watson Institute, with four locations around Pittsburgh, and serves children with special needs.

Salk in summer 1952 injected another 161 children and staff at the Polk State School, a public asylum in Venango County for children with mental disabilities. The school is now Polk Center, a state-funded center for people with intellectual disabilities, and is slated to close within three years. Since the Polk children were wards of the state, state officials gave their consent to the tests — a practice that would be considered unethical today.

An article in The Pittsburgh Press publicized vaccine tests on children with disabilities. (Post-Gazette Archives)

In a much-less publicized effort, 14 children with polio at the Industrial Home for Crippled Children in Squirrel Hill, now the Children’s Institute, were given “whopping doses” to prove the vaccine didn’t affect the kidneys, according to an April 24, 1955, article in The Pittsburgh Press. Salk said his team had obtained parental consent for the three-month test.

Salk also inoculated volunteers, including his laboratory staff, himself, his wife and three sons.

Test results leaked slowly to the public before the Journal of the American Medical Association published them on March 28, 1953. The next day, Salk appeared on the cover of Time magazine.

The National Foundation for Infantile Paralysis, now known as the March of Dimes, took control of the next phase: widespread testing. The foundation set up a Vaccine Advisory Committee, which designed the trials under the direction of Thomas Francis Jr., Salk’s mentor. 

Over Salk’s objections, the committee insisted the trials have one group given no vaccine, one group given a placebo and one group given the actual vaccine. Salk believed, as some people argue today, that giving someone a placebo was unethical, especially if that person later caught the disease.

Jonas Salk gives a child a vaccine at a Pittsburgh elementary school in February 1954. (University of Pittsburgh/Post-Gazette Archives)

The foundation lined up Parke-Davis of Detroit to manufacture large vaccine quantities for the national tests.

Another pilot test was launched in February 1954 at the Arsenal school in Lawrenceville and at 18 other area schools involving some 4,000 elementary school students.

A national test was scheduled to begin that April, but Salk started the trial ahead of time, on March 22, in Pittsburgh, inoculating 2,500 elementary schoolchildren at Falk School in Oakland; St. Lawrence in Garfield; St. Stephens in Hazelwood; Holy Rosary in Homewood; Sacred Heart in East Liberty; Resurrection in Brookline; St. Basil in Carrick; and St. George in Allentown. 

The nationwide field test, funded by the national foundation, involved about 1.8 million first-, second- and third-grade schoolchildren with their parents’ consent in 44 states, including 5,000 from Pennsylvania. 

Park-Davis and Eli Lilly pharmaceutical companies manufactured the test vaccine material, which had to be packed on ice. The vaccine required three inoculations.

Nationwide, about 20,000 physicians and public health officers, 40,000 registered nurses, 14,000 school principals, 50,000 teachers, and 200,000 volunteer workers took part in the trials, according to records at the University of Michigan’s medicine history center.

It took nearly a year to process the test data.

On April 12, 1955, Francis, director of the trials, presented the results at the University of Michigan in Ann Arbor, the site of his Vaccine Evaluation Center.

In a change from the usual dry atmosphere of a scientific conference, 150 reporters from print, radio and television attended, and 16 news cameras were lined up at the back of the room. Fifty-four thousand physicians watched remotely, and Eli Lilly paid $250,000 to broadcast the proceedings. Europeans tuned to Voice of America to hear the presentation.

Francis released copies of his report to the press just before he spoke. 

“Then came a dash for phones and typewriters to spread the news to the world,” reported The Pittsburgh Press. “People leaped over tables and slapped each other on the back ... ‘It works! It works! It works!’ newsmen shouted.” 

Pittsburgh Sun-Telegraph editors put the headline of the Salk vaccine's success above the newspaper masthead on April 12, 1955. (Post-Gazette Archives)

“SALK VACCINE OK, RATED 80 to 90%” screamed the headline in the Pittsburgh Sun-Telegraph.

The federal government hastily approved six pharmaceutical companies to manufacture the vaccine on large scale. 

The Federal Cold Storage building, 1501 Penn Ave., where the Salk vaccine was stored. (Emily Matthews/Post-Gazette)

Wyeth Laboratories in Marietta, Pa., near Lancaster, sent 1,500 pounds to Pittsburgh via the Pennsylvania Railroad. The shipment was enough for about 104,000 shots. It arrived April 24 and was kept in a locker in the Federal Cold Storage Co., on Penn Avenue in the Strip District, which up until recently was Wholey’s Cold Storage Facility. A state health department officer had the only key.

Telegrams went out to communities to pick up their vaccine quotas.

Teams of doctors and nurses moved into schools April 25 to give free inoculations to all first- and second-graders with parental consent, planning to inoculate 300 children a day in Pittsburgh.

A second free shot was to be given May 16. The third shot — an optional but recommended booster — would not. That would cost $2 and would be given at doctor’s offices. The national foundation covered the costs of the free shots, about $7.5 million, according to a 2014 article in HealthDay.

U.S. Secretary of Health, Education and Welfare Oveta Culp Hobby in February 1953. (Library of Congress)

The foundation had just 9 million shots available, enough for the youngest children but no more. The federal government had organized and funded nothing. At a May 1955 hearing before the U.S. Senate Labor and Public Welfare Committee, Oveta Culp Hobby, secretary of health, education and welfare, said, “I think no one could have foreseen the public demand.” 

The administration of President Dwight D. Eisenhower “did not intend to sponsor government interference with private enterprise — the distribution and sale of polio vaccine. Hobby wanted to wait to see if the states paid for vaccine before committing the federal government,” wrote Robert T. Pando in a 2008 dissertation at Florida State University.

The Eisenhower administration criticized free shots, saying it could lead to “socialized medicine by the back door.” Instead, the administration proposed covering the cost of injections to needy children only. Congress later approved $30 million for that purpose.

In Pennsylvania, 20% of the vaccine was to be put aside with the state health department for what the Pittsburgh Post-Gazette called “medically indigent families.” The rest was sold from doctors’ offices for $2 per shot, plus doctor fees. 

Between April 15 and May 7, 4.8 million doses of the vaccine were distributed nationwide.

But the program soon came to a screeching halt.

About 120,000 vaccine doses manufactured at Cutter Laboratories in Berkeley, Calif., were given to children. Suddenly, 40,000 of them had polio, 56 came down with paralytic polio and five died. The virus spread to the children’s families and towns, and another 113 people came down with paralytic polio with five dying.

Cutter withdrew its vaccine April 27. 

The infamous lot of Cutter polio vaccine containing live virus. Forty thousand children inoculated with Cutter vaccine came down with polio, and five of them died. (Associated Press)

It was one of the worst pharmaceutical disasters in the U.S. The 2005 book “The Cutter Incident: How America’s First Polio Vaccine Led to the Growing Vaccine Crisis” by Dr. Paul Offit described the incident in depth.

In meetings between representatives of the pharmaceutical companies and the National Institutes of Health, participants realized that it took much longer to kill the virus when commercial-scale quantities were involved. 

Wyeth quietly recalled one batch of its vaccine after scientists determined that one lot had caused seven cases of paralytic polio in children in Harrisburg, Philadelphia, Chester, Doylestown, Norristown and Towanda. Pamela Erlichman, 7, of Bucks County, died. 

Cutter’s problems were the most serious of the six companies making the vaccine. To isolate the virus, cells had to be extracted from lab monkeys, then the resulting material had to be filtered to remove the monkey cells, which could protect the virus from the formaldehyde used to kill it. 

An article on May 29, 1955, in The Pittsburgh Press spelled out the damage in Pennsylvania. (Post-Gazette Archives)

Cutter technicians used an ineffective filter that failed to remove all monkey cell debris. Cutter also let the filtered virus sit for long periods before treating it with formaldehyde. The long waits gave the cell debris time to clump together, further protecting the virus.

Finally, Cutter technicians did not follow Salk’s instructions about how to determine how long it would take to kill the virus in their lab, according to Offit’s book.

Meanwhile, the government was using testing standards that did not catch all the manufacturing errors.

In the fallout, almost everyone at the federal level involved in regulating the vaccine was fired and testing rules were tightened, Offit wrote. No one from Cutter lost his job.

The polio vaccination program in the U.S. resumed May 14, was halted again May 18, then restarted on July 14. 

New polio cases in the U.S. dropped from 57,879 in 1952 to 910 in 1962, according to the U.S. Communicable Disease Center.

Between April 12, 1955, and Aug. 1, 1956, 85.9 million doses of the Salk vaccine were released, the U.S. surgeon general announced.

This front page story in The Pittsburgh Press April 1, 1956, questions whether enough vaccine was on hand. (Post-Gazette Archives)

Keeping up with need proved difficult. Altogether, 8 million vaccines a month were being produced — an amount that would cover only half the American children and pregnant women who needed the shots before the summer polio season, Scripps-Howard reported on April 1, 1956.

The federal government set quarterly export quotas for the vaccine. For the last quarter of 1956 and the first quarter of 1957, that quota was 7 million doses each, the Associated Press reported in December 1956.

Abroad, distribution differed by country. Many Western nations — Canada, Britain, France, Denmark, the Netherlands and Sweden — developed their own vaccines based on the principles behind Salk’s and relied on domestic vaccine production. West Germany didn’t have a large-scale polio vaccine program until 1961 or 1962, and Spain didn’t have one until 1963.

Italy used the Salk vaccine, which had less successful results there, for only a few years. Eastern European nations began with imports from the U.S. and elsewhere, then turned to domestic production.

Distrust of the Salk vaccine partly led to its being replaced by one developed by his rival, Albert Sabin in Cincinnati. The Sabin vaccine was given orally as drops on a sugar cube and it cost less than the Salk vaccine.

Done properly, Salk’s approach involved using the dead polio virus. Salk’s virus caused the body to produce antibodies against the virus; it could not give a person polio.

Janita Gosser, 5, eats a "Sabin Sundae," a sugar cube laced with Sabin oral vaccine, in 1962 in Cincinnati. (AP Photo/The Cincinnati Enquirer, Bob Free, File)

Sabin’s approach involved a weakened but live virus. It carried a risk that about one in 2.4 million children who took it would develop paralytic polio, according to the federal Centers for Disease Control and Prevention. Also, people with the oral vaccine could spread the disease. 

With Salk’s inoculation dominating the U.S., Sabin tested his vaccine in the Soviet Union. The test was a success, and the Soviet Union ordered all of its citizens between the ages of 2 months and 20 years — 77 million people — to take the Sabin vaccine, according to “Polio Across the Iron Curtain: Hungary’s Cold War with and Epidemic,” a 2018 book by Dora Vharga.

By 1963, most countries including the U.S. had switched to the oral vaccine, and in 1979, natural paralytic polio — polio not caused by a vaccine — was eliminated in the U.S.

But from 1961 to 1989, the Sabin vaccine caused an average of nine cases of paralytic polio each year in American children, according to an article by Vincent Racaniello published Sept. 10, 2015, on the Virology Blog. 

Salk urged the government to return to his vaccine, which he made more effective in 1978. In 1998, the main group that advises the federal government about immunization made that recommendation. The oral vaccine is no longer available in this country.

Outside the U.S., the World Health Organization continues to favor the Sabin vaccine in countries experiencing natural polio. After natural polio is eliminated, WHO recommends switching to the Salk vaccine.

Worldwide polio cases dropped from 350,000 in 1988 to 33 in 2018, according to WHO and the Centers for Disease Control and Prevention. 

Salk became world famous.

However, he faced bitter recriminations within his field. Other scientists, including Sabin, denigrated him, his research and his vaccine. He had bucked the conventional wisdom that a live virus vaccination was superior, according to the New York Times.

According to the Salk Institute for Biologic Studies, Salk never earned any money from the vaccine and never patented it, preferring that it be used as widely as possible. He never won a Nobel Prize for his work.

“It's scandalous,” said David Oshinsky, author of “Polio: An American Story,” in a National Public Radio interview in 2014. “He [Salk] is the only major polio researcher never to have been inducted into the National Academy of Sciences.”

The Salk polio vaccine now is given to U.S. children in four inoculations. It is 99% effective and one of the safest routine vaccines, according to the CDC.

Laura Malt Schneiderman: lschneiderman@post-gazette.com.