Inside Salk; Salk Insitute

Insider's View

William Brody

Benjamin Franklin, perhaps the wisest of our nation’s founders, wrote the oft-repeated adage: “An ounce of prevention is worth a pound of cure.” But even the wise and practical Mr. Franklin made mistakes where prevention was concerned.

Around the time Franklin wrote these words, a deadly smallpox epidemic was sweeping across the United States and the rest of the world. The smallpox inoculation technique of the time had originated in Africa. An African servant of the clergyman Cotton Mather in Boston explained to Mather the use of smallpox inoculation in West Africa. Mather noted this down and convinced a local doctor, Zabdiel Boylston, to try this method during the Boston smallpox outbreak of 1721.

At the time, inoculation used a string that had been drawn through the pustule of a smallpox victim and then was dried and saved. For inoculation, an incision was made, and the string was drawn through it to infect the recipient with attenuated smallpox. During that period, the recipient would be contagious to others but would more often get a milder form of smallpox with a lower risk of death. The mortality rate was 2 percent for inoculated people versus 15 percent for non-inoculated people.

Unfortunately, the Franklin brothers’ Boston newspaper was critical of the 1721 smallpox inoculation, and Franklin decided not to inoculate his children, with disastrous consequences. “In 1736, I lost one of my sons,” Franklin would later write, “a fine boy of four years old, by the smallpox taken in the common way. I long regretted bitterly and still regret that I had not given it to him by inoculation.”

Following the Boston outbreak, inoculation became the state-of-the-art treatment until Dr. Edward Jenner’s discovery of the more effective and lower-risk cowpox vaccination, which was published in 1798. (Recipients of Jenner’s vaccine were not contagious to others, an important improvement.)

Despite being one of the leading thinkers of his time, Franklin made a tragic miscalculation about the importance of inoculation. Judging from his famous quip about prevention, he seems to have learned from his mistake, yet it is a mistake that continues to plague individuals and societies–one that finds its roots in popularized misinformation.

When Jonas Salk introduced his vaccine in 1955, using killed polio virus particles, the vaccine encountered significant scrutiny in the press, including an article by the muckraking columnist Walter Winchell, who claimed the use of the Salk vaccine would kill thousands of children. It was suspected that inflammatory journalism was being pushed sotto voce by Salk’s rival, Dr. Albert Sabin, who was developing an oral vaccine using live attenuated polio virus.

The United States switched to the oral polio vaccine (OPV), but it was eventually abandoned in favor of the Salk vaccine because there were isolated cases of polio that occurred in children who had been inoculated with the OPV.

The philosopher Georg Wilhelm Friedrich Hegel wrote, “We learn from history that we do not learn from history.” And on the eve of what would have been Jonas Salk’s 100th birthday were he living today, I have to wonder if Hegel wasn’t right–even as I hope he wasn’t. Despite the remarkable discovery of the Salk vaccine, we’ve learned recently that polio has not been eradicated worldwide. Even more profound, skepticism about the potential dangers of polio and other vaccines in our country has led to increasing abandonment of vaccinations, and we are beginning to see the reemergence of diseases like measles and whooping cough that can be effectively prevented by the use of vaccines.

While the work of Salk scientists doesn’t necessarily lead them to develop vaccines, many of their discoveries about cells, bacteria, viruses and immunology lay the foundation for future vaccine development for diseases like malaria, Ebola and, perhaps one day, HIV. But these preventives, like those of Franklin’s time and those available today, will only be effective if they are used.

Franklin’s own poignant experience only serves to emphasize that the route to wellness and healthy aging is to avoid encountering a disease to the best extent possible, or at least to defer as long as possible the onset of a debilitating illness.