Medicine: Vaccine Crisis

The big blackboard seemed to loom over the auditorium at California's Department of Public Health in Berkeley. It also loomed over the nation. For the blackboard charted every case of polio that had developed after use of vaccine made by Berkeley's Cutter Laboratories; it listed the date and site of vaccination, date of symptoms' onset, location of paralysis, age and sex—but not the name—of victims. As the week went on, the impersonal box score grew. The Salk vaccine still meant to most people what it had the week before—banishment of a crippling disease. But suddenly and tragically, its safety had been put in question.

The first sign that anything was wrong came when a six-year-old San Diego youngster, Lawrence Vicker, got home for lunch from Eugene Field School and complained that he did not feel like eating. What was more, he had a stiff neck. His mother took his temperature: 103°. Here were three symptoms of polio (although several other diseases cause similar symptoms). Yet Larry, like 26,000 other San Diego children, had been inoculated only five days earlier with the Salk vaccine.

In the hospital, it became clear that Larry indeed had polio. There were two possibilities. Since it was, after all, the beginning of the polio season, he might have been exposed to it before he was inoculated. Or he might have caught the disease from defective vaccine.

What Went Wrong? On the day Larry Vicker was stricken, a 13-month-old boy in Pocatello, Idaho got sick too. He had been vaccinated eight days earlier. Also in Pocatello, Susan Pierce, seven, became ill with bulbar polio three days after her inoculation. Within two days she was dead. In Moscow, Idaho, another seven-year-old girl died. A rash of cases was reported, from Napa, Calif, to Chicago.

The U.S. Public Health Service made a hurried check. All reported cases of polio among vaccinated children were youngsters who had received vaccine made by the Cutter Laboratories. This raised the agonizing possibility that a batch of vaccine had gone through with some live virus in it. Like all vaccines, the Salk preparation contains germs of the disease that it is meant to fight. In the Salk process, these virus particles are killed, with formaldehyde, so that they cannot keep the power to infect (but retain the power to help the system build antibodies). Although this apparently did not happen in a single case during last year's tests, it was conceivable that somewhere along the line there had been a laboratory slip-up in the job of killing the virus.

Just what could have gone wrong? No one may be sure for weeks (or even years). But one difficulty is suspected by doctors. The formaldehyde to kill the virus must be used in just the right amount: too little leaves some deadly live virus; too much may destroy it so thoroughly that it cannot stimulate the production of antibodies. This means a narrow margin of safety. Last year's Salk vaccine, made in small pilot plants under laboratory conditions, apparently succeeded in staying within this margin. But it may develop that the margin is too slight for large-scale commercial production. If so, the Salk vaccine may have to be modified by using different strains of virus, or different ways of killing them. Both can be done.