LIVE POLIO IRUS VACCINES

Discussion
595
If the chain of transmission is broken in a community
like Cincinnati, we do have the problem
next year, and the following, of new births in the
community, which will produce a susceptible
population who are no longer receiving the possibility
of immunization by means of naturally
occurring strains.
I wonder what plans Dr. Sabin has, because
this may be a model for other communities, and
I think that what is involved here ought to be
clear.
DR. SABIN: With the strains with which we are
working, I believe that the evidence required for
licensure has been accumulated, and before our
program was started I had a letter from the
Surgeon General's office (contrary to some of the
things that might have appeared in the newspapers
this morning) which stated-and I have
that letter on record-that with all the new data
accumulated in 1959 and the additional data that
are being accumulated in 1960, the Public Health
Service should be ready to consider applications
for licensure.
Therefore, I do expect that if specific requirements
for the product are put forth by the Public
Health Service, the American pharmaceutical
manufacturers, having something definite to work
with and having already made great progress on
the basis of the preliminary recommendations
provided by the Public Health Service, should be
in the position to make at least enough vaccine
for the Cincinnati children.
Now, the plan then would be to vaccinate children
beginning at about two to three months of
age. As I said before, I am not prepared to give
any recommendations at this time on what to do
with the newborn.
So the plan would definitely be to continue
with vaccination of the oncoming children
through their private physicians and through the
clinics. I think the private physicians in the
United States can play the most important role
in reaching the majority of the preschool-age
children. Some of the children, however, will
have to get their vaccine in clinics as part of
special health department programs.
I should like to make a comment at this point.
It is not my intention to make any suggestions
for programs in Sweden such as those Dr. Gard
has announced. To each his own. But I should
like to point out that we cannot disregard any
type of poliomyelitis virus. Type 3 and Type 2
viruses are important, and I think Type 2 can be,
and is becoming, just as important as Type 3.
I should also like to bring to the attention of
this group information that at least was new to
me and which I obtained while I was at the Moscow
conference. I had thought that poliomyelitis
was not a problem in China, but Dr. Ku, Fang-
Cho, who attended the conference in Moscow, informed
me that since 1955 it had become a problem,
and that in 1958 they had a predominantly
Type 2 poliomyelitis epidemic.
This brought to my mind that in the same area
of the world, in Okinawa, there had been a predominantly
Type 2 outbreak before. The following
year, in 1959, in Hanoi in North Viet
Nam, there was an epidemic of about 1,000 cases
of predominantly infantile paralysis, and the only
20 viruses they isolated were all Type 2.
You heard last year of the Type 2 epidemic in
Nicaragua, I believe. We cannot disregard any
type of poliomyelitis virus; in future programs
we must take into consideration all three types
of poliovirus vaccine.
DR. DICK: This Conference has had a much
more rational attitude than last year. Most people
are prepared to accept that we still have a number
of things to sort out. These problems are
going to be solved by the type of study which
Dr. Sabin and others are doing.
.At the same time, I wonder whether here we
have not a great opportunity for an international
study. We have two enormous population groups,
one highly immunized with live virus vaccines and
the other partially immunized with Salk vaccine.
If we could really concentrate on the use of inactive
vaccine on this side of the world, we
might have two comparative population groups in
which we would get a real answer on efficacy.
Now, this would perhaps involve two things, I
think. It would involve an interchange of the
methods of surveillance, from North America,
and, from the USSR, the technique of how to get
at 100 per cent of the population with vaccines.
In countries with effective Salk vaccination
programs, I think there is no immediate hurry to
move over to live virus vaccines until we can guarantee
that this method of immunization will be