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INTENSIVE IMMUNIZATION P R O G R A M

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H E A R IN G S [^JUL 2 IS 62

BEFO RE TH E

COMMITTEE ON 

INTERS TAT E AND FOR EIGN COMMERCE 

HOUSE OF REP RESEN TATIV ES

EIG HTY-S EV EN TH CONGRESS

_s SECOND SESSION

ON

H .R . 1 0 5 4 1

A BILL TO ASSIST STATES AND COMMUNITIES TO CARRY OUT 

INTE NSIVE VACCINATION PROGRAMS DESIGNED TO PROTECT 

TH EIR POPULATIONS, ESPECIALLY ALL PRESCHOOL CHILDREN, AGAINST POLIOMYELITIS, DIPHTH ERIA, WHOOPING 

COUGH, AND TETANUS, AND AGAINST OTHER DISEASES 

WHICH MAY IN THE FUTURE BECOME SUSCE PTIBL E OF 

PRACTICAL ELIMINATION AS A PUBLIC HEALTH PROBLEM 

THROUGH SUCH PROGRAMS

MAY 15 AND 16, 1962

Printe d for the use of the 

Committee on I ntersta te and Foreign Commerce

U.S. GOVERNMENT PR INTING OF FIC E 

WA SHINGTON : 1962
CO MMIT TE E ON IN TERSTA TE AN D FO RE IG N CO MM ER CE

OREN HA RR IS , Arkansa s, Chairman

I

<

JO HN BE LL WI LLIAMS , Mississippi

PE TER F. MACK, J r., Illinois

KE NNET H A. RO BE RT S, Alabama

MORGAN M. MO UL DE R, Missouri

HA RL EY O. STA GGERS, West Virginia

WAL TE R ROG ERS , Texas

SA MU EL N. FR IE DEL , Maryland

TO RB ER T H. MACDONALD, Massachusetts

GE OR GE M. RH OD ES, Pennsylvania

JOHN JARM AN , Oklahoma

LEO W. O'BR IEN, New York

JOHN E. MOSS, California

JOHN I). DINO EL L, Michigan

JOE M. KILG OR E, Texas

PAUL G. ROGERS, Florida

RO BE RT W. HE MPH IL L, South Carolina

DAN RO ST EN KO WS KI, Illinois

JOHN B. BE NN ET T, Michigan 

WILLIAM L. SP RING ER , Illinois 

PAU L F. SCHE NC K, Ohio 

J. AR TH UR YOU NGER, California 

HAROLD R. CO LL IER , Illinois 

MI LT ON W. GL EN N, New Jersey 

SAMU EL L. DE VINE , Ohio 

AN CH ER NELSE N, Minnesota 

HA STINGS KE ITH, Massachusetts 

WI LL AR D S. CU RT IN, Pennsylvania 

AB NE R W. SIBAL, Connecticut 

VE RN ON W. TH OMSON, Wisconsin 

PETER II. DO MI NICK , Colorado

JAME S C. HE AL EY , New York

HO RA CE R. KO RN EGAY , North Carolina

W. E. Wiuja mso n, Clerk

Kenneth J. Painter, Assistan t Clerk

Professional Sta ff

Andrew Stevenson

Kurt Borchardt

Sam G. Spal

Martin W. Cunningham

II
May 16, 19 62 .................. . .................................................... ........... 43 Text of H .R. 10541.____ _________ _________________ _____ _______ 3

Report of—

Agriculture Department______________________________________ 4

Budget Bureau_________________________________ 5

Comptroller General of the United State s_______________________ 5

Health, Education, and Welfare_______________________________ 6

Labor Department______________ 6

Statement of—

Adelhardt, Frances, McLean, Va_______________________________ 40 Biemiller, Andrew J., director, dep artment of legislation, AFL-CIO , 

accompanied by Lisbeth Bamberger, assistant director, departm ent 

of social security, AF L-C IO________________ ~______ ________ 77 Daily, Edwin F., M.D., vice president, Health Insurance Plan of

Greater New York_________________________________________ 75

Frechette , Dr. Alfred L., commissioner of public health, Commonwealth of Massachu setts____________________________________ 74 Gray, Dr. A. L., state health officer, State of Mississippi__________ 28 Miller, Clinton R., assistant to the president, natio nal health federation, Washington, D.C_____________________________________ 80 National Tuberculosis Association______________________________ 22 Perdue, Mrs. Iva, Washington, D.C____________________________ 128 Perkins, Dr. James E., managing director, Natio nal Tuberculosis

Association, New York, N.Y i__________ 19

Ribicoff, Hon. Abraham, Secretary of Health, Education, and Welfare,

accompanied by Hon. Wilbur Cohen, Assistant Secretary for 

Legislation, Departm ent of Health, Education, and Welfare; Dr. 

Clarence A. Smith, Chief, Communicable Disease Center, Public 

Health Service, Atlanta, Ga.; and Dr. John D. Porterfield, Deputy

Surgeon General___________________________________________ 43 Robinson, Dr. Miles H., Potomac, Md_________________________ 121 Stokes, Dr. J. Buroughs, manager, Christian science committee on

publication, Washington, D.C., office of the First Church of Christ

Scientist, Boston, Mass___ ,________________________________ 24 Sullivan, Hon. Leonor K., a Representative in Congress from the

State of Missouri________________________________________ 127

Teague, Dr. Russell E., commissioner of health, Frankfort, Ky., on

behalf of the American Public Health Association______________ 8

Additional data submitted to the committee—

“ A Note on Polio,” a reprint from the April 1, 1961, issue of the Saturday

Review, with illustration, subm itted by Clinton Miller__________ 115 Comparison of the incidence of poliomyelitis, total cases 1951-59,

graph submitted by Clinton Miller________ _________ _____ _ 93 Cost estimate of immunization program, table su bmitted bv Secretary

Ribicoff__________________________________________________ 3

Disease cases and deaths under 5 years of age, United States, table 

subm itted by Secretary Ribicoff_____________________________ 68 ‘‘Great Britain,” reprint from Time magazine dated April 20, 1962,

submitted by Dr. Miles H. Robinson_________________________ 122 Letter to the Speaker of the House of Representatives, Hon. John W. 

McCormack, from the Secretary of Health, Education, and Welfare,

Hon. Abraham Ribicoff, da ted February 27, 1962_______________ 1

Natural rise and fall of two diseases, poliomyelitis 1942-59, infectious hepatitis, 1949-59, graph subm itted by Clinton Miller______ 92

i i i
IV CONTENTS

Additional da ta subm itte d to the comm ittee— Continued Paralytic polio cases in the United States in 1957, 1958, 1959, includ­ ing pa ralytic polio cases in Salk vaccines, table submitted by Clinton 

Mi ller......................... ........... ........... ..................... ...................- - ......... “Polio Vaccine Virus Puzzles Scientists,” a reprint from the Chicago Sun-Times, April 16, 1962, submitted by Clinton Miller------------ - “Poliomyelitis Immunization,” reprint from the Journal of the Ameri­ can Medical Association, dated February 25, 1961, submitted by 

Clinton Miller________________________________________ - — “Poliomyelitis Vaccine,” a reprint from the Journal of the American Medical Association, dated Jan uar y 21, 1956, subm itted by Clinton 

It. Miller------------ -------- ----------------------- ------- ----------------- -- - Present status of polio vaccines, material submitted by Clinton It. 

Miller________________________________________ .----------------- Robinson, Dr. Miles H., supplemental statem ent sub mitted----------- “Seven Hundred Million Cavities,” reprint from the Washington Post dated March 14, 1961, subm itted by Dr. Miles H. Robinson-------- States with compulsory vaccination laws, listing furnished by Dr. 

Russell E. Teague-------------------------------------------------------------- Total reported disease cases and death s, United States, table submitted by Secretary Ribicoff------------------------------------------- ------ “T ruth About the Polio Vaccines,” reprint from the Chicago Tribune magazine, dated March 5, 1961, submitted by Clinton Miller------

Communications subm itted to the committee— American Medical Association, letter dated May 31, 1962, signed by 

F. J. L. Blasingame, M.D., executive vice president------------------ Cohen, Wilbur J., Departm ent of Health, Education, and Welfare, 

letter d ated May 28, 1962---------------------------------------------------- Dunsky, Dr. Irvin , president, Cincinnati Pediatric Society, le tter dated 

April 23, 1962....................... - ......... ......... ......... — ---------------------- MacLeod, Kenneth I. E., M.D., M.P .H., commissioner of health, city 

of Cincinnati, dated May 16, 1962------------------------------------------ Magee, Charles B. and Femie, letter dated May 11, 1962--------------- Marsh, Elinor E., M.D., acting direc tor of Hidalgo County Health

Dep artm ent, letter date d May 8, 1962------------------------------------ Renalds, Mrs. Julia, telegram dated May 14, 1962----------------------- Ribicoff, Hon. Abraham, Secretary of Health, Education, and Welfare, letter to Sneaker McCormack dated February 27, 1962...... ........... Whitaker, Mrs. Jud ith G., executive secretary, American Nurses’ 

Association Inc., letter dated May 22, 1962 ---------------------------- Zodun, Mrs. Leslie, telegram dated May 11, 1962......................... —

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132
INTE NSIV E IMMU NIZAT ION PROG RAMS

TUESDAY, MAY 15, 1962

H ouse of Repr esenta tives,

Commit tee on I nter state and F oreign Comm erce,

Washington, D.G.

The committee met, pursuant to notice, at 10:12 a.m., in room 1334, 

New House Office Building, Hon. Oren Harris (chairman of the 

committee) presiding.

The Chairman. The committee will come to order.

Today the committee begins hearings on another important administration proposal, II.R. 10541, commonly referred to as the Vaccination Assistance Act of 1962.

As chairman of the committee I introduced the bill at the request of 

the Secretary of Health, Education, and Welfare made by letter, dated 

February 27 of this year, addressed to the Speaker of the House.

I think, for the record, at this point a copy of the letter should be 

included in the record, together with a copy of the bill.

(The letter referred to plus a copy of II.R. 10541 and agency reports follow:)

Department of Health, Education, and Welfare,

Washington, D.C., February 27, 1962.

Hon. J ohn W. McCormack,

Speaker of the House of Representatives,

Washington, D.C.

Dear Mr. Speaker: I am enclosing for your consideratio n a draft of a bill 

to ass ist States and communities to car ry out intensive vaccination programs 

aga inst poliomyelitis and cer tain oth er infectious diseases.

This proposal legislation would carry out the President’s recommendation for 

such assistance in his special hea lth message.

Modem medical research has provided us with vaccines capable of conquering certain infectious diseases which have been major thr eats to the public 

health, and more such preventive agen ts can be anticipated in the near future. 

The purpose of this bill is to provide Federal leadership in assurin g that these 

medical discoveries will be so u tilized as to achieve the maximum benefits and 

protection to the public.

The d ra ft bill would amend the Public Health Service Act to authorize a shortterm program of special project grants to States and communities for intensive 

vaccination programs against poliomyelitis, diph theria, whooping cough, and 

teta nus. It would also auth orize similar aid for intensive programs directed 

toward other major infectious diseases when vaccines or other preventive agents 

become available which are capable of eliminating any such disease as a 

public he alth problem.

The need for this proposed auth oriz atio n can be illustrated by a brief review 

of the development and application of the Salk vaccine for the prevention of 

poliomyelitis. Seven years ago medical research developed, for the first time, 

an effective preventive measure aga inst this serious disease. As soon as the 

vaccine became available in adeq uate supply, the health resources of the Nation 

were mobilized in an effort to accelerate its distribution and to assure its ava ilability to succeptible persons thro ughout the country. The resu lts to date have 

been very gratifying, as indicated by the sha rp drop in its incidences of poliomyelitis throughout the Nation in recent years.

1
2 INTENSIVE IMMUNIZATION PROGRAMS

D es pite th is prog ress, ho we ve r, po lio m ye lit is has no t ye t been tr u ly conq uered 

in th e United St at es , as ev idenced by re ce nt st ud ie s of th e im m un iz atio n st atu s 

of ou r po pu latio n. Th ese st udie s re ve al th a t larg e segm en ts of th e po pu lat ion 

in all p art s of th e co un try st il l ha ve li tt le or no pr ot ec tio n ag ain st polio. Th e 

la rg est of th es e un pr ot ec te d gr ou ps is co mpr ise d of ch ildr en unde r 5 yea rs of 

age . Alth ou gh th es e ch ildr en are p art ic u la rl y su sc ep tib le to po lio mye litis, subst anti all y less th an on e-ha lf of them ha ve bee n ad eq ua te ly pr ot ec ted thro ug h 

va cc in ation. A pa rt from th eir in di vi dua l su sc ep tib ility to th e disease, thes e 

ch ild re n, to ge th er with oth er unv ac ci na te d pe rson s, co nst itute a co mm un ity 

ep ide mic haza rd which m ust be el im in at ed if we are to com plete our co nq ue st of 

po lio mye lit is.

T hi s patt ern of inco mplete pu blic pr ot ec tion , w ith la rg e po pu lation grou ps 

re m ai ni ng un va cc in ated , is not confi ned to po lio my eli tis . On th e co nt ra ry , it is 

ve ry clo sely pa ra llel ed in th e ca se of oth er di se as es fo r which effecti ve vaccines 

are av ai la bl e— di phth er ia , who op ing cough , an d te ta nus. Inde ed , th e ve ry same 

grou ps , an d part ic ula rl y th e presch oo l ch ild re n, wh o are la ck in g in protec tio n 

again st po lio mye lit is are also un pr ote ct ed again st th es e oth er se riou s infecti ou s 

di se as es . T his com mon prob lem ari se s from th e fa ct th a t th es e gr ou ps are th e 

m os t difficult to r ea ch thr ou gh ord in ary v ac ci na tio n pr og rams.

If we are to overc om e th e pu blic hea lth haza rd s re pre se nt ed b y th is pat te rn of 

inco mplete va cc in at io n pr ot ec tio n, a tw o- stag e na tion al ef fo rt will be requ ired . 

F ir st , an d m os t im med iately ne ce ss ar y, is a na tion w id e pr og ra m of in tens iv e 

co mmun ity va cc in at io n ca m pa ig ns aim ed a t th e co ve rage of all su bst an tial 

gr ou ps of un va cc in at ed su sc ep tib le pe rson s. Second, th es e in te ns iv e prog rams 

m us t be follo wed up w ith m ea su re s to st re ngt hen re gula r on go ing va cc in ation 

pr og ra m s, w ith p art ic u la r att enti on to mor e eff ectiv e co ve rage of th e ne wly b orn 

ea ch ye ar .

T he pr op os ed d ra ft le gi slat io n is di re ct ed pri m ar ily to w ar d th e firs t step in 

th is effo rt. It wo uld auth ori ze sp ec ial Fed er al as si st an ce to st im ula te a nd as si st 

in fin an cing in te ns iv e co mmun ity va cc in at io n pr og ra m s in it ia te d pri or to Ju ne 

30, 19(55, which are di re ct ed to w ar d el im in at io n of ou r pr es en t defic ien cie s of 

va cc in at io n again st po lio mye lit is, dip th er ia , wh oo pin g cough, an d te ta nu s. 

U nd er th e bi ll th es e pr og ra m s m ust be so de sig ne d an d co nd uc ted as to ac hiev e 

th e im m un iz atio n of pr ac tica lly all su sc ep tib le pe rson s in th e co mmun ity , p arti cula rl y ch ildre n who are unde r th e ag e of 5 ye ars. Co nv en ien ce an d inex ­

pe ns iv en es s w ill be the de ciding f acto rs to man y gr ou ps of in di vid ual s wh o ha ve 

not be en pr ev io us ly im mun ized . I t wi ll, th er ef or e, be ne ce ss ar y fo r each pro ­

gr am to pr ov id e enou gh pu blic or no np rofit co mmun ity va cc in ation fa ci lities to 

vac ci na te a t no or low co st al l wh o w ish to av ail them selves of th is me thod of 

vac ci na tio n again st po lio mye litis, dip hth er ia , wh oopin g cough, an d te ta nu s, 

or it s adm in is trat io n. Ho we ver, fo r th os e peo ple wh o pre fe r to tu rn to th eir 

p ri vate ph ys ic ia ns fo r th eir va cc in atio ns , fr ee vaccine pu rc ha se d w ith th e ai d of 

F edera l fu nds could als o be mad e av ai la bl e to th eir ph ys ic ia ns fo r va cc in ation of 

ch ildre n under 5.

Fed er al g ra n t fu nd s could be used fo r th e pu rc ha se of va cc ine fo r ch ild re n 

under 5 years of ag e an d fo r th e sa la ri es an d re la te d ex pe ns es of ad di tion al 

S ta te an d loca l he al th pe rson ne l re qui re d to prom ote an d or ga ni ze intens iv e 

co m m un ity pr og ra m s an d to m ai nta in th e ep ide milo gic an d la bora to ry su rv ei lla nc e re qu ired . The Sta te s an d co mmun ities, fo r th eir part , wo uld be resp on sible fo r su pp or tin g, th ro ug h pu blic fu nds or othe rw ise, al l oth er elem en ts of the 

in te ns iv e pr og ra m s— in cl ud ing th e se rv ices of ph ys icians , nu rses , an d ot her 

pe rs on ne l re qu ired in th e co nd uc t of e ac h co mmun ity pr og ram, an d th e pu rc ha se 

of va cc ine fo r pe rso ns oth er th an ch ildr en un de r five. The metho ds of or ga ni zing an d co nd uc tin g loc al pr og ra m s— includ ing the choic e as to which of th e 

av ai la ble po lio va ccines wi ll be us ed fo r di ff er en t grou ps— wo uld be le ft to Sta te 

an d loca l de te rm in at io n.

W ith re sp ec t to th e follo wup or va cc in at io n m ai nt en an ce pr og ra m s, th e d ra ft 

bi ll spe cifies th a t an “int en sive co mmun ity va cc in ation pr ogra m ” sh all includ e 

pl an s an d m ea su re s loo king to w ar d stre ngt hen in g of ong oing, co mmun ity pr ogr am s. * * *” Fe de ra l ass is ta nce unde r th is prop osed ne w pr og ra m wo uld be 

av ai la ble on ly fo r th e de ve lopm en t an d in st al la tion of such pl an s an d mea su res, 

ho we ver. It wo uld no t be av ai la ble fo r th e co nt in uing s uppor t of th es e ongoing 

pr og ra m s. W ha te ve r Fed er al ai d may be re qu ired fo r th is pu rp os e wo uld be p ro ­

vided, as it is now , th ro ug h th e re gula r m at ch in g gra nt pr og ra m s au th or iz ed by 

ex is ting pr ov isions of th e Pub lic H ea lth Se rvice Ac t an d by ti tl e B of the So cia l 

Se cu rity Act.
INTENSIVE IMMUNIZATION PROGRAMS 3

In ad di tion to th e pr ov isions re la ti ng spec ifica lly to pro gr am s of va cc in atio n 

again st p oliomye litis, dip hth er ia , wh oo ping c oug h, an d te ta nus, th e d ra ft bill also 

auth ori ze s si m ilar ai d fo r in te ns iv e pr og ra m s di re ct ed again st oth er se riou s in ­

fe ct io us dise ases, su ch as mea sle s, fo r which eff ectiv e pr ev en tive ag en ts may 

become av ai la bl e in fu tu re ye ar s. Thi s “s ta ndby ” au th ori zati on do es no t com ­

m it th e Fed er al Gov ernm en t to p art ic ip ate in th e co sts of al l im m un izatio n pr ogra m s de rivi ng fro m th e disc ov ery of new va cc ines or p re ve nt iv e ag en ts in fu tu re 

ye ar s. It is specifically lim ite d to pr og ra m s dir ec te d again st an in fe ctio us 

di se as e which “r ep re se nt s a m aj or pu blic hea lth prob lem * * *” an d wh ich is 

“s us ce pt ib le of pr ac tica l el im in at io n as a pu blic healt h pr ob lem” th ro ug h th e 

ki nd of in te ns iv e co mmun ity pro gr am s fo r which g ra nts wou ld be au th or iz ed .

In ou r opinion, th e prov ision of Fed er al ai d to S ta te s an d co mmun iti es fo r th e 

pu rp os es au th ori ze d by th e d ra ft bill will gre atl y ad d to th e pro te ct io n of th e 

N at io n’s he al th an d wi ll re pre se nt a fo rw ar d st ep in ass uri ng th a t fu tu re adva nc es in med ical re se ar ch w ill be pr om pt ly an d effecti ve ly ap pl ie d to w ar d th is 

nati onal ob jec tiv e.

We sh al l ap pr ec ia te it if you will re fe r th e enclo sed d ra ft bill to th e ap pr op ri ate co mm itt ee fo r co ns id er at io n.

In co mplian ce w ith Pub lic La w SOI, 84 th Co ng res s, th ere is enclo sed a st ate ­

m en t of es tim at ed co sts an d pe rs on ne l re qu irem en ts which wo uld be en tailed 

by e na ct m en t of th e prop os ed leg isla tion .

The B ur ea u of th e Bud ge t ad vise s th a t en ac tm en t of th is legi slat io n wo uld be 

in a cc ord w ith t he p ro gr am o f t he P re si de nt .

Sinc erely ,

Abraha m Ribicoff, Se cr etar y.

Co st es tim at e

[In millions of dollars]

1903 1904 1965

New obligational a uthority:

Gr ants_______________-_________________________ ____ 12.7 

(8.5) 

(4.2) 

.875

9.9

(5.7)

(4.2)

.875

9.9

(5.7)

(4.2)

.875

Vaccine_________ . _____ - .. .. .... ...........

Oth er_________________ _____________________

Dire ct operations.............. ...... _ . ............

To tal _____ ____ _________________ ___ _______ 13. 575

8.845

(5.695) 

(3.150)

.656

10. 775

12.480 

(7.650) 

(4.830) 

1.007

10. 775

9.9 

(5. 7) 

(4.2)

.875

Estimated expenditures: 1

Grants___________________________________________

V accin e_ . -___ _ ___ _____ __ ________

Other .................... ........... - ......... - . ..............

Direct operations____________________ __________

To tal...................... ......... ............................... .................... 9. 501 13.487 10.775

1

 No expenditures are es timated beyond the 1st 3 years with respect to the polio, diph theria, whooping 

cough, and teta nus vaccination programs except as completion of intensive vaccination programs begun 

during the 1st 3 years may require the rescheduling of some expenditures beyond June 30, 1965.

[H R . 105 41, 87 th Cong., 2d sess.]

A B IL L To assi st S ta te s an d co m m un iti es to ca rr y out in te ns iv e va cc in at io n prog rams 

de sign ed to pr ote ct th eir po pu la tion s, espe cially al l presch oo l ch ild ren, ag ai nst poliom ye litis, dip hth er ia , who op ing cough, an d te ta nus, an d again st oth er dise ases wh ich 

m ay in th e fu tu re become su sc ep tibl e of pra ct ic al el im in at io n as a pu blic hea lth problem 

th ro ugh su ch pr og ra m s

B e it en ac ted try th e Sen ate a nd Hou se of Rep re se nta tive s of the United Sta te s

of Am er ic a in C ongre ss as se mbled , T h at th is A ct may b e ci te d as th e “V ac cina tio n 

A ss ista nc e A ct of 1962” .

Sec. 2. P a rt B of ti tl e II I of th e Pub lic H ea lth Se rvice Act is am en de d by 

ad di ng a ft e r section 316 t he fo llo wing new section :

“grants for in te nsi ve vac cina tion programs

“ Sec. 317. (a ) The re are he re by au th or iz ed to be ap pro pri at ed fo r th e fisc al 

year en ding Ju ne 30, 1963. an d ea ch succ ee ding y ea r, su ch su m s as may be ne ce ssa ry to en ab le th e Su rgeon G en er al to mak e g ra nts to S ta te s an d po litica l su bd ivision s or in st ru m enta li ti es of th e S ta te s und er th is section. Su ch g ra n ts ma y 

be used to pa y th a t po rti on of th e co st of in te ns iv e co mmun ity va cc in at io n progr am s again st po lio mye lit is, dip hth eri a, wh oo ping coug h, an d te ta n u s which is
4 INTENSIVE IMMUNIZATION PROGRAMS

reasonably attrib uta ble to (1) purchase of vaccines needed to protect children 

under the age of five ye ars and (2) salaries and rela ted expenses of additional 

Sta te and local health personnel needed to promote and organize such programs, 

and personnel and rela ted expenses needed to mainta in additional epidemiologic 

and laboratory surveillance occasioned by such programs. Such g rants may also 

be used to pay similar costs in connection with intensive community vaccination 

prog rams aga inst any other diseases of an infectious nature which the Surgeon 

General finds represents a major public health problem in term s of high mortality, morbidity, disability, or epidemic potential and to be susceptible of practical 

elimination as a public health problem through intensive immunization activity 

over a limited period of time with vaccines or other preventive agents which may 

become available in the future.

“ (b) For purposes of this section an ‘intensive community vaccination program’ means a program of limited duration which is so designed and conducted 

as to achieve, with the cooperation of practicing physicians, official health agencies, voluntary organizations, and volunteers, the immunization over the period 

of the program of all, or prac tically all, susceptible persons in a community, 

particularly children who are under the age of live years, and which includes 

plans and measures looking tow ard the strengthening of ongoing community program s f or the immunization of infants and for maintenance of immunity in the 

remaind er of the population. No gra nt may be made under this section with 

respe ct to an intensive community vaccination program again st poliomyelitis, 

diph theria, whooping cough, and teta nus which begins after Jun e 30, 1005.

“ (c) Payments under this section may be made in advance or by way of 

reimbursement, in such installments, and on such terms and conditions as the 

Surgeon General finds necessary to carry out the purposes of this section, and the 

Surgeon General may, if the applican t State or oth er political subdivision or 

instrumentality so requests, purchase and furnish vaccines and other preventive 

agents in lieu of making money gran ts for the purch ase thereof.

“ (d) The Surgeon General, at the request of a Sta te or other public agency, 

may reduce the grant to such agency under this section by the amount of the pay, 

allowances, traveling expenses, and any other costs in connection with the detail 

of an officer or employee of the Public Health Service to such agency when such 

detail is made for the convenience of and at the requ est of such agency and for 

the purpose of carrying out a function for which a gra nt is made under this 

section. The amount by which such gra nt is so reduced shall be available for 

paym ent of such costs by the Surgeon General, but shall, for purposes of subsection (c ), be deemed to have been paid to such agency.

“ (e) Nothing in this section shall limit or otherw ise restrict the use of funds 

which are granted to a Sta te or to a political subdivision of a Sta te under title V 

of th e Social Security Act, other provisions of this Act, or other Federal law and 

which are available for th e purchase of vaccine or for organizing, promoting, conducting, or partici pating in immunization programs, from being used for such 

purposes in connection with programs assisted through g ran ts under this section.’’

Department of Agriculture,

Washington, April 9, 1962. Hon. Oren Harris,

Chairman, Committee on Inter sta te and Foreign Commerce,

House o f Representatives,

Washington, D.C.

Dear Mr. Harris : Tha nk you for giving us an opportunity to report on II.R. 10541, a bill to assist States and communities to carry out intensive vaccination 

programs designed to protect their populations, especially all preschool children, 

aga inst poliomyelitis, diphtheria , whooping cough, and teta nus, and against other 

diseases which may in the future become susceptible of practical elimination 

as a public health problem through such programs.

We find upon review th at this bill does not affect ma tte rs within the jurisdiction of this Department. However, since we consider this bill would benefit 

many children in the rural areas of the Nation we believe its adoption would be 

desirable.

The Bureau of the Budget advises that there is no objection to the p resentation 

of this report from the standpoint of the administration’s program.

Sincerely yours,

Orville L. Freeman, Secretary.
INTENSIVE IMMUNIZATION PROGRAMS 0

Executive Office ofthe President,

Bureau ofthe Budget,

Washington, D.C., March 28,1962.

Hon. Oren Harris,

Chairman, Committee on In tersta te and Foreign Commerce,

House of Representatives,

Washington, D.C.

Dear Mr. Chairman : This is in reply to your letter of March 7, 1962, requesting the views of the Bureau of the Budget on H.R. 10541, a bill to assist 

States and communities to car ry out intensive vaccination programs designed to 

protect the ir populations, especially all preschool children, aga inst poliomyelitis, 

diphtheria, whooping cough, and tetanu s, and a gainst oth er diseases which may in 

the fut ure become susceptible of practica l elimination as a public health problem 

through such programs.

This bill provides for a 3-year program of gra nts to States and the ir political 

subdivisions for the immediate initiation of intensive community vaccination 

campaigns aga inst poliomyelitis, whooping cough, diphtheri, and tetanus. The 

Federal funds authorized by the bill would be used for the purchase of the required vaccines for all children under 5 yea rs old and for the salarie s and expenses of the additional State and local hea lth personnel required for the organization and promotion of the community campaigns and to provide epidemiological and laboratory surveillance of the program. In addition to the special 

provisions r elating to rhese illnesses, the bill authorizes sim ilar program aga inst 

other infectious diseases which represe nt major public hea lth problems when 

vaccines or other effective preventive agents become available.

This proposed legislation was prepared by the adm inistration and would car ry 

out the recommendation for a nationwid e vaccination program contained in 

the Pre sident’s message to the Congress on February 27, 1962, on hea lth programs. I am authorized to advise you th at the enactment of H.R. 10541 would 

be in accord with the program of the President.

Sincerely yours,

Phil lip S. Hughes,

Ass ista nt Director for Legisla tive Reference.

Comptroller General ofthe United States,

Washington, May 8 ,1962.

B-74254

Hon. Oren H arris,

Chairman, Committee on Interstate and Foreign Commerce,

House of Representatives.

Dear Mr. Chairman : Your lette r of April 4, 1962, acknowledged April 6, 

1962, forw arde d for our comments and rep ort H.R. 10541, 87th Congress, entitled 

“A bill to ass ist States and communities to carry out intensive vaccination programs designed to protect the ir populations, especially all preschool children, 

against poliomyelitis, d iphtheria, whooping cough, and tetanus, and aga inst other 

diseases which may in the futur e become susceptible of practical elimination 

as a public health problem through such programs.”

The bill would ca rry out the term s of the title clause by authorizing appropria tions for the fiscal ye ar 1963 and succeeding fiscal years to enable th e Surgeon 

General to make gra nts to States and the ir political subdivisions or instr umen talities for th is purpose. While grants may not be made for vaccination programs ag ain st poliomyelitis, diphtheria , whooping cough, and tetanus which begin 

after Jun e 30,1965, there is no time limit on other vaccination programs.

We have no special information on the subject of the proposed legislation and 

therefore, make no recommendation concerning the merits of H.R. 10541. However, we wish to comment on certa in aspects of the bill.

The bill provides for an additional gran t program to be administered by the 

Public Hea lth Service. No provision is made in the bill nor in legislation applicable to other grant programs now auth orized by the Public Health Service Act, 

as amended, to requ ire a grantee to keep adequate cost records of the projects 

to which the Federal Government makes financial contributions, or specifically 

authorizing the Surgeon General or the Comptroller General access to the grante e’s 

records for purposes of a udit and exam ination. In view of the incre ase in gra nt 

programs over the last several yea rs we feel that in ord er to determine whether
6 INTENSIVE IMMUNIZATION PROGRAMS

gra nt funds have been expended for the purpose for which the grant was made 

the grantee should be required by law to keep records which would fully disclose 

the disposition of such funds. We also feel that the agency as well as the 

General Accounting Office should be perm itted to have access to the grantee’s 

records for the purpose of aud it and examination. We therefore suggest that 

consideration be given to amending the hill to include such requirements with 

respe ct to the proposed new program, or preferably to an amendment of the 

Public Hea lth Service Act to cover all gra nt programs therein authorized. The 

latte r could be accomplished by the following langu age :

“Records and Audit

“ (a) Each recipient of assistance under this Act shall keep such records as the 

Surgeon General shall prescribe, including records which fully disclose th e amount 

and disposition by such recipient of the proceeds of such grants, the total cost 

of the project or undertaking in connection with which such funds are given or 

used, and the amount of tha t portion of the cost of the project or undertaking 

supplied by other sources, and such other records as will fac ilitate an effective 

audit.

“(b) The Secretary of Health, Education, and Welfare and the Comptroller 

General of the United States or any of the ir duly authorized represen tatives shall 

have access for the purpose of audit and examination to any books, documents, 

papers, and records of the recip ients that are pertine nt to the grants received 

under th is Act.”

In administering the above provision we do not contemplate making a detailed 

exam ination of the books and records of every recipient of a gran t, or even a 

majo r p art of them. However, selective checks may be made to provide reasonable 

assu rance that grant funds are being properly applied or expended.

Sincerely yours,

Joseph Campbell,

Comptroller General of the United States.

Department of Health, Education, and Welfare,

March 11,, 1962. Hon. Oren H arris,

Chairman, Committee on Interstate and Foreign Commerce,

House of Representatives,

Washington, D.C.

Dear Mr. Chairman : This is in response to your request for a report on H.R. 

10541, a bill to assist States and communities to carry out intensive vaccination programs designed to protect the ir populations, especially all preschool children, aga inst poliomelitis, diphtheria, whooping cough, and tetanus, and 

against other diseases which may in the fut ure become susceptible of practical 

elimination as a public health problem through such programs.

H.R. 10541 embodies the adm inistration’s vaccination proposal. In the 

form of a draft bill it was transm itte d by this Depa rtment to the Speaker of 

the House of Representatives on February 27, 1962, and was refe rred to your 

committee on March 5.

For the reasons given in our letter to the Speaker in suppo rt of the bill we 

recommend i ts ea rly enactment.

Sincerely,

Abe Ribicoff, Secretary.

Department of Labor, 

Washington, April!,, 1962. Hon. Oren H arris,

Chairman, Committee on Interstate and Foreign Commerce,

House of Representatives,

Washington, D.C.

Dear Congressman Harris: This is in furth er response to your requ est for comments on II.R. 10541, a bill to ass ist States and communities to car ry out 

intensive vaccination programs designed to protect the ir populations, especially 

all preschool children, against poliomyelitis, diphtheria, whooping cough, and 

tetan us, and aga inst other diseases which may in the future become susceptible 

of practical elimination as a public health problem through such programs.
IN TENS IVE IM MU NIZATIO N PROGRAMS 7

Ther e is li tt le do ub t as to th e ne ed fo r pre ve nt iv e m ea su re s fo r re du ci ng 

th e incide nc e of th es e dise as es which ca us e un ne ce ss ar y su ffer in g or even dea th 

am on g ou r po pu latio n, espe ciall y yo un g ch ildr en . The D epar tm en t of Lab or 

is vi ta lly co nc erne d w ith th is si tu at io n, part ic ula rl y in vie w of th e fa ct th a t 

pr ac tica l metho ds of pr ev en ting an d co nt ro llin g such di se as es are now av ai la bl e. 

We. th er ef or e, fa vo r effecti ve le gi sl at iv e ac tion to de al w ith th is problem .

As you kno w, th e P re si den t in his mes sa ge on he al th pr og ra m s of Feb ru ary 

27, 1902, st ate d th a t “t he ba sic re so ur ce of a na tion is it s peo ple. It s st re ngth 

ca n be no gre ate r th an th e hea lth an d v it ali ty of it s po pu latio n. Pre ve nt ab le 

sic kn ess, di sa bi lity , an d ph ys ical or m en ta l in ca pa ci ty are m att ers of bo th in ­

di vi du al an d national co nc ern.”

In view of th e forego ing, th e D epar tm en t of Lab or su pp or ts th e en ac tm en t of 

H.R. 10541. We pre fe r, ho wev er, to le av e co mmen t on th e te ch ni ca l as pe ct s 

of th e bill to thos e ag en cies direc tly co nc erne d w ith its ad m in is trat io n.

Th e B ure au of th e Bud ge t ad vise s th a t th ere is no ob jection to th e pre se nta ­

tio n of th is rei>ort from th e st an dpoin t of th e adm in is tr ati on’s pr og ram.

Yo urs s ince rely,

Akti iu r J. Goldberg,

Secretary of Labor.

The Chairman. The purpose of the proposed legislation is to authorize a short-term program of special project grants to States and 

communities for an intensive vaccination program against polio, 

diphtheria, whooping cough, tetanus, and other major and destructive diseases as vaccines become available for them.

The members of the committee, who served on the committee when 

the Salk vaccine legislation was under consideration, will recall the 

tremendous interest which existed at tha t time in the new vaccine 

that, promised to eradicate polio. We all know of the tremendous 

strides that have been made toward the achievement of this laudable 

objective.

Secretary Ribicolf’s letter indicates, however, tha t many children 

under 5 years of age who are in th e most susceptible age group are 

still unprotected against polio as well as other diseases for which 

vaccines are available.

The program proposed in this legislation is designed to bring about 

greater protection particularly for children in this age group.

Vaccination programs frequently arouse antagonism on the part, of 

certain groups and individuals who do not believe in the wisdom of 

such programs. The proposed legislation is no exception.

I understand that some witnesses, who will testify this morning, are 

seeking assurances that the legislation if enacted, will not result in 

compulsory vaccination.

It is unusual for the committee to hear the opposition before hearing from the administration, which has reguested enactment of this 

legislation. Sometimes we have got to cut the cloth to fit the pattern, 

and today is no exception.

The Secretary, Mr. Ribicoff, will testify as a witness in support of 

the legislation on behalf of the administration, but he is unable to be 

here today. We felt, however, that we could not delay the beginning 

of the hearings because the committee has a very heavy schedule, and 

I have some difficulty in working out, a program to accommodate all 

of the phases of our work, and enabling the full committee to discharge its responsibility and at the same time leaving opportunities 

for the important work of the subcommittees.

This morning our first witness will be Dr. Russell E. Teague, commissioner of health, representing the American Public Health Association.

Dr. Teague, we will be glad to hear your statement.
8 INTENSIV E IMMUNIZATION PROGRAMS

STATEMENT OF DR. RUSSELL E. TEAGUE, COMMISSIONER OF

HEALTH, FRA NKFOR T, KY., ON BEHA LF OF TH E AMERIC AN

PUB LIC HE AL TH ASSOCIATION

Dr. T eague. Mr. C hai rman and members of the committee, I am D r. 

Russell E. Teagu e, comm issioner of hea lth, of Kentu cky . I am a docto r o f medicine w ith a specialty in public health.

I am c hairm an of the committee on pub lic policy an d legisla tion of 

the Am erican Pu blic Hea lth Association, and am here tod ay rep resenti ng thi s grou p.

Th e Am erican Publi c He alth Association is composed of ap prox ima tely 33,000 persons engaged by S tat e a nd local and volun tar y healt h 

agencies, worki ng in the field of preven tin g disease amongst the popu ­

lation . We have four diseases for which we have excelle nt vaccines 

availab le. These diseases are poliomy elitis, diph theria, whooping 

cough, and te tan us.

These vaccines are very effective in pre venting thes e diseases, and 

our o nly t ho ug ht is in g ettin g everyone t o tak e th em and be p rotected. 

We need an inte nsiv e program to get chi ldr en to tak e th e vaccines 

th at are av ailabl e to them.

Th e State s fo r m any year s have had p rog ram s, rel ying up on edu catio nal tech niques and m aking vaccines ava ilab le free to indig en t ch ildre n. Ou r medical societies have been acti ve in p romo tin g i mm unization pro gra ms, bu t we still have not acco mplished the end th at we could 

by ap plying wh at we know and ap plying these vaccines to the total 

population .

Dip ht he ria is still qu ite pre valen t in ma ny pa rts of ou r co untry. In 

fac t, in the last 6 years I have h ad two serio us epidemics of diph the ria . 

In Meade County, in 1957, we ha d 100 cases with 4 death s amo ngst 

young chi ldren. In Georgeto wn, Ky., las t year we h ad 50 cases with 

2 death s, and these were severe epidemics of the most virulent kind, 

and it took a lot of diligenc e to save the lives of the ch ild ren who had 

the disease.

We are still having too much poliomyelitis. The effectiveness of th e 

Salk vaccine has dem onstrated th at it can be elimin ated but not enough 

child ren have t aken the vaccine.

Stu die s m ade by the Pu bli c H ea lth Se rvice in dica te t ha t on a n ati on ­

wide basis no t more than 38 percen t of children un de r 6 have had 

polio vaccine. Many com munities have give n more than this and 

many com munities have given less t ha n this , but thi s is on an average 

fo r th e co untry as a whole.

Whooping cough is one o f the m ost dea dly diseases we ha ve in childre n under 6 years of age, and especially under 2 years of age. I t is 

a very serious disease in i nfa nts .

I t q uite often goes into pneumonia a nd causes d eath in the ch ildr en. 

An d, of course, tetan us is a very f ata l disease t ha t no one sh ould have, 

because the tet an us vaccine is the best vaccine th at has ever been 

devised.

Ev ery man who has ever served in the military services has had 

tet anus vaccine b ut, un fortu nately, so many of our y oung chil dren do 

not get it.

Pa rents who employ p ediatrician s to look a fter their children usu ally 

see that, they receive a com bina tion of these thre e, D P T ; th at is 

diph theria, pertussis, a nd tet anus vaccine.
INTENSIVE IMMUNIZATION PROGRAMS 9

And some general practitioners give it in their practice but the number of children that receive this is not enough. So the American Public Health Association, with its 33,000 members, does endorse this 

bill and agree with it in principle. Mr. Chairman, there is one part of the bill we do not agree with, 

and-----

The Chairman. Tell me, what did you say DPT meant?

Dr. Teague. Diphtheria, pertussis, and tetanus.

“Pertussis” is the medical word for whooping cough.

The Chairman. Thank you.

Dr. Teague. As I stated, the American Public Health Association 

agrees with your bill and endorses it in principle, and it thinks that it 

would be a good thing for the country. We do feel, however, tha t the Federal Government should deal with the States rather than dealing with local political subdivisions and instrumentalities of the States, because the State health depa rt­ ments should coordinate their entire vaccinating programs within the 

confines of the State. The constitutions of the various States puts the responsibility for the health of the people in the State, and in many areas the States have delegated this to local boards of health in local communities, but the States still have the responsibility of keeping track of these diseases that are occurring and taking steps to control those diseases. Therefore, our organization would like to see H.R. 10541 amended 

to leave out the political subdivisions and instrumentalities within the States so tha t the grants would be made to the State, and let the State health departments arrange for the programs of distributing it 

within the borders of the State. On the second page, lines 7 and 8, the words “and politcal subdi­ visions or instrumentalities of the States” should be deleted, we be­ lieve, with similar deletions in other parts of the bill where these 

words occur. Our experience with the Public Health Service in other g rant areas, where the State boards of health and the State health commissioners deal directly with the Public Health Service on formula grant bases, indicates this method does provide a good instrument for us to devise 

programs within our States to eradicate disease. The competence for controlling disease lies within your State health departments, and the American Public Health Association believes tha t this bill would work better if the Public Health Services would 

deal with the State. Again, I reiterate, the American Public Health Association endorses 

this bill and is in favor of it.

Thank you, sir.

The Chairman. Doctor, I want to thank you for your statement, 

and we appreciate your suggestions. I shall be glad to consider furth er your suggestion with reference to the political subdivisions or instrumentalities of the States. I think consideration probably will have to be given as to whether or not the program will go through the States. I think it was intended tha t it be decentralized, so the people can go to their local health unit 

in their county.
10 INTENSIVE IMMUNIZATION PROGRAMS

Dr. Teague. Oh, yes, sir. What I mean is th at the for mu la gr an t 

fo r the Fe deral Gov ernment deali ng with the com mun ity should be 

throug h the S tate.

Th e vaccine would be given at the local com munity level, and the 

money would be trans mitted by t he State down to the local com mun ities, ju st as we do in all of the other for mu la gr an ts th at the Sta tes 

receive from th e P ublic Health Service.

I did not mean that the vaccine would not be given to local com* 

munities, bu t thi s bill, the way it is wr itten, would pe rm it the Pub lic 

Hea lth Service to deal directly with a comm unity within a State wi thout the fund s or the vaccine going throug h the St ate de pa rtm en t of 

hea lth.

Th e Chairman. I am not sure th at was so inte nde d, hu t we will 

pursu e it and find out.

Dr. T eague. Th an k you.

Th e C hair man. Ar e t here any questio ns?

Mr. Mack. Yes.

Doc tor, how much money do you think would be necessary to carry 

ou t this bill ?

Dr. Teague. Th is is quite difficult to d ete rmine at the pres ent time.

I think this bill con tain s a sta tem ent th at this would be a sho rtran ge intensified pro gra m. An estimate th at has been made by the 

De pa rtm ent of He alth, Ed uca tion, and Welf are would call fo r someth in g in the order of to $10 million for a perio d of 3 or 4 yea rs 

to completely immunize all of the preschool children in the cou ntry. 

Th ere a re appro xim ate ly 4.5 million children born each year, and this 

should be kept up. Tha t would be 4.5 million chi ldr en immunized 

each year.

Now, most of this imm unizati on is done by private practitione rs in 

th eir pract ice th at is bein g given now, and thes e fun ds th at would be 

made ava ilab le un der thi s act—it does not so ap prop ria te bu t it 

would be req uired un de r thi s act—would be to fill the gap for those 

who are not now ge tti ng the vaccine from priva te pract itio ners, and 

to stimu late physic ian s to do more.

I think if we could star t pro gra ms in the c omm unities it would re ­

sult in more immu nizations by p riv ate practition ers .

Th e vaccine, acco rding to t his act, may be used by p riv ate physic ians 

and p ractici ng physician s, by official healt h agencies, volun tary health 

agencies, or any othe r gro up that can pu t on an imm uniz ation 

pro gra m.

I have no exa ct figures, sir. I believe M r. Ribicoff would pro bab ly 

have these when the De partm ent make s its pre sen tation , but my best 

guess would be appro xim ate ly 9 million a ye ar for 3 o r 4 years.

Mr. Mack. The ind ividuals today are pa ying for these vaccination s; 

is that right?

Dr. Teague. Yes.

Mr. Mack. Th roug h the p riv ate p ractition ers?

Dr. T eague. The y do, b ut, as I sta ted in my testimony, only 38 pe rcent of the children go to doctors and pay fo r it now.

So there is a large g ap of unvac cinated child ren in the pop ulation.

Mr. Mack. You are suggesting , the n, th at we mak e these vaccines 

available to those who a re not gettin g them to day ?
INTE NSIV E IMMUNIZATION PROGRAMS 11

I)r. Teague. I think the vaccines should be made available to the 

States by the Federal Government as an assistance to the States, 

to provide an impetus to get more children immunized.

This could be used or it could be given in public clinics. It could 

also be given by private physicians in their offices for which the 

physician might make a charge for administering the vaccine.

Mr. Mack. Today they charge for the vaccine as well as their 

services?

Dr. Teague. The vaccine, yes, is bought through commercial channels today.

Mr. Mack. And if this bill were approved, then the vaccines would 

be made available free?

Dr. Teague. For preschool children; yes, sir.

Mr. Mack. For all preschool children, including those who are today paying for it ?

Dr. T eague. No. I think the amount or the figure I gave you, of 

$0 million, was the difference between those now immunized and 

those who are not. It is enough to fill the gap.

Mr. Mack. Is it your idea that the people who are able to pay for 

it should continue to pay for it ?

Dr. Teague. Yes, sir.

Mr. Mack. And this bill would be for those people who are not 

financially able to take care of it ?

Dr. Teague. Partly, and partly as an incentive for those who are 

not now going to doctors to get it.

Many areas do not have pediatricians and have a shortage of general 

practitioners, and the physician is so involved in taking care of the 

sick that he does not have time to put on an immunization campaign. 

This is a function usually of the official health department of the 

community, to see that campaigns and public clinics are set up to 

administer the vaccine.

We have many counties in my State with only one physician, and 

he is involved in treating the sick, and he does not have time to do 

an immunization program. This is to implement what the practicing 

profession is now doing.

Mr. Mack. Well, would it not really be, in effect, though, making 

the vaccines available to all preschool children free?

Dr. T eague. This is true. It could lie that way, but it would take 

more money than the $9 million.

Mr. Mack. As a matter of fact, it would be very difficult to carry 

out the program without making it available free to those people 

who are-----

Dr. Teague. I would say this would vary from community to community, depending upon the tradition and the practices of tha t 

community.

Traditionally, in some counties all the physicians chip in with the 

local health department and give the vaccines free at the present time.

In other areas physicians give it to those who can pay, and charge 

for it, and give it to those who cannot, without charge. And State 

and local health departments are now buying vaccine in large quantities for the indigent.
12 INTENSIVE IMMUNIZATION PROGRAMS

We believe th at we need the stim ulation of Fe de ral interest, Fe dera l leader ship, and Fe deral assistance to the St ates to give th at 

lit tle impetus n ecessary to get more ch ildren immun ized.

Mr. Mack. Th an k you, Doctor.

Th e Chairma n. Mr. You nger.

Mr. Younger. Doc tor, at firs t blush, it seems as tho ugh you are 

pro posin g about $180,000 each for 50 States.

Do yo u think th at it is economic for the State s to come to th e Fe dera l G overnm ent to set up all o f the mac hinery f or a $180,000 stake?

Dr . T eague. Sir, I am not quite sure th at the m oney is as imp ortan t 

as the Feder al lea der ship to get a nation wide prog ram goi ng at one 

tim e to wipe out the fo ur diseases.

I think the Sta tes, many of them, need the money th at would be 

ava ilable throug h such gr an ts because they just now do no t have it 

ava ilab le to fur nish vaccine in larg e enough q uantities.

I f Sta tes do this independe ntly and sep ara tely, which many of 

the m have been doing f or p ast years, the re is a h odg epodge o f disease 

control. We would like to see the Na tion tr y to get a unifo rm pr ogr am throughout the cou ntry.

I am sure you can remember th at there was no un ifo rm ity in tu be rculosis control or venereal disease control until the Federal Governme nt came in with gr an ts to get a un ifo rm prog ram throug ho ut the 

country going and wipe out certain diseases.

And it take s this sort of coordinated effo rt on the p art of th e whole 

country to wipe out the disease.

Mr. Younger. The n you are not concerned wi th th e ap prop ria tio n 

as much as you are with the philosophy of ge tti ng t he F edera l Govern me nt to promote it?

Dr. Teague. Tha t is r ight , and I think the g ra nt s are necessary because in th is bill it provides not only f or fu nds bu t th e loan of Federal 

person nel to the State s where personnel are no t available.

Th e Public He alth Serv ice needs thes e funds to employ personnel 

and trai n them in the field of imm unology, and assign them ou t in the 

States to he lp them get these p rog ram s going.

Mr. Y ounger. Why do you advance the idea of segrega tion in thi s 

prog ram ?

Dr . Teague. I do not. I do n ot know wh at you m ean by that.

Mr. YouNger. We ll, surely , you say th at those who can afford to 

pa y fo r it will receive it and those who can not, will have to pay for 

it. Is th at not segregatio n ?

Dr . Teague. No. I say th at those people who wa nt th eir children 

to be immunized sho uld go to a physicia n an d pa y for it, and then 

those who are not mo tivate d sufficiently eno ugh to go to a phy sician 

and pay fo r it might go to a public clin ic and receive this vaccine.

Mr. Younger. Yes, bu t if you are g oin g to have a pro gra m should 

you not furni sh the vaccine to all doctors free, and let them pa rtic ipate! in the pro gra m and vaccinate?

Dr. Teague. I th in k this wou ld be done inso far as this vaccine is 

available, bu t ap pa rentl y th is bill does no t provide enough vaccine 

fo r everyone.
INTENSIVE IMMUNIZATION PROGRAMS 13

It only provides enough for children under 5.

Mr. Younger. That is what I mean. But even children under 5, 

whatever is given-----

I)r. Teague. I would be in favor of th at, sir, of providing the vaccine free to-----

Air. Younger. Free to all of the practicing physicians to immunize 

children under 5 years old ?

Dr. Teague. I would be in favor of that, sir.

Mr. Younger. You would advocate that?

Dr. Teague. Yes. sir.

Mr. Younger. So tha t it would be widespread and available to 

everybody. There would not be any one family who would have to 

go to the public health or another one having to go to the physician.

They can go and get it each time. I should think that the doctors, 

if they participate in the program, they might very well say, “All 

right, all the children under 5 we will immunize or give them this 

vaccine for nothing.” You might get that agreement I do not know, 

but if you are going to have a full program, throughout the United 

States, it seems to me tha t you are going to have to get the cooperation of all of the practicing physicians.

Dr. Teague. Absolutely. This is why we are for this bill. We 

think this will do this very thing that you are saying.

Our objective is to eradicate these four diseases, to get them so 

controlled that they will just be rare.

We think we can eradicate some of them, and certainly this bill is 

a step toward doing this.

We have had diphtheria vaccine and whooping cough and tetanus 

vaccine for many, many years, and the States and communities and 

medical societies have been working together to try to do it, but we 

just have not done it.

And I think we need national leadership in the field of immunology 

to stimulate it, and one way is by providing Federal assistance, 

through funds and personnel, to provide vaccine for everyone.

Mr. Younger. The only way now is that if you want to get a passport to go to a foreign country you have to have the vaccination-----

Dr. Teague. Yes; well, many States have compulsory smallpox 

vaccination and some States have passed compulsory laws requiring 

these four diseases to be.

For instance, in my State we have a law just passed by our last 

legislature, requiring every person from age 6 months to age 18 to be 

vaccinated against these four diseases.

This is enforced by entrance upon school. They are required to 

bring a certificate, showing that they have been immunized successfully against these four diseases and smallpox, and many States are 

passing such laws.

The Federal entrance into this field of promoting immunization 

would give impetus to more States taking this action and completely 

eradicating these diseases.

Mr. Younger. For the record, could you furnish us with a list of 

States that have legislation in this field ?

Dr. Teague. Yes, sir.

84426— 62 2
14 INTENSIVE IMMUNIZATION PROGRAMS

(The inform ati on req uested is as follows:)

Sta te s w it h co mpu lsor y va cc ination law s

A rk an sas: Sm allpox .

C a li fo rn ia : P oli o, sm all po x.

D is tr ic t of C olu mbia : Sm alli x,x .

H a w a ii : Sm allpox , di pht her ia , typh oid.

K a n sa s: S mallpox , di ph th er ia , pe rtus si s, t eta nus, polio.

Ken tu ck y : Sm allpox , di ph th er ia , pe rtus si s, te ta nus, i»olio.

M a ry la n d : Sm all po x.

M ass achuse tt s: Sm allpox.

Michiga n : S ma llp ox , dip ht he ria, pe rtus sis, te ta nus, polio.

M is so uri : S mallpox , di ph th er ia , pe rtus si s, te ta nus, polio.

New H am psh ir e: Sm allpox.

New M ex ico: S ta te boa rd o f h ea lth specifies.

Ne w Y o rk : Sm allpo x.

N orth C ar ol in a : Sm allpox, dip hth er ia , per tu ss is , te ta nus, p olio.

O hio : S mallpox , d ip ht he ria, p er tu ss is , te ta nus, polio.

P en n sy lv an ia : Sm allpox.

Rho de I s la n d : Sm all po x.

So ut h C aro li n a: Sm allpo x.

V irgin ia : Sm all po x.

W est Virg in ia : Sm allpox, di pht her ia .

Mr. Younger. Th at is all.

Th e Chairma n. When you say “this Held,” you mean insofar as 

these fou r diseases are concerned ?

Mr. Younger. Th at is right.

I)r. Teague. I will get t ha t for you.

Th e C hairman. Mr. Rogers?

Mr. Rogers of Texas. Doctor, has the re been any discussion, in 

talking abo ut these bills and this vaccina tion pro gra m, of Federal 

com pulsio n ?

Dr. T eague. No, sir ; no, sir.

Mr. Rogers of Texas. I notice th at you said th at this bill would 

be a step tow ard the solution of the problem, and I was jus t wondering 

if they were an tic ipating the use of Federal legislation in th e same 

manner as you rela ted is being used in the Sta tes to compel this?

Dr. Teague. No, sir. The rel ationship of the U.S . Publi c He alth 

Service to the Sta tes in th e field of health has alw ays lieen one of 

gran t-i n-aid and assistance, and stimu lation to the Sta tes, and giv ing 

us ad vice and consulta tion services, and tha t typ e of help.

There has been no inst ance th at I know of in which the Federal 

Gov ernment has taken or mad e any compulsory action exce pt du rin g 

the wa r when the re was an act to control venereal diseases, b y mak ing 

prostituti on illeg al in certain pa rts of the country where troops were 

located.

Th at is the only Federal law th at I know of in which the Federal 

Governm ent has had an y co mpulsory act.

Mr. Rogers of Texas. W ha t I ha d in min d was indirect com pulsion, like you say to a fam ily, “Now, yo ur child cannot go to school 

unless i t is vaccinated.”

Dr. Teague. Yes, that can lie done at the St ate level bu t not at 

the Federal level.

Mr. R( xjers of Texas. Yes, I understand, bu t the fac t is th at you 

can say to the Sta te, “Unless you do it out of compulsion or a compulsory7

 vaccinatio n law, then you will not be allowed to pa rti cipa te 

in these g rant f und s.”
INTENSIVE IMMUNIZATION PROGRAMS 15

I)r. Teague. This could he done but I would not favor that, sir.

Mr. Rogers of Texas. Now, you say in your State you have a compulsory vaccination law with regard to five or four diseases.

Now, suppose you ran into a religious situation, where you have 

some people who have certain religious beliefs who do not believe in 

vaccination, and they say that they will not be vaccinated?

Dr. Teague. Our State law provides for that in all diseases except 

smallpox. Everyone is required to have that.

But these other four diseases, on those, there is a section in the 

law that says that people who belong to certain national religious 

groups, and will present a certificate to the school tha t their religion, 

which is a national group, prohibits them from taking the vaccine, 

if they present this certificate they can be exempt.

These groups are in such small number that I do not believe th at 

this exemption would affect the control of the disease.

However, the law goes furth er to say, in my State, that if there is 

an epidemic which occurs, the State board of health may take action 

to immunize everyone, including the religious exemptions.

Now, most of the States tha t have passed this law have put a religious exemption clause in it. This provides that if a person will 

present a statement that they belong to a nationally recognized religious group whose beliefs are against immunization they are exempt 

from the law.

Mr. Rogers of Texas. Then the child can attend school ?

Dr. T eague. Yes, they can on the basis of that certificate.

But the small number of these particular religious groups in the 

population is not sufficiently large to affect the total or have any significant effect on the total effect of getting people immunized and 

eradicating the disease.

Mr. Rogers of Texas. Now, Doctor, is it your plan under the 

proposal that this money be furnished the States and the States 

enter into this program any way they want to?

In other words, they could have mass immunization or they could 

turn this vaccine, that is purchased, over to doctors?

Dr. Teague. I think I would like to see it left to the States to 

determine the kind of program th at they want.

I would hope that the Public Health Service would offer consultation and guidance, and assistance, to the States in developing 

these programs. They are doing this already in some diseases.

Mr. Rogers of Texas. Now, of course, the cost of immunization, if 

this is turned over to doctors, will depend upon what the doctor 

•charges for inserting the needle.

I mean, one doctor may charge $10 and another $1.

Dr. Teague. This is true.

Mr. Rogers of Texas. So even though the vaccine is free to the 

doctor, the charge that the patient is subjected to depends upon what 

he wants to charge him.

Now, under this bill, Doctor, I notice that there is no limit, as I 

understand it, on the use of the funds for, we will say, advertising 

campaigns to get people to l>e vaccinated.

Is that correct ?

Dr. Teague. This would be one part of the total program.
16 INTENSIVE IMMUNIZATION PROGRAMS

The law specifically says th at the Surge on Gen eral shall determ ine 

methods of dev eloping a pro gra m, an intensified pro gra m, to get 

people to take these vaccines.

So this wou ld empower the Sur geo n Gen eral to pu t on cam pai gns, 

I wou ld s ay; yes, sir.

Mr. Rogers of Texas. To pu t on television or rad io cam paigns to 

get the people to ge t vaccin ated ?

Dr. T eague. Yes.

Mr. Rogers of Texas. In o ther words, it would go fa r b eyond j ust 

the purch ase of the vaccine itself and the distr ibu tio n of it?

Dr . Teague. Tha t is e xactly rig ht, and we need a mass educational 

prog ram on this.

Th e television indu str y of this country donates a conside rable 

am ount of tim e now for wh at they call pub lic service typ es of 

pro gra ms.

And I t hink it would be very well if we could ge t a nat ion wide mass 

media edu cational pro gra m for immu nizatio n, and it sho uld be done. 

Th is bill would prov ide for that.

Mr. R ogers of Texas. Th ank you, sir.

Th e C hairma n. Mr. Sibal ?

Mr. Sibal. Doctor, to go back to a po int th at Mr. Yo unger made, 

is it yo ur feeling th at an act of Con gress would stimu late nat ion al 

att en tio n and would, in effect, provide the missing lin k of ap proa ch ­

ing this to a total basis thr ou gh ou t the Nation 2

Is th at corr ect ?

Dr. Teague. Yes, sir.

Mr. Sibal. I am concerned abo ut the need fo r this, if th is does not 

involve a gr ea t deal of finan cial burden on the indiv idu al State s for 

the Congres s to inter jec t itself in this , and I am concerned wi th the 

ide a th at, in orde r for any prog ram to be ado pted on essentially a 

nationw ide basis, even a prog ram of health, th at it tak es a congres ­

sional act.

Do you not hav e inter sta te groups ? Do you no t have, fo r exam ple, 

interstate assoc iatio ns of public hea lth directors ?

Dr. Teague. Yes. They will be here to testify late r th is m orning, 

sir.

Th e Associa tion of State & Te rrito ria l He alth Officers w ill be here, 

an d the org aniza tio n th at I am rep res enting, the Am erican Public 

Hea lth Ass ociatio n, has St ate asso ciations in each Sta te.

We ha ve policies on these m atters , but we feel th at we need gu idance 

fro m ou r Fe de ral healt h de pa rtm en t, our Public Hea lth Sen dee, 

and we think th at if they were empowered to enter the field of immu niz ation, to assist the Sta tes , th at th is would add stimu lus to the 

en tir e pro gra m.

Mr. Sibal. I know you feel th at way, bu t I cannot q uite unders tan d 

wh y it is necessary.

Ce rta inly you do not have a pa rti cu la rly difficult technical problem 

in ter ms of imm unizing people wi th alr eady existing vaccines.

An d I wou ld think th at a jo in t effo rt, throug h yo ur public health 

associations, and perha ps the Gover nors conference, would cer tainly 

ge t each State on the job in this.

And it seems to me th at we talk all th e tim e abo ut bringi ng these 

things as close to the people as possible and yet, on the othe r hand,
INTE NSIVE IMMUNIZATION PROGRAMS 17

we say, “Well, here we do no t need the money; we do no t need any 

gr ea t tech nical advic e, bu t we need an imp ression, more or less, of 

natio nal int ere st.”

Fr an kly, I am not convinced th at th is is the kin d of th in g th at is 

necessary for the Congress to act on.

Dr. Teague. I did no t mean to infer , sir, th at we did no t need the 

money. I th in k pa rti cu larly State s lik e Kentu cky and So uthern 

St ates do need fina ncia l assistance fro m the Fe de ral Government-----

Mr. Sibal. We ll, was------

Dr. T eague. An d the technical advice of it.

Mr. Sibal. We ll, wh at is the ave rage cost------

Dr. Teague. Our St ate health de pa rtm en t? Ab out $6 million a 

year.

Mr. Sibal. We are tal king about an av era ge cost of less tha n $200,000 

fo r each Sta te.

Dr. Teague. Th is is fo r the group of pre-scho ol children un de r 5, 

an d I think this w ould do it.

I f an ap prop ria tio n of som ething like $10 million a ye ar fo r 3 or 

4 or 5 years we re made, that w ould be $50 m illion and y ou could e radicate these diseases, I believe, wi th the exis tin g pro gra ms that we now 

hav e going on in pr ivate practic e and so fo rth . Th is wou ld be in 

ad ditio n to the existing pr ogram s th at are now go ing on.

Mr. Sibal. Bu t you do not feel th at th is could be done wit hout 

congres sion al action ?

Dr. Teague. No, sir. I speak fro m experience in other disease 

control p rog ram s.

We ha d a s potty V D control pro gra m and a spotty TB c ontrol pro ­

gram , and all kinds, un til the Publi c Hea lth Serv ice was empowered 

to cen tralize the prog ram and assist the State s and get a unifo rm 

type of pr og ram thr ou gh ou t the cou ntry .

An d I feel th at this would be he lpful in case of imm uniz ations.

Mr. Sibal. You look at the St ate services as esse ntia lly a coo rdinated par t of the Fe deral service ?

Dr. Teague. Th ro ug h the las t 50 years the U.S . Pu blic He alth 

Serv ice, the St ate healt h departm ents, and local he alt h departm ents, 

have wor ked in a pa rtn ersh ip arrang em en t up and down, righ t down 

t hro ugh th e gras sro ots and back u p a gain.

Th is has been one of the most inter estin g rel ati onships in government th at I hav e ever witnessed, this pa rtne rshi p arrangeme nt.

It needs coo rdination at the top level throug h the 50 State s down 

to the 3,000 countie s in the cou ntry. Ac tua lly, each St ate he alt h 

officer is req uir ed by Fe deral la w to come to W ashin gto n annuall y a nd 

advise the Surge on Gener al on the nationw ide pro gra ms, and we do 

that.

I th ink th is is a uniq ue arra ng em en t of Fede ral, S tat e, and local p art ­

ne rship: Yes, sir.

Mr. Sibal. We ll, do you feel—well, I will wi thdraw th at question.

The relati on ship whi ch you describe as a pa rtn ersh ip then esse ntially req uires th at any attack on he alt h be done throug h the Fe deral 

Gov ernment wi th Fe de ral leadership.

Is that righ t ?

Dr. Teague. I t is be tte r done if it is done nat ion wide at the same 

tim e ra th er than spora dic ally and sp ottedly by the various States 

an d communities.
18 INTENSIVE IMMUNIZATION PROGRAMS

Mr. Sibal. We ll, how about the State s who att ack these problems; 

within th eir own bor der s?

Would a pro gra m like thi s—while 1 recog nize the money is not 

very great, the principle to me is—would a program , fed era lly developed, in this are a essentially put the money in the State s which have 

done n othin g ra th er t han in the Stat es which have shown some i ni tiative ?

I)r . Teague. I would think not. Th is bill does not tell how the 

money—does not spell out how the money would be dis trib ute d.

Bu t 1 would think that it possibly would be distr ibu ted on a form ­

ula gr an t basis, based upon population , pe r cap ita income, and the 

need of people, and thi s sort of thing , like all the oth er gr an ts are 

mad e to us fo r health purposes.

The S tates th at hav e done trem end ous jobs in imm uniz ation are few. 

Th ere are not many that have attack ed th is problem wholly.

There are some States that have be tte r imm uniz ation prog rams t ha n 

othe r States, and I think this would level it out.

Mr. Sibal. I t w ould tend to level it out ?

I)r . Teague. Yes ; so th at all the State s would have good programs.

Mr. Sibal. Wo uld it tend to level it out in some areas, such as if 

a State is do ing a superio r job, it would level it o ut to an infer ior------

Dr. T eague. No, si r; I would not think so. It w ould ten d to b rin g 

the oth ers up to that level. I do not see how it could reduce wh at a 

St ate has alrea dy done.

Mr. Sibal. Th ank yo u, Mr. C hairm an.

The Chairman. Mr. Rogers?

Mr. Rogers of Florida. Mr. Ch air ma n, I have just one question. 

As I un derst and it, your fee ling is th at this shou ld be app roa che d 

nationw ide -----

Dr. Teague. Yes.

Mr. Rogers of Fl orida (con tin uin g). Th at it does not do too much 

good to immunize in just a few are as in pa rtic ul ar St ates ; th at to 

rea lly figh t the disease and wipe ou t the disease, if imm unizati on is 

goi ng to be effective, it must lie don e all over.

Is that true ?

Dr. Teague. Th at is correct. For instance , you have era dic ate d 

polio in Miam i by doing it all at one time. Now, why can we not do 

thi s fo r the Nation at one time? Th is is my belief, t ha t it can be done.

Mr. Rogers o f Florida. I won dere d if you had any figures on what 

the sav ings might be if we could era dic ate these diseases?

Dr. Teague. I do not have figures on that.

I am sure the D ep artm en t o f He alth, E du catio n, and W elf are could 

sup ply these, because I only have figures fo r my own Sta te, bu t it 

would be a treme ndous s aving in life and illness, especially in infants 

who get whoop ing cough and this sort of thing.

Mr. Rogers of Florida. Th ank you.

Th ank you, Mr. C hairm an.

The Chairman. Mr. Ja rm an , do you hav e any q uestions?

Mr. J arman. No questions.

The Chair man. You do not prete nd th at there is any com pulsion 

in th is bill i tself-----

Dr. T eague. No, sir ; and I do no t th in k th ere sh ould be.
INTENSIVE IMMUNIZATION PROGRAMS 19

I think this should he left to the States and communities, because the 

enforcement would have to be tied into a school system or something 

of this sort, and this would be difficult from the Federal level.

The Chairman. Thank you very much.

Well, just a minute. I do have another question. You stated that 

you represent the American Public Health Association.

I)r. Teague. Yes, sir.

The Chairman. Can you speak for the State public health officers?

Dr. Teague. No, si r; not now. Dr. Gray will be here.

I think he is fourth on your list there, and he will be here to speak 

for the Association of State Public Health Officers sometime today.

The Chairman. I see. In other words, Dr. Gray represents the 

State public health officers, does he not?

Dr. Teague. Yes, sir. Yes, sir.

The Chairman. All right. Thank you.

The next witness is Dr. James E. Perkins, managing director of the 

National Tuberculosis Association.

Mr. Perkins?

STATEM ENT OF DR. JAM ES E. PE RK INS, MANAGING DIRECTOR, 

NATIONA L TUBERCULOSIS ASSOCIATION, NE W YORK. N.Y.

Dr. P erkins. Mr. Chairman and members of the committee, I am 

Dr. James E. Perkins of the National Tuberculosis Association. I received my doctor of medicine degree from the University of Minnesota, and my master of public health and doctor of public health 

degrees from the Johns Hopkins University.

I have served as an epidemiologist in the Minnesota and New York 

State Departments of Health, as a district State health officer in 

upstate New York, as director of the Division of Communicable 

Diseases of the New York State Health Department from 1938 to 

1946, deputy commissioner of the New York State Health Department 

in 1946 and 1947, and have been managing director of the National 

Tuberculosis Association since 1948.

I have a very brief statement here.

I have prepared a copy and have given it to the stenotypist. I shall 

read only certain portions of it.

I start out this way because I am sure you must be curious why 

someone from the National Tuberculosis Association is testifying 

with regard to this bill.

I will only state that, historically, the National Tuberculosis Association and its 2,500 affiliated associations throughout the country have 

been pioneers in the development of the child health programs and 

school health programs. So we have been interested for many years 

in this field of school health and child health.

Furthermore, for over a decade we have been very much concerned 

with regard to other respiratory diseases and not only with the 

eradication of tuberculosis. But we have not publicized this to a great 

extent because we feel there is already too much apathy with regard 

to the eradication of tuberculosis itself.

Today there are diseases of childhood for which human medicine 

has discovered no answer and in fron t of which we stand hopeless 

while the disease pursues its inexorable course.
20 INTE NSIV E IMMUNIZATION PROGRAMS

Hap pily, the communicable diseases with whi ch this legislation is 

pr im arily concerned have had their t er ro r removed by medical prog ­

ress if the necessary weapons are utilized, and new weapons will 

sh ortly be a vailable, such as an effective vaccine ag ain st measles.

I t is difficult fo r us to realize th at di ph ther ia was considered a 

ve ry serious public he alt h problem only a few decades ago. An d, 

as Dr . Teagu e has ind icated, even tod ay we hav e unnecessary ep idem ics of diph the ria .

When I sta rte d my public healt h car eer in th e early thirt ies as 

an epidem iolo gist, first in Minn esota and the n in New Yo rk Sta te, 

it was one of my majo r concerns. Cases of and death s from di ph ­

th er ia have been dram ati cally reduced throug h immunizatio n, but 

th er e should be none at all.

M ortality from who oping cough has been gr ea ter than th at fro m 

diph ther ia in recent years. In his classic book on pre ventive medicine, Rosenau sta ted th at the indiffe ren t attit ud e with which the 

public viewed whooping cough contrasted sh arply with the fact th at 

it is one of the most distressing and fa ta l of the acu te infections of 

childhood.

Ag ain , one of my majo r concerns in the lat e th irtie s and early 

fo rti es was who oping cough, and a stu dy of t he value of vaccinatio n 

ag ains t this disease in whi ch I pa rti cip ated esta blis hed the value of 

th is preventive procedure .

A t th at tim e t here was some dou bt as to the effectiveness of whoopin g cough vaccine, and we conducted a carefully controlled stu dy 

in Bingham ton , N.Y. As fa r as I know, its value has never been 

cha llen ged since, and the subseque nt decline of whoop ing cough has 

been a deq uate testimony to the effectiveness of the currentl y ava ilab le 

whoopin g cough vaccine.

So fa r as tet anus is concerned, only 445 cases were rep ort ed in the 

Uni ted State s du rin g 1960, bu t almost tw o-third s of these pers ons 

died. An d none of us need be rem inded of the te rr or which strike s 

the average com munity when a single case of poliom yelitis occurs. 

W hy do any of these diseases stil l occur?

In the final ana lysis, the res ponsibility fo r the ad ul t’s he alt h must 

lar ge ly lie with the indiv idual but th is cannot be the case with the 

young child, whose pro tection depends on his fam ily, the fam ily 

physicia n, and his com mu nity’s health departm ent. Altho ugh this 

country in general has ha d a commendable record of response to 

publi c he alt h measures, such as vaccinatio n, there are pa rents who 

are no t sufficiently convinced or concerned to seek actively such pr otec tion for th ei r children.

Unless all possible effo rts are mad e by public healt h autho rities 

to offer servic es in as con venient a ma nner as possible and to organize 

com munity resources so as to encourage maxim um accep tance, some 

children will rem ain at ris k to thes e unnecessary serio us and often 

fa ta l diseases.

Th e provision of Fe de ral fun ds specifically fo r vac cinatio n pr ogram s should enable he alth departm ents, inc rea sin gly pressed by 

the expensive burde ns of chronic disease program s, to place in creased 

emphasis on immunizatio n services, one of th ei r basic, elementary 

functio ns, wit hout jeo pardizi ng su pp ort of th ei r othe r pro gra ms. 

I t is known th at the degree of coverage by recommended immunizatio n varies w ith different localitie s.
INTENSIVE IMMUNIZATION PROGRAMS 21

In 1959, when one-third of the Na tio n’s children un de r 6 ha d no t 

yet been imm unized with Sa lk vaccine, over a year af te r mass im ­

mu niz ation had been ur ged , th e NT A exh orted its associations t o work 

wi th he alt h departm ents to encourage bette r pub lic pa rti cipa tio n in 

such cam paigns . It h as and is con ducting s im ila r activ itie s wi th rega rd t o influenza imm unization.

Today , we know th at coverage of th e c hil d popu lat ion by polio vac ­

cine has imp roved—80 perce nt of all the children un de r the age of 

4 are b elieved to have received some polio vaccine and 66 percent have 

received the complete series of ino culatio ns recommended for total 

protection . In a d emo cratic society, this is p rob ably a g ood record— 

bu t it is n ot good enough.

We are dealing here with com mun icable and pre venta ble disease. 

It s prev ention in chi ldr en lies in the ha nd s o f others. Ou r discussion 

of these diseases has stressed th ei r lethal qua lities bu t we should not 

forge t th at such diseases are pa rti cu la rly distressing because of the 

freq uency with which they cause perm anent dam age even when not 

fatal, such as paray lsis in poliomy elitis and chronic lung disease in 

the whoop ing coug h victim.

Needless to say, all such illnesses are frighten ing an d tra um atic 

episodes f or the child and his fa mi ly, re gar dle ss of the outcome.

I t is our belief th at the re sho uld be no excuse fo r less then essentia lly com plete immu nization of our chi ldr en with these trie d and 

successful vaccines. To acco mplish this, however, req uires very careful plan ning and organiz ation, an d the cooperatio n and coord ina tion 

of man y gro ups in the comm unity.

The prog ram of the Na tional Tub erculsosis Ass ociatio n and its 

medical section, the America n Th oracic Society, is devoted to the contro l and , where possible, the e rad ica tio n of resp ira tory disease which 

affects or is tra ns mitted throug h the resp ira tory system . Today , 

era dic ation is possible in those diseases for which we have effective 

vaccines.

Because the proposed legisla tion, S. 2910 and II. R. 10541, should 

offer a conside rable imp etus to the goal of c omplete immu nizatio n of 

ou r child populat ion from these dangero us diseases, it receives the 

unq ualified su pp ort of our o rganiza tio n and it is o ur hope th at i t will 

receive fav ora ble consideration by th is committee.

Th an k you, Mr. Chairma n.

Th e Chairm an. Tha nk you very much, Doctor.

Mr. Younger , do you hav e any q uestions?

Mr. Younger. Doctor, your organiza tio n has done a v ery fine w ork 

in erad icating tube rculosis.

Has that been don e under the aid or a ssistance of the Fe de ral Govern me nt ?

We have he alt h ins titutes here, wo rking all the time on research 

in tube rculosis.

W ha t else has the Fe deral Government done?

Dr. P erk ins. A gr ea t deal, sir. In fac t, I think we were pa rtially 

resp onsible fo r the esta blis hment of the tuberculosis prog ram un it 

in the U.S. Pu blic Hea lth Service some y ears ago.

An d we m ake F ed era l gran ts ava ilab le now from the Pu blic He alth 

Service. I wish they were higher .
22 INTENSIVE IMMUNIZATION PROGRAMS

We have at the present time $3.5 million available in formula 

grants, plus $500,000 for special project grants for areas of special 

need in local communities throughout the country.

In my opinion, the provision of these grants was largely responsible 

for stimulating a much greater effort in tuberculosis control. Even 

though some of these amounts to individual States are pretty small— 

you divide $3.5 million by 50 and you can see what you get—nevertheless, these have been extremely helpful in stimulating control 

programs in these areas, plus the good advice which the State health 

departments and local health departments receive through the experts 

in the U.S. Public Health Service in this field.

Furthermore, some of the finest research work in tuberculosis is 

being conducted by the tuberculosis program of the U.S. Public Health 

Service. I am not talking about the National Institutes of Health. 

They are involved, too.

Put there is a field research unit in the tuberculosis program 

which has done some splendid work and which at the present time is 

investigating the possible prophylactic use of our best drug, isoniazid, 

in further reducing the incidence of tuberculosis, particularly among 

household contacts and others exposed to tuberculosis.

Mr. Younger. That field group, is that under the Surgeon General?

I)r. Perkins. Yes, sir.

Mr. Younger. Tha t is all.

The Chairman. Doctor, thank you very much, and your entire 

statement will be included in the record.

Dr. Perkins. Thank you, sir.

(The prepared statement of Dr. Perkins follows:)

State m ent of m Nat io na l T ub er cu lo sis Ass oci ation to t h e Com m it te e on

I nt er st ate and F oreig n Com mer ce on II .I t. 10541

I am Dr. Jam es E. Perkins of the National Tuberculosis Association. I 

received my doctor of medicine degree from the University of Minnesota, and my 

mas ter of public health and doctor of public health degrees from the Johns Hopkins University. I have served as an epidemiologist in the Minnesota and New 

York Sta te Departments of Health, as a district State health officer in upstate 

New York, as director of the division of communicable diseases in the New York 

Sta te Department of Health from 1938 to 194G, deputy commissioner of the 

New York Sta te Health Department in 194G and 1947, and have been managing 

dir ector of the National Tuberculosis Association since 1948.

The National Tuberculosis Association has alw ays had a stak e in child health. 

In the early days of the tuberculosis movement, preventoriums were maintained 

l).v tuberculosis associations to separate children from tuberculous families. 

Today, when the incidence of the disease has shifted to the older ages, vigilance 

is still maintain ed to find children who are tuberculin reactors, in orde r to prevent through the use of the newer antitubercu losis drugs the development of 

clinical disease, especially meningitis, which was invariably a fatal disease 

until the discovery of streptomycin. Vaccination with BCG is recommended in 

certain highly exposed groups although other methods of prevention are more 

adva ntageous in most situations.

The intere sts of the voluntary tuberculosis movement in child health were 

never parochial. As early as 1917, associatio ns were experimenting with methods 

of inculcating health habits in children by means of a school program called the 

Modern Health Crusade. In 1924, the NTA took the lead in supporting the 

report of the joint committee of the Natio nal Education Association and the 

American Medical Association, a report which was to mark the beginning of a 

new era in child health education by emphasizing the need to motivate the child 

as well as improve his environment.
INTENSIVE IMMUNIZATION PROGRAMS 23

Exam in at io ns of pre scho ol ch ildr en fo r al l dis ab ilitie s an d well-r ou nd ed med ica l pr og ra m s w ith in sch oo ls ha ve been su pp or te d by tu be rc ul os is as so ci at io ns 

th ro ug ho ut th e yea rs an d m an y of th es e pion ee r dem onst ra tions led to est ab li sh ­

m en t of fu ll- tim e pr og ra m s in sch ools. NT A staf f co nt in ue to c on du ct wor ks ho ps 

fo r th e tr ain in g o f te ac her s in m att ers of hea lth ed uc at io n an d de vo te mu ch tim e 

to ot her ph as es of school hea lth, which in ma ny are as are st il l giv en too li ttle 

at te ntion. Our ju st ific at io n fo r ef fo rts bey ond th e co ns id er at io n of tu be rc ulos is 

alon e is th e ob vio us fa c t th a t th e ch ild’s he al th ca nn ot be co m pa rtm en ta lize d 

an d th a t th e en vi ro nm en t of the c hild an d hi s ea rly att it u d es will o ften de term in e 

th e fu tu re p att ern of his he al th . Fur th er m ore , fo r year s th e N at io nal Tub er cu ­

lo sis Assoc iatio n an d its 2,500 affil iated loc al as so ci at io ns hav e been concern ed 

w ith th e co nt ro l of al l re spir ato ry di se as es an d not on ly th e er ad ic at io n of 

tu be rculos is. Tod ay th ere are di se as es of ch ild ho od fo r which hu m an med icine has dis cover ed no an sw er an d in fr ont of which we st and he lp le ss w hile th e di se as e pursu es its in ex or ab le co urse. H ap pi ly , th e co mmun ica ble di se as es w ith wh ich 

th is legi slat io n is pri m ar ily co nc erne d ha ve ha d th eir te rro r rem ov ed by med ica l 

pr og re ss if th e ne ce ss ar y wea po ns are utili ze d, an d ne w wea po ns w ill sh or tly 

be av aila bl e, such as an effecti ve va cc ine again st mea sle s. I t is dif ficult fo r us 

to re al iz e th a t dip ht he ri a w as co ns id ered a ve ry se riou s pu blic hea lth pro ble m 

on ly a few de ca de s ago. W he n I st art ed my pu blic hea lth care er in th e ea rly 

th ir ti es as an epide miol og ist , fi rs t in M in ne so ta an d th en in New Yo rk St ate, 

it w as one of my m aj or co nc erns . Cas es of an d death s fr om dip hth er ia ha ve 

been dra m at ic al ly redu ce d th ro ugh im m un iz atio n, but th ere sh ou ld be non e 

a t all . M ort al ity fr om wh oo pin g coug h has been gre ate r th an th a t from di phth er ia 

in re ce nt ye ar s. In h is clas sic book o n pre ve nt iv e me dicin e, Ros en au s ta te d th at 

th e in di ffer en t att it u d e w ith which th e pu blic vie we d who op ing cough con ­

tr ast ed sh arp ly w ith th e fa ct th a t it is on e of th e mos t dis tres si ng and fa ta l of 

th e ac ute in fe ctio ns of child ho od . Ag ain , one of my m ajo r co nc erns in the la te 

th ir ti es and e ar ly fo rt ie s w as w ho op ing cough, an d a st ud y of th e v al ue o f va ccinat io n ag ain st th is di se as e in whi ch I part ic ip ate d es ta bl is he d th e va lu e of th is 

pr ev en tive pr oc ed ur e. So fa r as te ta n u s is co nc erne d, on ly 445 ca se s we re 

re po rt ed in th e United S ta te s duri ng 11X50 but al m os t tw o- th irds of th es e i>ersons 

died . An d no ne of us ne ed be re m in de d of th e te rr o r which st ri kes th e a ve ra ge 

co mm un ity whe n a sing le ca se of po lio mye lit is occurs. W hy do an y of the se 

dis ea se s st ill oc cu r?

In th e final an alys is, th e re sp on sibi lity fo r th e ad u lt ’s hea lth m us t larg ely 

lie w ith th e in di vi du al but th is ca nn ot be th e ca se w ith th e yo un g child , wh ose 

pr ot ec tion de pe nd s on hi s fa m ily, th e fa m ily ph ys ic ian, an d his co mmun ity ’s 

healt h de pa rt m en t. Alth ou gh th is co un tr y in ge ne ra l has ha d a co mm endable 

reco rd of resp on se to pu blic healt h m ea su re s su ch as va cc in ation, th er e are 

pare nts wh o a re no t sufficie ntl y conv inc ed or co nc erne d to see k ac tiv ely suc h 

pr ot ec tion fo r th eir ch ild ren. Unless all po ssible ef fo rts are mad e by pu blic 

he al th au th ori ti es to off er se rv ices in as co nv en ient a m an ner as possibl e an d 

to or ga ni ze co mmun ity re so ur ce s so as to en co ur ag e max im um acceptan ce , 

som e ch ildr en will re m ain a t ri sk to th es e un ne ce ss ar y se riou s an d of ten fa ta l 

di se as es . The prov ision of Fed er al fu nd s spec ifica lly fo r va cc in at io n pr og ra m s shou ld 

en ab le he al th de pa rtm en ts , in cr ea sing ly pr es se d by th e ex pe ns ive bu rd en s of 

ch ro ni c di se as e pr og ra ms, to p lace in cr ea se d em ph as is on im m un izatio n ser vic es, 

one of th eir basic , el em en ta ry fu nc tion s, w ithout je opar diz in g su pp or t of 

th eir oth er pr og ra ms. It is kn ow n th a t th e de gr ee of co ve rage by recomme nd ed 

im m un izatio n va ri es w ith di ff er en t loca lities . In 1959, whe n on e- th ird of th e 

N at io n’s ch ildr en und er 6 ha d no t yet been im mun ized w ith Sa lk vaccine, ov er 

a yea r aft er mas s im m un izatio n ha d been ur ge d, th e NT A ex ho rted it s asso ci atio ns to wo rk w ith healt h dep ar tm en ts to en co ur ag e bett er pu blic p art ic ipa tion in such ca mpa igns . I t has an d is co nd uc tin g si m ilar act iv itie s w ith 

re ga rd to influ en za im mun izatio n. Tod ay , we kn ow th a t co ve rage of th e ch ild 

po pu lation by polio va cc ine has im prov ed —80 pe rc en t of al l th e ch ildr en under 

th e ag e of fo ur are be lie ved to ha ve rece ived some polio va cc ine an d 66 per ce nt 

ha ve rec eive d th e co mplete se ries of in oc ul atio ns rec om men de d fo r to ta l pro ­

tection. In a de m oc ra tic socie ty, th is is prob ab ly a good re co rd —b u t i t is no t 

good enou gh .

We a re de al in g he re w ith co mmun icab le an d pr ev en ta ble di se as e. Its pre ­

ve ntio n in ch ildr en lie s in th e hands of o th er s. O ur disc us sion of th es e di se as es 

ha s st re ss ed th eir le th al qual itie s but we shou ld not fo rg et th a t su ch di se as es
24 INTENSIVE IMMUNIZATION PROGRAMS

are partic ularly distressing because of the frequency with which they cause 

perm anen t damage even when not fatal, such as paralysis in poliomyelitis and 

chronic lung disease in the whooping-cough victim. Needless to say, all such 

illnesses are frighten ing and trau matic episodes for the child and his family, 

regardless of the outcome. It is our belief that there should be no excuse for 

less tha n essentially complete immunization of our child ren with these trie d 

and successful vaccines. To accomplish this, however, requires very care ful 

planning and organization, and the cooperation and coordination of many 

groups in the community.

The program of the National Tuberculosis Association and its medical section, the American Thoracic Society, is devoted to the control and, where possible, the eradication of respira tory disease which affects or is tran smitted 

thro ugh the respira tory system. Today, eradication is possible in those 

diseases for which we have effective vaccines. Because the proposed legislation, S. 2910 and II.R. 10541, should offer a considerable impetus to the goal 

of complete immunization of our child population from these dangerous diseases, 

it receives the unqualified supp ort of our organization and it is our hope tha t 

it will receive favorable consideration by this committee.

The Chairman. Dr. A. L. Gray. Is Dr. Gray not here ?

Dr. J. Buroughs Stokes.

STATEMENT OF DR. J. BUROUGHS STOKES, MANAGER, CHRISTIAN

SCIENCE COMMITTEE ON PUBLICATION, WASHINGTON, D.C.,

OFFICE, OF THE FIRST CHURCH OF CHRIST, SCIENTIST, BOSTON.

MASS.

Dr. Stokes. Air. Chairman-----

The Chairman. Would you identify yourself for the record, Dr. 

Stokes?

Dr. Stokes. Yes, sir. Aly name is J. Buroughs Stokes. I am 

manager of the Washington, D.C., office, Christian Science Committee 

on Publication of the Fir st Church of Christ, Scientist, in Boston, 

Alass. The Christian Science board of directors, the administrative 

head of the Christian Science denomination, has authorized my a ppearance before you.

The Vaccination Assistance Act of 1962 (II.R. 10541), we understand. is to assist States and communities by Federal grant to carry 

out an intensive vaccination program to protect their populations 

against certain diseases.

We do not disagree with the proposal of the bill as it applies to 

those who rely upon medical methods for the prevention and cure of 

disease. But, as you no doubt know, Christian Scientists rely solely 

upon pra yer or spiritual means for the prevention and cure of disease. 

The Christian Science method of healing has for many years been 

recognized by the laws of the United States and those of every State 

in the Union. To a Christian Scientist the prevention and healing 

of disease is an integral part of his worship. Further , the prophylactic and therapeutic method of Christian Science depends on spiritual means alone and cannot be successfully combined with medical 

methods.

It seems to us tha t unintentionally the sponsors of H.R. 10541 have 

proposed the establishment of a program which, if instituted, would 

interfere with our righ t to depend solely on our religious practice for 

the prevention of disease. This bv virtue of the sweeping and allinclusive provisions of the bill which, in effect, propose the mass inoculation of the entire population regardless of religious convictions.
INTENSIVE IMMUNIZATION PROGRAMS 25

For example, throughout the bill reference is made to “an intensive 

community vaccination program” and specifically, in section 317(b ), 

page 3, line 7, it states:

* * * the immunization over the period of the program of all or practically all 

susceptible persons in the community.

Officials of the Department of Health, Education, and Welfare have 

assured me that it is not the intent or desire of the administration to 

foster a compulsory program. Nevertheless, by not stating this unequivocally in the bill, it is reasonable to assume that it may be so 

interpreted by health agencies, voluntary organizations, the local press, 

and publicity agents at the community and State level. Evidence that 

this will be the case is shown by the following quotation from the 

Washington (D.C.) Post of January 19, from an article commenting 

on the administration’s medical program. It reads:

The Kennedy proposal would require th at every pa rt of the Nation show a 

100-percent protective factor, or as nea r that goal as anyone could reasonably 

expect.

While we can appreciate the purpose of this proposed legislation 

to prevent on a national scale the spread of communicable diseases, we 

are confident th at the Congress would not wish to do so at the cost of 

violating existing religious liberties. In the great majority of States 

where immunization laws have been enacted, exemptions have been 

provided for those who object to vaccination on religious grounds. 

But undoubtedly the enactment of H.ll. 10541 in its present form 

would operate to encourage States and communities to require 100- 

percent participation in the vaccination program, which certainly 

would be a blow to religious liberty in this country.

We know that it is not the inten t of the administration, the members of your committee, or the Congress to make this a compulsory 

program or to interfere with or restrict the religious freedom of the 

individual. We hope, therefore, th at you will agree to a specific pro ­

vision being inserted in the bill to prevent such an invasion of rights 

and liberties.

The following amendment is proposed for this purpose:

Page 3, line 14, following the word “population,” insert new sentence reading as follows:

Nothing in this section shall be construed to require a Sta te or community to 

have a compulsory intensive vaccination program, or to prevent the exemption 

of any person, and the child, infant, or ward of any person who objects to 

immunization on religious grounds.

Mr. Chairman, possibly it would be of interest to your committee 

to know that I have discussed in detail this amendment with Assistant 

Secretary of Health, Education, and Welfare, Mr. Wilbur Cohen. 

The Department has since assured me that it is not in disagreement 

with our amendment.

The opportunity to make this presentation before your committee 

is sincerely appreciated, and we ask your sympathetic consideration 

of this statement and the proposed amendment.

The Chairman. Thank you, Dr. Stokes.

Mr. Mack?

Mr. Mack. Dr. Stokes, the States which have passed laws normally 

give you this exception, do they not ?

Dr. Stores. Tha t is correct.
26 INTENSIV E IMMUNIZATION PROGRAMS

Mr. Mack. I believe th at the previous witn ess testified th at the 

Federal Gover nment did not have the au thor ity to make this 

compulsory.

Do you agree with th at statem ent ?

Dr. Stokes. I have heard from the officials in the De partm ent of 

He alth, Ed ucati on, and Welf are th at they do not desire th at this be 

made comp ulso ry but, as you heard from the f orm er witness, th e effect 

of any enactment by the Federal Government stimu lates intere st at 

the grassroot level and may be mi sin terpre ted so th at the people, becom ing overly zealous, would try to make the pro gra m com pulsory 

and have everyone immunized and thus wash out the relig ious exem ptions which h ave been given to us or to anyone wh o objects on religious 

ground s.

Fo r that reason we ask th at our amend ment be included so th at 

the re will be no dou bt th at th ey know the intent of the adm inistrat ion 

and the p leasure of Congress in th is m atter.

Mr. Mack. Dr. Teague’s statem ent incl ude d this provision, I 

thou gh t, with reg ard to legislation to mak e this compulsory, and it 

was very c lea r in his sta tem ent that, it was not to be compulsory.

Dr. Stokes. Th at is correct, and I so u nd ers tan d it to be th at way, 

but we w ould like to hav e it in the b ill, if possible, so there will be no 

misi nte rpretat ion .

Mr. Mack. Th an k you, Mr. Chairm an.

The Chairman. Mr. Schenck?

Mr. Sche nck . Th an k you, Mr. Chairma n.

Dr. Stokes, I wa nt to commend you fo r yo ur very clear and fine 

presen tation.

Wh ile I am not a m ember o f the C hristian Scien tist Church, I have 

gr ea t resp ect and hon or fo r their beliefs and th ei r positions.

May I say th at , perha ps, and 1 hon estly reg ret this is so because I 

am sure such trip s are h elpful I am one of the few members of Con ­

gress who has not travel ed outside of the Un ite d State s or made ap ­

plication for a pas spo rt or p erm it or v isa o r an ything of th at natur e, 

but I un derst and that, in ord er to tra vel outside of the Un ite d State s 

and then return to the Un ited Sta tes, you must have cer tain shots 

of one kind or anoth er in ord er to ree nter the Un ite d State s af te r 

being in some certain areas of the world where certa in diseases are 

likely to be con trac ted.

What, does the Ch ris tia n Science Ch urch do in instances like th at?

Dr. Stokes. Tha t is very good question, Mr. Schenck.

In this m atter the Pu blic He alth Serv ice has been most cooperative. 

As you know, there is a prov ision in th e law th at any tra veler, going 

abroad , can ret urn to the Un ite d States and come in without subm itting to sm allpox vac cinatio ns in the event b eco mes from an area where 

the re has been no sma llpo x report ed f or 2 weeks.

In the event th at there has been a sm allp ox epidemic in a p ar tic ul ar 

cou ntry from which he is returning he may choose to come in under 

surveillance , which is not, in any way, objectionable except th at the 

pub lic officials at the qu aran tin e station will sta te that you mu st be 

isolated if you come from a smallpox area, and rep ort to the Pub lic 

He alt h officials within a certain numb er of days in the event there is an 

outbreak on the body.
INTENSIV E IMMUNIZATION PROGRAMS 27

Now, for the Christian Scientist, when we have returned from the 

Continent or any p art of the world, upon presentation of proof that 

we are Christian Scientists, and rely solely upon prayer and spiritual 

means alone for healing, the public officials have allowed us to come 

in without submitting to immunization, provided we indicate tha t we 

will be agreeable to report any physical outbreak after arrival.

Now, this applies not only to Christian Scientists, hut to Presbyterians, Lutherans, Catholics, Jewish people, and so forth, as well. In 

fact, anyone can come into the country under this regulation because, 

as you gentlemen do know, there are many people who cannot submit 

to vaccination because of chemicalization and other reasons. We are 

protected in this manner, Mr. Schenck.

Mr. Sciienck. Thank you.

Thank you, Mr. Chairman.

The Chairman. Mr. Moss?

Mr. Younger ?

Mr. Y hunger. No questions. But I want you to know, Dr. Stokes,. 

I thoroughly agree with your program. I am not one of those who 

thinks the Federal Government is so all powerful and all knowing 

tha t we can prescribe for everybody.

I)r. Stokes. Thank you, Mr. Younger.

The Chairman. Mr. Dingell ?

Mr. Dingell. Thank you, Mr. Chairman.

I was wondering—you indicated you would like to have an amendment to create an appropriate legislative history, as a member of this 

committee, and one who has read this bill rather carefully, 1 do not 

construe it myself to mean that States would be-compelled.to—-in the 

course of their very broad programs of inoculation—inoculate persons who did not agree with that as a matter of religious doctrine.

I was wondering—are there States which do, in compulsory programs, compel all persons, Christian Scientists, and others, who do 

not believe in vaccination as a matter of religious principle to be 

vaccinated right along with the rest of the population ?

Mr. Stokes. Yes, sir; there are at the present time 11 States and the 

District of Columbia which have laws requiring children to be vaccinated in order to attend school, and do not grant any exemptions.

Mr. Dingell. What is done by the Christian Scientists under this 

situation ?

Dr. Stokes. Of course, this situation is quite understandable in 

many respects—if it has been on the books for a long time, not much 

can be done about it legislatively. We. of course, object to it. But we 

as Christian Scientists obey the laws of the land, and, therefore, submit. 

But we always request, if possible, exemption, because as one of the 

former witnesses said, the medical profession recognizes that it is not 

necessary to vaccinate everyone to prevent an epidemic—that if the 

vaccine is any good at all, from their point of view, the person who is 

vaccinated certainly is protected against the person who is not vaccinated. And so, therefore, there have been in some instances exemptions allowed. But, on the whole, if the law says that you must be 

vaccinated, then a Christian Scientist will obey that law.

Mr. Dingell. I>et me ask you this. Are you familiar with the 

practice of including in reports an interpretation of the statute?

Dr. Stokes. I don’t quite understand the question, sir.
28 INTENSIVE IMMUNIZATION PROGRAMS

Mr. Dingell. Are you familiar with the practice of including in 

the committee report, a document put out under the committee's title 

and heading and authority, interpreting the bills reported out by the 

committee, an interpretation of legislation ? Would you be satisfied if 

we were to put substantially similar language into the report stating 

tha t it is not the intent of the committee here to-----

Dr. Stokes. Mr. Dingell, that is very helpful and kind of you to 

say that. It would be helpful. But inasmuch as the committee report does not circulate through the entire country in the same way 

the law would, it would be therefore liable to misinterpretation, by 

the people in the local community areas, which we wish to prevent. 

Therefore, the protection would be greater if it was written into the 

law, since it would not harm the law, and since the administration has 

agreed that this will not in any way hurt the legislation. It would 

only be a safeguard to stand for religious liberties of the American 

people.

Mr. Dingell. Thank you very much. Thank you, Mr. Chairman.

The Chairman. Thank you very much. You do think that if the 

amendment were to be adopted, that there would be no feeling at all 

among your people.

Dr. Stokes. I agree, sir, that would be correct.

The Chairman. Thank you very much.

Dr. Stokes. Thank you, Mr. Harris, thank you, gentlemen.

The Chairman. I understand Dr. Gray has arrived. Dr. Gray, 

we would lie glad to have your testimony. I believe you are from 

Jackson, Miss., representing the State public health division.

Dr. Gray. That is right.

The Chairman. I am glad at this time to recognize the ranking 

Democratic member on this committee, your own Congressman, who 

is well known, beloved, and very able and highly respected here. He 

might want to have something to say to welcome you to this committee.

Mr. Williams. Mr. Chairman, thank you for recognizing me. I 

have known Dr. Gray for many, many years. As a matter of fact, 

Dr. Gray once rescued me on a lake when my motor had konked out 

on me, and he happened to come by, and towed me into the bank, it 

was just about dark. I don’t know what might have happened to 

me if I had been left out there through the night.

Perm it me to say that Dr. Gray has a very distinguished record 

of public service in the field of public health. I can assure you that 

there is no more devoted person in the country performing the work 

to which he has dedicated himself than Dr. Gray.

We are happy to have you with us, Doctor.

STATEMENT OF DR. A. L. GRAY, STATE HEALTH OFFICER, STATE 

OF MISSISS IPPI

Dr. Gray. Thank you very much—Mr. Chairman, members of the 

committee, Congressman Williams.

I would like to say my business is saving lives. Tha t is why I 

dragged him out of the lake over there.

Air. Chairman, and members of the committee, I am Dr. A. L. Gray, 

State health officer of the State of Mississippi. I am here representing
INTENSIVE IMMUNIZATION PROGRAMS 29

the Ass ociatio n of State & Ter rito rial He alth Officers, in pre sen ting 

testim ony f or this association, in rega rd to I I.R . 10541. We app rec iate 

the privilege o f being h eard.

Th is is th e pr epare d state me nt.

Tes timony of State and te rr itor ia l health officers su pp ortin g the 

princ ipl es and objectives of II. R. 10541, Vaccination Assistance Act 

of 1962, and recommen ding revisio ns thereo f.

Th e Assoc iatio n of S tate & Ter rito rial He alth Officers h as fo r m any 

years support ed wid espread immu niz ation pro gra ms, and strongly 

supp orts th e inten t of th e act as stated in the first p ar ag ra ph of the bill, 

na mely:

To a ss is t Sta te s an d co mm un iti es to carr y ou t in tens iv e va cc in ation pr og ra m s, 

de sig ne d to pr ot ec t th eir po pu la tion s, es pe cially all pre scho ol ch ild re n, ag ai nst 

po lio mye litis, d ip hth er ia , who op ing cough, an d te ta nus, and a gai nst o th er d isea se s 

which may in th e fu tu re become su sc ep tib le of pr ac tica l elim in atio n as a pu blic 

he al th prob lem th ro ug h su ch pr og ra m s.

We would like to sug ges t certa in revisions which we believe would 

make the bill more effective in ach ieving the sta ted goals. Th e suggested revision are as f ollows:

HOUSE B IL L , II .R . 1 0 5 4 1 , GR AN TS FOR IN TE N SIV E VA CC IN AT IO N PRO GRAMS

1. Pa ge 2, section 31 7( a), lines 7 and 8. Dele te the words “an d 

political subdivision s and ins tru me nta lities of the State s.”

Page 4, section 31 7(d), line 2, dele te the words “o r oth er pub lic 

agency .”

Pa ge 4, section 317(e), lines 14 and 15, delete the words “o r to a 

political subdivision of a St ate.”

Th is reco mmendation is m ade in recognition of the well-established 

and accepted rel ationships between the Public He alth Service and the 

Sta tes. The State health de partm ents, tog eth er with local com mun ities, are in a bette r position to recog nize and eva luate local needs fo r 

imm unization, and to develop bala nced pro gra ms within the Sta te.

2. Pa ge 2, section 31 7( a), line 13, inse rt af te r the word “ye ars” and 

before the word “and ,” the phras e “an d such other gro ups havin g 

special needs as may be appro ved by the Surge on Ge neral.” Th is 

recommen dation is being made to make possible the inclusion of especially susceptible gro ups, such as 5- an d 6-year-old preschool children , 

preg na nt women, and certain hospital and ins tituti onal reside nts and 

stall's who may be pa rti cu larly exposed and susceptible to com municable diseases.

3. Pag e 2, section 3 17 (a), lines 17 and 18. After the word “su rveillance, delete the word s “occasioned by such prog ram s,” and substitute 

the words “and social science studie s associated with such prog rams 

or necessary in such pro gra ms .” Th is recommen dation is being m ade 

because it is recognized that social science studie s are need ed in many 

areas to determine how best to reach cer tain gro ups of the po pu lat ion 

who have failed to tak e advanta ge of the immu niz ation pro gra ms 

previously available to them.

4. Pa ges 2 and 3, section 31 7( a), lines 25 and 1. A ft er the word 

“a cti vity,” dele te the wor ds “ov er a lim ited period of tim e.” Pa ge 3, 

section 317 (b ), lines 4 and 5, af te r the words “ means a p rogram ,” delete 

the words “o f lim ited dur ation.”

8 4 4 2 6 - 0 2 -
30 INTENSIVE IMMUNIZATION PROGRAMS

Pa ge 3, section 31 7(b), lines 14, 15, 16, and 17, delete the sentence

no grant may be made under this section with respect to an intensive community vaccin ation program against poliomyelitis, diphtheria, whooping cough, 

and teta nus, which begins a fte r Ju ne 30, 1905.

The se reco mm end atio ns are bein g mad e, as it is the belief of our 

association th at an intensified immunizatio n prog ram must be ma intai ned over an exte nde d period of tim e if it is to be completely 

successful. “C rash” or sho rt-term prog ram s do have value, bu t certa in com munity resources may be lost in dev eloping such pro gra ms , 

new population gro ups will need p rotection th roug h imm unization and 

boo ster type imm unizations must me offered. Th e latter justify 

con tinu ed em phasis on imm uniz ation.

Pa ge 3, section 317, after line 17, we would prop ose to add a new 

section, (c ), to re ad as foll ow s:

Such grants shall be made to States on a formula basis taking into consideration such facto rs as extent of the problem, population of children under 5 years 

of age and per capita income, with the provision th at the States must submit 

a plan by the end of the first qua rter of the Federal fiscal year for use of the 

funds, or any portion thereof, to carry out the intent of this act. If a State 

fail s to qualify within this quarter, its allocation shall be made available to 

the remaining States on a sim ilar formula basis.

That, would be a new section.

We are rec ommending th is amendm ent because we believe th at every 

State h as some need fo r extend ing the pro tection of imm unization to 

its entire population , and every State should have the op po rtu nity of 

qu ali fying for its fa ir sha re of these funds by wr iting an accepta ble 

pla n fo r use of the moneys.

Ag ain , we would emp hasize our su pp ort of the intent of th is bill. 

We believe th at if revised as we hav e suggested, it will make a real 

con trib ution to the Na tio n’s h ealth, pa rti cu la rly small chi ldren, and 

we appre ciate the op po rtu nity of presen tin g this testimo ny to you.

Th an k you, gen tlem en.

The Chairm an. Dr . Gray, t ha nk you for your testimo ny and your 

suggestio ns fo r lan guage chan ges to ca rry out wh at your orga nization feels would be desirab le to str ength en the pro gra m.

Mr. W illiams, an y questions ?

Mr. Willia ms. T have no question, M r. Ch airma n. I w ould like to 

compliment mv good frien d Dr. Gr ay on his s plendid statem ent.

T feel indeed th at the suggested changes in the legisla tion th at he 

has offered are w ort hy o f co nsider ation by the committee.

The Chair man. Mr. Schenck.

Mr. Sche nck. Th an k you, Mr. C hairm an.

T also wish to join my colleague, Mr. W illiam s, here, in commending 

Dr . Gray on his statem ent fo r his association.

Now, as I understand the genera l pur pose of your suggested chan ges 

are based upon ma kin g th is p erm anent legisla tion, based upon m aking 

it adm inis tere d only throug h St ate he alth departm ents, and not 

throug h local communities.

Dr. Gray. Not dire ct, t ha t is righ t.

Mr. Schenck. Basically, th at is the purpo se of yo ur sugg ested 

changes.

Dr . Gray. Tho se are the chief difficulties we see in the prop osed 

legisla tion at the presen t time. If I mi ght, I would like to comment 

a little .
INTENSIVE IMMUNIZATION PROGRAMS 31

We feel that the State health departments in the various States, 

in working with local health departments, understand better the 

total and relative need from one area of the State to the other, 

and the total State, than might be developed from some central point 

in Washington. If it goes direct to some local community from the. 

allocating agency, we feel there would be inequities throughout the 

State, and not a State level and properly balanced program throughout the State.

Mr. Schenck. Thank you.

Dr. Gray. And so far as the permanence of the bill, we would not 

propose anything of a permanent nature at this time. But we realize 

that there are scientific facts that we cannot overcome within a 3- 

year period, and there are difficulties tha t come out of any kind of 

a crash program—people are just as likely to forget, or even more 

so, than they are to be stirred up at a given time over a problem of 

this type. So it takes continuity over a long period of time to do this 

kind of program.

Mr. Schenck. Thank you, Dr. Gray.

The Chairman. Mr. Dingell.

Mr. Dingell. Thank you, Mr. Chairman.

I wonder—you favor the centralization of activities of this kind in 

the local State governments, do you not ?

Dr. Gray. Yes.

Mr. Dingell. The theory, sir, would be that the State is better able 

to determine the needs of its people—am I correct—than the Federal 

Government operating from Washington—tha t would be your theory ?

Dr. Gray. Yes, sir.

Mr. Dingell. Now, how are we to say, then, tha t the city or the 

county cannot better determine the needs of its people than the State?

Dr. Gray. Well, I would say tha t the State health department and 

its executive officers throughout this country are overall responsible 

generally for the total public health program in the State.

Mr. Dingell. Isn’t tha t tine of the Federal Government in Wash­ ington ?

I )r. Gray. Well, it probably is, yes.

Mr. Dingell. In other words, they are responsible for the health 

of the whole people, and the excuse of the Federal Government operatin g in this field of endeavor at all is the fact tha t the Federal 

Government has a responsibility to all the people, and not just to the 

State agency; am I correct ?

Dr. Gray. Well, a given State agency represents all the people in that State.

Air. Dingell. And so does the local community health agency—am 

I correct ?—represent all the people in the local community. For example, let’s take my city of Detroit. They are, I assume, at least as 

keenly aware of the needs of the people of the city of Detroit as is 

the State agency; am I correct ?

Dr. Gray. They probably are.

Mr. Dingell. And as a matter of fact, they are a good deal closer 

to the people, and probably more keenlv aware of the needs of the 

people and the wishes of the people—am I correct—in regard to their 

local health problems.

Dr. Gray. I presume so.
32 INTENSIVE IMMUNIZATION PROGRAMS

Mr. Dingell. So why do we den y the cities and the local communities an opp or tunity to pa rti cipa te in this pro gra m ?

Dr. Gray. Th is w ouldn’t be denyin g them.

Mr. Dingell. Let’s tak e a very concrete exam ple. You suggest 

th at in the event the S tat e shall refuse to come in un de r the pro gra m, 

th at there fore the State should be excluded from the prog ram , and 

if the St ate is excluded fro m the pro gra m, under your suggested 

amendmen t, every com mun ity, cou nty, village, town in the State will 

be denied participa tio n in the pro gra m. Am I correct ?

Dr. Gray. Well, in p repa rin g this statem ent, the S tate health officers 

di dn ’t an tic ipa te th at any State would refuse to come in.

Mr. Dingell. Let’s assume that in its wisdom the State leg islatu re 

refuses to ap prop ria te money for St ate particip ati on in a p rogra m of 

th is sort. But let’s assume th at a city like De tro it or a cou nty like 

Wayn e, in Mic higan, were to desire to come in, and were to be willing 

to set up the money for a pro gra m of thi s kind. Isn t it a fact th at 

yo ur ame ndm ents , as suggested, would deny the city of De tro it and 

cou nty of W ayn e an o pp or tunity to p art icipate in this, sim ply because 

the leg islatu re in its wisdom had refu sed to ap prop ria te the money, 

or refuse d to authorize State pa rticip ati on in a p rogram of this sort ? 

Am I co rrect?

Dr. Gray. Well, T pres ume that the State health officers, in their 

conference, based their sta tem ent only on the pro position th at all 

State s would come in.

Mr. Dingf.ll. But if they did not, if in the wisdom of the legislature the y chose not to pa rti cipa te, and a State subdivision , like 

a city or cou nty, did choose to, where would th at city and county be, 

and where would the people who reside therein be? They would be 

exclude d fro m the benefits of this pro gra m—which T assume are 

substan tia l, or you would not be h ere p resent endorsing the pro gra m.

Dr. Gray. That, is r ight. I would like to m ake th is comment. As 

fa r as the rel ationships between ou r State health departm ent and 

the P ub lic He alth S ervic e, and the Ch ild ren ’s B ure au, throug h which 

thes e moneys come, the y have been most satisfacto ry all the way 

throug h the years. I would like to make a personal comment now. 

Th is is not fo r the association.

So fa r a s th is bill is at the p resent time, I su pp ort it. Bu t we feel— 

the St ate healt h officers feel that these suggestion s would help in the 

tot al ad minist ratio n of the pro gra m.

Mr. Dingell. I wan t you to un derst and—I am a gr ea t cham pion 

of the St ate healt h officers. I th in k they are doing a splen did job. 

And I th in k you are doing an excellent job in yo ur cap acity both as 

a S tate health officer and as a w itness toda y. But I do w ant to protect 

our people from the possibility of the very un towa rd circumstanc e 

which conceivably could ha ppen in the case of my State o r some of the 

oth er State s if y ou r amend ments were adopted.

Dr. Gray. Well, th at possibility was not con sidered by the State 

health officers’ association.

Mr. Dingell. Ou r State leg islatu re has on ma ny occasions refu sed 

to pa rti cipa te in pro gra ms which would hav e confe rre d very substa nt ial benefits for the people in our Sta te. In one instan ce the y refuse d to come in under the tem porary AD C prog ram , which would 

have allo wed th e child ren o f the unem ployed in the State to lie tr eated
INTENSIVE IMMUNIZATION PROGRAMS 33

as AD C recipie nts. I can foresee a sim ila r happ en ing here. An d 

that is the reason I am conc erned about yo ur amendm ents . And I 

wan t to e xplore th is with you.

Dr. Gray. Might I make th is comment—anothe r person al one now.

It seems to me th at , as I un de rst an d it, th is money th at would be 

mad e ava ilable to begin with, in this 3-year period, would be nonmatchable. It wouldn’t necessa rily have to be matched.

Now in view of our fee lin g as State he alt h officers th at y ou can not 

eliminat e and control disease by a sudden gush of activ ity and then 

stop------

Mr. D ingell. I am sure th is is corr ect.

Dr. Gray. In view of th at , 1 feel th at th is would be a be tte r b ill if 

the 3-y ear prog ram goes on, like you proposed, bu t th at it hav e in ­

corpo rat ed in the legislation a pro vision that a fter th at 3-year period, 

the n the States a nd com munities begin to pu t up some money.

Mr. Dingell. I see. I th ink th at would be wholesome, th at they 

should do th at.

Dr. Gray. I t hink they should, too.

Mr. D ingell. Doc tor, you have been most helpf ul. I hop e you won’t 

take any of my comm ents this mo rning as being un kind or in any 

way hostile, because they were not so constru ed.

Dr. G ray. I understand the necessity of yo ur line o f query. I know 

yo ur S tate h ealth officer very well, Dr. Eus tice , and he is an ou tst an ding pub lic health statesm an.

Mr. Dingell. Doctor, than k you very much.

1'he Chairma n. Mr. You nger.

Mr. Younger. Doc tor, does your organiz ation agre e to the amend ­

ment pro posed by Dr. Stokes?

Dr. Gray. Dr. Stokes?

Mr. Younger. Yes.

Dr. Gray. I didn 't get here in tim e to h ear his p roposal.

Mr. Younger. Tha t would give an exemption for those who object 

to vac cinatio n on the gro unds of religious belief.

Dr. Gray. Well, our assoc iatio n did not even discuss th at item, 

because we did not anticipa te that the Federal compulsion would be 

involved. Ce rta inly I would feel like that this kin d of thing would 

necessa rily need to be left up to the State s and on down to the communitie s.

Now in ou r Stat e we have a S tat e law which autho rizes school bo ards 

to require imm uniz ation. In th at law, the school board s are au thor ­

ized to exem pt certain ind ividuals. And one of them is those on the 

basis of religious faith , when th at fa ith is certified to by the head of 

the church, w hatev er tha t ch urch is.

Mr. Y ounger. We have it un der the dr af t laws also, th at one is 

exem pt from the dr af t, military service, on the grou nd s of religious 

belief.

I am somewh at concerned abo ut yo ur pro posed amend me nt which 

would delegate to the S urg eon Gene ral the r ight to inc lud e such oth er 

gro ups which have a special need. Now th at seems to open up the 

doo r fo r just unlim ited pro ced ure on t he p ar t of the Su rgeon General. 

He can take any nu mber, as thi s program is a dva nced, fo r the im munizati on of childr en, 5 years and und er.
34 INTENSIVE IMMUNIZATION PROGRAMS

If you are g oin g to mak e a p rogram and say, all rig ht, the Surgeon 

General can include any othe r gro up th at he wants to------

Dr. G ray. May I s tate one of th e chief reasons why th at was p ut in 

there. Th is bill states un de r 5 yea rs o f age. In every Sta te, ther e are 

lar ge n um ber s o f ret arde d children —they are always preschool so far 

as school activ ity is concerned. Bu t t he ir age is 10, 15, 20. They need 

prote ction. They are more like ly to get disease th an anybody else, 

because of t he ir lack of menta l competency. Tha t was th e ch ief group 

th at was discussed in this regard .

Mr. Younger. It looks to me as tho ugh you could include th at grou p 

wi th a more defin ite amendmen t, th an to ju st open up the floodgate. 

Oth erw ise, in your ame ndm ent, you migh t as well abolish the bill and 

say th at we are going to have immu nizatio n of any grou p th at is 

picked out by the Surgeon General.

Dr. Gray. If I may, I would like to give my person al opinion , 

aga in, a nd no t spe aki ng fo r the association.

For insta nce, I doub t seriously the wisdom of wa sting a lot of time 

and money on g iving polio vaccine to people over 40 or 50. An d yet it 

is recommended nationw ide. Th ere is not enou gh po lio there to ju sti fy 

it. It migh t lead to th at sort of a possibility.

An d so fa r as these special gro ups are concerned, I per son ally 

would n’t be too concerned abo ut them, because every St ate and commu nity can g et resources to take care of those m ost u nf ortuna te grou ps.

Mr. Younger. Th en to meet those special gro ups, you wou ld no t 

per son ally—n ot spe aki ng fo r the organiz ation—ac tua lly need th is 

bro ad au thor ity in the Su rgeon General.

Dr. Gray. Well, so fa r as o ur S tate is con cerned, if i t is passed like 

it is, we will use wh at is give n to Mississ ippi well, in th e wo rding o f 

the law.

Mr. Younger. Th an k you very m uch, Doctor.

Th e Chairman. Mr. Moss, I don’t believe I gave you an op po rtu ­

nity to ask questions.

Mr. Moss. Doctor, you are speak ing now fo r the St ate health officers 

of the 50 State s.

Dr. Gray. Yes, sir.

Mr. Moss. Were the amendmen ts proposed, str ik ing the political 

subdivisions or ins tru me nta liti es, con curred in by all 50 of t he h ealth 

officers ?

Dr. Gray. No, ther e were no t all 50 at th e meeting.

Mr. Moss. I am concerned, because of the fact th at in some ju risdiction s—an d I wou ld have to do some caref ul checkin g to be certain 

as to which ones—th ere is a very high deg ree of autonomy given to 

ch art ere d citie s and counties. I believe t hat is the case in Ca lifornia . 

An d I don ’t know w hethe r they are required, und er law , at t he pre sen t 

time, in my State , or wh eth er the St ate could req uire them to coordina te their prog rams and sub mit t hem throug h the State government.

I am wo ndering if we might not e nco unter p roblem s in some areas 

by imposin g, as a res ult of an ena ctm ent of the Congress, a req uir eme nt on th e States to change the law.

Dr . Gray. T hat mi gh t be so. Incide ntally, a rep res entative from 

Cal ifo rn ia was in this gro up th at pro posed thes e changes. An d I 

kno w Dr. Me rril l very well. Tha t kind of an issue wasn’t d iscussed 

in o ur deliberatio ns.
INTENSIVE IMMUNIZATION PROGRAMS 35

Mr. Moss. The principal objective of those amendmel^sAy^o ^cuVe 

the utmost coordination at the State level.

Dr. Gray. Tha t is right.

Mr. Moss. Couldn’t we, by appropriate language, requh^WfarAR^, 

ordination where it is possible—but where it is not, then perlTrit 'Tfle 

individual community to make its application—if tha t is consistent 

with the laws of that State ?

Dr. Gray. I would say—again speaking personally—that if a given 

State board of health, or State health department, didn’t want to 

follow along, then the door ought to be opened to local communities.

Mr. Moss. Well, I was thinking of an instance where perhaps the 

State board of health might well desire to-----

Dr. Gray. Refrain?

Mr. Moss. No—to go along, but lacked the authority to handle the 

necessary coordination.

Dr. Gray. Well, I realize there is tremendous divergence and va riation from one State to another, from the standpoint of the organization of the public health program at the State level and on down 

to the communities, and other governmental ramifications. And 

tha t makes it increasingly difficult to make a law like this really fair 

all the way around. I understand that.

Mr. Moss. Don’t you think that perhaps while constructing the bill 

in such manner as to seek the coordination in the State, and to try 

to have programs submitted only through the State, th at there should 

be some escape hatch to take care of those areas where, because of 

various legal or political patterns, the local community has to go it 

alone.

Dr. Gray. I personally believe th at. But tha t is not my prerogative to state t hat for the State and territorial health officers.

Mr. Moss. I was interested in the last amendment you proposed.

I was not able to take down the entire text of the amendment. “Such 

gran ts on a formula basis.”

Dr. Gray. Tha t is right.

Mr. Moss. The formula to be devised by the Surgeon General ?

Dr. Gray. Yes.

Mr. Moss. And to take cognizance of special needs of the population and of the ability of the States or communities to underwrite-----

Dr. Gray. Tha t is right.

Mr. Moss (continuing). A program from their own resources.

Dr. Gray. That is similar to the present method of distributing 

other Federal health funds.

Mr. Moss. And you feel tha t under the pattern now existing in 

these other programs, tha t a completely equitable formula would be 

arrived at.

Dr. Gray. I don’t know tha t any formula was ever completely 

equitable.

Mr. Moss. Well, within reason.

Dr. Gray. I believe the formulas we now operate under are just 

about as fair as can be made. The reason this was suggested was 

tha t it was brought out over and over that—just as an example—your 

State of California might well, under the present situation, get up 

good projects and make applications and take all the money, before 

the rest of us got to moving.
36 INTENSIVE IMMUNIZATION PROGRAMS

Mr. Moss. No, I don’t think that, would be proper. Rut I am interest ed in the ab ility of t he Surgeon Gen eral to devise an acceptable 

form ula . If there is alread y a gen eral agr eem ent th at he had succeeded in the other program s in ach ieving an equitab le allocati on, 

then I have no objec tion.

Dr. Gray. We ll, I believe that the State healt h officers, in their 

regu lar association meetings, h ave re peatedly discussed these for mu la 

gr an ts, and oc casionally they find some little d efec t, they think—I am 

sure th at the association feels th at the for mu la gr an t basis th at has 

been used in the pas t is a reasonably good method of distr ibut ing the 

fun ds.

Mr. Moss. That is all t he qu estions I have, M r. Chairma n. I want 

to than k you, Doctor.

Mr. Willia ms. Mr. Chairma n, may I be recognized for a q uestion?

The Chairma n. Mr. Williams.

Mr. Williams. As I understand it, Doctor—and c orrect me if I am 

wrong—gene rally spe aking the purpo se of the amendmen ts th at y ou 

suggested, to delete the words “and political subdivision s or instr ume nta lities,” is to give recognition to the fac t, wh eth er it be admitted 

by most people or not, th at the State s are the basic units of gov ernment, and th at the St ate health officers a re be tte r qualified , and in a 

be tte r position to set up a coo rdinated prog ram than Wash ing ton , 

which is a tho usa nd mile s away.

Dr. Gray. Tha t is rig ht. An d anoth er po int—brin ging this down 

loca lly, Mr. Willia ms—if , for insta nce, G ul fp or t, in Harris on C oun ty, 

un de r the pre sen t law decid ed—th e cha mber of commerce decided 

“well, we a re goin g to p ut on a big show down h ere” in this imm uniz atio n pro gra m, and they could pu t pressu res on you fellows to get 

allo cati ons of money— where tha t are a m ight be the least in need from 

the sta nd po int of all of the fac tors th at det erm ine need. Ye t the y 

would get the money—and Hollis Sp rin gs, in no rth Mississippi, and 

th at cou nty, might not be able to get any , whe re it migh t have the 

greatest need. An d th at is the reason we adh ere to the princ iple of 

all ocating t hrou gh St ate hea lth departm ents.

The Chairman. Doctor, as I told Dr . Teagu e earlier tod ay, I do 

no t know wh at was intended bv th is lan guage which is included in 

the bill. We will hav e an expla nat ion fro m the Secre tary of HEW 

when he comes and testifies tom orro w, I believe. Bu t I ha d th e feeling 

th at th is lan guage was intend ed to have the fund s fo r this prog ram 

channeled t hrou gh the Stat e, and from t he re to th e local communities, 

which is usu ally the procedure. In othe r words, those politi cal subdivisions are instru men tal ities of th e Sta tes. I believe th at was what 

was inte nde d.

Dr. Gray. We ll, presum ably, then, St ate healt h officers m isu nderstood the int entio n, because they were af ra id of, first, dir ect to commu nity allocation, and secondly, they realized th at in some State s it 

might be possible for , for instance, a political school pro gra m, superintend ent of edu cation , fo r insta nce, to decide “Well, I am going to 

pu t on thi s immu niz ation p rogra m, so I will get the money as a State 

agency.”

The Chairma n. You w ould have in mind, w ould you not, th at th e 

admi nis tra tio n of this prog ram be thro ug h the State healt h offices, 

and t hro ugh t ha t office to the c ounty and local offices.
INTENSIVE IMMUNIZATION PROGRAMS 37

I)r. Gray. Tha t is right. It would create no problems in Mississippi, because of our organization down there.

The Chairman. We will explore th at further.

Mr. Schenck. Mr. Chairman.

The Chairman. Mr. Schenck.

Mr. Schenck. Is the Hill-B urton hospitalization program handled 

upon that basis?

Dr. Gray. I think every State has a governing group at State level 

to channel Federal funds down to the States, and the applications 

up to the Federal level. That is true in our State. The commission 

on hospital care, of which I am an ex officio member, is the reason 

I happen to know something about it.

Mr. Schenck. Mr. Chairman I was just trying to illustrate the 

point, that a great many programs are administered, such as the 

doctor indicates, such as interstate highway programs, and ABC 

highways within the States, and the H ill-Burton and so forth—many 

of them are administered through the State administrative officers. Is 

that not true ?

The Chairman. Tha t is true.

Mr. Williams. Mr. Chairman.

The Chairman. Mr. Williams.

Mr. Williams. Doctor, I would like to ask one or two questions 

in connection with the need for Federal assistance for this type of 

program.

What kind of programs do you now have in effect in Mississippi 

for vaccination?

Dr. Gray. In the first place we have a full-time health service in 

every county, 82 counties in Mississippi, and have had for many 

years, the last 1 having been organized in 1952.

Now, those health departments, local health departments, are staffed 

from poorly to good. Some of them have no more than a full-time 

nurse and a clerk and a part-time sanitarian, and a little supervision 

from a district health officer. But in general it is good.

Now, one of their basic programs since public health started to 

move in Mississippi many years ago, under Drs. Leathers and Underwood, one of the basic programs lias been immunization with every 

effective immunizing agent we could get our hands on and pay for, 

given to any person within a given described age group and so on, 

without regard to whether he had a Cadillac or went barefooted— 

we didn 't have time to determine those things. Last year, for instance, 1961, our public health program administered well over a 

million injections of various immunizing agents, including polio, 

diphtheria, tetanus, and so on. But tha t is not enough. It is all our 

personnel could stir up—in other words—and all that we could get 

to with the cost of t be vaccine and everything else.

We feel in our own State tha t the greatest need, which this bill 

would help provide, would be people—contact people, to add to the 

health department. Because these people tha t don’t move for immunization when it is made available generally, and most people do— 

it takes personal contact with them by somebody—and that is expensive, to get them to come into the immunization center, whether 

it is a physician’s office or health department office.

I think tha t kind of thing would be very helpful as it might come 

out of this legislation.
38 INTENSIVE IMMUNIZATION PROGRAMS

Mr. Williams. Doctor, did you includ e a requ est fo r addit ion al 

personnel in your budget th at was pre sen ted to the State leg islatu re 

this year ?

Dr. Gray. Yes, I did.

Mr. Williams. Wa s i t refused?

Dr . Gray. Well, it looks like the St ate leg islatu re is doi ng a lit tle 

trimming on most all the budgets , and th at includes ours—because of 

the critical fin ancial sit uatio n they foun d the mselves in.

Mr. Williams. Le t’s n ot discuss th at publicly at the moment.

Dr. Gray. Bu t we have never ha d in all of the counties really 

adequate personnel in the first place. W ha t we have had has been 

good, bu t the re just was not enough of them. An d of course the 

chief reason is money.

Air. Williams. The thing th at distu rbs me abo ut this typ e of pr ogram —I will be very can did—is the fa ct th at the Federal Government is some $300 billion in debt, and the State s, even the St ate of 

Mississippi, which is usua lly b attli ng it out with the State of A rk an ­

sas to see which one is the poorest St ate in the Union each year, is 

in an infinitely bette r economic situ ati on th an the Federal G overnm ent. 

Of course I realize th at it is not quite as simple as say ing th at the 

State s shou ld go ahe ad and finance all of thi s, because the Fe deral 

Governmen t has pr eem pte d so man y o f the S ta te ’s sources of revenue. 

Bu t th at is the th ing t hat di sturbs me about this typ e of pro gra m.

Public hea lth, in my opinion, is initi ally an d prim arily , if no t in 

fact exclusively, the responsibility of the Sta tes . As I say, th at is 

the thing th at distur bs me about this type o f pro gra m. Whil e I un ­

derstand it is necessary on occasion, a t th e same time------

Dr. Gray. May I disag ree with you on one point ?

Mr. W illiams. Well, you won’t be the first person th at has disagreed w ith me.

Dr. Gray. You say th at pub lic he alth is pr im arily the responsibility of the Sta te.

Mr. Williams. Und er the Const itution.

Dr. Gray. All rig ht . Now, here is the reason why the State can’t 

assume all the resp onsibility for con tagion con trol, because contagion 

doesn’t recognize the line between Ar kansas and Mississippi, pa rtic ­

ularly since everybody is going some where all the time now. Sm all ­

pox in London and Germany recent ly distu rbed us in Mississippi. 

We didn ’t have any, b ut we kept our eyes open, and we had channe ls 

open to be sure th at we didn ’t get it in Mississippi.

So I would say th at Mississippi cannot possibly, no matter if we 

spent double wh at we are spe nding on con tagion control, inc lud ing 

immunizatio n, and Ar ka nsas and Lo uis ian a and Alaba ma and Te nnessee, which b order us, di dn ’t do th e same t hing , we cou ldn’t possibly 

con trol th e co ntag ion in Mississippi.

Air. Willia ms. Doctor, I will have to yield to you on th at point. 

You hav e made a very persuasive argu men t in th at respect. I am 

speakin g basically of the philoso phy of the Government th at most 

of our peo ple subscribe to, as you well know.

Dr. Gray. Tha t is righ t.

Air. Williams. I realize th at it can’t be a completely rigi d policy. 

But it does allow for flexibility.
INTENSIVE IMMUNIZATION PROGRAMS 39

However, I would go back to the pro position th at I think th at the 

pr im ar y resp ons ibility, if not pe rhaps the exclu sive res ponsibility — 

bu t the p rim ary responsibility does rest with the local peop le to meet 

th ei r local needs in this respec t.

Dr . Gray. I might po int out in th at reg ard, in our State------

Mr. Williams. If th at were not tru e, then I am incline d to think 

th at we should abolish our S tate he alt h departm ents and se t u p simply 

a Fed eral health d epart me nt.

Dr. Gray. Well, t hat is wh at we are try in g to keep you fro m doing.

Now, I would like to po int out, tho ugh, th at the c ounties in Mississip pi have alw ays pu t up substan tia l su pp ort fo r public he alth—up 

to 2 m ills in e very co unty in the S tat e. Tha t is an o n-g oing thin g. So 

the counties are p ut tin g in a good b it of money—even the towns. Then 

the S tate comes in with a cons iderable sha re of money. An d the n the 

Federal f unds really save our lives. Tha t includ es yo urs.

Mr. Williams. Th an k you , sir.

Mr. Dingell. If my colleague would yie ld—D oct or, you are fam ilia r with the work of the Com mun icable Disease Ce nte r and Public 

Hea lth Service in A tla nta, are you no t ?

Dr. Gray. Very well.

Mr. Dingell. I assum e yo ur relati on ship with the Pu blic He alth 

Service has been very good, has it no t ?

Dr. Gray. Absolutely.

Mr. Dingell. Ha ve you ever fou nd them com ing in and dictating 

to you ?

Dr. Gray. No, sir.

Mr. Dingell. I s th ere an y cen ter w hich does o r would be capable of 

doing the work of the Com mun icable Disease Cente r, in Atla nta, in 

terms of wa tch ing what goes on in the field of public healt h, with 

rega rd to influenza, di ph theria, typ ho id, any one of the dan ger ous 

communicable diseases, which do st ar t and move aro und the country?

Dr. Gray. It is th e m ost c ompetent governmental un it in t he N atio n 

now fo r an overview of the tota l national prob lem as i t relates to internatio nal problems, and vice versa. It has a staff of very com petent 

consultants to advise with the State s, the State healt h departm ents. 

We have worked with them for yea rs, in a field trai ni ng pro gra m, 

where they assig n their new rec ruits, to get g ras sro ots activity. They 

have been most helpful to Mississip pi, and I am sure all other States.

Air. D ingell. One of the m ain fun ctions of th at a gency is to watch 

the m ovem ent of these communicable diseases as th ey tr av el acro ss the 

country. For exam ple, in the winte rtim e the y watch very closely 

different typ es o f flu, as it moves across th e co untry.

Dr. G ray. Tha t is righ t.

Air. Dinge ll. The y also have the res ponsibility of wa tch ing , fo r 

example, polio, as it moves aro un d the country, and it ha s defin ite 

pa tte rn s of movement, does it no t ?

Dr. Gray. Tha t is righ t.

Air. D ingell. It will o rig inate in one area, an d i t will move, and you 

can almost tra ce the traffic of people as they move across the cou ntry 

ca rryi ng these viruses an d so f orth. Is n’t t ha t a fact ?

Dr . Gray. Tha t is tru e as lon g as we have com petent lab ora tory 

definitive measures. Now, the re are some of these diseases th at are 

very difficult to pin down on a p attern basis, because lab orato ry identi ­

fication is te rrifically expensive , and m ost State s—a lot of State s don’t
40 INTENSIVE IMMUNIZATION PROGRAMS

have adequate laboratory facilities. But we do get reference laboratory work done by CDC—very helpful. Mississippi doesn’t have a 

virus laboratory, I am sorry to say, because we cannot support it, 

so far.

Mr. Dingell. Thank you, Dr. Gray.

The Chairman. Doctor, thank you very much. We are glad to 

have your statement.

F rances Adelhardt.

STATEMENT OF MISS FRANCES ADELHARDT, McLEAN, VA.

Miss Adelhardt. Yes, Mr. Chairman.

The Chairman. Do you represent yourself, or any group or organization?

Miss Adelhardt. Technically I just represent myself, although I do 

speak for the natural hygienists—society of natural hygienists.

The Chairman. You live in McLean, Va.

Miss Adelhardt. Yes, sir.

The Chairman. Would it inconvenience you to come back at a later 

time, or do you want to go ahead now ?

Miss Adelhardt. Well, I have today yet, sir.

The Chairman. Well, come around.

Miss Adelhardt. Thank you.

The Chairman. You may proceed.

Miss Adelhardt. Mr. Chairman, and members of the committee, I 

am Frances Adelhardt of 5739 Carlin Lane, McLean, Va. I am here 

as a natural hygienist to oppose the bill, H.R. 10541. Because of the 

short notice of these hearings, we have not had a chance to prepare 

an official statement. I therefore speak only as a member of, but not 

in official capacity for the Natural Hygiene Society. I would like to 

point out, however, that my views and opinions on this subject are 

shared by the thousands of other natural hygienists. We oppose this 

Vaccination Assistance Act of 1962 for the following reasons:

1. We natural hygienists believe that health is attained and preserved only through natural means, that vaccines will not prevent 

disease, and that inoculation with serums and vaccines will itself cause 

illness.

2. We are opposed to the use of public funds to further a project 

which is based on the beliefs of only one segment of the population.

In order to clarify how this bill is directly opposed to our principles 

and practices, I will briefly explain the natural hygienists’ convictions 

on the subject of health.

We believe that health is maintained through natural means—that 

is, materials and conditions normal to the organism. As a house is 

repaired with the same materials of which it was built, so the body 

is healed and kept in a state of health with the same materials that 

went into its creation—namely, natural food, pure water, fresh air, 

rest, exercise, sunshine. We believe that the forces of nature are always at work to maintain health and repair damage to the body, and 

tha t the only way that man can assist nature’s healing process is to 

remove harmful influences and provide the conditions of health.

In striving for a high type of health bv natural means, we eliminate 

from our lives all harmful and unnatural influences, among which are 

the vaccines in question. We do not believe that health is dependent
INTENSIVE IMMUNIZATION PROGRAMS 41

on rare and exotic substances or on knowledge attained by only a few, 

but tha t it is man’s natural state, attainable by everyone through 

obedience to a few simple natural laws.

We believe tha t vaccines, which are made by inducing illness in 

animals, are poisonous substances, and tha t when they are injected 

into the healthy body they cause a reaction which is in itself a mild 

form of disease. This disease we believe, only drains the body of vital 

energy as any illness does. We believe tha t such vital energy, immunity to disease, and body strength can be built up only from the 

same building materials tha t create flesh, blood, and bone—namely, the 

beforementioned wholesome food, pure water, fresh air, etc. We do 

not believe th at something can come from nothing, tha t strength can 

come from weakening influences, tha t power can be increased by expenditure of power; and since the body’s vital energy is expended in 

counteracting vaccines, this vital energy or body resistance is lowered, 

not increased by the use of these vaccines.

We believe it is contrary to reason to sow poison and expect to reap 

health. For this reason we believe that to inject foreign substances 

into the blood stream is to violate the integrity of the body and to 

create a health hazard which varies with individual makeup. It has 

been reported that many children have contracted polio as a result of 

polio shots, that many have developed serious illnesses of either the 

same or of a different variety as a result of the vaccine that was intended to render them immune, and that some of these children died.

I believe it is a crime to jeopardize the life of even one child in a vaccination program that has not been proved effective nor is endorsed 

by the population unanimously.

In view of these beliefs, we feel that it is an infringement on our 

liberty to be forced to participate in and contribute to this program 

of vaccination to which we are diametrically opposed. Let us not forget one of the principles on which this country was founded, that 

the Government shall protect the rights of the minority. Using our 

tax money in the furtherance of wholesale vaccination is denying the 

minority the freedom to direct the ir lives as they see fit. To pass this 

bill would perpetrate an injustice on thousands of natural hygienists, 

to say nothing of certain religious groups and others who may oppose 

vaccination. To kill this bill would harm no one, nor would it deny 

anyone the righ t or opportunity to seek treatment by these methods 

if he so believes and desires. And to those who feel tha t the unvaccinated present a problem of contagion, let me close with this thought: 

If vaccination is indeed effective, then the unvaccinated would be no 

health threat to the vaccinated.

I thank you, Mr. Chairman.

The Chairman. I thank you, Miss Adelhardt, for your statement. 

I would like to remind you tha t this bill was introduced on March 

5 of this year. This is May 15. I think there would have been ample 

time for your group or organization, to have considered this proposal.

The committee will adjourn until 10 o’clock in the morning, at 

which time the Secretary of H ealth, Education, and Welfare will be 

the first witness.

(Whereupon at 12:15 p.m. the committee adjourned, to reconvene at 

10 a.m., Wednesday, May 16,1962.)

INTE NSIV E IMMUN IZATIO N PROG RAMS

W EDN ESDA Y, M AY 16, 19 62

H ouse of R epr esentative s,

Comm itte e on I nterstate and F oreign Commerce,

"Washington, D.C.

The c om mittee me t, purs ua nt to recess, at 10:10 a.m., in room 1334, 

New Ho use Office Bui ld in g, Hon . Oren H arr is (c ha irm an of th e 

comm ittee) pr es iding.

The Cha irman . The com mittee will come to orde r.

Thi s m or ni ng , as we co ntinue h ea ring s on H .R . 10541, t he m ass va ccina tio n bill, we ar e ve ry glad to welcom e back to th is co mm itte e th e 

distin gu ishe d Se cr et ar y of H ea lth, Edu ca tion , an d W el fa re th e H onorab le Abr ah am Ridicoff.

Mr. Se cr etary, we w an t to t han k you fo r t he cou rte sie s t h a t you hav e 

ex tend ed to th is com mi ttee duri ng yo ur te nu re of th is im port an t office.

W e know , of cou rse, full well th a t th e tim e will come ve ry soon 

when, by yo ur ow n choice, you ar e go ing b ack h om e an d will no long er 

serve in th e c ap ac ity th at you now oc cup y.

W e ho pe th at you will be ba ck be fo re th is co mm itte e on ot he r occas ion s be fo re yo u re lin qu ish yo ur po sitio n. Thi s is said to let you 

know th a t even th ou gh man y of us m ig ht no t be in who lehe arted 

ag reem en t with s ome of th e th in gs wh ich you h av e prop osed in re pre ­

se nting th e ad m in istrat io n, you ha ve been exceedingly he lp fu l to th e 

comm itte e, an d we w an t to th an k you f or it.

W e ar e gl ad to h av e you he re this m or ni ng on th is i m port an t legislatio n.

A lth ou gh we realize th a t th is is a re la tiv el y sm all pr og ra m mo ney - 

wise, f ro m t he s ta nd poi nt of th e effe ct t h at it m ay ha ve o n th e welfare 

an d he al th of o ur peop le it is of trem en do us im po rta nc e.

W e k now t hat you are g re at ly interes ted in th is pro gr am . W e k no w 

th at it is one of th e ad m in is tr at io n’s pr op os als th at you ha ve ur ge d 

ov er a p eriod of time, and we a re g la d to hea r you th is m or ni ng on th is 

subje ct.

We a re gla d t o hav e y ou r testi mon y.

STATEMENT OF HON. ABRAHAM RIBICOFF, SECRETARY OF

HEALTH, EDUCATION, AND WELFARE; ACCOMPANIED BY HON.

WILBUR COHEN, ASSISTANT SECRETARY FOR LEGISLATION,

DEPARTMENT OF HEALTH, EDUCATION. AND WELFA RE; DR.

CLARENCE A. SMITH. CHIEF, COMMUNICABLE DISEASE CENTER,

PUBLIC HEALTH SERVICE, ATLANTA. GA.; AND DR. JOHN D.

PORTERFIELD, DEPUTY SURGEON GENERAL

Sec re ta ry R ibic off. Tha nk y ou, M r. Cha irm an .

Mr. Cha irm an an d me mb ers of th e co mmittee, I am please d to ap ­

pea r be fo re you in su ppo rt of th is legi slatio n aim ed at im pr ov in g 

th e he al th o f th e A merican peop le.

43
44 INTENSIVE IMMUNIZATION PROGRAMS

H.R. 10541, the bill under con sideration this morning, was intro ­

duced by yo ur chairma n to ca rry out a specific reco mmendation in 

Presiden t Ke nn edy’s 1962 he alt h message to the Congress. It s immediate purpo se is to stimu late a nationw ide v accination prog ram to 

stamp out fo ur serious diseases—poliom yelitis, diph theria, whoopin g 

cough, and tetanus.

Al tho ugh most people have the imp ression th at three o f these four 

diseases long ago ceased to be a th reat, in 1960—the la st y ear for which 

we have com plete inf orm ation—the fo ur diseases accounte d fo r more 

than 600 dea ths, fo r many tho usa nds of ind ividual cases of sickness, 

and fo r a lar ge perce nta ge of thes e sick the th re at th at the y w’ould 

suffer lifelo ng effects of these diseases and consequently lose many 

millions of doll ars of income.

From the sta nd po int of medical science, the s tat us o f each of these 

four diseases rep res ent s a scientific victory. Medical rese arch has d eveloped for each a safe and effective vaccine th at can prevent t he occurrence of the disease in vaccin ated persons.

Th e most recent victory , you will recall, was spark ed by the develop ment of the Salk polio vaccine 8 yea rs ago. In the few yea rs 

since, this scientific breakth rou gh took place, polio has dropped ra pidly from its form er place high on the lis t of killing and crippling 

diseases. In 1952, the re were 21,000 new cases of pa ralytic polio. 

Last year the re were only 829 new cases of paralytic polio re porte d for 

the entire Un ite d States. Th is is a gr at ifyi ng acco mplishm ent, a 

brilliant victo ry for medical science.

But the very figures that proclaim a victory also reveal a failure. 

How ever small the total figures may ap pe ar in contr ast with those of 

a decad e ago, each of these cases rep res ents the same period o f suffering, the same ma jor expense, and the same fear of las tin g crippling 

effect as any case occurrin g in ea rlier years. Ind eed , these tra gedie s 

must have lieen especially bi tte r fo r the victim s and their fam ilies to 

accept, because all—or virtu ally all —could have been preven ted. A 

hig hly effective vaccine ha d been discovered. I t was ava ilab le in adequate sup ply in all par ts of the cou ntry. Ye t 829 persons—mostly 

you ng children—con tracted this d rea d disease.

The reason for this failu re t hat m ars th e victory is c learly revealed 

by recent studies of th e imm uniz ation s tat us of our population . These 

stud ies show th at in all pa rts of ou r coun try lar ge segm ents of the 

population still rem ain unv accinated, or h ave only pa rti al pro tection, 

again st polio. The lar gest of these gro ups is com prised of preschool 

age children. Of some 21 million child ren under 5, only 7 million 

have received the full vaccina tion pro tection recom mended fo r polio. 

Yet childre n in this age gro up are especially susceptible to the disease. 

In other words, the record is poo rest in the specific ar ea where it should 

be best. Each of these unpro tected persons rep res ent s anoth er poten ­

tial tragedy. An d, in com binatio n, the y also rep res ent a com munity 

hea lth hazar d, fo r any such gro up of unvac cinated persons conta ins 

the pote ntial of an epidem ic outbre ak.

If th ese figures relate d only t o the sta tus of polio immu nizatio n, it 

mig ht be possible to comfort ourselves with assuranc es th at time , 

plu s the a vailabil ity now’ of the new’ oral vaccine, will soon imp rove 

ou r record of pro tection. But sim ila r studie s—consisting of good 

sam plings in every age gro up and in several sections of the country —
INTENSIVE IMMUNIZATION PROGRAMS 45

also reveal ed a n almost ide ntical situa tio n fo r va ccin ation ag ain st three 

othe r diseases—di ph theria, p ertussis (usu ally ca lled whoop ing co ugh), 

and tetanus—and the irony of our failu re is even str on ge r in thes e 

diseases because effective vaccines h ave been ava ilab le fo r many years. 

W ith m ino r d eviatio ns, t he very same gro up who are lackin g in polio 

pro tec tion—w ith preschool child ren as the sta nd ou t grou p—are also 

unpro tected aga ins t th e othe r diseases.

An othe r sign ific ant fac t reve aled by the nation wid e stu dy of polio 

vac cinatio n is th at the high est percen tage of unprote cte d persons, 

in all sections of the co untry and in every age group, is fou nd in 

(neighborhoods in vVhich low-incom e fam ilie s live. In polio, for 

exam ple, amo ng some age groups the vac cinatio n level in the lowincome families is 25 percen t low er tha n in high-income groups despite 

the many free clinics in r ece nt yea rs.

W ha t these figures reveal is a fai lure, or a majo r sho rtco ming, in 

the plan ning and con duct of regu lar vaccination effo rts in most co mmunities. The existing vaccinatio n pro gra ms con duc ted in many 

com mun ities have been reason ably effective in rea ching some gro ups 

of the pop ulation, but the y have two majo r weaknesses. Fir st , they 

hav e been so closely relate d to school adm issions th at they have pr ovid ed poo r coverage fo r preschool children. Second, they have been 

lea st effective in rea chi ng families in low-income neighborhoods. Th is 

la tter difficulty is no t due sim ply to the cost ba rrier, fo r prob lems 

hav e been enco untered in such neig hbo rhoods even when vaccinatio n 

is readil y av aila ble wi tho ut ch arge .

W ha tev er the cause, the essential ing red ien ts of the rem edy are 

clearly indicated. W ha t we need is to revamp and reinfo rce the pat ­

tern s of o ur estab lished com munity program s wi th measure s th at will 

su bs tantially eliminate our backlog of vac cinatio n deficiencies and , 

at the same tim e, do a more effective job in pr ov iding new pro tection 

to the hard- to- rea ch groups. He re aga in, the know-how is alr eady 

availab le. Th e problem is only one of applicat ion . In a numb er of 

com munities in rec ent ye ars, grea t success has been achieved throug h 

intensive com munity wid e polio vac cinatio n program s deve loped fo r 

the specific pur pose of rea ching those gro ups and ind ivi duals who 

hav e not been covered by previous pro grams.

The se cam paigns hav e shown the valid ity o f two objectives of this 

leg islati on : Fi rs t, th at ma chi ner y—people and fund s and vaccine— 

is necessary for the push needed in a successful inte nsive com munity ­

wide effor t; a nd, second, t ha t pr op erly set up and run such vaccination 

cam pai gns will resu lt in est ablishin g the atm osp here and organiz atio n fo r re gu lar vac cin ation prog ram s on a perm anent basis after 

the cam paign is over.

By way of ill us tra tin g such cam paigns , let me briefly describe the 

prog ram in Columbus, Ga., which was rec ently cond ucted, on a 

dem onstration basis, with assistance from the Pu blic H ea lth Service.

Th e Georgia proje ct was a coo perativ e effort between the Service 

and State and cou nty public healt h officials a nd w ith the endorsem ent 

of the local medical society. A sam ple survey , cond ucted befo re the 

cam pai gn, showed th at alm ost ha lf of the children under 5 and jus t 

over ha lf of the peop le between 15 and 40 in low-income neigh borhood s had not been ade quately v accinated.

84426— 62------ 4
46 INTENSIVE IMMUNIZATION PROGRAMS

The local people in Columb us set out to vaccinate as many of their 

fellow citizens as could be persu ade d by all methods of pro motion al 

ingenu ity. The cam paign consisted of 24 day s of inte nse activ ity — 

spr ead o ver a 7-week period. As a r esult, over 90 perc ent of the pr eschool children in this low-income neig hbo rhood has now had some 

vaccine and the num ber of y oung adult s with some vaccine pro tection 

has increased fro m 50 to 80 percen t.

Altho ugh the Publi c He alth Serv ice initiated th is p roject and had 

a hand in its conduct, the drive was, in all im po rta nt aspects, a local 

undertakin g.

If com parable cam paigns could be mounte d throug ho ut the coun ­

try, we could comp lete the conquest of polio in the United States. 

W ith com parativ ely little e xtr a cost and elfort, these same com munity 

camp aig ns could also be broadened to inclu de immu niz ation again st 

diph theria, w hooping cough, and tetanus. I t is stan da rd p ublic health 

pra ctice to adminis ter a single combined vaccine, known as D PT—fo r 

di ph theria, pertussis (wh oopin g cough), and tet anus—to provide 

pro tec tion again st these three diseases. The schedule of ad minist ration for D PT vaccine can be rea dil y dovetailed with th at for either 

typ e of polio vaccine. Since stud ies show th at the same preschool 

children who lack polio pro tection are also lackin g in D PT vac cination, one intensive com mun ity imm unization prog ram could rea dily 

serv e a fo urfold purpose.

Fina lly , one add itio nal pub lic health gain could be achieved by 

well-p lanned and coo rdin ated com munity cam pai gns of this type. 

Because the p rim ary aim of the pro gra m in all com munities would be 

pro tec tion for all ch ildren un der 5 yea rs of age, the groundwo rk would 

be laid fo r con verting reg ular ongoing pro gra ms to a new emphasis 

on imm unization d uring th e first y ear of life. Such a sh ift in emp hasis 

offers the best saf eguard ag ain st serious vac cinatio n deficiencies in 

futur e.

The princ ipa l pur pose of IT.R. 10541 is to encourage and assist 

State s and communities to deve lop and carry out inte nsiv e comm unity 

program s of thi s nature. Such a nation wid e appro ach to the problem 

offers several adv antage s o ver an unc oordinated series of local actions.

Fi rs t, the biggest obstacle to lie overcome is one of inert ia or lack 

of int ere st on the p ar t of the public. The most effective appro ach to 

such an obstacle is to back up local initiative and action with a simultan eou s national pro gra m which make s full use of the resources of 

na tio na l organization s—in clu din g professiona l and volun tary 

groups—an d national communica tions media. In such a pro gra m 

the mom entu m and cum ulative forc e of combined efforts give extra 

stre ng th to every local pro gram.

Second, a con centrat ed and coo rdinated att ack has many advantag es fro m the s tan dp oint o f overall pro gra m efficiency an d economy. 

4 he services of exp ert con sultan ts and specialists can be more read ily 

obtained and more effectively used. Some edu cational and inform atio na l mate ria ls an d program s can be used by a numb er of comm unities, eit he r sim ulta neo usly or in a plan ned sequence. Eq uip me nt 

and sup plies can be obtained and deployed more efficiently, as can 

ce rta in labo rat ory services and facilities.

Fi na lly , if we are to achieve the goal of virtu al e lim ina tion of these 

disea ses, a nationwid e att ack is necessary. In a country with such a
INTENSIVE IMMUNIZATION PROGRAMS 47

mobile population as ours, it would be folly not to approach disease 

elimination across the Nation in a relatively short period of time.

The bill would authorize a temporary program of Federal project grants to States or their local subdivisions to meet part of the 

costs of intensive community vaccination programs against poliomyelitis, diptheria, whooping cough, and tetanus.

Federal grant funds could be used fo r meeting the costs of the vaccine needed to protect all children under the age of 5 years and for 

the salaries and related expenses of additional State and local public 

health personnel needed to promote and organize community programs and to maintain laboratory and field evaluation in connection 

with the program.

These additional personnel to be paid out of Federal grant funds 

would be used in a wide variety of ways. They could be specialists 

trained in community organization whose job would be to mobilize 

the volunteers necessary to conduct the programs. They could be 

people with special talents to conduct surveys to determine areas of 

greatest need or to evaluate the results of the program. Or, for example, they could l>e virologists trained in the diagnosis of polio who 

would aid in evaluating the results of the elimination program.

In addition to this immediate grant program against the four specified diseases, the bill also contains a standby authorization for 

similar gran t assistance for community vaccination programs against 

other infectious diseases which represent major public health problems and which are susceptible of practical elimination through preventive agents which may become available in the future.

Because of the inclusion of this “standby authorization,” the bill 

contains no specific time or money limitations on appropriations authorized by this new section. With respect to the immediate fourdisease programs, however, the bill does limit Federal aid to community programs which are begun within the next 3 years. Our 

best estimate of the costs related to this immediate program indicate— 

if there is complete nationwide participation—that the total Federal 

appropriations required would be approximately $13.5 million for 

the first year and $10.75 million for each of the next 2 years. Actual 

program costs would depend upon the degree of State and local par ­

ticipation.

There are two features of the statutory definition of an “intensive 

community vaccination program” tha t deserve special comment.

Fir st is the requirement tha t such a program must be aimed at 

achieving the immunization of “all, or practically all, susceptible 

persons in a community.” The principal purpose of this requirement 

is to make it clear that the Federal grant funds under this authority 

are for intensive programs only and cannot be used in connection with 

routine vaccination programs. It does not mean, however, that the 

program must undertake to vaccinate every person in the community. 

It is limited to “susceptible persons”—meaning those who are in the 

age groups which are most susceptible to disease attack.

Second, the requirement tha t an intensive community vaccination 

program must include measures for strengthening and improving ongoing programs is a key feature of the proposal. While Federal aid 

under this authority will not be available for such ongoing programs 

in future years, it is essential tha t the upgrading of these regular
48 INTENSIVE IMMUNIZATION PROGRAMS

programs be singled out for special emphasis. Otherwise, the beneficial effects of the intensive programs would be only tr ansito ry; they 

would wipe out existing deficiencies in community protection only to 

have similar deficiencies start to accumulate again because of inadequacies in the ongoing program.

The limitation on the use of Federal grant funds to the purchase of 

vaccine fo r children under 5 and to the salaries and related expenses 

of additional State and local health personnel does not mean that 

these are the only appropriate items of expenditure in connection with 

an intensive vaccination program. Rather, it represents an attempt 

to apply the principle of the matching fund requirement to the special needs and circumstances of intensive community vaccination 

programs.

The usual matching requirement—which specifies the number of 

State or local dollars that must be expended for every Federal dollar 

granted—is poorly suited to the needs of this program. A large and 

valuable part of the community’s contribution will be in the form of 

voluntary services on the part of professional and lay workers. In 

some instances p art of the money costs may be met from nongovernmental sources. Under these circumstances a statutory dollar matching ratio would lead to many complications and inequities. What is 

proposed, instead, is that Federal funds may be used to pay for the 

purchase of vaccine required for the most susceptible group of unvaccinated persons, and also for the additional health agency staff 

which will serve as the nucleus for planning and direction of the 

program. The States or communities would then be obliged to meet 

all the other necessary costs—either from public or private sources. 

Because of this large local contribution, not only in terms of funds 

but also of people’s time, the Federal moneys would be truly stimulatory.

In a very real sense, the most important feature of this proposal is 

not to be found in the specific statutory provisions. Rather, it lies 

in the broad discretion left to State and local agencies in developing 

programs best suited to their local needs and circumstances. Bet, me 

illustrate how this legislation could work in a particular State or 

locality.

Under the legislation, the State or locality has the responsibility for 

developing a plan of action and submitting a grant application describing the program contemplated.

The applicant can be either a State health agency, if it wishes to 

participate in developing and coordinating community programs in 

the State, or it may be a single community if no statewide program 

is initiated.

One of the first, local determinations to be made will be to define 

the particula r local needs—what groups in what neighborhoods should 

be singled out for special attention and effort. In some communities 

only pre-school-age children may warrant such specialized efforts. 

In other communities some adult groups may require special program 

attention.

The applicant will also have complete freedom in the choice of vaccines to l>e used. For example, it will decide fo r itself what use will 

be made of the new oral polio vaccine or of the Salk vaccine.
INTENSIV E IMMUNIZATION PROGRAMS 49

It will also be up to each community, or each State, to determine 

where the vaccinations will be administered—in regular public health 

clinics, in temporary neighborhood centers, in mobile units, or in 

private physicians’ offices. Common to all programs, however, will 

be the need for these facilities to be readily available to the parents 

of small children, whether they be in the shopping centers, churches, 

or on street corners.

Vaccine purchased with Federal funds could be made available to 

private physicians for vaccination in their offices of children under 

5 as long as adequate free immunization services for these children 

are available. In nearly all communities, of course, the objectives of 

this program will require special emphasis on the availability of vaccination at little or no cost, since a high percentage of the susceptible 

groups will consist of persons in low-income areas. This would not, 

however, preclude a community from determining locally whether 

persons over 5 years of age should be charged for vaccination services 

provided during an intensive immunization program.

Finally, a great deal of variation is to be expected in the patterns 

and methods of promotional and educational campaigns employed to 

assure public awareness regarding the need for vaccinations and where 

and when they can be obtained. This is the most critical feature of 

the program, from the standpoint of final results, for the key problem 

in such a program is how to reach the hard-to-reach groups.

The provision of the bill that authorizes similar temporary grant 

assistance for intensive campaigns against other diseases for which 

effective preventive agents may be developed in future years is limited 

in two important respects.

First, it can be used only in connection with programs directed toward an infectious disease which represents a major public health 

problem.

The authorization is also limited to a disease which, through an 

intensive immunization program, is “susceptible of practical elimination as a public health problem.” This would rule out programs built 

around vaccines which are administered annually or provide immunity for only a very limited period of time.

Finally, it should be noted tha t this provision is an authorization 

only. It does not in any way commit the Federal Government to participation in the costs of any or all new immunization programs resulting from future medical discoveries.

We believe, however, that some such standby authorization, limited 

as it is to temporary aid programs for the conquest of diseases which 

are major public health problems, would provide a useful means for 

insuring that future victories in medical science can be promptly and 

fully utilized in protection of the public's health.

In conclusion, Mr. Chairman, let me repeat a few key points for the 

sake of emphasis. Medical science has given us the means of eradicating polio, diphtheria, whooping cough, and tetanus, but we have 

yet to complete our conquest of these diseases. Regular immunization programs have cut the attack rates down, but intensive campaigns are needed to complete the job.

Until we make this special effort, in all parts of the country, we will 

continue every year to pay a costly and unnecessary toll in terms of 

death, suffering, and lasting disabilities. II.R. 10541 offers a prac-
50 INTENSIVE IMMUNIZATION PROGRAMS

tical prog ram for pu ttin g an end to th is needless toll throug h a concentr ate d prog ram of coo rdin ated action. We urg e its favorable 

con sideration by yo ur committee.

I am rea dy to answer questions, M r. Chairma n, and I h ave w ith me 

Mr. W ilb ur Cohen, Assistant S ecretary; Dr. Clarence A. Sm ith, C hief 

of the Com munica ble Disease Cen ter, in Atla nta, Ga.; and Dr. Jo hn 

D. Porterfield , Acti ng Surgeon G eneral.

The Chairman. Th ank you, Mr. Secre tary, for yo ur statement. 

You hav e made a very cle ar prese nta tion o f th e pr ogram .

As you know, however, we like t o make a full and comp lete record 

and the re are some questions, I think , th at would be ap prop riate for 

that.

Before star ting any questions may I ackn owledge the presence of 

the six th grade class, of the Ste wa rt-Tucka hoe School, in Ar lin gton , 

Va.

The teac her is Miss Costello.

We are pleased to extend a welcome to you, Miss Coste llo and yo ur 

six th g rade class.

We a re honored th at you have come to the C omm ittee on In tersta te 

and Foreign Commerce to observe the session this mornin g.

Wo have the Sec retary of He alth, Ed ucation, and Welfare , the 

Honorab le Abrah am Ribicoff, who is now tes tifying on a bill th at 

would establish a mass inocula tion prog ram in an effo rt to stamp out 

certain communicable diseases.

Th is is a te mp orary program , is i t no t ?

Secre tary R ibicoff. Tha t is correct, Mr. C hai rman.

'Phe Chairma n. I observe t hat the bill itself is open insofar as the 

amount o f funds th at will be au tho rized and th e time ?

Secre tary Ribicoff. Tha t is correct.

Th e Chairma n. Actua lly, t hen from the bill itself it is perm anent 

legisla tion ?

Secre tar y Ribicoff. Yes, except fo r the par t th at has to do with 

polio , d iphthe ria , whooping cough, and tet anu s.

We conte mp late 3 y ear s fo r th at period, and the rest is------

Th e Chairm an. I wan ted to ask abo ut th at section yesterda y, but 

I tho ug ht I w’ould wa it until you arriv ed th is mornin g.

On pag e 3, on line 14, insofar as the four diseases are concerned, 

it wou ld not be effective af te r Jun e 30,1965 ?

Secre tary Ribicoff. Correct, Mr. Chairma n.

The Chairm an. Th is is a ra th er unique way of approa ch ing the 

prob lem of wh at other diesases w’ould be antic ipa ted follow ing 1965 

that, maybe, should be met with this k ind of p rog ram .

Secre tary Rtbicoff. Well, righ t now I could give you one example.

Some ou tst an ding work is being don e in the case of measles, and it 

could very well be, in the very ne ar f utur e, tha t an immunizatio n progra m migh t be develope d t hat wo uld w ar ra nt the licensing of an an timeasles vaccine.

We feel th at when thi s takes plac e we should have the au th or ity t o 

move in fo r an imm unization prog ram again st measles.

Th e Chairman. Surely , Mr. Secre tar y, you would no t wa nt to deprive a c hild of the wo nde rful ex peri ence of h av ing the measles, w ould 

you?

Secre tary Ribicoff. Yes, I would. I think it is an experience th at 

most mothers and fathers and children would gla dly forego.
INTENSIVE IMMUNIZATION PROGRAMS 51

I think some of us h ad measles in later years. An d, of course, such 

researc h work is bein g done in so many other diseases th at it could 

very well be th at in the near fu tu re years a vaccine m igh t be discovered 

fo r oth er diseases.

We think that , un der those circum stan ces, we sho uld be read y to move 

in fast with overa ll p rog ram s.

Th e Chairman. Well, has there been an y pro gre ss mad e on doing 

anything about mu mps ?

Secre tar y R ibicoff. Res earc h is being done in mumps.

I t has not gotten as fa r as to have field eva lua tion. Field e valuation 

is being done in measles b ut not in mumps.

But this, aga in, may be som eth ing th at m igh t come up in the f uture 

in the developm ent of science.

Th e Chairman. I had mum ps, I think, when I was abo ut 14 or 15 

yea rs of age, and I think I s pre ad th em all over Arka nsas. I also had 

a high fev er w ith it.

We ll, a l ot of concern can be caused by many of these diseases.

Now, t he tot al cost antic ipa ted , as you ind ica ted in your s tate ment, 

is $13.5 million for the firs t year, $10.5 million fo r the second year, 

and $10.75 million for each of the next 2 y ears .

That would, of course, be the m aximum am ount to experience total 

accomplishme nt ?

Secre tar y Ribicoff. Tha t is rig ht. I mean, this is the maximum 

amount tha t we would a nticip ate.

I f all of the State s took advanta ge of this prog ram this sum of 

money wou ld be able to handle the whole program , but yet -----

Th e Chairma n. H ow man y yea rs wou ld it tak e to elimin ate these 

four diseases in your jud gm ent ?

Se cre tar y R ibicoff. Three years. The f eeling is------

Th e Chairman. Or, actually, will the y ever be completely 

eliminated?

Se cretary Ribicoff. I will let the Ch ief o f the Com mun icable Di sease Ce nte r answer that. He is a much gr ea ter au thor ity than I am 

on this.

Dr . Smit h. Mr. Chairma n, the re is a possibility th at th e use o f the 

live polio vaccine may depress the tran sf er of the wild virus in the 

com munity so th at to all int ents and purposes it will be eliminated.

Th e other three diseases can be elim ina ted as a pub lic healt h prob ­

lem by keepi ng the immune sta tus of the pop ula tion, pa rticul arly of 

the young childre n, to 80 perce nt o r above.

Th e Chairman. While we are at this point, many years ago we 

sta rte d a prog ram of tot al era dic ation of ma laria. Now, do we have 

any m alaria any where in this countr y an y more?

Dr . Smit h. No, sir. Th ere is no mala ria in this country th at 

developed in this country.

We ha ve occasional cases------

Th e Chairm an. Wh en I w as a lit tle boy, I did t ake some chill tonic. 

Tha t was fo r m ala ria . Bu t we have progressed in sof ar as tha t disease 

is concerned, where we do no t have to worr y about it.

Is th at true ?

Secre tar y Ribicoff. Tha t is correct.

Th e Chairman. Bu t there is no vaccine ag ains t ma lar ia, is there?

Dr . Smit h. Th e p rotection in t his co untry a ga inst mala ria is due to
52 INTENSIVE IMMUNIZATION PROGRAMS

the g radu al elim ina tio n of people ca rry ing the disease-causing orga nism and mosquito control. Na tural occurring cases seldom occur in 

this country at the present time.

The C hair man. Bu t the fact is the people are not vaccinated ag ain st 

mala ria ?

Dr. Smith. No, sir. When people in our pop ula tion move to 

mala ria areas they still may get mala ria and may rein troduc e it into 

the country .

Th e C hairm an. Well, does th at mean th at we ju st about have wiped 

ou t the disease ?

I)r. Smith. We have wiped out the disease, an d the re is no longer, 

in this cou ntry, any exposure of the susceptible pop ulation .

I he Chair man. And th at is wha t you would do with these four 

diseases th at you are try in g to get a t at th is m omen t ?

Dr. Smith. It might, be possible to com pare t he polio control objectives to this, but not that of the other th ree diseases.

Immu niz ations will have to be ma intain ed, hopefully within the 

first ye ar of life, indefinitely .

The Chairma n. Could you sup ply fo r the record the numb er of 

cases th at we have had rep orted in this country , say, within the las t 

2 or 3 yea rs ?

Secre tar y Ribicoff. Yes, we can. In I960 we had 2,525 cases of 

pa ralytic polio. We do no t have the n um ber o f death s fo r 1960. In 

1959 the re were 6,289 paralyti c polio cases, with 454 deaths.

In 1959 the re were 934 diph theria cases with 72 deaths. In 1959 

the re were 40,005 cases of w hooping cough with 269 deaths .

Fo r tetan us there were 445 cases with 283 deaths.

Now, we can sub mit fo r the reco rd, Mr. Ch air ma n, the sta tistics 

from the yea rs 1952 down th rou gh 1961.

The Chairman. You may do that .

(The inform ati on referred to foll ow s:)

Total reported disease cases and deaths, United States

1952.

1953. 

1954

1955.

1956.

1957.

1958.

1959.

1960.

1961.

P o li o m y e li ti s

p a ra ly ti c

D ip h th e r ia W h o o p in g co ugh T e ta n u s

C ases D e a th s C ase s D e a th s C ases D e a th s C ases D e a th s

21 ,2 69 3,1 45 2,96 0 217 45 ,0 30 402 484 360 15 ,648 1,45 0 2,35 5 156 37 ,1 29 270 506 337 18 ,308 1,36 8 2,0 41 145 60 ,8 86 373 524 332 13 ,850 1,04 3 1,984 150 62 ,7 86 467 462 265 7,91 1 566 1,56 8 103 31 ,7 32 266 468 246 2.4 99 221 1,2 11 81 28 ,295 183 447 279 3, 69 7 255 918 74 32 ,1 48 177 445 303 6, 28 9 454 934 72 40 ,0 05 269 445 283 2, 52 5 (’) 918 (>) 14 .809 (') 368 (') 829 (>) 591 («) (■) (') (*) C)

1

 N o t a v a il a b le .

The Chair man. Now about the ad minist ratio n o f this propo sal, you 

would leave it to the State s an d the localities?

Sec reta ry Ribicoff. Th e S tates; yes, sir.

The Chairman. Dr. Teagu e was here yeste rday, the comm issioner 

of hea lth of Kentu cky fo r the Am erican Pu blic Hea lth Association,
INTENSIVE IMMUNIZATION PROGRAMS 5 3

and later Dr. Gray, representing the public health officials of the 

States. They recommended to strike the provision “and political 

subdivisions and instrumentalities.”

What would be your reaction to that ?

Secretary Ribicoff. I would say thi s: I would be against that. I 

would be willing to say that, should any State come out with a statewide program, I would be willing to allow the State to run the whole 

program. The danger to striking that provision would be clear, if a 

State, which was unwilling to do this on a statewide basis, but had a 

number of communities in the State which desired a program.

Now I think it would be wrong to penalize communities in a State 

if, for any reason, some States decided against the statewide program.

But I certainly would say that if a State had a statewide program 

I would be willing to leave the whole matter to the State instead of 

the localities.

I think there should be a saving clause in there, if tha t is the committee’s inclination. In the event the State did not have a statewide 

program, any locality would have a right to apply to the Public 

Health Service for a program of its own. I think it would be wrong 

to penalize individual communities if, for some reason, a State refused to develop the program.

The Chairman. Do you know of any State that does not carry on a 

fairly good public health program ?

Secretary Ribicoef. I think they all carry on a p retty good public 

health program, but I cannot anticipate at this time whether one 

State or another would refuse to go into the program.

And I see nothing lost by such a clause, because you would assure 

the States complete control but, in the event they refused to go into 

it, at least you would not deprive a local community from having that 

option.

The Chairman. T think there is some m erit in the position. I do 

not want to usurp all of the time. I have taken more than I should 

have at this moment, but I think I will pass now.

Mr. Younger?

Mr. Younger. Thank you, Mr. Chairman.

In the first place, as I understand from the testimony yesterday 

and this bill, as drafted, it is not a compulsory immunization program.

Secretary Ribicoef. That is correct, Congressman Younger.

Mr. Y ounger. Are you willing to accept the amendment which was 

proposed yesterday by Dr. Stokes?

Secretary Ribicoff. Yes, we are.

Mr. Younger. You are willing to accept that ?

Secretary Ribicoff. Yes, we are, Congressman Younger.

Mr. Younger. What kind of a formula-----

The Chairman. What was that ? I am sorry, but I did not hear 

that.

Mr. Y oungfr. He is willing to accept Dr. Stokes’ amendment with 

regard to compulsion or the elimination of compulsory immunization on religious grounds as proposed by Dr. Stokes.

Idle Chairman. Yes, I appreciate that, but I think there is nothing 

compulsory about this program, is there ?

Secretary Ribicoff. There is not.
54 INTENSIVE IMMUNIZATION PROGRAMS

The Chairman. In other words, I think it should be made rather 

clear. Is there any authorization whatsoever tha t makes this compulsory ?

Secretary Ribicoff. Nothing at all. This is completely voluntary 

and there is nothing compelling any child to he vaccinated.

The Chairman. I think that should he understood.

Mr. Younger. I had, as a preliminary question, tha t particular 

point.

The question which I have is, to make it abundantly clear, and to 

accept file amendment tha t was proposed yesterday, there is no objection to it, and this is not a compulsory bill, and there is no-----

Secretary Ribicoff. I have no objection.

Mr. Younger. What kind of a formula do you anticipate for the 

distribution of these funds among the various States?

Secretary Ribicoff. It is not a formula at all. It is done on a 

project-by-project basis without a formula because we believe we have 

enough funds to take care of vaccinating all of the children of America under 5 years of age.

Therefore, there would be no need for a formula. Each community or each State would come in with its plan, submit it to the 

Surgeon General, and funds would be made available to take care of 

whatever specific program a State might have.

So we do not think tha t it is necessary to have a formula because, 

actually, you are arranging to take care of all of the children of 

America under 5 years of age. So no formula is necessary, and there 

is enough to take care of every State.

Mr. Younger. In other words, you would anticipate tha t out of 

this $13.5 million tha t every State could be assured of enough vaccine for all children of preschool age?

Secretary Ribicoff. Correct. Correct, sir.

Mr. Younger. So there would be no need-----

Secretary Ribicoff. Tha t is right.

Mr. Younger (continuing). For any formula?

Secretary Ribicoff. Tha t is correct.

Mr. Younger. Tha t is, like the Hill-Burton formula ?

Secretary Ribicoff. That is right.

Mr. Younger. In your statistics about the deaths from polio, were 

there any deaths recorded where the vaccine had been used ?

Dr. Smith. Yes? there are, Mr. Younger.

Occasionally this happens with all vaccines. The Salk vaccine at 

the present time is about 85 percent effective.

And so that, in those who have obtained the Salk vaccine, only 

about 15 percent are susceptible.

Mr. Younger. In other words, it is, from your records, about 85 

percent effective at the present time?

Dr. Smith. Yes, sir.

Mr. Younger. I s the oral vaccine any more effective than the Salk 

vaccine ?

Dr. Smith. We feel that the oral vaccine has failures too. In certain periods of the year particularly, the growth of the attenuated 

virus in the intestines of the child may be inhibited by other viruses 

growing there. For protection you have to insure growth of the attenuated virus, and our committee suggests tha t this be done by
INTENSIVE IMMUNIZATION PROGRAMS 55

adding a fourth dose at the end of 1 year, which will fill in any holes 

in the immunity against any of the three types of polio.

Mr. Younger. Mr. Secretary, I was following your testimony, and 

I thought you left out one sentence, and I was wondering if there was 

any reason for it.

Tha t is the last sentence in the para graph where you say:

It is also due in part to social customs and practices and to the difficulties of 

stirrin g some groups into action through the usual media of health information 

and education.

Tha t sentence you did not read.

Secretary Ribicoff. I did not? I suppose I missed it accidentally 

in reading it. No, I did not leave it out on purpose.

Mr. Younger. It was no intentional oversight?

Secretary Ribicoff. No, it was not. That should be considered part 

of the record.

Mr. Younger. Now, there is one thing tha t I would like to get your 

■opinion on.

As you know, this year we are faced with probably one of the largest 

deficits of any peacetime year in our history. We are also facing a 

very serious deficit of an undeterminable amount for the next fiscal 

year.

IIow many new programs do you think we can take on in the face 

of these continuing deficits ?

Secretary Ribicoff. Well, I would say that every nation and every 

president and every congress has to make its choices.

If we could wipe out these diseases for the small sums of money 

involved here, I think the United States should do so; and, as far as 

I am concerned, if it were to increase the deficit by $13 million, plus 

$10 million, plus $10 million, to wipe out these diseases and prevent 

death and suffering, I think we as a nation should do it.

Mr. Younger. Well, do you think tha t in your Department you 

could cut down some of the work to save that $13 million? Would 

it be better spent in this way than in some other way t hat you now 

have in your Department ?

Secretary Ribicoff. I would say, sir, tha t I have found from my 

brief experience so far in this Department that usually Congress adds 

more money to our recommendations. So it is not a question of 

cutting down. We find Congress much more generous with its allocations of funds than even we seek.

So when people talk about this Department advocating the spending 

•of money, may I respectfully suggest, sir, tha t this is something for 

Congress to be concerned with. We believe that we recommend to the 

Congress of the United States a sound budget, based upon what we 

•consider the orderly growth in many of these matters which are for 

the general welfare of the people. But I find, in my experience, that 

■Congress usually goes us a few better.

Mr. Younger. In regard to your budget this year did the House 

appropriate more money than you requested ?

Secretary Ribicoff. I would say in certain categories they did-----

Mr. Younger. I mean, the overall appropriation. Is it large r tha n 

you requested ?

Secretary Ribicoff. I think this year they did not, but they might 

before they are through.
56 INTENSIVE IMMUNIZATION PROGRAMS

Air. Younger. You think tha t the other body might?

Secretary Ribicoff. Not the other body. There are other matters 

still pending. The other day, on our welfare bill, this Congress voted 

$4 more per person under the public assistance program from the 

Federal Government to the States, which increased the amount to $140 

million more than we asked for.

So we are faced with this and, for certain research programs, they 

voted more; other programs they cut, but usually it ends up, before 

Congress goes home, voting more than we have asked for.

Mr. Younger. This year you were able to take $102 million into the 

reserve out of this year's appropriation?

Secretary Ribicoff. That is right.

Air. Younger. So that this $13.5 million ought not increase your 

normal budget?

Secretary Ribicoff. I am sorry. Will you please repeat that question?

Air. Younger. I say, this year you were able to set aside—as I recall 

in your testimony here before the committee at a prior time, $102 million was put in reserves.

Some of it has been allocated out of that reserve since then; I think 

$15 million or something.

Secretary Ribicoff. Very little. I think it is somewhere between 

$14 and $15 million.

(The following information was submitted in clarification of this 

testim ony:)

The Lab or-HEW ap prop ria tio ns bill for 1963, as pas sed by the House, contained $4,879,380,000 for pro gra ms of the De partm ent of Health, Educa tion, and 

We lfare. The Hou se allo wance was a net decre ase of $105,720,000 below the 

rec ommenda tion s con tained in the Pr es iden t’s budget. Th is change resulted 

from increa ses over the Pr es iden t’s budget am ounting to $142,710,000, decreases 

am ounti ng to $71,349,000, de fe rra l of ap prop ria tio ns am ounting to $98,481,000 

contingent on the extension of expir ing legisla tion, and deferra l of pay me nts to 

th e OASI tr ust f und for pa st m ilitar y service cred it in the amo unt o f $78,600,000.

Air. Younger. So tha t you could rather assure us that this $13.5 

million ought not to increase your budget ?

Secretary Ribicoff. I cannot assure you of that, sir. I mean, it 

is very easy to make a speech as to how much money people are 

spending and then find that we are ordered or required to spend 

more money by way of grants or other means than we have advocated.

Now, I understand tha t the Congress voted some $70 million more 

in our budget than we had advocated. I mean the House.

Where tha t will end up before the other body gets through before 

you go into conference, I do not know.

Air. Younger. Do you think that is $70 million more than you need ?

Secretary Ribicoff. Let me say this: It is $70 million more than 

we asked for.

Air. Y ounger. Well, you asked for all you need?

Secretary Ribicoff. We think we did.

Air. Younger. That is all, Air. Chairman.

Air. Macdonald (presiding). Air. AIoss, do you have any questions?

Mr. AIoss. Air. Secretary, do you suppose the Department could 

come up with some language for the committee’s consideration to 

bring in or to reconcile the views expressed yesterday by Dr. Gray 

and those expressed here today by you: namely, that where a State
INTENSIVE IMMUNIZATION PROGRAMS 57

has a program it would require tha t the program be administered 

through the State departments of public health ?

Secretary Ribicoff. That is correct.

Mr. Moss. But where the State does not have a program then it 

would be possible to deal directly with local communities?

Secretary Ribicoff. That is correct.

Mr. Moss. I recall yesterday asking Dr. Gray whether he would 

agree that such a proposal was desirable and his answer was:

I would say, again speaking personally, th at if a given Sta te board of health 

or State health department did not wan t to follow along then the door ought 

to be opened to local communities.

Secretary Ribicoff. Well, then, I think that Dr. Gray and I agree 

with one another. L would say tha t we certainly would be willing 

to have such language written right into the measure.

Mr. Moss. The thing th at I was concerned about was the possibility 

tha t in some of the States, without changing th e law, it is not possible for the State necessarily to take on-----

Secretary Ribicoff. That is correct.

Mr. Moss. T1 lis assignment.

Secretary Ribicoff. That is correct.

Mr. M oss. And by the striking of the language and permitting the 

dealing directly with local communities we would be dictating new 

policy to State government.

And 1 think we should avoid that wherever possible.

Secretary Ribicoff. It is not a question of new policy. You might 

have a situation where a State legislature may not be in session, where 

a S tate might not be in a position to appropria te for their p articipation or where some conflict in the State legislature might prevent authorization and yet there may be nothing in the basic law in that State 

that would prevent a community from participating.

Let’s say that there was a conflict in California and let’s say the 

city of San Francisco or the city of Los Angeles wanted a program.

I think it would be tragic to deprive San Francisco or Los Angeles 

of this opportunity if the municipality itself, through its own council 

and own form of government, would want a program for its children.

Mr. Moss. Could you propose language for the committee-----

Secretary Ribicoff. Yes; we would tie very pleased to submit language to the committee covering this.

Mr. Moss. There were a number of other amendments suggested by 

Dr. Gray.

One was striking such language on page 3 of the bill and making it 

a long-range program.

Tha t is, striking the sentence beginning on line 14 through line 

17.

Secretary Ribicoff. Well, 1 would say this: T think we should 

make it clear that we should make a concentrated effort to wipe out 

these diseases within the next 3 years.

However, if there is an inclination on the part of the committee to 

have a continuing program afte r this time, I think that could lie 

worked out, and I would lie willing to do so. I think it would be unfortunate if we did not make it clear that there should lie a concentrated attack to wipe out these diseases, and that we might lie more 

generous in the first 3 years, because the objective is to wipe out these 

diseases on a national basis.
58 INTENSIVE IMMUNIZATION PROGRAMS

Now, you might, a fter the 3-year period, have a program of matching grants where the States and the localities, who wanted a program, 

would request and match Federal funds; but I think there should be 

some inducement to the States to move fast because what we are really 

trying to do with this legislation is to wipe out these diseases.

Mr. Moss. I think th at was the recommendation again of Dr. Gray, 

tha t perhaps following the initial 3 years that there be some matching 

formula.

Secretary Ribicoff. If the committee would like us to, we would 

be pleased to submit language to accomplish this for the committee’s 

consideration.

Mr. Moss. I think it would be very helpful.

Secretary Ribicoff. Yes; we will submit that.

Mr. Moss. And then there was a proposal to substitute language 

for a formula of allocating to the States.

I am trying to find that amendment here. Yes, there was a question 

raised yesterday by Dr. Gray of adding language, “and such other 

groups having special needs as approved by the Surgeon General.”

Secretary Ribicoff. Where would that be?

Mr. Moss. That would be on page 2, line 13, after “the age of 5 

years” insert “and such other groups having special needs as approved 

by the Surgeon General.”

Secretary Ribicoff. I think, in talking to Dr. Smith, tha t what 

Dr. Gray was talking about were special groups tha t might be in 

State mental hospitals or in prisons confined close together and where 

the risk would be special.

This would be a very, very small number tha t would be involved, 

and we would have no objection to that if this is what the committee 

has in mind.

Mr. Y ounger. Will the gentleman yield ?

Mr. Moss. Yes; I will be very happy to yield.

Mr. Younger. I think, Mr. Secretary, he defined tha t as a group* 

of children, mental cases and so forth, that are over preschool age that 

still have not been vaccinated.

I think that is the class that he was defining yesterday.

Mr. Moss. That is correct. I think he particularly mentioned the 

retarded children.

Mr. Younger. Yes; retarded children.

Secretary Ribicoff. I would say th at I think it is a very good idea 

and there would be no objection to that.

Mr. Moss. There is agreement between the Department and Dr. 

Gray in that-----

Secretary Ribicoff. Yes.

Mr. Moss. That this would deal with this limited group and would 

not be intended to broaden the scope of the-----

Secretary Ribicoff. That is right, and I think we could supply 

language to that effect. If it were a definition of this limited group 

we would have no objection.

Mr. Moss. I think that is all the questions I have, Mr. Chairman.

The Chairman. Mr. Devine?

Mr. Devine. Mr. Secretary, I regret that I was unavoidably detained, and did not hear your formal statement.

I have just one question. I am not fully acquainted with the provisions of this legislation.
INTENSIVE IMMUNIZATION PROGRAMS 59

Is th is a com pulsory or m anda tory------

Secre tary Ribicoff. No; it is not com pulsory. It is volun tary.

Mr. Devine. All rig ht. Do you th in k on a volun tary basis you 

can g et complete coverage ?

Secre tary Ribicoff. Yes; I t hi nk we can.

If it were nation wide and there was a con cen trat ion with the coopera tion which you would hav e fro m civic organi zation s, medical 

organi zation s, the Ad vertisin g Council of America, with wh at you 

were s eeking to accomplish, I do believe th at we would be v ery successful in the se program s.

I think I showed an example, and I would like to leave with th is 

committee a n e xam ple of the pu blicity d ur ing th e Colum bus, Ga., polio 

cam paign of how this was done in Colu mbus, Ga., on a tria l basis. I 

think you m igh t be interested .

I ref erred in my testimo ny to the Columbus, Ga., exp erim ent, and 

we do believe th at with a natio nal push from the Publi c Hea lth 

Service, and the local commun ities, and the St ate healt h departm ents 

fo r wh at you are t ry in g to do fo r children , I do think th at we would 

be very successful in t his pro gra m.

Mr. Devine. Well, I do not wish to belabo r the com mittee with 

som ething th at you pro bab ly alr eady covered in yo ur testimony.

I know in m y own com munity in Colu mbus, Ohio, we h ad a volun ­

ta ry prog ram by the local au thorities on the polio vaccine, and we 

were quite successf ul with th e nu mb er o f volunteers.

Secre tar y Ribicoff. Yes. I th in k the experience of the Publi c 

He alth Service has been th at whe re a com munity rea lly means bus iness and concentrat es, and where you can ge t the com munity su ppo rt, that this w orks out very successfully.

Mr. Devine. Th an k you.

Th at is all, Mr. C hai rman.

The Chairma n. Do you have any questions, Air. Ma cdo nald?

Mr. Macdonald. No, sir, I do not, Mr. Ch airma n, bu t I would like 

to complime nt the Se cre tary on his fine sta tem ent.

I would also like to ask consent of the chairma n th at the position 

of Dr. Al fre d L. Fre chette, commissioner of the Dep artm en t of 

Public Hea lth of the Com monwe alth of Massac husetts be inserted in 

the record.

Dr. Freche tte states that the Massachu setts De pa rtm en t of Publi c 

Hea lth wishes to record itself in str on g su pp or t of th is pro gra m. 

An d 1 wou ld like to have his lette r inserted in the rec ord follow ing 

the testimo ny of the Se cretary .

The Chairman. W ith ou t objection, l et it be included in the record 

at the point referre d to.

Mr. Nelsen ?

Mr. Nelsen. Th an k you, Mr. Chairma n.

Air. Secre tar y, th is bill will be lar gely administered the n, as I 

un derst and it, by the v arious Sta tes ?

Secretary7 Ribicoff. Cor rect.

Air. Nelsen. Wo uld it then req uir e a gr ea ter am ount of personnel 

to han dle this?

Secre tary Ribicoff. No, we do no t think so; very minor personnel, 

bu t w hat they need is au xiliary.
60 INTENSIVE IMMUNIZATION PROGRAMS

There is provision in this bill to pay, from these funds, this auxiliary what the States would need to put into effect, and we do not think 

that it would require very much in additional personnel.

We do anticipate, on most of these, that a lot of it would be voluntary. Civic organizations, medical organizations, school authorities, and such, usually cooperate and there are many volunteers in 

all of the communities that participate in such projects.

Mr. Nei .sen. I am interested in knowing how many additional 

employees does Health, Education, and Welfare have, that have been 

added, we will say. The last figure I heard was some 7,000. What 

is it now ?

Secretary Ribicoff. It depends on what time you are talking about 

and how many programs you gentlemen authorize.

Mr. Nelsen. In this administration.

Secretary Ribicoff. When you say administration, I want to make 

this very clear. The Secretary never adds people because he goes 

out in the blue and hires them. Congress votes programs and authorizes the Secretary to hire people to carry out these programs. 

So the Secretary needs the people to carry out the programs that 

Congress votes.

And then, of course, it is very easy to make a statement tha t under 

the administration of such and such a Secretary or such and such a 

President, so many thousands of employees have lieen hired. But 

may T say to you, sir, tha t it is only on funds voted by the Congress 

of the United States that personnel is hired.

Mr. Nelsen. T think that might be disputed some.

Secretary Ribicoff. Well-----

Mr. Nelsen. No more questions.

The Chairman. Mr. Dingell ?

Mr. Dingell. Thank you, Mr. Chairman.

Mr. Secretary, I would like to join my colleagues in welcoming you 

before the committee this morning. It is a privilege to have you here 

and to note the vigorous work lieing done in the public interest in the 

Department of Health, Education, and Welfare under your extraordinary and able leadership.

I am also proud to welcome an old friend and constituent, your able 

Assistant Secretary, a man of extraordinary capability and devotion 

to public interest, Mr. Wilbur Cohen, who is also an old friend, not 

only of myself but of my family.

I note that you have generally resolved the questions which were 

raised yesterday previous to your coming. I would like to just briefly 

have you discuss with the committee the extrao rdinary work being 

done by the Public Health Service in its Communicable Disease Center in Atlanta and the absence of this kind of service elsewhere in the 

United States.

I am sure this would be most helpful to the committee and to the 

record.

Secretary Ribicoff. Well, as a matter of fact, we happen to have 

the Chief of the Communicable Disease Center right to my right, 

Dr. Clarence Smith, and I know of no man more qualified to do so.

Congressman Dingell, I am pleased to have Dr. Smith explain that 

to you, what is being done in the Communicable Disease Center in 

Atlanta.
INTENSIVE IMMUNIZATION PROGRAMS 61

Mr. Dingele. Doctor, 1 think it would be very helpful.

I)r. Smith. Thank you, sir. The Communicable Disease Center 

acts as the national coordinating point for all communicable disease, 

control programs and applied research programs in the country. In 

these partic ular diseases-----

The Chairman. Talk up just a little bit, Doctor.

Dr. Smith. Yes, sir. In these particular diseases we are running 

prototype community programs in polio and in maintenance programs for all four diseases. We have large field studies going on 

utilizing the two kinds of proposed measles vaccines, both singly 

and in combination, and we assist States in laboratory and 

epidemiologic surveillance of all communicable diseases in the 

country.

Mr. Dingele. As a matter of fact, this Center is the repository of 

practically all knowledge on the progress of communicable diseases in 

this country, is it not?

Dr. Smith. We try to add to the knowledge and be aware of all 

knowledge developed elsewhere, yes, sir.

Mr. Dingele. as a m atter of fact, is there any State agency which 

does or can duplicate the work done in the Communicable Disease 

Center?

Dr. Smith. No, sir.

Mr. Dingele. This is the only such center? Would I be fair in 

assuming as we were told yesterday by one of the State people that 

there really are no funds on the State level available to make this kind 

of information and service available to the other States and tha t the 

Public Health Service is the only organization in Government, F ederal or State, which is capable of doing this and which does do this 

very valuable service?

Dr. Smith. Yes, sir. I think this is quite right. The type of 

activities that we have at the Center would be impratical for such 

State to set up since our efforts extend over the whole gamut of 

communicable diseases any one of which may or may not be a major 

problem in a specific State.

Mr. Dingele. Of course, the work done under this bill will largely 

be coordinated through your Communicable Disease Center in consultation with the States, am I correct?

Dr. Smith. Yes, sir.

Mr. Dingele. You have done some remarkable work in terms of 

following communicable diseases across the country, for example, flu 

and other diseases, even polio, as they progress across the country.

Do you recall any instances of friction between the Public Health 

Service and the States, with regard to programs of this kind or where 

Federal or State agencies have not worked together, where there 

have been complaints by the States, or where there has been duplication, waste, or overlap?

Dr. Smith. I think in general we work very happily with the 

States. Our whole method of operation is based on complete cooperation. Much of the statistical information that we get in—all 

of the statistical information that we get in—is furnished to us at 

weekly intervals by the States.

We have a group of young epidemiologists who are available to 

the States on request for problems beyond their resources or requiring

84426 — 02 ----- 5
62 INTENSIVE IMMUNIZATION PROGRAMS

more people than th ey have available for invest iga tion. An d because 

of th is close worki ng rel ationship pract ica lly on a day -to-day basis, 

I th in k we have good relations.

Mr. Dingell. Th an k you very m uch, Mr. Ch airma n.

Th e Chairman. Mr. Ke ith ?

Mr. K ei th . No questions, Mr. Chairm an.

Th e C hairman. Mr. Rogers?

Mr. Rogers of Florida. Th an k you very much.

Mr. Secre tary, it is good to see you here an d we appre cia te you r 

testim ony.

Could you tell me ju st a lit tle bit about the Fe de ral Government’s 

pa rti cipa tio n in the polio pro gra m? As I recall, there were fun ds 

exp end ed in t hat program which are similar to wh at you would t ry to 

accomplish in this bill with oth er diseases. Is t h at cor rect?

Se cretary Ribicoff. "Well, in 1955 Congress passed an act which 

was late r exte nded on Fe br ua ry 15 to Ju ne 30, 1957, in which the 

Pu blic Hea lth Service adm inistered $53.6 millio n in grants- in-ai d 

to State s for the purchase of vaccines. Then in May 1960 there 

was a special ap prop ria tio n for the purchase of o ral polio vaccine to 

be used in control of epidemics. Th at is the extent of the Fed eral 

participa tio n.

Mr. Rogers of Florida. Some $50 to $60 m illion, pro bab ly, is th at 

rig ht ?

Secre tar y Ribicoff. About $54.5 million at var iou s times.

Mr. Rogers of Florida. Yes. And here you are ask ing for how 

much only ?

Se cre tar y Ribicoff. We are ask ing for autho riz ati on for $13.5 in 

1963, an d $10.7 million in 1964 and $10.7 millio n in 1965.

Mr. R ogers of Florida. Yes. Now, have you any estimate as 

to the sav ings that have been bro ught about as a result, fo r instance, 

in polio, the control of polio? As I understand it, in 1952 you had 

some 21,000 cases a nd last year, o r in 1960,1 guess it was, you had only 

about 800 cases.

Se cre tar y Ribicoff. Well, in the 4 years p rio r to int rod uction of the 

Sa lk vaccine an ave rage of 17,000 persons were paralyzed by polio 

each year. If cases had continued at this rate, almost 80,000 addition al 

cases would hav e occurre d since the Salk vaccine became available 

and wid ely used in 1956. Assum ing conserv atively th at 35,000 cases 

had been pre vente d in the past 6 ye ars, a savings of over $82 million 

in pa tien t care costs alone has resulted, an d the p res erv ation of hum an 

usefulness in terms of pro bab le life tim e earnings exceeds $1 billion, 

let alone the pain and suffering and deaths.

Before you came in, the chair ma n requested us to pu t in a table 

showing the decline of polio fo r the past 10 yea rs, and we are g oing 

to sub mit that fo r the purpo ses of the record to give you all the 

figures on this.

Mr. D ominick. Will the gentleman yield there ?

Mr. Rogers of Florida. .lust one moment, and I will.

Well, I think this is a very good point to make and should be 

brou gh t out, th at the treme ndous savings , of course, not only in life 

and suffering bu t a monetary sav ing to the economy of this Nation 

is very m uch involved in th is t ype o f approach .

Secre tary Ribicoff. And not only that, bu t I will give you the 

figures on deaths. In 1952 the re were 3,145 dea ths. In 1953, 1,450.
INTENSIVE IMMUNIZATION PROGRAMS 63

In 1954, 1,368. In 1955, 1,043. In 1956, 566. In 1957, 221. In 1958, 

225. In 1959, 454. In 1960, estimate, prov isional figu re of 260.

An d when you conside r th at the re were, in 1952, 21,269 cases of 

pa ralytic polio and in 19(51 there were 8(54 cases, you can see the 

fan tas tic progress t hat is lieing made. And if we can practic all y wipe 

out these diseases by the expenditu re of such a small sum of money, 

I think th at a very worthwhile and necessary pro ject for our Nation.

Mr. Rogers of Flori da. I yi eld to the gentlem an.

Mr. Dominick. Ce rta inl y, Mr. Secre tary, you are not say ing that 

the Public Hea lth Service was resp onsible for sto pp ing polio in this 

way.

Secre tary Ribicoff. No, sir. I am not say ing th at at all.

Mr. Dominic k. Tha t is the point I wan t to make. These figures 

are all very intere sting, but it certa inly isn 't the Pub lic He alth Service that has been responsible for it.

Secre tary Ribicoff. I would say this, sir. I would say that it is the 

recognition and the e ncouragem ent o f research. It is th e cooperation 

of researc hers , doctors, and Public Hea lth people. I th ink the Pu blic He alth Service or its Com mun icable Disease Cente r has been one 

of the g rea t gu ardian s o f the health of ou r Nat ion a nd the elimination 

of communicable, diseases of many kinds. And I do n't know of any 

substitute in the Un ite d State s fo r the Public He alt h Serv ice's Communicable Disease Center. Th ere is nothing to com pare with it any 

place in the world, and I think all of us in the Un ite d State s should 

be very pro ud of the services render ed by the Publi c He alth Service 

and wha t they have achieved in th ei r yea rs of service to this Nation.

Mr. Younger. Will the gen tlem an yield fo r jus t one question?

Mr. Rogers of Florida. May I say one thing , and then I will give 

up the floor?

I do want to say, Mr. Secre tary, th at I think this Congres s has 

recognized the efforts th at the Publi c He alt h Service has played in 

thi s field and certainly by ca rrying on this program and ge tti ng the 

results of the vaccine to peop le, it has cut down the diseases, which is 

shown by the fac ts and figures. So I comm end the Public He alth 

Serv ice very definite ly for a grea t p art.

Secre tary Ribicoff. I would say this.

Mr. Rogers of Florida. A gr ea t pa rt in thi s pro gra m.

Secre tary Ribicoff. I am no t taking cre dit for it. Th e Public 

He alth Serv ice is one of the oldest arm s of our Federal Government 

and I would say th at there is no thing in Am eric a th at can com pare 

with the conti nuing crus ade of the Publi c He alth Serv ice fo r the 

overall healt h of the Am erican people. I think th at th is is something th at all of us should be ve ry pro ud of.

Mr. Rogers of Florid a. Yes. Th an k you.

Th an k you, Mr. Chairma n.

Mr. Macdonald (presid ing). Mr. C urtin ?

Mr. Curtin . No questions.

Mr. Macdonald. Mr. He mp hill ?

Mr. H em ph ill . Th an k you, M r. C hairm an.

I was called to the phone when Mr. H ar ris was ask ing you some 

questions, and if you have alr eady answered this, sir , please tell me.

On pages 8 and 9 of vour sta tem ent you exp lained the amoun t of 

money which you say will be necessary fo r a ful l imp lem entatio n of
64 INTENSIVE IMMUNIZATION PROGRAMS

the 3-year program , and you say on page 8 in the th ird pa ragr ap h th at 

the stan dby autho rization has no definite amou nt of money which you 

would expect at t his time.

Secre tary Ribicoff. Th at is oth er infectious diseases.

Mr. Hem piiil l. And Mr. Har ris asked you what othe r infectious 

diseases, and I was called to th e phone and you were d iscu ssin g mumps.

Secre tary Ribicoff. Yes. Well, the one that is almo st ready for 

use fo r the American people is measles. Mum ps is more indefinite. 

But the re is so much being done in research, we don’t know when 

the re will be a break through in others. But we would hope th at a 

vaccine f or im muniza tion against measles would be very soon available 

to the American people.

Mr. Hem phill. Well, 1 had in mind at that time o ur res ponsibility 

because the legislation proposes on page 2, line 6, it merely says, “such 

sums as may be necessary” to enable the Surgeo n General to admi nis ­

ter thi s pa rti cu lar program. And nowhere in the leg isla tion as I see 

it is th ere any lim itation on the amount of the autho rization. Am I 

corre ct in th at?

Sec retary Ribicoff. That is corre ct. Of course, that would be up 

to the Ap prop ria tio ns Committee. We can give you our estimates 

for polio, whooping cough, tetanu s, and diph theria. The figures that 

we gave you the new autho rity fo r the first year of $13,575,000, for 

1964, $10,775,000, in 1965, $10,775,000, we believe is ample to take 

care of the needs. We cou ldn’t estima te at the pres ent time for any 

fu tu re diseases for which we do n ot have a vaccine.

Mr. Hem phill. Well, I had in mind the fact that if this legislation 

was rep ort ed out of the committee and we went to the Rules Com ­

mittee an d then to the floor with it, the questions are going to be asked 

us every time.

Now, what objection will the Departm ent have to us wr iting into 

the legislation the amounts over the 3-year period as we have done 

in other legislation ?

Secre tary Ribicoff. Noobjection ata ll , sir.

Mr. Hem phill. Now, th en, the next question is in connection with 

the sta ndby autho riz ati on , and I have every sym pat hy with yo ur 

position, but shouldn 't we have some figu re because it occurs to me 

th at in the field of nat ional hea lth, while Congress wan ts some lim itat ion of au thor ity , and act ually I think once you prove your case 

you are not goi ng to have any difficulty ge tting the necessary ap pr opriat ion , but I think when we autho riz e it, we ought to have some 

figure to shoot at. Is it possible to give us any figures?

Secre tary Ribicoff. I would have to be honest with you. If you 

said, “W ha t wou ld you an tic ipa te fo r measle s?” The answer would 

have to be a guess. We know we can figure out the costs fo r polio. 

We know what the costs are for the othe r three diseases. We can 

figure out how many susceptible child ren there are. But we a re not 

in a position to tell you in honesty, if we have a bre akthr ough in 

measles next yea r, wha t it will cost to era dic ate measles. Th ere fore 

1 am not in a position to tell this com mittee the cost of the sta ndby 

autho rization.

Mr. Hemphill. Wo uld the effort necessary to get special legislation 

on th at seriously delay such a p rog ram ?
INTE NSIV E IMMUNIZATION PROGRAMS 65

Se cre tar y Ribicoff. My fee ling is th is: Know ing the Congress, 

should the b reak throug h come in measles, and if we came befo re this 

com mittee, 1 do believe th at yo ur comm ittee would act fast.

Mr. H em phill. I do n't think you would have a bit of trou ble.

Secre tar y Ribicoff. I rea lly don't thi nk so, either.

Mr. Hemphill. Now, one ot he r question was proposed in connection 

with yo ur state ment on pag e 6 in connection with the DPT pro gra m. 

I have been concerned, and pe rhaps unnecessarily so, fo r some time 

over the possibility th at if the fan atics of the Com munist world 

decided on a chemical war fa re or biological wa rfa re, wha t pr ep ar ations we have made insofar as the civi lian pop ula tion is concerned 

fo r some sort of mass immunizatio n. Has tha t been taken into considera tion in connection with thi s legisla tion ?

I)r. S mi th. At the present time, the vaccine cost for use in the a dult 

po pu lat ion —the diph ther ia-te tanu s com binatio n—will not be taken 

care of.

On the oth er han d, the pro motional cost, the imp lem enta tion cost, 

fo r a campaign inc lud ing these age gro ups can be su pported from thi s 

legisla tion .

Mr. Hem phill. Well, maybe I didn 't pose my question rig ht, sir. 

'Phe thought occurred to me tha t if we were to get in a big war of 

some kin d, not nece ssarily glob al but it could almost be of that proportion, and involved with chem ical and biological wa rfa re which 

would be spre ad of diseases which mig ht not kill but might inca pac itate, cri pple, or irr ita te, som eth ing sim ila r to eit he r ge tting at the 

psychology of the Am erican peop le or reduci ng their usefulness or 

th eir desire to win, what pr ep arations, if any, lias your Departm ent 

considered in connection with this defense problem ? And if it is 

som ething that is classified, I don't want to know it, but if it isn't I 

would like to know it.

Dr. Smit h. 1 think our pa rti cu la r res ponsibility is in the field of 

communicable diseases and any imm unizati on of the overall population under the c ond itions you described would be of g rea t adv antage .

Mr. Hem phill. Wo uld I be f ai r in surm ising th at in the big picture 

of thi s legislation , you con tem pla te the experienc e which will give 

you som ething to go on in the event that you found that necessary in 

a national emergency? Is that con tem plated?

Dr. Smith. I thi nk it would give us experience in com munity 

org aniza tio n and fast imp lem entatio n of pro gra ms of imm uniz ation.

Mr. Hem phill. Cou ld you make a statement tod ay that the Depa rtm ent has th at concept as p art of its concept in connection with thi s 

legislation ?

Dr. S mi th . With in this legisla tion , the direct rel ations hip would 

be in tetanus. The American College of Su rg ery's Civ il Defense 

Com mittee is very anx ious fo r State s to conside r this need when this 

pro gra m is available to them.

Mr. Hem phill. Th an k y ou ,si r.

Mr. Macdonald. Mr. Secre tar y, before I reco gnize Mr. Sibal of 

yo ur home Sta te, I would jus t like to say this, and I don't know 

wheth er this is ap prop ria te because all I know is wha t I read in the 

papers, but it might be the last op po rtu nity that I would have to sit 

m while you testify b efore this committee.
66 INTENSIVE IMMUNIZATION PROGRAMS

I would like to say—I can ’t speak fo r the committee hut certainl y 

on behalf of myself as a member of the committee, I would like to 

com plim ent you on the trem endous job you have done while you have 

been in th is position.

I think t ha t the whole Nation and you r home State owes you a debt 

of gr atitu de and I would like to public ly say so.

Air. Sibal ?

Mr. Sibal. Air. C hairm an, I have no que stio ns; hut I would like to 

tak e thi s op po rtu nity to join with my colle ague in welcoming Sec reta ry Rib icon, an old frien d and a very distinguished citizen of my 

State of Connecticut.

Air. AIacdonald. Air. Dominick ?

Air. Dominick. Th ank you, Air. C hai rman.

Air. Secre tary, on page 2 of your statem ent, at the bottom, you say 

th at o f some 21 million children und er 5, only 7 million have received 

the full vaccination protection. I presume th at out of thi s 21 million 

a good num ber have sta rte d on it, is th at correct?

Sec retary Ribicoff. Th at iscorrect.

Air. Dominick. I s the re any ind ication th at they are not going to 

complete it?

Dr. S mi th . The figures are thes e: In the 0 to 4 age gro up, 20 pe rcent have no imm unizati on whatsoever. Ap proxim ate ly 80 percent 

have some protection and 34 percent have ade qua te pro tection—four 

or more.

Air. Dominic k. You mean fou r or more shots?

Dr . S mith. Yes. Of th e Salk vaccine.

Air. Dominick. Now, you have no figures on the oth er diseases?

Dr. Smit h. No, sir. AVe arriv e at nation al figures by analogy . In 

the areas where we have completed statistic al surveys and checked 

them for accuracy in general the peop le who have not had complete 

Salk vaccinatio n have not had complete vaccina tion with D PT . These 

have been done in many area s of the country and in different socioeconomic gro ups. Always the comp ara bility is close.

Air. Dom inick. If you don ’t have any figures, Doc tor, how do you 

know the co mp arability is close?

Dr. Smit h. AVe have in many selected areas. AATe don ’t hav e results of a natio nal survey. The figures for polio were obtained by 

the Census Bu rea u at our req uest a nd were developed from interviews 

of 45,000 householders.

These figures we think are firm. Our smaller stud ies in different 

area s of the country lead us to believe th at the figures for the oth er 

diseases are co mparable because in every place we have stud ied it the y 

have been com parable.

Air. Dominic k. So your figures on a nation wide basis, the n, are 

developed from a survey of 45,000 families on polio alone?

Dr. Smith. Yes, sir.

Air. Domin ick. Secondly, Air. Se cre tar y, wh at inf orma tio n do you 

have t ha t the S tates don’t have sufficient funds to conduct a prog ram 

of this kind on their own?

Secre tary Ribicoff. The only inf orma tio n we have is th at the y are 

not doing it. And we do believe th at the health of our people is 

a na tional p roblem, a nd unless they have th is stimu lation th at it won’t 

be done. AATe do believe that the Fe de ral Gover nment ’s prog ram in
INTENSIVE IMMUNIZATION PROGRAMS 67

1955, with its some $50 million-odd for vaccine, was what triggered 

the action of the States to undertake the vast mass inoculation pro ­

gram with Salk vaccine. This sum is so small that it is important to 

stimulate the States.

The States aren’t doing it generally. Since they are not doing it, we 

think it is important that it be done for the health of our people.

Mr. Dominick. In other words, you feel tha t the Federal Government should step in and take over this program by virtue of the fact 

that the States are not doing what you consider an adequate job on 

this at this point?

Secretary Ribicoff. I would say frankly that this is the case. Since 

health and communicable diseases are so important to the national 

condition, since communicable diseases certainly jump across State 

lines it is important that this be done for the general welfare and 

health of the people of all 50 States and the territories.

Mr. Dominick. Now, Mr. Secretary, this bill is limited to children 

under the age of 5, is it not?

Secretary Ribicoff. Tha t is correct.

Mr. Dominick. Presumably anybody over the age of 5 who didn’t 

get immunized this wav would still be spreading these diseases, would 

t hey not ?

Secretary Ribicoff. I th ink the difference is that the largest number 

of unimmunized is in this age group. Many States do have vaccination programs connected with their school program and they see to 

it that school-age children are immunized as part of the local and 

State health programs. The great problem we have is that under the 

age of 5 before these children go to school they are not immunized 

and are susceptible.

Mr. Dominick. Let me ask you this question. Do you have any 

figures indicating what the incidence of disease is on those under 5? 

In other words, it seems to me that you have given us some figures in 

here on the overall population but not on those whom you propose to 

trea t under this bill.

Dr. S mith. You would like to have cases and deaths under 5?

Mr. Dominick. Well, I just thought if we were going to be dealing 

with children under 5 we ought to know what we are dealing with.

Dr. Smith. All right, sir. In 1956 there were 4.295 total cases of 

polio reported, with 2,842 of them paralytic and with 127 deaths.

In 19-----

Mr. Dominick. This is under 6 or under 5?

Dr. Smith. Under 5.

In 1957, the total number was 1,633; paralytic, 1,118; deaths, 53.

In 1958, the total was 2,138; paralytic, 1,707; 57 deaths.

In 1959, 3,130; 2,624 paraly tic; 87 deaths.

In 1960, 1,246 total cases, 1,073 paralytic cases, and the deaths are 

not in yet.

Mr. Dominick. Tha t is a fairly small percentage, is it not, Doctor?

Dr. Smith. Yes.

Mr. Dominick. And this is the only disease for which you have 

those figures except by analogy?

Dr. Smith. No, sir. We do have actual count of deaths in the 

other diseases, and I can submit them for the record or read them if 

you would like.
68 INTENSIVE IMMUNIZATION PROGRAMS

Mr. Dom inick . Mr. Chairma n, could we have those submitted for 

the record on the o ther diseases?

The Chairm an. Yes. If the Secre tar y can make that inform atio n 

availab le, it will he included in the record at th is point.

Secre tary Ribicoff. We will be pleased to do so.

(The document referre d to follows :)

Disease cases and deaths under 5 years of aye. United States

1956 1957 1958 1959 1960

Pol iom yel itis :

Tota l.................... .......... .............................. 4,295 1,633 2,138 3,130 1,246 

1.073 Par al yt ic _______ _________ 2,842 1,118 1,707 

57

2,624 

87 D ea th s...... ........................ ........................... 127 53 (’)

235

Dip ht he ria :

C as es. . . . . 378 328 263 262 D ea th s___ . ................. 47 43 30 36 (') Pe rtu ssi s:

Cases 2

D ea th s_____________ ________ 252 173 173 263 (') Te tanu s:

Cases 2

...................................

D e a th s .. ......... . . . 97 93 105 99 (•)

1

 No t ava ilab le.

2

 Not available by age c lassification.

Mi-. Dominic k. Th an k you, Mr. Chairma n.

I want to say righ t here that I have a vast respect for the Public 

He alth Service and have been working with them fairl y con stantly 

in my own Sta te. Th e point I was ma kin g when I asked Mr. Rogers 

to yield was simply that I tho ught tha t perha ps I)r. Salk ought to 

be given some credit for the decrease in polio.

Secre tary Ribicoff. We are quite sure about that.

Mr. D< 1M IN IC K . It was not just the respon sibility of the public 

health dep artme nt that did it.

Now just a few more que stions here. I not ice that there is no restriction or requirement as to the numb er of addit ion al personnel that 

would 1 >e add ed fo r the purpose o f this bill in any State o r locality.

Do you feel t ha t the re should l>e an y such re striction ?

Secre tary Ribicoff. No, because in the first place, you don't know 

the extent o f the pro gra m in a ny one Sta te. You have population dif ­

ferences. You have different problems. We believe the pro jects sub ­

mitted will show the add itio nal employees needed to assist in these 

projects. These applicat ion s will be examined by the Public Health 

Service.

They will be S tate em ployees and not Federal employees, eith er.

Mr. Dom inick. How many do you estima te will be necessary to be 

added ?

Dr. Smith. We won’t lie able to make a total estimate until we get 

the State pla ns and know the numb er of State employees tha t will lie 

needed to implement the State pro gra m.

Mr. Dom inick. Well, then, how did you arriv e at yo ur estimated 

cost of $13.5 million fo r the first year ?

Dr. Smith. We arr ive d at th at by prici ng out the vaccine costs for 

all children under 5, u sing total population for polio, and susce ptible 

pop ulation for D PT: developing bro ad plans to sup port the lab ora ­

tory and surveillan ce needs of the St ate in rela tion to their present 

competence and abi lity in the lab orato ry and epidemiolog ic areas.
INTENSIV E IMMUNIZATION PROGRAMS 69

Mr. Dom inick. So would it be fa ir to say th at yo ur estimate of 

costs does not inclu de the salaries and rela ted expenses of addit ion al 

State and local hea lth personnel needed to promote and help and or ­

gan ize the pro gra m ?

I)r. Smit h. No, sir. I think this pro gra m will sup port a nucleus 

opera tion in every Sta te. Th ere was no att em pt to try to price out 

the total pro gra m which we hope can he done with present facilities, 

with volu nteers, w ith such or ganiz ations------

Mr. Dom inick. Let me ask you this, then, Doctor. If th ere is a need 

for pu tti ng addition al people on, will that he an ad dit ion al expense 

over and beyond you r $13.5 million ?

Dr. Smith. No, sir. Th is is a pa rt of the pic tur e and will vary 

acc ord ing to the S tate plans.

Mr. Dom inick. I don't see how it can he pa rt of the pic tur e if 

you haven't inclu ded it in yo ur estimat e. I am really confused on 

this. You say that, you did it by the cost of the vaccine as rela ted to 

the various State s and then you say that the re won't he any ad ditional costs for personnel even tho ugh it is pro vid ed for in here.

Dr. Smith. No, s ir. I was talk ing about pers onnel when I talk ed 

about com munity org ani zer s, lab orato ry and epidemiolog ical surve illance, this sort of thing .

Mr. Dom inick. 1 see. Now is there any indication in the Sta tes 

that people are not becoming vaccina ted because the re is no available 

vaccine or fun ds for t he vaccinat ion ?

Dr. S mith. In every area where we have made studies, the fact 

tha t there are in pa rti cu la r population segments large gro ups who 

have not been vaccinated does not mean that the com mun ity hasn't 

got vaccinatio n facilities availab le. These are the people who do 

not resp ond readily to health maintenan ce pro grams. Pa rti cu lar 

efforts and pa rti cu lar camp aig ns pointed to these specific pop ulation 

groups have to he mounte d in orde r to get them out to accept the 

vaccine.

Mr. Dom inick. And have the State s failed to tak e the ini tiative in 

con ducting such cam paigns ?

Dr. Smit h. I think the State s are doing a big pa rt of the job. 

When you look at the num ber of school-age children who have been 

com pletely immunize d, it is an impressive picture. The fact that 

they have not been able to get to the pres chooler—and particu larly 

the preschooler in the lower socioeconomic are a—is not because they 

wou ldn't like to hut because they haven't had pro gra ms to point to 

thi s p ar tic ul ar critic al area.

Mr. Dom inick . And whose respon sibility is th at , do you feel?

Dr . Sm it h. I think in communicable diseases it is a joint resp onsibility. I do n't believe the Public Health Service has any intention 

of taking over th is responsibility.

Mr. Dom inick. You missed the point of my que stio n, Doc tor. 

Whose respon sibility within the State s is it that the y have not done 

I hi-?

Dr. S mith. The State health officer is ad ministrativ ely res ponsible fo r his whole area. Most of them have com munica ble disease 

control officers who t ake the im mediate responsibility.

Mr. D< im inick. Is it your fee ling that a St ate agency cou ld create 

a cam paign which would lie sufficient to get these peop le to be 

immunized ?
70 INTENSIVE IMMUNIZATION PROGRAMS

I)r. S mith. Yes, sir. 1 believe they can.

Mr. Dominick. If they can do that, then is there any necessity for 

the Federal Government getting into it?

Dr. Smith. This is a problem of augmenting ongoing programs 

with Federal funds to make it possible for the combined efforts of 

the State and Federal Governments to be applied to these areas.

Mr. Dominick. I understand the purpose of the bill all right. 

What I am trying to find out is if we mounted a campaign on a 

State-by-State basis, do you thing the States have the funds and 

the ability to handle these programs ?

Dr. Smith. To handle their part of it ?

Mr. Dominick. Without any Federal funds?

Dr. Smith. No, sir; I do not believe they would.

Mr. Dominick. Do you have a breakdown in the States showing 

which ones could not do this?

Dr. Smith. We see the total State plan of the State each year 

and we can assemble information showing how much money each 

State is applying to this particular purpose. I think it would take 

an immense study to see if funds could be redirected within the States, 

which is really the responsibility of the State health officer, not the 

Public Health Service.

Mr. Dominick. How much effort has the Public Health Service 

made to cooperate with the State health officers to mount campaigns 

of this kind ?

Dr. Smith. Except on a demonstration basis, very little.

Mr. Dominick. Thank you, Mr. Chairman.

The Chairman. Mr. Younger?

Mr. Younger. Mr. Chairman, could I ask just two questions? I 

had forgotten about Dr. Salk. Was he in private practice or was he 

in public health or what was his background ?

Secretary Ribicoff. I thing lie was professor of experimental medicine at the University of Pittsburgh—research and development.

Mr. Younger. At the University of Pittsburgh when the vaccine 

was discovered?

Secretary Ribicoff. At the Universitv of Pittsburgh.

Mr. Y ounger. One other question. You mentioned about Congress 

adding all of these new programs. Can you name a program that 

Congress has put into an appropriation bill that was not recommended 

by-----

Secretary Ribicoff. Xot the new-----

Mr. Younger. By the administration ?

Secretary Ribicoff. Xot a new program, but adding on to the program, Congressman Younger. If you want us to give you the figures 

from last year’s budget—I don’t have them in front of me—of how 

much more Congress voted than we advocated, I would be pleased 

to supply that fo r the record.

Mr. Y ounger. And any new programs tha t were added by Congress that were not recommended by the administration ?

Secretary Ribicoff. I think it is a matter of degree. I think you 

haven’t added any new programs but you have expanded programs 

that we have advocated.

Mr. Younger. Without recommendation by the administration?

Secretarj’ Ribicoff. That is right.
INTENSIVE IMMUNIZATION PROGRAMS 71

Mr. Younger. Will you furnish those, please? I would like to 

have them for the record.

(The following information was submitted for the record:)

The Labor-HEW Appropriation Act for 1902 included appropriations for the 

Depa rtment of Health, Education, and Welfare amounting to $4,260,429,000. 

This represented total increases of $203,012,000 above the Pre sident’s budget 

estimate, with offsetting decreases of $137,419,081 for a net congressional increase of $65,592,919. The majo r elements of the decrease were $100 million in 

grants to States for public assistance, and $27 million in vocational reha bilitation 

grants, the latte r of which repre sente d essentially a bookkeeping adjustmen t. A 

supplemental estimate for public assistance gra nts for 1962 is now before the 

Congress.

The funds added to the HEW budget by the Congress were distributed among 

many of the programs of the Department. The major components of the increase, however, were $155 million for the extramu ral and intram ura l medical 

research programs of the National Institut es of Health, $25 million for hospital 

construction grants, $5 million for grants for the construction of cancer research 

facilities, $3 million for research and training in the held of vocational rehabilitation, $1.5 million for radiological health. $4.3 million for grants for maternal 

and child welfare, and $1.8 million for shellfish sanitation. Increases of smaller 

magnitude were made in a variety of other programs.

Mr. Nelsen. Mr. Younger, will you yield ?

Mr. Younger. Yes.

Mr. Nelsen. The proposal that we are hearing today 1 feel has 

merit, and I like the part of it where the States are to become a great 

part in the administration of it. But as the record will read, according to Secretary Ribicoff’s answer to my question, added employees 

are a result of what Congress has forced on HEW. I ran an agency 

and I found out you could reduce personnel in some areas and might 

have to add some in another. My question was how many employees 

you have added and I think it is important and 1 think we have a 

right to know not only in your departm ent but all departments.

r did not get an answer and, Mr. Chairman, if the staff would get 

the information for me, I would appreciate it. I would like to know 

how many employees have been added in Health, Education, and 

Welfare.

I th ink I am entitled to an answer, Mr. Chairman.

Secretary Ribicoff. I mean I can’t give you th at in all the departments off' the top of my hat. I will be pleased to submit them with a 

breakdown of what programs and purposes they were used for. This 

I will be pleased to submit to you, Mr. Chairman. They are a matter 

of public record and we will be pleased to supply that to you.

(The information requested follows:)

As of March 31, 1962, the total employment of the Department was 74.577. 

This represents an increase of 4.237 d urin g the first 9 months of fiscal year 1962 

over the total employment as of Jun e 30, 1961.

The major portion of this increase has take n place in the Social Security Administra tion, and is related to the additional workloads in the Bureau of Old-Age 

and Survivors Insu rance created by the enac tment of the 1960 and 1961 amendments to the Social Security Act. This accounts for approximately 2,800 of the 

full and part-time employees who have been added to the Department’s staff.

The other major element of increase is approxim ately 1,200 employees in the 

Public Hea lth Service. These are engaged mainly in the extramural, intr amura l, 

and techn ical supjiort programs of th e National Institut es of Health, the environmental health programs of the Bureau of Sta te Services, and the medical care 

programs of the Division of Indian Health.
72 INTENS IVE IMMU NIZ ATION PROGRAMS

Th e re m ai nd er of th e in cr ea se s in em ploy men t in fiscal yea r 11)02 ha ve been 

divide d am on g th e Fo od an d D ru g A dm in is trat io n, ilie Office of Ed uc ati on , St. 

E liza be th s Hos pital, an d th e Office of th e Sec re ta ry , an d are re la te d to the 

ex pa nd in g pr og ra m s of thos e agencie s.

Mr. Nelsen. Th at is all.

The C hairman. Mr. Secre tary, what is the difference between 

proje ct gran t and a form ula g rant ?

Dr . Smi th . The project gr an t is a gr an t to the St ate made on the 

basis of an app lication that describes the activ ity . The amount of a 

for mu la gran t is commonly determ ined on the basis of extent of the 

prob lem, the S tate population , and the per cap ita income in the State.

Th is means that in formula gra nts , every State , wheth er read y or 

not, for thi s pro gram, would receive its sha re of the total ap pr op riation each year.

In project grants, the moneys can be distr ibuted over the 3-year 

period according to the need and read iness of the pa rticul ar State 

involved.

Th e (' 'iiair man. In oth er words, you prefer the project gran ts?

Dr. Smith. Yes, sir.

The Chair man. And a form ula gran t under th is pro gra m, you do 

not think would be suitab le?

Suppose the costs of the pro gram sub mitted by the State s were to 

exceed the am oun ts tha t would be obtained from the bill. What 

would happen then ?

Secre tary Ribicoff. In this case we don’t believe so. We have very 

carefully figured out by the costs of the vaccine and previous expe rience tha t there is enou gh money to take care of all the children 

un de r 5.

Th e Chairm an. In oth er words—1 know, but if you did n't get what 

you asked for, would it be then adm inis tere d pro rata?

Secre tary Ribicoff. T hen you would have to cut back the p rog ram . 

In other words, if Congres s d id not give you what you had requested, 

the n, of course, you could only take care of a smalle r num ber of 

projects. The n, of course, if you had a formu la, instead of a project 

gr an t, you might have a problem. Money might be allo cate d for 

St ate X who had no program a nd you might have S tate Y who Mould 

not have eno ugh; and there might be some chi ldr en who could have 

been inoculated and weren’t because money was set aside for a State 

that did n't seek it.

The Chairman. Th is money Mould be for the purchase of the 

vaccine ?

Secre tar y Ribicoff. Fo r the State personnel t o -----

Th e Chairma n. T o be administered?

Se cre tar y Ribicoff. To adminis ter and to do the job, yes, sir.

The C hair man. You Mould have in mind ma kin g vaccine a vailable 

M’itho ut cha rge to doctors ?

Secre tar y Ribicoff. The State Mould have its own policy. In oth er 

Mords, we wou ld give the State money. It could purchase its omu vaccine or we could pur cha se vaccine for the Sta tes, depen din g on 

the State preferenc e. The State then Mould come up with its plan 

for the locality—to sup ply it to doctors or to pub lic health centers 

or to school systems—whate ver system or pro gra m the State itself 

or the locality developed, Mr. Chairma n. But it is c ontemplated that
INTENSIVE IMMUNIZATION PROGRAMS 73

if a State wanted vaccine to go to private physicians to he administered, the vaccine would he supplied to the States for distribution 

to the private doctors.

'The Chairman. Mr. Secretary, let me on behalf of the committee 

thank you very much. We appreciate your appearance this morning 

and the testimony on this part.

Secretary Ribicoff. Thank you very much.

(The following letter was later received from the Department of 

Health, Education, and Welfare:)

Depa rtm ent of Hea lt h, E duc atio n, and Welfare,

W as hing ton, May 28, 1962.

Hon. Oren H arris,

Ch airm an , Com m itt ee oil In te rs ta te an d Fo re ign Co mm erc e,

Hou se o f Fep re se nt ati res , W as hing ton, D.C.

Dear Mr. Cha irman : In resp on se to th e co m m ittee’s re qu es t, I am enclo sin g 

a d ra ft of tw o am en dm en ts to th e prop osed Vac cina tio n Assistanc e Ac t of 1962 

(H .R . 10541) which wo uld rec on cil e th e hil l more clo sel y w ith two su gg es tio ns 

fo r revisio n prop osed by th e As sociati on of S ta te an d T err it o ri al H ea lth Officers.

Th e fir st am en dm en t re la te s to th e qu es tion of di re ct g ra nts to loca l po lit ical 

subd ivisi on s. We fee l it im por ta nt th at su ch loc al co mmun iti es no t be denie d 

th e op po rtun ity to part ic ip ate in th e vac ci na tio n pr og ra m s prop os ed in the bill 

when a S ta te fo r an y reas on is no t pre pa re d to ta k e le ad er sh ip in a st at ew id e 

pr og ram. On th e oth er ha nd , we ag re e th a t it wou ld be des irab le to ob tain the 

ap pr ov al of th e S ta te hea lth au th ori ty in su ch cases. Th e am en dm en t sugg ested 

wo uld re ta in th is auth ori za tion fo r di re ct g ra n ts to loc al ar ea s, bu t wo uld re ­

qui re th e ap pr ov al in su ch ca ses of th e S ta te hea lth auth ori ty .

Th e sec ond am en dm en t wo uld mo dif y th e li m itat io n co nt ai ne d in the bill 

with re sp ec t to th e ag e gr ou p of ch ildr en eli gible to rece ive fr ee va cc ine un de r 

the pr og ra m. It wo uld recogn ize th at th er e may be som e ot her selecte d grou ps 

of ch ild re n in ad ditio n to thos e un de r 5 years of ag e wh o are no t no rm ally 

se rv ed by sch ool va cc in at io n pr og ra m s. The am en dm en t wo uld au th or iz e the 

Su rgeo n Gen er al by re gu la tion to ex te nd th e el ig ib ility fo r free vaccine to 

su ch grou ps.

We ha ve also giv en fu rth e r co ns id er at io n to th e su gg estio n disc us sed du ring 

th e he ar in gs th a t th e le gi slatio n be am en de d to pr ov id e spec ial Fed er al fina nc ial 

as si st an ce fo r co nt in ui ng va cc in atio n pr og ra m s ag ai nst polio, dip hth er ia , wh ooping cou gh, an d te ta nus a ft e r th e 3- ye ar in te ns iv e pr og ra m s now covered by the 

bill. It is ou r reco m men da tio n th at such an am en dm en t shou ld no t be ad op ted 

at th is tim e be ca us e th er e are al re ad y tw o auth ori za tions fo r gra nts to Sta te s 

wh ich ca n be an d are be ing us ed fo r th is pu rpos e. Th ese are th e m at er nal an d 

ch ild he al th g ra nts ap pro pri ate d u nde r auth ori ty of t it le V of th e Socia l Se cu rity 

Act, an d th e g ra n t fu nd s ap pro pri at ed under auth ori ty of section 31 4( c) of th e 

Pu blic H ea lth Se rvice Act. We believ e th a t w ith th es e tw o ex is ting auth ori zation s no ad ditio nal co nt in ui ng au th ori ty wo uld be neede d.

I am also en clos ing fo r inclus ion in th e reco rd, a st ate m ent on th e nat io na l 

de fens e im pl ic at io ns of th e pro po sed va cc in at io n pr og ra m wh ich mo re fu lly 

an sw er s th e qu es tion as ke d on th is su bj ec t duri ng th e he ar in gs .

Sinc erely yo urs,

Wilbur J. Coiien , A ss is ta nt Se cr etar y.

En clos ur es .

Ame ndments to H.R. 10541

(R eq ue sted of Sec re ta ry Rib icoff by Con gressm an Moss at May 1G. 1962, 

hea ri ng on bill)

( /) App ro va l of S ta te he alth au th or itie s

Pa ge 2, lin e 7. in se rt th e follo wing be fore “p ol itic al ” : “, w ith th e ap pr ov al 

of th e S ta te hea lth au th ori ty , to ”.

(2 ) Pu rcha se of va cc in es fo r ad di tio na l grou ps

Pa ge 2. lin e 13. in se rt th e follo wing a ft e r “y ears ” : “a nd such add itio nal 

gr ou ps of ch ildr en as may be de scrib ed in re gu la tion s of th e Su rgeo n G en er al 

up on hi s fin din g th at th ey are no t no rm ally se rv ed by sch ool va cc in atio n 

pr og ra m s” .
74 INTENSIVE IMMUNIZATION PROGRAMS

National Defense Implications of the Vaccination Assistance Act of 1962

II.R. 10541 has many implications important to the Nation ’s defense.

At the prese nt time the adu lt population of this country has a low level of 

immunization aga inst teta nus and diphtheria. In time of disaster these two 

diseases could be of major importance.

It is estim ated that 70 percent of the casualties of a nucle ar disaste r would 

have traum atic injuries. Many of these injuries will be penetra ting wounds, 

contamin ated witli dirt. The spores of tetanus are universally present in the 

soil, and there fore many of the wounded will be potential cases of tetanus 

Even with intensive hospital treatment, which will not be available in time ol 

disaster, less than 50 percent would survive.

The crowded living conditions in shelters, would be conclusive to diphtheria. 

Dip htheria was a majo r health problem during the satura tion bombings of 

Germany.

Therefore, establishing immunity to these two diseases now would be of immeasurable importance in time of disaster. The hea lth mobilization activities 

of the Public Health Sendee and the disa ster committees of medical societies 

strongly endorse the concept of immunization for th e Nation’s defense.

The provisions of H.R. 10541 would provide the basis for widespread vaccination of children under 5 years of age and, through the promotion and organization of intensive community vaccination programs, grea tly stimulate the 

diphtheria and tetanus vaccination of the adu lt population. In addition, the 

experience gained from conducting such intensive community programs would be 

of considerable value in terms of emergency.

Thus the bill, while not designed as a general defense measure, would be of 

sub stan tial benefit in this regard.

Th e Chair man. We have a statem ent here from Dr. Al fre d 

Freche tte and if the re is no objection, it will ap pe ar at this point in 

the record.

(The statem ent of Al fre d L. Frech ette, M.D., comm issioner of 

pub lic hea lth, Com mon wealth of Massachusetts, follow s:)

Statement of Alfred L. Frechette, M.D., Commissioner of Public Health, 

Commonwealth of Massachusetts

The I’resident’s proposal to provide Federal assistance to State and local 

programs for immunization of preschool children is praiseworthy and timely. 

The value of such a program lies in the impetus t ha t i t can give to local programs 

which in many cases do not provide sufficiently thorough coverage of young 

children with rega rd to the immunizations th at they should have. The Massachu setts Departm ent of Public Health wishes to record itself in strong supi»ort 

of this program.

When the percentage of immunized schoolchildren is only moderately good 

there is a continuing danger that outbreaks of diphtheria, whooping cough, 

smallpox or poliomyelitis may occur. Such outbreak s are dangerous to all persons, young or old, who are not immune, and also the ir control is far more expensive and time-consuming than their prevention by means of thorough 

preschool immunization. In such a program, tetanu s toxoid immunization 

should also be included, not only to protect individual children against this 

dreadful disease, but eventually to eliminate the need for tetanus antitoxin with 

its risk of severe reactions.

This comment is not intended to be critica l of local programs; indeed the 

essence of effective public hea lth activity—as w ith all similar activities—is local 

interest, initiative, and participation. Ths has been abundantly proved—if 

proof was needed—by the various community drives for mass oral poliomyelitis 

immunization which have take n place in many other areas, and recently in 

Massachusetts. In all such programs the degree of success is very much dependent on the extent to which the community takes active responsibility for 

the program.

However, dedication and enthusiasm are not in themselves enough. Futherinore, the lack of sufficient funds frequently kills of such enthusiasm before it 

can take root; and the lack of adequate technical guidance and careful surveillance of local programs often spells fail ure for such program s. As pointed out 

above, the emphasis must be on the importance of excellent rather than merely
INTENSIVE IMMUNIZATION PROGRAMS ZO

“good” immunization programs. And it is in maintain ing excellence that Federal supp ort can be most valuable. Pa st experience has shown repeatedly that 

Federal participation in the suppo rt of State health programs has often made 

a critical difference in the chances of achieving success in such programs. This 

principle will certain ly apply to State and local immunization programs, since 

the provisions of II.It. 10541 and S. 2010 for assisting vaccine purchase, epidemiologic and labo rato ry surveillance, etc., are exactly what is generally needed 

to convert an inadequa te program into a really effective one.

The proposed bill would presumably operate in basically the same way as 

the alre ady well-tested Federal programs to support State and local control of 

venereal diseases, tuberculosis, etc. The principle of State and local planning 

and action, with Federal fiscal assistance and technical guidance, is a sound 

and accepted one. If applied to immunization, as proposed in these bills, it 

should make it possible to eliminate poliomyelitis, diphtheria, whooping cough, 

and eventually tetanus as public health problems.

The Chairman. It is now 12 o’clock. The House is in session.

May we ha ve order j us t a minute.

I would like to see wh at we can do abo ut he ari ng the othe r witnesses. We have four witnesses yet to be heard. I won dere d if those 

witnesses who are to be h eard could be back at 3 o’clock th is aftern oon ?

We will un derta ke th at, then , a nd see if we can ’t-----

Dr. Daily. I ’m sorry, I cannot.

The Chairman. W ha t is your nam e ?

STATEMENT OF ED WIN F. DAILY, M.D., VICE PRESIDENT, HEALTH 

INSURANCE PLAN OF GREATER NEW YORK

Dr. Daily. Dr. D aily from New Y ork.

Th e Chairma n. Dr. Daily, we are going to have a rollcall righ t 

away. We can’t go on now. We will ju st have to arrang e some 

oth er convenient time fo r you. 1 had hoped to get throug h with this 

this week if we could. I assume th at it will not be sat isfactor y just 

to subm it you r s tatem ent ?

Dr. Daily. I would be very ha pp y to. I t is ready for submission. 

I can sub mit i t to you now.

The Chairman. Very well. We will be glad to have you sub mit 

it fo r the record, and you are Ed win F. Da ily, vice presi dent of the 

Hea lth Insuran ce Pl an of Gr eater New York, and also rep res enting 

Group Hea lth Associa tion of Am erica, 625 Madiso n Avenue, New 

Yo rk 22, N.Y .

You may sub mit yo ur sta tem ent fo r the record.

(T he prep ared statem ent of Dr. Ed win F. Daily with attach ed 

resolu tion follow s:)

Statement by Edwin F. Daily, M.D., Vice President, Health Insurance

Plan of Greater New York

I am Dr. Edwin F. Daily, vice president of the Health Insuranc e Plan of 

Gre ater New York, a nonprofit health insurance plan providing comprehensive 

medical care for 030,000 men, women, and children. I speak today both for HIP 

and for the Group Health Association of America, of which HIP is a member 

organizatio n.

I wish to endorse the bill and commend the Members of Congress who are interested in furthe ring such legislation. The purpose of the bill—to protect all the 

American people aga inst diseases such as poliomyelitis, diphtheria, whooping 

cough, and teta nus —is admirable.

In my own organization, HIP, we have made a major effort to immunize our 

large insured population. Studies have shown that our infants are 95 percent 

immunized for smallpox, diphtheria, whooping cough, and teta nus before they 

are 1 yea r of age.
76 INTENSIVE IMMUNIZATION PROGRAMS

In or ga ni ze d med ical ca re plan s, su ch as 1I IP an d th e ot her pr ep aid grou p 

pr ac tice p lans aff iliate d w ith the Gr ou p H ea lth Assoc iatio n of Am eri ca, s ta ndard s 

of ca re can an d are es ta bl is he d an d ca rr ie d ou t. fa m ilies can he re gu la rly in ­

form ed ab ou t im mun izatio ns , an d all par ticip ati ng ph ys icians glad ly carr y out 

ou r im mun izatio n efforts . Sin ce ou r ph ys ic ians a re pa id on a sa la ry ba sis ra th er 

th an fee fo r service , th er e is a very re al ince ntive to pr ev en t ill ne ss an d thereb y 

les sen th e need fo r med ical ca re du ring illne ss.

Las t ye ar II1P decid ed to provide , w ith ou t ch ar ge to its su bs cribers, all m at eri als used fo r im mun izatio n. Th e cos t of som e va cc ines can be a dete rr ent to a 

fa m ily w ith se ve ra l ch ild re n. Fo r e xa mp le, t he Sa lk vacc ine ha d cos t us a pp ro xi ­

mately $1 i>er inje ctio n an d. wi th th re e in je ct io ns pe r )>erson, th e cos t to a family 

w ith tw o pare nts an d five ch ildr en wo uld be $21.

Wh en tile Su rgeo n Gen eral of the U.S. Pu blic H ea lth Se rvice rece ntly ap prov ed 

type III or al vaccine fo r polio, H IP , with th e ad vice of em in en t epide miol og ist s, 

decid ed to im mun ize prom ptly as m an y of its in su re d pe rson s as po ssible . In less 

th an 5 we eks we ha d (a ) sent special le tt ers to al l of ou r su bs cr ib er s telli ng 

wh y th ey shou ld ha ve th e new vaccine a nd whe re an d wh en it w ou ld be prov ided 

by the 31 H IP me dical gr oup s; (ft) so lic ite d bids an d pu rc ha se d th e vaccine 

needed ; (c ) re he ar se d w ith th e staf f o f e ac h of t he 31 med ical grou ps e ve ry det ai l 

fo r ca rr yi ng ou t a larg e-scale ma ss im m un izatio n pro gra m ; an d (rf) requ es ted 

an d rec eiv ed the co op eration of th e police dep ar tm en t in ha nd lin g an tici pa te d 

tra ffic problem s.

On a Sat urd ay an d Su nd ay ea rly in May, ov er 150,000 men , wom en, an d ch ildr en took th e new or al vaccine fo r polio from sm all pa per cu ps an d. fo r in fa nt s, 

by a dr op pe r di re ct ly into th e mo uth . It was a joy to see thes e fa m ili es ha pp ily 

part ic ip ati ng in a well-p lan ne d im mun izatio n pr og ra m . No one ha d to w ai t mo re 

th an a few m in utes sin ce 1 nu rs e can ea sily feed th e va ccine to ov er 1,000 pe rson s 

pe r ho ur.

I ha ve tol d you abou t th is one effort a t m as s im mun izatio n be ca us e it is a 

cl ea r cu t. tim ely ex am pl e of w ha t you are de siro us of ac co mplish ing un de r the 

prov isions of II.It . 10541.

I he ar tily en do rse th is legisla tio n.

I also wish to pr es en t th e follo wing reso lu tio n ad op ted un an im ou sly at a mee ting of th e Group H ea lth Associat ion of Ame ric a now in an nua l session in 

W as hi ng ton. D.O.

(At it s an nu al mee tin g to da y in th e Ho tel Sb ore lm m, Gr ou p H ea lth As sociati on 

of Am erica voted un an im ou sly to ad op t th e follo wing reso lutio ns in su pp or t of 

th e Va ccina tio n Assistanc e Act of 1962 (I I.It . 10541 an d S. 20 10) :)

“W he reas it is a ba sic te ne t of the Group H ea lth As sociati on of Am eri ca, Inc., 

th a t pr ev en tive medici ne is one of the ke ys to ne s of high qu al ity me dic al care ; 

pl an s affil iated w ith GIIAA. with a to ta l mem be rship exceedin g! mi llio n perso ns, 

ha ve lon g im ple mented th is conv iction by utilizi ng all av ai la bl e tech ni qu es fo r 

th e prev en tio n of un ne ce ss ar y illne ss an d pre m at ure d eath : ac tivi ties to w ar d 

th is e nd ha ve f re qu en tly includ ed le ad er sh ip and co op eration in broa d co mmun ity 

im mun izatio n pro gr am s: an d

"W he re as th er e are still larg e nu mbe rs of peo ple wh o ar e no t ye t ad eq ua te ly 

pr ot ec ted ag ai nst cer ta in pr ev en ta bl e co mmun ica ble diseases, an d who apparen tly ca nn ot be reac he d by co nv en tio na l im m un izatio n pr og ra m s th at ha ve been 

tr ie d in th e p a s t; a nd

"W he re as t he pr op os ed Vac cin ation Assistanc e Act of 1962 wo uld ‘as si st Sta te s 

an d co mm un iti es to carr y ou t intens iv e va cc in at io n pr og ra m s desig ne d to pr ot ec t 

th eir po pu latio ns , esjie cia lly all preschoo l ch ild re n, ag ain st po lio mye litis, dip hth er ia . who op ing cough, an d te ta nu s, an d again st oth er dise ases which ma y in 

(he fu tu re become su sc ep tib le of pr ac tica l el im in at io n as a pu blic hea lth pr ob ­

lem th ro ug h su ch pro gra m s’ : an d

‘Wh er ea s it ca n be ex pe cted th a t pr og ra m s car ri ed on w ith ai d pr ov ided fo r 

by the Vac cina tio n A ss ista nc e Act of 1962 co uld effecti ve ly el im in at e pr ev en ta bl e 

comm un ica ble d is eases: The re fo re , be it

“Resolve d, T h at th e Gro up H ea lth Assoc iatio n of Am erica. Inc ., ur ge s th e 

prom pt en ac tm en t of th e Vac cina tio n A ss ista nc e Act of 1962, (H .R . 16541 and 

S. 2910) : an d be it f u rt h er

“Res olve d, T hat GIIAA ur ge its mem be r pla ns to co op er at e fu lly in th e im ple ­

men ta tio n of local co mmun ity pr og ra m s th a t ca n be ex pe cted to be unde rtak en 

un de r th e pr ov isions of th e Vac cina tio n A ssistanc e Act of 1962."
INTENSIVE IMMUNIZATION PROGRAMS 77

Th e C hairman. Off the record.

( Discussion oft' the record.)

Mr. Dingell. Mr. Ch airma n, I wonder if the Doctor could just 

tell us whether he favo rsth e legis lation or n o tf.

Dr. Daily. 1 am com pletely in f avor of the legislation.

Mr. Dingell. Do you have any sugg estio ns or amendments or

chan ges?

Dr. Daily. I do not sugg est any amendm ents or changes in the 

langua ge.

Mr. Dingell. You have been v ery helpful. Th ank you.

Th e Chairma n. The com mittee will adjou rn and will be back here

at 3 o’clock.

(W hereu pon, at 12 o'clock noon the committee recessed, to reconvene at 3 p.m., on the same day .)

AF TE RN OO N SE SSION

'Phe C hairman. Th e comm ittee will come to orde r.

Off the record.

( Discussion off the reco rd.)

The C hairman. We are very glad to have as ou r next witness 

Mr. Andrew J . Biemiller.

Mr. Biemiller, we are gla d to welcome you back to the committee. 

It is alw ays a pleasure to have a forme r member of thi s committee 

return and give us the benefit of his wisdom, counsel, and good 

jud gm ent.

STATEMENT OF ANDREW J. BIEMILLER, DIRECTOR, DEPARTMENT

OF LEGISLATION, AFL-CIO: ACCOMPANIED BY LISBETH BAMBERGER, ASSISTANT DIRECTOR, DEPARTMENT OF SOCIAL

SECURITY, AFL-CIO

Mr. Biemille r. Th an k you, Mr. C hai rman.

Fo r the record my nam e is Andre w »J. Biem iller. I am the di ­

rec tor of the A FL -C IO Depar tment of Leg islation , and my office is 

at 815 16th Street NAY., in AA’ashing ton .

I am accomp anie d by Miss Lee Bam berger, assista nt dir ector of 

the A FL -C IO Depar tment o f Social Insu rance.

The su pp ort of the A FL -C IO for the Vaccin atio n Assistance Act 

of 1962, ILK. 10541 is based on a very simple premise. We have 

at hand the scientific tools to elimin ate entire ly the suffering and 

death caused by polio, d iphthe ria , whooping cough, a nd teta nus . AYe 

have had these tools ava ilab le for a num ber of years. But until 

now these tools have not been employed effectively enough to accom ­

plish the jo b—the total erad ica tion of these diseases.

It is cle ar that the methods used up to now to pro vide protection 

again st these inflections diseases have simply not reached large numbers of the Nation's citizens—and what is pa rti cu larly deplorable, 

vast num bers of childr en have been left unp rotected.

Phe children who are adequat ely immunized tod ay are the fo rtuna te ones. A breakdown of vac cinatio n sta tistics shows that the 

pro tected ones are fortu na te not only in that respect, but that they 

tend to be the chi ldren blessed with oth er advanta ges as well.

844 26— 02------ 0
78 INTENSIVE IMMUNIZATION PROGRAMS

Tak e p rotection again st polio, f or exam ple. Among ch ildren under 

5 in Har risb ur g, Pa ., 65 percen t of the upper socioeconomic gro up 

had received thr ee or more Salk vaccine shots, com pared to 35 pe rcent in the low er socioeconomic gro up. In Atla nta, Ga., 78 percent 

of the children under 5 in the upper gro up were protected. Fo r the 

lower grou p th e figure was 30 perc ent.

Map s th at plo t the geo graphic location of cases of pa raly tic polio 

in recent years gra phica lly tell the story of our failures. Before 

the advent of vaccine, cases of polio were sprea d out quite evenly, 

throu ghout a city. Today, cases of pa ralytic polio are concentrated 

in a city's c entral core. Th is is w here th e poorer, the less privile ged , 

the mi nority gro ups are to be found, and this is where the unv accinated remain.

At, the 1960 mi dw inter clinical sessions of the Americ an Medical 

Associatio n, I)r. E. Russel Ale xander, Chief of the Surveillance Section of the U.S. Public Health Serv ice Com mun icable Disease Center, 

gave a rep ort on the dis trib ution of cases of pa ralytic polio since 

the discovery of Salk vaccine. We find this repo rt profo undly dist urb ing. I am now qu otin g from i t :

Fundamentally, there is a concentration among preschool, lower socioeconomic 

children in crowded urban areas and selected rural localizations. This pattern was first seen in 1956, after widespread use of vaccine * * * a rathe r 

general distribu tion in Chicago in 1952, (co ntrasts) with a well demarcated 

concentration among lower socioeconomic groups in crowded slums in 1956, 

predominately Negro in this instance.

This year in Providence, R.I., poliomyelitis was concentrated in children 

in lower socioeconomic housing developments, where failure to utilize the 

available vaccine, completely, has resulted in island s of susceptibles in an 

otherwise well-protected community. In Baltim ore, the localization in crowded 

slums was even more evide nt; the attack rate in Negroes was approximately 

twice that in the white population, and large suburban areas remained free of 

disease.

When the occurrence is in other tha n urban areas the pattern persists. 

Besides the concentrations among Negroes and Puerto Ricans in cities, we 

find concentrations in poor farming areas, among Indians, and isolated religious sects. In all instances the pattern of polio is the pattern of the 

unvaccinated.

The bill now befo re you represents the first proposal of sufficient 

scope and vision to deal effectively with thi s situation. W ith its 

enactment we can expect finally to reach those who have rem ained 

beyond the reach of the pro gra ms th at have been attem pte d in the 

past, and thu s to eliminat e at last class differences in the pro tection of 

children again st preven tab le infectiou s diseases. At tem pts at the 

applicat ion of scien tific diseases. Atte mpts at the appli cat ion of 

scientific developments to pre vent these diseases have depended until 

now on a com binatio n of hopes, uncoord ina ted and loosely organized 

local cam paigns , and on often cha otic distr ibution of vaccine supplies. Th is b ill seeks to supplement the efforts which have no t wh olly 

succeeded with a p rogram where the resources of the F edera l Gover nment can be uti lized by local com munities to make vaccines available 

and to pro vide needed organiz ing skills.

From the experien ce of the A FL -C IO in m any com munity v acc ination driv es of the past, we are led to agree with the observa tion of 

the Secre tary of He alth, Ed ucati on, and W elfare th at “convenience 

and inexpensiveness will be the decid ing fac tor s to man y gro ups of
INTENSIVE IMMUNIZATION PROGRAMS 79

individuals who have not l>een previously immunized." We support 

heartily Secretary Kibicotf's conclusion tha t it will be—

ne ce ss ar y fo r ea ch pr og ra m to pr ov id e en ou gh pu blic or no np ro fit co mmuni ty va cc in ation fa ci lities to vac ci na te a t no or low co st al l wh o w ish to av ail 

them selves of th is metho d of va cc in atio n an d, in th e ca se of ch ildr en und er 5. 

w ith ou t ch ar ge fo r th e vaccine or its ad m in is trat io n.

The executive council of the A FL-CIO has reviewed the proposed 

legislation, and acted on April 27 to give its unanimous endorsement 

in the following statement:

Th e ex ec ut ive coun cil is mo st gr at ifie d to no te th a t th e P re si den t has prop osed 

a pr og ra m to er adic ate polio, dip hth er ia , wh oo ping cough , an d te ta nus from the 

Nati on , an d th a t legi slat io n to put th is pr og ra m in to effect has been in trod uc ed 

in th e Co ng res s by Sen at or L is te r Hill an d R ep re se nt at iv e Or en H ar ri s.

Thi s co un try has th e reso ur ce s to el im in at e th es e dise as es , but th es e dise as es 

are st il l ca us in g di sa bility an d pre m atu re de at h. We are no t ap plyi ng ou r 

tech ni ca l kno w-how, and we mus t.

Im pr ov ed te ch ni qu es to co ntro l in fe ct io us di se as es ha ve no t, up to now, be ne ­

fite d al l American s. F or ex am ple, w hi le th e ad ven t of Sa lk va cc ine has gr ea tly 

redu ce d th e incide nc e of par aly ti c polio, am on g ch ildr en unde r 5—a grou p p articu la rl y su sc ep tib le to polio— les s th an h alf ha ve been ad eq ua te ly pr ot ec ted 

th ro ug h va cc in ation. Chi ld re n wh o liv e in slum s an d oth er bl ig ht ed ar eas 

re m ai n un pr ot ec te d in even la rg er nu mbe rs, an d th es e are th e are as whe re th e 

re m ai ni ng ca se s of polio are pr ed om in an tly to be foun d.

Th e P re si dent’s pr og ra m, in co rp or at ed in th e H ill- H arr is va cc in ation ass is tan ce bi lls ( II.It . 10541 an d S. 29010), wou ld au th ori ze Fe de ra l fu nd s to cover 

th e fu ll co st of va cc ine fo r all ch ildr en unde r 5 yea rs of age , an d to as si st in 

mee tin g th e co st of or ga ni zing vac ci na tio n dr iv es .

Th e A FL-C IO has lon g ur ge d th a t mor e be do ne to mak e th e be ne fits of med ica l disc ov eries widely av ai la ble to al l th e Amer ican peo ple. We are gr at ifi ed 

th a t th e Fed er al Gov ernm en t is ex ert in g it s le ad er sh ip in th is dire ctio n. We 

hea rt ily supi>ort II.R . 10541 an d S. 2910, and ex pe ct to co op erate w ith oth er 

vo lu nt ar y gr ou ps an d pu blic ag en cies in im plem en tin g in al l co mmun iti es th e 

im m un izatio n pr og ra m co nt em pl at ed by th is legi slatio n.

In conclusion, Mr. Chairman, on behalf of our members and their 

families, we strongly urge this committee to act promptly and favorably on this program, so that we may hasten the day when suffering 

and death from polio, diphtheria, whooping cough, tetanus, and other 

infectious diseases will no longer coexist with the scientific techniques 

which could prevent them.

The Chairman. Thank you, Mr. Biemiller.

Mr. Hemphill, have you got any questions?

Mr. Hemphill. No, thank you, Mr. Chairman.

The Chairman. Mr. Younger, do you have any questions?

Mr. Younger. No.

The Chairman. We appreciate having your support for this program. There have been a good many questions that have cleared up 

some of the things in the program and you heard the testimony of the 

Secretary this morning. Would it be appropriate to say tha t you 

share approximately the same views that he expressed with reference 

to some adjustments that could be made to this bill ?

Mr. Biemiller. Yes, Mr. Chairman, that is correct. I sat through 

practically all of the Secretary’s testimony and I would concur in the 

views tha t he expressed this morning on certain adjustments that you 

think are needed in the bill.

We in the labor movement have known for years that almost any 

piece of legislation can be improved and sometimes modifications are 

needed here and there. Certainly I saw nothing in the testimony of
SO INTENSIVE IMMUNIZATION PROGRAMS

(he Secretary this morning that I think would do harm to the bill, 

and any improvements that will hasten its passage are devoutly to be 

desired.

The Chairman. Thank you very much. We do appreciate your 

appearance here.

Mr. Biemiller. Thank you very much, Mr. Chairman.

The Chairman. And the lady with you, Mr. Biemiller.

Miss Bamberger. Thank you, Mr. Chairman.

'fhe (h iairman. Mr. Clinton R. Miller, assistant to the president, 

National Health Federation, here in Washington.

Mr. Miller, you may proceed.

STATEMENT OF CLINTON R. MILLER. ASSISTANT TO THE PRESIDENT. NATIONAL HEALTH FEDERATION. WASHINGTON. D.C.

Mr. Miller. Mr. Chairman, for the record 1 am Clinton Miller, 

assistant to the president of the National Health Federation. Our 

main office is 709 Mission Street, San Francisco 3, ('alif. Our Washington office is at 1012 14th Street, Washington, D.C.

Mr. Chairman, in order to save the time of yourself and the committee, may I request that my statement be included in the record 

and I should like to confine my oral statement to a few brief remarks.

I'he Chairman. Mr. Miller, under the rules, that is the procedure 

that we have here which, of course, is part of the Reorganization Act 

of 194(5, and therefore 1 was going to suggest that you might pursue 

this course and your statement will be put in the record at this point.

('I'he document referred to follows:)

Sta te men t by Clinto n It. Mii .i.er, Rep res en ti ng th e Nati ona l Hea lt h

F ed eration

Th e N at io na l H ea lth Fed er at io n is a no np rofit, he al th ri ghts co rp or at io n wi th 

its ma in offices a t 709 Mission Stree t. Sa n Fr an cisc o, Ca lif. O ur W as hi ng ton 

office is in the Con tin en tal Bu ilding . 1012 14th St re et . NW.. W ashing ton 5, D.C.

Th e Natio na l H ea lth Fed er at io n is a na tion al orga ni za tio n. con qiosed of th ou ­

sa nd s of mem be rs wh o believ e in fre ed om of choic e in m att ers of hea lth whe re 

th e ex ercise of th at free do m do es no t vi ol ate th e eq ua l fre ed om of an ot he r.

We wish to ap iiea r as a witn es s an d to file a st at em en t fo r the reco rd . Th e 

pre se nt at io n of testim on y by th e N at io na l H ea lth Fed er at io n in op jiosition to 

II.It . 10541 do es no t me an th at th e Natio na l H ea lth Fed er at io n is opp ose d to 

va cc in ation as a mea ns of pr ot ec tio n of in di vi du al s agai nst po lio mye litis, di ph ­

th eri a wh oo ping cough, te ta nus, an d oth er di se as es wh ich ma y in th e fu tu re 

bec ome su sc ep tib le of pr ac tica l el im in at io n th ro ug h va cc inati on .

The N at io na l H ea lth Fed er at io n has mem be rs wh o believe in th e efficacy of 

va cc in ation, wh o ha ve ha d them selves an d th eir ch ild re n va cc in ated , an d who 

ur ge oth ers to do lik ew ise .

T h eir ur gi ng , ho we ver, wo uld stop sh ort o f su pp or tii ng legi slatio n to mak e 

th eir ow n vie ws th e officia l vie ws of Ameri ca. The y wo uld stop sh ort of su ppo rtin g legi slatio n to re quir e oth er mem be rs of th e N at io na l H ea lth Fed er at io n 

an d of Ameri ca, wh o do no t be lie ve in vac ci na tio n to pa y th e co st of inte ns iv e 

comm un ity va cc in atio n pr og ra m s th ro ugh ta xati on to su pp or t Fed er al gr an ts.

Th ey be lie ve in free do m of choic e in m att ers of hea lth w ith th e same intens ity th at they be lie ve in fre ed om of choic e in m at te rs of rel igion. The only 

tim e they wo uld fee l ju stified in vio la ting an A m er ic an 's ex er ci se of his free do m 

of choice in m at te rs of hea lth wo uld he whe n such ex er ci se of fre edom violate d 

the equal ri gh t of an ot he r. Clearly a t th e pre se nt tim e no one is denied va ccina tio n fo r them selves or th ei r ch ildr en if th ey de si re it. The re fo re , citiz en s 

who ex ercise th eir free do m of choic e by ch oo sin g no t to be va cc in ated are not 

deny ing an eq ua l ri ght to an ot he r by th e e xe rc ise of thi s fre edom .
INTENSIVE IMMUNIZATION PROGRAMS 81

Thi s pr in cipl e of fre edom is a su per io r an d mo re fu nd am en ta l co ns id er at io n 

th an th a t of va cc ination. The re are thos e jieo ple who so st ou tly be lie ve in th e 

pr in cipl e of va cc in ation th at th eir en th us ia sm lead s the m to an in to le ra nce of 

an yo ne w ho ju st as st ou tly does no t b eli ev e in it.

So lon g as th e Go ve rnme nt m ai nta in s a neutr al rol e, an d all ow s th e ex ch an ge 

of id ea s on va cc in ation or oth er hea lth be lie fs to he betw ee n in di vi du al s an d 

grou ps of in di vi du al s, th er e will he a hea lthy ex ch an ge of idea s an d ap pr oa ch es 

whic h will lead to pr ac tica l el im in at io n of the specific di se as es men tio ne d in 

II.R. 10541, an d othe rs.

It is gra nte d th a t th is insisten ce on free do m will allow som e to mak e mistake s. 

It is ackn ow led ge d th at som e will mak e had cho ices. Bu t is n't th at w ha t fr ee ­

dom is?— th e ri ght to be wrong ? If we are not fr ee to m ak e wrong cho ices, 

th en we are no t fre e. Th e ty ra nny th at fo rc es a m an to be hea lt hy is as much 

to be f ea re d as th e ty ra nny th at fo rc es a man to be good.

To thos e who wo uld ar gu e th at fre ed om in" e conomic m att ers is on e thing, 

hu t th a t a m ista ke in th e m att er of va cc in at io n ca n be fa ta l, we wou ld ag ree 

th a t th is is true. Th ose who de fe nd fre ed om m us t be pre pa re d to sh are the 

re sp on sibi lity fo r thos e who su ffer from po or choices. B ut we wo uld po in t ou t 

th at if a pe rso n mak es a poor choic e in rel igion, som e claim th a t they might be 

consigned to an et er nity of to rm en t. Ye t we allow peop le in th is co un try fr ee ­

dom in suc h an i m port an t m at te r.

Thi s does no t mea n th at we are in di ffer en t to God as a na tion , or are un aw ar e 

th a t in di vi du al s will mak e ba d re lig io us choic es. It do es mea n th at we believ e 

as a na tion , an d th e fo un de rs of ou r C on st itution believed th at the pr otec tio n of 

the free do m of choic e in th es e m att ers is th e be st way fo r th e mo st peo ple to 

mak e th e ri gh t cho ice. It has th e re fr es hin g de fens e th at thos e who mak e the 

wrong choic e ha ve only them selves to bla me , an d are th e on ly on es to s uff er.

Th os e who believe in fre ed om of dunce in m att ers of po litics, rel igion, and 

he al th , em ph as ize th at m in or ity vie ws of one ge ne ra tion bec ome m aj ority views 

of an ot he r. H isto ry ha s a w on de rful les son to teac h us he re if we will lea rn 

it. H isto ry will reco rd a man of o ne ag e as a wise ma n, even thou gh subs eq ue nt 

re se ar ch might prov e his th eo ries to he in er ro r, if he re fr ai ned fro m force of 

an y ki nd in sh ari ng of his be lie fs w ith his disc iples an d co ntem po rarie s. But it 

will reco rd th e sa m e ma n with th e sa m e th eo ries as a fool or a ty ra nt, who uses, 

or allo ws to lie used, force of an y ki nd — not th e le as t of wh ich is go ve rnmen tal 

force—-to gain ac ce pt an ce f or hi s belie fs.

H um ility ab ou t th e ex te nt of on e's know led ge, or of th e colle cti ve know led ge 

of an y ag e is al w ay s th e m ar k of gr ea tn es s, pr og ress, an d un de rs ta nd in g. It 

br ee ds to le ra nc e, love, un ity , an d al l th e oth er hu m an vir tu es th at mak e fo r a 

ha pp y ex is ta nc e while we in di vi du al ly an d colle cti vely live ou r ear th ly exist en ce .

Fr ee do m in m att ers of relig ion were no t lig ht ly com e by, fo r hi stor y rec ords 

man y m art y rs wh o die d to ex pl ai n th is ye ar nin g fo r fre ed om to la te r ge ne ra ­

tio ns. Th e prob lem is still un reso lved as to wh ich m art yr die d fo r th e true st 

rel igion, bu t it is cl ea r th at th er e w as a uni ty am on g al l m art yrs in th eir belief 

th at “C on gress (t h e st ate ) sh al l mak e no law re sp ec ting an es ta bl ishm en t of 

relig ion or pr oh ib itin g the fr ee ex er ci se th er eo f * * It rem aine d for 

American patr io ts to embody th is b elief in a Con stitu tio n.

I>r. Ben jam in Rus h a sign er of th e D ec la ra tion o f Inde pe nd en ce, an d Co ng res sman is qu oted as sa yi ng “T he C on st itution of th e Re public shou ld mak e pro visio n 

fo r med ical fre ed om as we ll as fo r relig io us fre edom . To re st ri ct th e art of 

he al in g to one cl as s of me n an d de ny eq ua l privile ge s to oth er s will co nst itut e 

th e ba st ile of me dical science. All su ch laws ar e un -A merica n an d despotic. 

Th ey a re f ra gm en ts o f m on ar ch y an d ha ve no p alc e in a Re pu bli c."

We m ai nta in th at th is righ t w as im plied, if not w ritten . If his sugg estio n 

ha d bee n em bo died in th e C on st itution as one of th e Bill of Ri gh ts, we wo uld be 

co ns id er ing th is le gi slatio n in a di ffer en t lig ht today. Subst itute th e ph ra se 

“in tens iv e re lig io us pr og ra m s" fo r “i nt en sive va cc ination pr og ra m s" in th e bill 

II.It . 10541, an d yo u will see how cl ea rly it wo uld ha ve violated such an am en dme nt, ha d it been w ritten , an d includ ed in th e B ill of R ights.

But th e fa ct is th at it was no t w ri tt en, an d we are le ft to ar gue th at it was 

ce rt ain ly implied. At th e tim e B en ja m in Rus h mad e th is ple a, it wa s ar gu ed 

th at th is "r ig ht" was as su med by th e guar ante ed free do m of rel igion an d di dn 't 

ne ed to 1m> c odified. Thi s was tr u e fo r hi s tim e. Dr. R us h’s concern w as f or the 

fu tu re , not th e then pres en t po ss ib ility of ab us e in th is m at te r. In ci de ntal ly. 

I >r. Ru sh was a st ro ng b eli ev er in vac ci na tio n th eo ri es o f Je nner , bu t em ph asize d 

th e g re ate r nee d fo r fre ed om in all he al th m at te rs . It has fa llen th e lo t of th is
82 INTENSIVE IMMUNIZATION PROGRAMS

generation to solve this problem. The bill II.R. 10541 is one testing ground for 

the limitation or extension of governmental control in ma tters of health.

Dr. Herbert Ratner, M.D., director of public health, in Oak Par k, Ill., and 

associate clinical professor of preventive medicine and public health, Stritc h 

School of Medicine, Chicago, has raised some penetra ting questions on the Salk 

vaccine and mass vaccination. In my written statement, I have included his 

lette r to the editor published Jan uary 21, 1956, in the Jou rna l of the American 

Medical Association (vol. 160, No. 3, pp. 231-232). At this time (1956) Dr. 

Ratner was a rat her lonely voice, critical of the Salk vaccine promotors inadeq uate information to the medical profession. He charged “We should recognize that only one side of the ledger is being presented by the promoters of this 

vaccine.”

Other prominent medical doctors, biostatisticians, and scientists were found 

to share Dr. Ra tne r’s concern to have both sides of the ledger fairly presented. 

The Illinois Medical Jou rnal of August 11X50 (vol. 118, No. 2), prin ted a panel 

discussion entitled “The Present Status of Polio Vaccines.” This was presented 

before the section on preventive medicine and public hea lth at the 120th annual 

meeting of the ISMS in Chicago, May 26, 1960. I have included this artic le 

with bibliography and notes in my written statement. The distinguished 

panelists were Herald R. Cox, Sc. D., Pearl River, N.Y.; Bernard G. Greenberg, 

Ph. D., Chapel Hill, N.C.; Herman Kleinman, M.D., Minneapolis; Paul Meir, 

Ph. D., Chicago.

In this article, Dr. Herbert Ratner points out tha t—“In the fall of 1955 Dr. 

Langmuir had predicted that by 1957 there would be less than 100 cases of 

paralytic polio in the United States. As you know, 4 yea rs and 300 million 

doses of Salk vaccine later, we had in 1959 approximately 6,000 cases of paralytic 

polio, 1,000 of which were in persons who had received three, four, and more 

shots of the Salk vaccine. So you see, expectancy of the Salk vaccine has not 

lived up to actu ality, and Dr. Langmuir was righ t when he said the figures of 

1959 were sobering.”

A quote by Dr. Langm uir pointed out the reason for the panel. He was 

in charge of polio surveillance for the U.S. Public Health Service, and had 

been an ard ent proponent of the Salk vaccine even prio r to the Francis report 

of 1955. In a symposium on polio in New Jersey the previous month, he had 

stated that a cur ren t resurgence of the disease, partic ula rly the para lytic 

form, provides “cause for immediate concern” and that the upward polio trend 

in the United States during the past 2 years (1958 and 1959) “has been a 

sobering experience for o verenthusiastic health officers and epidemiologists alike."

Dr. Ra tne r pointed out that “Prior to the introduction of the Salk vaccine, 

the National Foundation defined an epidemic as 20 or more cases of polio 

per yea r per 100,000 population. On this basis there were many epidemics 

thro ughout the United States yearly.” After its introduction, a community 

was considered to have an epidemic when it had 35 cases of polio per year per 

100,000 population. No reason is given for changing the rules. But in a community that before Salk vaccine release and by the old rules (of 20 per 100,000) 

would at trac t headline atte ntion because of an “epidemic” could have the 

same number and more cases af ter 1955, and not a word woulld be printed. 

Indeed, there were less “epidemics” after the introduction of the Salk vaccine 

in 1955. Bu t it was because they had changed the definition of an epidemic. 

It was not a real, but a semantic elimination of epidemics. It is no wonder 

that some physicians who remained skeptical about the original theories behind 

the vaccine, became increasin gly bold in exposing the falla cies used in its 

evaluation.

Dr. Bernard Greenberg, the panel’s statistician states : “as such (a sta tis tician), my primary concern, my only concern, is the very misleading way tha t 

most of this data (on the Salk vaccine) has been handled from a statistical 

point of view.”

He deals a devastating blow to the arguments of the Public Hea lth Service 

th at the increase in paralytic polio for 1958 and 1959 could be blamed on those 

who refused to be vaccinated (about 49 percent of the American population). 

Professor Greenberg is head of the Departm ent of Bio statistics of the University of North Carolina School of Public Hea lth and form er chairman of the 

Committee on Evaluation and Standa rds of the American Public Hea lth Association. Follow carefully his excellent argument, for it is a sound rebuttal 

against the need for the mass vaccination bill, H.R. 10541.

Dr. Bernard Greenberg: “There has been a rise during the past 2 years 

in the incidence rates of paralytic poliomyelitis in the United States. The
INTENSIVE IMMUNIZATION PROGRAMS 8 3

rate in 195S was about 50 percent higher than that for 1957, and in 1959 about 

80 percent higher tha n in 1958. If 1959 is compared with the low year of 

1957, the increase is about 170 percent. At the same time, the rates for nonparalytic polio have been declining in relation to the 1957 base.

“As a result of this trend in paralytic poliomyelitis, various officials in the 

Public Health Service, official health agencies, and one large voluntary hea lth 

organization have been utilizing the press, radio, television, and other media 

to sound an alar m bell in a heroic effort to persuade more Americans to take 

advantage of the vaccination procedures available to them. * * *

“One of the most obvious pieces of misinform ation being delivered to the 

American public is that the 50-percent rise in paralytic poliomyelitis in 1958 

and the real accelerated increase in 1959 have been caused by persons failing 

to be vaccinated. This represents a certain am ount of doubletalk and an unwillingness to face facts and to evaluate the tru e effectiveness of the Salk vaccine. 

It is doubletalk from the standpoint of logical reasoning: If the Salk vaccine 

is to take credit for the decline from 1955 to 1957, how can those indiv iduals 

who were vaccinated several years ago contribute to the increase in 1958 and 

1959? Are not these persons still vaccinated ?

“The number of persons over 2 yea rs of age in 1960 who have not been 

vaccinated cann ot be more, and must be considerably less, than the number 

who had no vaccination in 1957. Yet a recent Associated Press release to 

warn about the impending thr ea t referred to the idea that the ‘main reason 

is that millions of children and adu lts have never ever been vaccinated.’ If 

they were never vaccinated, undoubtedly many more tha n were reported were 

unvaccinated during 1955, 1956, and 1957 when the same officials were claiming 

that the reduction in rates was due to the vaccine. * * *

“A scientific exam ination of the data, and the manner in which the data 

were manipulated, will reveal th at the tru e effectiveness of the present Salk 

vaccine is unknown and g reatly overrate d.”

Dr. Greenberg furth er reveals two insta nces where the PHS revealed bias 

in faulty statistical manipulations in the poliomyelitis surveillance unit study. 

The PSU had reported about 80 perc ent effectiveness in North Carolina for 

a single shot when in fact one dose was practically ineffective.

But the most incredible discovery is a change in the rules by changing the 

definition of “paraly tic poliomyelitis” before and after the 1955 introduction 

of the Salk vaccine. It is like comparing a sneeze and pneumonia. “Prior 

to 1954,” Joan Beck, in repo rting this same panel in the Chicago Sunday 

Tribune (Mar. 5, 1961), observes, “any physician who reported a case of pa ralytic poliomyelitis was doing his patient a favor because funds were available 

to help pay his medical expenses (from a large voluntary health orga niza tion). 

At th at time most health departments used a definition of paralytic i>oliomyelitis which specified “partial or complete paralysis of one or more muscle 

groups, detected on two exam inations at lea st 24 hours apart.” Laboratory confirmation and the presence of residual paralysis were not required.

“In 1955, these criteria were changed. Now, unless there is para lysis las ting at leas t 60 days after the onset of the disease, it is not diagnosed as 

paralytic polio.

“During this period, too, Coxsackie virus infections and asep tic meningitis 

have been distinguished from paralytic poliomyeltis,” explained Dr. Greenberg. 

“Prior to 1954, large numbers of these cases undoubtedly were mislabeled as 

paralytic polio.”

One cannot expect these startling facts to be kept under cover in America, 

no ma tter how strong the national desire to believe in the Salk vaccine. As 

I have indicated, the Chicago Sunday Tribune featured a three-page article 

by Joan Beck entitled “The Truth About the Polio Vaccines” (Mar. 5, 1961) 

which I have included in full in my writ ten statement.

This was followed by “A Note on Polio” in the Saturday Review on April 1. 

1961. I have included the note in full with its chart in my written statement, 

but a significant political tie-in is worthy of note here—I quote the Saturday 

Rev iew:

“During the month of March 1961, the President of the United State s. John F. 

Kennedy, announced that in the name of the American people he had autho rized a gift of Salk ‘killed virus’ polio vaccine to the i>eople of Cuba to fight a 

polio epidemic on tha t unhappy island.

“At leas t one physician who heard of the President’s action wired the White 

House an immediate warning that the Salk vaccine is known to be ineffective 

in stopping the sprea d of a going epidemic.
84 INTENSIVE IMMUNIZATION PROGRAMS

‘ T he w ar ni ng w ire po in te d out th a t th e R uss ia n wo oers of Cub a’s Fi de l 

Cas tro are well ac qu ai nt ed w ith th e su per io r effecti ve ne ss of ora l liv e va ccin es (t he Sa bin va cc ine is on ly on e of th re e) deve lope d in th is co untry an d 

used w ide ly in t he U.S .S. R. b ut n ot yet a vai la ble her e.

“I t was aft er th at w ire was de liv ered th a t Pre si dent Ke nn ed y as ke d th e 

Co ng res s to appro pri at e sp ec ial fu nd s fo r a st an dby supp ly of ora l liv e vi ru s 

polio vaccine.

“W ho ga ve th e Pre si den t the po or ad vice th a t led to th e mea ni ng less gi ft 

to Cu ba?

"S R 's science ed itor does no t pr et en d to kno w. Rut no rm al ro ut es of re sp on ­

sibilit y in suc h m att ers lea d to the U.S. Pu blic H ea lth Servi ce, wh ich , alo ng 

w ith the Nationa l Fou nd at io n fo r In fa ntile Par al ysi s, ha s bee n pu sh in g th e 

Sa lk vac cine.

"A roun d th e same tim e th at th e Pre side nt was be ing ta ke n off ba lan ce , th e 

Jo urn al of the Am erican Me dic al Assoc iatio n pu blishe d, in an sw er to a docto rre ad er 's qu estio n, a st at em en t by I)r . H er be rt R at ne r, pu blic he al th officer of 

Da k Pa rk . Ill. (l ar ges t villa ge in th e w orld) , th a t "i t is now recogn ize d th a t 

much o f th e Sa lk vacc ine used in th e Un ite d S ta te s ha s bee n wor th le ss . * * * 

because it is an un st an da rd iz ed pr od uc t of an uns ta ndar iz ed proc es s.”

It shou ld be ob served he re th a t II.R. 10541 is an am en dm en t to sec. 2, p art 

B, of ti tl e II I of th e Pu blic Hea lth Se rvice Act, an d we as su m e wou ld be adm in istere d by th e PU S. A subs eq ue nt issu e of th e AMA Jo u rn al carr ie d a 

se ries of art ic le s by th re e U.S. Pu blic H ea lth officials adm itting th a t th e Sa lk 

va cc ine’s va lue ha d been gr ea tly ov er es tim ated , bu t st ill in si st in g th a t it was 

hig hly effe ctiv e. Now we are fac ed w ith th e po ss ibili ty th a t it ca us es ca nc er. 

In th e Chica go Su n-T im es, Monda y, Ap ril Iff, 1{X>2, th ere is an art ic le by E ar l 

I bell on SV-40, a newly dis covered "s om ething ” in Sa lk vaccine. The ar ti cle 

co nt ai ns th is co nje ctu re :

“C on jectur e No. 1 : SV -40 ma y ca us e ca nc er in hu m an beings. Th is, of 

cours e, is th e mo st fr ig hte ni ng ide a. Millio ns of pe rson s ha ve rec eive d Sa lk 

inje ctio ns (k illing th e po lio v irus do es no t me an killin g SV—40 ).

"No w th e la te st wo rk show s th at SV -40 can gro w in th e tiss ue of hu m an 

being s an d ca n mak e cells gro w fa st er . Rut ma ny vi ru se s ca n do th is w ithou t 

ca us in g ca nc er. Ho we ver, the re po rt on th e chromo some s mak es th e ca nc er 

po ssibili ty so mew ha t st ro nger .”

Now th e pu rp os e of th e NHF in re ad in g th is testim on y into th e reco rd is not, 

we ag ai n em ph asize , th at we are opi>osed to va cc ination, an d ce rt ai nly no t to 

th e Sa lk vacc ine as sing led ou t from th e othe rs . As st ro ng a case ca n be mad e 

ag ai ns t th e or al va cc ines (t her e are now th re e), an d th e va cc ines used fo r 

dip ht he ri a, wh oo pin g cough , an d te ta nu s, th e oth er th re e spe cific co nc erns of 

th e bill. We simply w an t to be su re th ere is a cl ea r un der st an din g th a t th ere 

is fa r from un an im ity of th ou gh t in Ame ric a on th e su bjec t even am on g thos e 

who belie ve in th e pr in ci pl e of va cc ination. To ru sh thro ug h II. R. 10541 w ith ou t 

fu lly am en di ng it to a llo w no w hisp er o f force or coerci on to be ex ercised ag ai nst 

thos e wh o mig ht oppose th e p art ic la r va cc in atio n ap proa ch chosen wo uld be 

les s th an wise.

H er e we wish to po int ou t th at in loc al an d S ta te law s, it ha s been cu stom ar y 

to all ow thos e wh o ha ve contr ar y relig io us co nv ictio ns to be allow ed to re fr ain 

fro m pa rt ic ip at io n in ot he rw ise co mpu lso ry va cc in atio n prog rams. We believe 

th at th is pr ot ec tion (o f relig ious conscien ce ) sh ou ld be includ ed in an y le gi slatio n on va cc in ation, bu t fu rt her, th at it shou ld cl ea rly sp ec ify th at a pe rson 

ca n re fu se va cc in atio n if it is contr ar y to his belie fs. Th ey do no t ha ve to 

be relig ious.

We are aw ar e th at th ere is no prov isi on fo r comp lusio n in II.R . 10541, bu t 

th e ph ra se s “in te ns iv e co mmun ity va cc in at io n pr og ra m s (p. 2, lin es 3, 10, 10, 

e tc .». a nd "t he im m un iz atio n ov er th e pe riod of th e pr og ra m of a ll, or pra ct ic al ly 

al l" (p. 3. lin es 7. K, an d 0 ) , an d es pe cially, "a nd wh ich includ es pl an s an d 

m ea su re s loo king to w ar d th e st re ng th en in g of ongoing co mmun ity pr og ra m s 

fo r th e im m un izatio n of in fa nts an d fo r th e m ai nt en an ce of im m un ity in th e 

re m ai nd er of th e po pu la tion” (p. 3. lin es 10 an d 14 ), ra is es qu es tio ns of compu lsion. Many “on go ing co mm un ity pr og ra m s ha ve co mpu lso ry requ irem en ts, often 

tie d in to re gis tr at io n fo r pu blic sch ools. T hi s wo uld l»e a po ssible plac e fo r th e 

inse rti on of the am en dm en t “p rovide d th a t an y jie rson ma y re fu se va cc in ation 

fo r the mselves, th eir ch ild re n, or w ar ds if it is contr ary to th eir l»elief. wh ich 

inc ludes, bu t is not re st ri ct ed o r lim ite d to, religi ou s be lie f.”
INTENSIVE IMMUNIZATION PROGRAMS 85

If, in th e ligh t of al l th e testim on y give n to th is co mm ittee, it is de cide d by th e 

m aj ori ty th at th e hill is de sira bl e, we mos t stro ng ly ur ge th at th is guara nte e of 

free do m b e includ ed as a n am en dm en t.

We fu rt h er ur ge th at no money be gra nte d to su pp or t an “ongoin g co mmun ity 

pr og ra m ” un less th a t loc al pr og ra m carr ie s th e pr ot ec tion of th is fre ed om -ofconsc ien ce am en dm en t.

Pe op le fee l ve ry deep ly ab ou t th eir relig ion, he al th , an d po litics , an d shou ld 

ha ve fre ed om un de r th e law fro m comp ulsio n in thes e field s, so long as by th e 

ex er cise of th is fre ed om th ey don't en da nger th e hea lth of oth er s an d ther eb y 

de ny them an eq ua l fre ed om . Cl ea rly , a de m an d fo r pr ot ec tio n again st fo rc e or 

comp ulsio n to part ic ip ate in mass va cc in at io n pr og ra m s do es no t de ny an y 

citiz en an eq ua l ri ght to part ic ip ate in them no r th e pr otec tio n th at suc h 

par ticip ati on provide s.

T H E QUE ST IO N OF SIDE EF FE CTS OF SERA AN D VA CC IN ES

At th is po in t in my w ri tt en st at em en t, I ha ve includ ed sev en pa ge s fro m th e 

book “S ide Ef fec ts of D ru gs ” comp iled by L. Me.vler. M.D. This re port s on the 

un w an te d eff ects of drug s, se ra , an d va ccines, as re po rted in the med ical li te ra ­

tu re of th e world du ring th e perio d 1958-60 . It was pu blish ed in 1960 by th e 

Exc er pt a Medica Fou nd atio n, Amsterda m, Lo ndo n, an d New York. We ha ve 

re pr in te d pa ge s 194-200.

Th e bil l does no t co ncern itse lf w ith th e m att er of side eff ects of vaccines. It 

as su m es th a t th er e is either a broa d ge ne ra l kn ow led ge am on g th e pu blic of 

th is ugly, da ng er ou s (a nd someti me s fa ta l) side eff ect of va cc in ation, or els e 

th a t such in fo rm at io n is no t needed or w an te d by th e mas s of U.S. citize ns to 

be va cc in ated . We dis ag re e w ith ei th er as su m pt io n. We in si st th a t th e America n pu blic ha ve th e ri gh t an d th e intelli ge nc e to ev al uate th e good w ith th e ba d 

of an y va cc in ation pr og ra m. Th ey shou ld be fu lly in fo rm ed of th e ex pe ct atio ns , 

lim itat io ns , an d mos t ce rt ai nly th e sid e effects of va cc ination. The cr itic of 

th e pr og ra m sh ou ld ha ve th e same ri ght to file a “m in or ity re port ” which shou ld 

ac co mpa ny pr es s re le as es la ud in g th e efficiency an d st re ss in g th e ur ge nc y of an y 

part ic ula r va cc in at io n pr og ram. Thi s sh ou ld be a bu ilt -in sa fe gua rd of check 

an d ba lanc e in med ica l ex pe rim en ts w ith mass po pu latio ns . The re is no mo re 

va lidi ty he re fo r th e ar gu m en t th at “t his is a m att er fo r th e exper ts ” th an th er e 

is in th e field of po litics. A fter all, in po lit ic s we a re co ncern ed w ith a possi ble 

los s of free do m, an d in va cc in atio n pr og ra m s w ith los s of life or hea lth. The re 

are so me c ur es t h a t are wor se t han the dis ea se.

Con side r th e follo wing fro m page 197 of Dr. Mey ler’s bo ok :

"P ert uss is va cc ine (w ho op ing co ug h) . Up to now som e 100 ca se s of en ce ph ­

ali ti s ha ve been re po rted . In hal f of th e ca ses, th e ph en om en a set in w ith in 6 

ho ur s aft e r th e in je ct io n, an d ne ve r la te r th an 72 ho urs. About half of th e 

pati ents mad e a co mplete rec ov ery, ab ou t on e- th ird ha d se riou s pe rm an en t ne ur olog ical les ion s, an d ab ou t on e- sixth die d. Th e in cr ea se d su sc ep tib ility to poliom ye lit is is st re ss ed . Th e va lue of per tu ss is im m un iz atio n is stre ss ed , bu t so is 

the gr av e da ng er of fu rt h e r in oc ul atio ns wh en a pr ev io us one ha s prod uc ed an y 

su gg estio n of a ne ur ol og ical reac tio n.

"On ac co un t of th e risk of en ce ph aliti s, it is ad vise d not to va cc in ate ch ild re n 

if epilepsy , se iz ur es , en ce ph al iti s, or m en ta l dis or de rs ha ve oc cu rred in th ei r 

fa m ily hi stor y. If th e ch ild ha s ha d an infe ctio us disease, th e va cc in ation shou ld 

be iM»stponed until 4 mon th s af te rw ard . Child re n wh o ha ve re ce nt ly bee n vaccina te d ag ai nst va riola or polio shou ld no t be va cc in ated . D ur in g an ep idem ic 

of po lio mye litis, no va cc in at io ns shou ld be give n.”

Here it shou ld be no ted th at'm aybe th er e is room fo r a co ng ress iona l in ve st iga tio n in to th e prob lem of re po rtin g epide mics . Is a po lio e pide mic 20 ca se s pe r 

100,000 or is it 35 ca se s j>er 100.000? Who d ec ides u po n w hat e vide nc e w hat const it ute s an ep idem ic? W as im po rtan ce of po lio ep idem ic kn ow led ge to pare nts 

ab ou t to co ns ider wh oo ping cou gh va cc in at io ns ta ke n in to co ns id er at io n when 

th e ru le w as ch an ge d in 1955? Does th e ch an ge in th e ru le of re por ting polio 

ep idem ics pr es en t a haz ar d to ch ildr en pla nn in g who op ing cough va cc in at io n 

be ca use ep idem ics th a t were epide mics in 1954 are not now re por te d as ep idem ics 

in 1962? To w hat de gree are oth er va cc in at io ns co ntr ain dic ate d duri ng polio 

ep ide mics ?

On pa ge 198. Dr. L. Me.vler re port s:

"D ip ht he ri a va cc in e: A 1 ^- year- old ch ild be ca me se ve rely ill a ft e r th e second 

inje ctio n an d died in com a 4 da ys aft erw ard . The first inje ctio n ha d no t produced an y sign s.”
86 INTENSIVE IMMUNIZATION PROGRAMS

In mass vaccination programs it is common practice to omit or ignore such 

inform ation in presentin g the case for vaccination to the public. There is a 

tendency to let the “exp erts” make the decisions, after which they summarize 

the evidence with such press release stateme nts as “absolutely safe,” and other 

stateme nts designed not to educate, but to inspire absolute confidence.

We point out th at the tendency of a mass vaccination program is to herd 

people. People are not cattle or sheep. They should not be herded. A mass 

vaccination program carries a built-in temptation to oversimplify the problem ; 

to exaggerate the benefits; to minimize or completely ignore the ha za rd s; to 

discourage or silence scholarly, thoughtful, and cautious opi»osition; to create 

an urgency where none ex ists; to whip up an enthusiasm among citizens that 

can carry with it the seeds of impatience, if not intole ran ce; to extend the 

concept of the police power of the state in quara ntine far beyond its proper 

lim itation; to assume simplicity when there is actually gre at complexity; to 

continue supp ort of a vaccine long aft er it has been discredited; to make a 

choice between two or more equally good vaccines and promote one at the 

expense of the ot her ; and to ridicule honest and informed dissent.

Preside nt Kennedy, in the state of the Union message Jan uary 30, 1901, said: 

“Let it be clear that this adm inistratio n recognizes the value of daring and 

dissent—th at we greet healthy controversy as the hallmark of healthy change.”

A bill such as II.It. 10541 without amendment safeguards could well discourage what little “healthy controversy” still exis ts in the field of vaccination.

John Stu art Mill has said: “It often happens that the universal belief of one 

age—a belief from which no one was free, nor without an extraordinary effort 

of genius could, at that time, be free—becomes to a subsequent uge so palpable 

an absu rdity that the only difficulty is to imagine how such a thing can ever 

have appeared credible.”

It is conceivable that a fut ure age may d isdainfully look a t our preoccupation 

with vaccination. Indeed, the entire concept may be replaced with another 

approach. In such an eventuality, it would record as statesmen or tyrants the 

lawmakers who protected or trampled the righ ts of those who opposed the 

concept for one reason or another in this age.

I submitted or will submit with this summary, to the clerk of the committee, 

the following artic les or abstracts of article s or books which I respectfully 

request be inserted into the record of this committee he aring:

1. A letter to the editor by Dr. Herbert Ratner, M.D., to the Jou rnal of the 

American Medical Association, Jan uar y 21, 1956, volume 160, No. 3, pages 

231 and 232.

2. Pa rt I and pa rt II of an article, “The Present Status of Polio Vaccines,” 

a panel discussion r eprinted from the Illinois Medical Journal, volume 118, No. 2, 

August 2, 1960, and volume 118, No. 3, September I960.

3. Bibliography and notes on the article “The Present Status of Polio Vaccines,” Illinois Medical Journal, prepared by Dr. Herbert Ratner, M.D.1

4. An answer to a doctor-read er question by Dr. Herbert Ratner in the Journal of the American Medical Association.

5. A three-page article in the Chicago Tribune magazine. March 5, 1961. by 

Joa n Beck, entitled "The Truth About the Polio Vaccines.”

6. “A Note on Polio,” with chart, from April 1, 1961, issue of Saturday Review.

7. An article, “Polio Vaccine Virus Puzzles Scientists,” from the Chicago 

Sun Times, April 1G, 1962.

8. Pages 194 to 200 (ch. XX VI), “Sera and Vaccines,” from “Side Effects of 

Drugs,” compiled by Dr. L. Meyler, M.D.. I960.1

9. Pages 138 to 150 and pages 163 to 172 from “Who Is Your Doctor and Why?” 

by Dr. Alonzo J. Shadman. M.D.. House of Edinboro, Boston, 1958, Library of 

Congress catalog card No. 58-10390. This briefly explains the homeopathic 

medical doctor's approach to vaccination and polio.1

10. A booklet, “Diet Prevents Polio,” by Dr. Benjamin P. Sandler, M.D.1

11. An article. “The Changing Incidence and Mortality of Infectious Disease 

in Relation to Changed Trends in Nutritio n,” by Dr. W. J. McCormick, M.D., 

Toronto, Canada.1

The Chairman. You may proceed to give a resume of it.

Mr. Miller. I appreciate this courtesy, Mr. Chairman, and in the 

interests of time, along with my statement I should like permission to

1

 In committee files.
INTENSIVE IMMUNIZATION PROGRAMS 87

include in the record the f ollowing abs tra cts or a rticle s an d one booklet 

which give different vie wpoints on the vaccina tion question.

Specifically, I list a booklet on polio by Dr. Benja min P. Sandler , 

selected page s on vaccinatio n and polio by Dr. Alon zo J. Shadma n, 

and an article by Dr. W. J . McCormick, M.D., of Toron to, Canad a, 

and oth er articles and l etters by Dr. Ra tner, D r. Meyer, et c etera, as I 

have listed on page 17 of my wr itten report.

The Chairma n. Y en ’ well. They may be included in the record. 

I note, however, th at the refe rence to Dr. Sa nd ler is in the for m of 

a booklet. It has addition al inf orm ation, inc lud ing certa in tables.

I don’t believe we would be able to incl ude the entire booklet in the 

record, but we will receive it for the files fo r the benefit of the 

committee.

Mr. Miller. Th e reason I mentioned th at pa rticul ar booklet first, 

Mr. Ch airma n, is because o f t he unique natur e of the testim ony that it 

contains. The booklet is e nti tle d “D iet Prevents Polio,” and it is the 

burde n of the au thor ’s thesis th at a blood sugar level which can be 

controlled by the die t can pre vent polio without any vac cinatio n—he 

is n ot oppo sed to vacc ination as he sta tes in the book, bu t he presents 

his int ere sting the ory that die t alone can ren der immu nity to polio. 

And I feel th at the entire book is necessary for the mem bers of the 

committee who might wish to examine thi s ra th er unu sual thesis.

The Chairman. It will be ava ilab le fo r all members of the 

committee.

(T he docume nts ref err ed to follow :)

[R ep ri nte d fro m th e Jo urn al of th e American Me dic al Assoc iatio n, Ja n. 21, 1956]

Poliomyelitis Vaccine

To the Editor :

During the week of November 14, 1935, at meetings of the American Public 

Health Association in Kasas City, the U.S. Public Health Service released two 

reports on poliomyelitis. One report on November 15 presented by Dr. Langmuir’s group from the Poliomyelitis Surveillance Committee stressed the great 

effectiveness of one inoculation of the Salk vaccine used in 1955, namely, a 

50- to 80-percent reduction in paralytic poliomyelitis. The other report on 

November 17, presented by Dr. Scheele, stressed the safety of the current Salk 

vaccine. The w idespread national publicity that followed these reports naturally 

led the public and medical profession at large to believe that we now had a 

safe and highly effective vaccine. However, what was not made sufficiently 

clear in the reports and the press stories that covered the country was that the 

first report, stressing excellent effectiveness, referred to an earlier model of a 

Salk vaccine and that the second report, stressing current safety, referred to a 

later model. The effectiveness report on the earlie r model was based on results 

achieved in children, the bulk of whom received vaccines t ha t were m anufactured 

prior to the development of the postinoculation poliomyelitis cases first reported 

on April 27. Such vaccines were admittedly the product of a process in which 

there were “fundame ntal weaknesses in the safe ty testing procedures” (Scheele, 

Aug. 25), which did not have the benefit of the more sensitive cortisone-treated 

monkey tests (form ally required on September 10) and which did not have the 

adva ntage of crucial filtration procedures that followed the recognition of “the 

absolute need for removal of particles within which virus may be protected from 

inactivation by formaldehyde” (Scheele, Nov. 17).

There is substan tial evidence (B ulletin of the American Association of Public 

Health Physicians, November 1935) indicating that manufac turers ’ vaccine, 

other than Cu tter’s, had varying amounts of live virus in it and that what is
88 INTENSIVE IMMUNIZATION PROGRAMS

being m ea su re d fo r eff ec tiv en ess is no t Sal k' s kille d vi ru s vacc ine bu t a live 

vi ru s va cc ine lab eled Sa lk—obv iously po w er fu l bu t also mo re da ng erou s. At 

an y ra te , it shou ld be ev iden t th at th e Sa lk vaccine, fo r wh ich gre at eff ec tiv en ess 

is cla im ed on th e ba si s of one inoc ul atio n, is a prod uc t th at is no long er on the 

m ar ket no r in th e ha nds of ph ys ic ia ns (w e ho pe ) an d th at was th e pr od uc t of 

an in ad eq ua te m an ufa ct uri ng p roce ss a nd in ad eq uate a nd re la tive ly les s sens iti ve 

sa fe ty t es ts. Th e re por t on No vemb er 17, d ea ling witli th e cu rr en t Sa lk v ac cine 's 

sa fe ty , is th e in te rim re por t of th e Pub lic H ealth Se rvice Te ch nica l Com mittee 

on Po lio mye lit is Va ccine as pu blishe d in th e Jo u rn al, De cemb er 10, 1055. Th e 

pu blication of th is re po rt is inte nd ed to gu ide an d to ke ep ph ys ic ians inform ed 

of deve lopm en ts in th e Sa lk vaccine pr og ra m . T he re port itse lf ha s on e st rikin g 

pe cu liar ity. Th ou gh it de als w ith dat ed de cision s mad e at specific mee tin gs 

he ld sin ce May 26, no t one sin gle date is lis te d in th e do cu me nt. Not eve n is 

th e dat e of th e issu an ce of th e in te rim re port given. It is as if we are de alin g 

w ith a tim el es s do cu men t th at purp ort s to give bo th ac tive an d re tr oa ct iv e 

re as su ra nc e.

Th ou gh th e in te nt io n of th is om iss ion of dat es is on ly kn ow ab le to th e com ­

mitt ee , th e confusion lead in g fro m th is om iss ion is kn ow ab le to th e re ad er . I 

will at te m pt to in di ca te th e ex tent to wh ich th e re por t has been in fo rm at iv e as 

to the natu re of a sa fe r Sa lk vaccine an d, in th e pra ct ic al or de r, th e ex te nt to 

wh ich his re port ad ds to th e cu rr en t co nfus ion. The su m m ar y hig hl ig ht s in 

th e clar ificatio n of a sa fe r Sa lk vaccine are as fo llow s: (1 ) “the ab so lu te need 

fo r * * * su itab ly spaced filtra tion pr oc ed ur es ” (t his prov isi on mad e it s fir st 

ap pe ar an ce in th e minim al requ irem en ts as am en de d No vemb er 11. 1955) an d 

(2 ) “a sa fe ty -tes t pr og ra m * * * st re ng th en ed by im prov ing sam plin g pr oce du re s * * * an d by incr ea sing th e se ns iti vi ty of th e mo nkey sa fe ty te st s” (t he 

te st ut iliz in g th e co rtison e- trea te d mo nkey mad e it s firs t ap pea ra nce in the 

mi nim um re qu irem en ts as am ende d on Se ptem be r 10, an d as re am en de d on 

No vemb er 11 ).

Ho we ver, is th is th e vaccine th at is in th e ha nd s of ph ys icians an d hea lth 

de pa rtm en ts ? Th e in te ri m re po rt itse lf an d th e st at em en t of Dr. Sclieele, re ­

po rted in W ashing ton News in th e Jo urn al, De cemb er 3, lead s us to believe th at 

it is. In the la tt e r ne ws stor y, it is st at ed th at "p ro du ctio n of th e Sa lk poliomye lit is vaccine , wh ich has been lag ging * * * will sta rt pic king up someti me 

in De cemb er an d prob ab ly will rea ch a no rm al ra te by Feb ru ar y. Re ason for 

th e lag * * * is th e m aj or ch an ge s mad e la st May in va cc ine pr od uc tio n an d 

te st in g re qu irem en ts an d th e co ntin uing refin em en ts sin ce th a t dat e * * * [t he] 

mod ifi ca tio ns were in co rp or at ed fo rm ally into minim um st an dar ds fo r produ cing a nd te st in g th e va ccine on Novem ber 11 * *

How ev er, it shou ld be cl ea r th at th e new re qu irem en ts of la st May su bs equ en tly re su lted in st ea dy prod uc tio n th ro ug ho ut th e su m mer an d did not ca us e 

th e de lay in th e la te fa ll prod uc tio n re fe rr ed to abo ve. It sho uld also be re ­

mem be red, as co nf irm ator y, th a t in May it w as recogn ize d th at th e new re quir em en ts wo uld on ly h alt va cc ine pr od uc tio n te m por ar ily. Th er ef or e, the de la y 

in pr od uc tion see ms to be as so ci at ed w ith th e minim um re qu irem en ts am en de d 

Nov em ber 11. In an att em pt to con firm th is an d to disc ov er w he th er the vaccine 

in my po ssessio n (v ac ci ne w ith an ex pi ra tion date of Ap ril 6 an d 7) conforme d 

to th e No vemb er 11 minim um re qu irem en ts fo r sa fe pr od uc tio n, in qu iry wa s 

mad e of th e m an ufa ct ure r, a m an ufa ctu re r wh o in ci de nt al ly ha pp en s to be at 

pr es en t th e le ad in g pr od uc er of th e Sa lk vaccine. Th e an sw er was di sq uieting. 

No t on ly did th e va cc ine in my possessio n not co nform to the No vem ber 11 re ­

qu irem en ts but th e mor e th an 1 mi llion cubic ce ntim et er s of vaccine iss ued by 

th e same m anufa ctu re r th e week of De cemb er 12 also did not co nform to the 

No vemb er 11 re qu irem en ts, in so fa r as it ex clu de d a cr uc ia l filtra tion step re ­

qu ired du ring th e in ac tiva tion pro cess. Furt her m ore , th e m an ufa ctu re r's re pre se nta tive st at ed th a t no such va ccine ca n be ex pe cted fro m the m, an d 

pr es um ab ly ot he r compa nies, unti l th e end of Ja n u ary , thou gh in th e mea ntim e 

they wo uld co ntin ue to re le as e vacc ine al re ad y in proc es s no t co nfor ming to 

thes e requ ire men ts.

The Sa lk vac cine, then , whic h we were en co ur ag ed to be lie ve is both hig hly 

eff ective an d sa fe on th e ba sis of rece nt re po rts, tu rn s ou t to be. wh en hig hly 

effective, a vaccine th at is no long er on th e m ar ket an d, when safe , a vaccine 

th at has yet to mak e its ap pe ar an ce an d clin ically prov e its effecti ve ne ss. Yet. 

in th e fa ce of th is pa ra do x, th e pu blic is being urge d from all di re ctio ns , ex ce pt
INTENSIVE IMMUNIZATION PROGRAMS 89

th a t of the pr ac tici ng ph ys ician , to get th eir in oc ul atio ns im m ed iately . Thi s, in 

sp ite of th e fa ct th at th er e is a sh or ta ge of v ac cine an d th at th e vacc ine av ai la ble 

is in fe rior if no t obsolet e. To co mp let e th e pi ct ur e, ot he r th in gs shou ld be sa id . 

All ph ys icians hope an d pr ay th at we now ha ve a sa fe an d effecti ve vaccine. 

Thi s hop e, ho wev er, shou ld no t rob us of ou r ob jective an d cri ti cal fa cu ltie s. 

When we ha ve a sa fe an d effecti ve vaccine, we w an t to know it an d no t ba se it 

on slen de r, inf irm , a nd co nt ra di ct ory c ri te ri a.

Categ or ic ally , th e follo wing re m ar ks ca n be said, an d I ag ai n re fe r th e re ad er 

fo r fu rt h er am plifi ca tio n to th e Bulletin of th e American Assoc iatio n of Pu blic 

H ea lth P hysi ci an s: 1. Th e ep idem iologica l tech ni qu es of the po lio mye lit is su rve illan ce un it fo r th e det er m in at io n of c lini ca l sa fe ty of the va ccine ha ve prov ed 

an d re m ain in ad qu at e. Thi s is high ligh te d in par t by th e U.S. Pu blic H ea lth 

Se rvice in th eir fin din g of live vi ru s in a seve nth lot of C utter vaccine, wh ich 

pr ev ious ly was ex on er at ed on ep idem iologica l grou nd s. 2. Th e re po rt in g of 

po lio mye lit is ca ses as so ciated with th e vacc ine has proved to he inc om ple te. 

Th e fa ct th at po lio mye lit is su rv ei llan ce unit ha s drop pe d the re port in g of c ru ci al 

sa te llite ca ses is a ca se in po int. 3. The fa ct th a t millions of ch ildr en ha ve been 

in oc ulated w itho ut ov ert an d obvio us ha rm is no t a cr iter io n fo r th e sa fe ty of 

the vaccine. To begin with , even wh en a re ad ily de tect ab le live vi ru s Sa lk 

vaccine wa s used in Id ah o, only 1 ou t of ov er 1,600 ch ild ren came down with 

polio my eli tis . T hi s mea ns th at ha d th e 7 million ch ild ren, es tim at ed to ha ve 

rec eiv ed th eir first sh ot in the N at io na l Fou nd at io n fo r In fa ntile Par aly si s 

prog ram, been inoc ul ated with a re ad ily det ec ta bl e liv e vi ru s Sa lk vaccine , 

6,996,000 wo uld not ha ve com e down w ith po lio mye lit is an yw ay . The ca re fu l 

su rv eillan ce th a t is ne ce ss ar y to as se ss sa fe ty in a va ccine with le ss er am ou nt s 

of liv e vi ru s is obv ious.

T h e Id ah o d ata sim ply con firms th e fa ct that, po lio mye lit is is a low -in cid ence 

di se as e an d th a t th er e is it hig h de gree of ac qu ired im mun ity an d m an y natu ra l 

fa ct or s pr ev en ting th e oc cu rren ce of th e di se as e (a s co ntr as te d to an “in fe ct io n” ) 

in th e Nation at lar ge. In Sa lk va cc ines w ith le ss er am ou nt s of liv e viru s, the 

cr ux of tin* da ng er lies in the prod uc tio n of ca rr ie r st ate s an d th e de ve lopm en t 

of sa te ll it e ca ses, wh ich the U.S. Pu blic H ea lth Se rvice has not been su rv ey in g 

sin ce the middle of the su m m er an d wh ich were inco mpletely su rv ey ed pri or to 

th is perio d. 4. Ev eryo ne shou ld recogn ize th a t 1955 was a low po lio mye lit is y ea r 

inde pe nd en tly of the us e of th e Sa lk vaccine , wh ich was only giv en to 9 mi llio n 

ch ild ren. T he sl ig ht co nt ribu tion th at an uns af e Sa lk vacc ine may ha ve mad e 

to th e redu ct io n of par aly ti c po lio mye lit is in 1955 is co un te rb al an ce d by the 

kn ow n co ntrib ut io n it mad e to th e in cr ea se in para ly ti c po lio mye lit is in 1955. 

5. Ph ys ic ians shou ld rec og niz e one pec uliar aspe ct, of th e ex pert s’ re ce nt decis ion 

to stick to a th re e- sh ot sche du le fo r some fo r 1956 pr ot ec tio n ra th e r th an one 

sh ot fo r man y. Logic wo uld dic ta te th at, w ith th e sh or ta ge of vaccine, it is 

bett er to ha ve a 50- to 80 -perce nt re du ct io n of para ly ti c po lio mye lit is in th re e 

tim es th e nu m be r of p eople t han to ha ve a n ad ditio nal 20- to 50 -percent pr otec tio n 

in on e- th ird th e nu mbe r. Pre su m ab ly, exper ts a re no t co nv inc ed of th e rou gh 

st ud ie s prov in g a hig h de gr ee of effecti ve ne ss a ft e r one inje ctio n of the tr an sfe ra bil ity of th es e st ati st ic s ba sed on a repl ac ed an d su sp ec t vaccine . 6. Th e 

me dical pr of es sion shou ld reca ll, in th e ligh t of th e fin din gs pert ai nin g to sa fe ty 

in th e in te rim re po rt, th a t du ring th e su m m er th e pr om ot er s of th e vaccine 

co ntin ue d to ur ge mass in oc ul atio ns in sp ite of recogn ize d igno ranc e on th ei r 

part . Th ey w er e in the da rk as to w hat ha d gone wrong with th e C utt er vaccine, wh ich ha d pa ssed al l es ta bl ishe d sa fe ty te st s ex is ting at th e tim e. Th ey 

also ur ge d m as s inoc ul atio n de sp ite th e fa ct th at one of th e two m aj or pr od uc ers 

of th e va ccine sin ce th e field tr ia ls of 1954 ha d begu n to find live vi ru s in the 

va cc ine back in May, by us ing te st in g pr oc ed ur es more st ri ngen t th an tho se 

re qu ired by th e Gov ernm en t, th e re as on s fo r wh ich were un kn ow n to the 

ph ar m ac eu tica l ho use an d the Gov ernm en t. N ei th er th e publi c no r th e me dic al 

prof ession was info rm ed of thes e ju st ifie d unce rt ai nties , no r is it. cer ta in th at we 

are ye t be ing ad eq uat el y inform ed . 7. Fin al ly , we shou ld rec ogniz e th at only 

one side of th e ledg er is being pr es en ted by th e pr om ote rs of th is vac cin e. Th e 

pr ic e th at ha s been pa id ami th e risk s th a t hav e been take n fo r th e du biou s 

re su lts th at ha ve bee n ob tain ed are no t men tio ne d. The price th at we ha ve 

pa id, an d are co nt in ui ng to pay , goes fa r beyo nd thos e know n va cc in ated 

ch ild re n who ha ve com e d ow n w ith po lio mye lit is.

H erbert R atne r. M.D., 

Hea lth Commissioner, Oak Park, Ill.
90 INTENSIVE IMMUNIZATION PROGRAMS

The Present Status of 1‘olto Vaccines

(Pre sented before the Section on Preventive Medicine and Public Health at the 120th annual meeting of the ISMS in Chicago, May 26‘, 1960.)

(Note.—This panel discussion was edited from a transc ript. Opinions pre­ sented are those of the panel members and do not necessarily represent 

those of the society]

Moderato r: Herbert Ratner, M.D., direc tor of public health, Oak Park, and associate clinical professor of preventive medicine and public health, Stritch 

School of Medicine, Chicago.

Panelists : Herald It. Cox, Sc. D., Pearl River, N.Y.; Bernard G. Greenberg, Ph. U., Chapel Hill, N.C.; Herman Kleinman, M.D., Minneapolis; Paul 

Meier, Ph. D., Chicago. PA RT I 1

Dr. Herbert Ratner. In this panel we are first going to discuss the Salk vaccine, later the live virus vaccine. None of us have any commitments or allegiances except to the truth. Dr. Cox, of course, is from a pharmaceutical house, but he is not here to sell you his vaccine. He happens to be one of the world’s leading a uthorities on live virus vaccines, as well as killed vaccines. His repu tation for integrity is exceptional and unchallenged. lie has devoted 14 yea rs to the development of the live polio virus vaccine specifically. He is here to share his knowledge with you. You will have full freedom to ques­ tion and to dispute. Dr. Cox is director of virus resea rch at Lederle, and is at present, president elect of the Society of American Bacteriologists. Dr. Kleinman is an epidemiologist from the Minnesota Department of Health. He is intimately connected with tha t depa rtment’s pioneering field studies on Cox live polio virus vaccine. Yesterday, he landed from Russia, where he was an official delegate of the U.S. Public Health Service at a conference on polio viru s vaccines. He was coauthor in 1957 with Dr. Leonard Schuman of a paper entitled, “The Efficacy of l’olimyelitis Vaccine with Special Reference to Its Use in Minnesota 1955-1956,” wherein they concluded that “analysis has revealed (th at) the use of two doses of Salk poliomyelitis vaccine * * * 

(was) 83 percent protectiv e agains t pa ralytic poliomyelitis.” Professor Meier is a biostatistician from the University of Chicago. In the field of polio, he is best known for his analysis “Safety Testing of Polio­ myelitis Vaccine” (Science, May 31, 1957), which suggested that a searching stud y of the entire Salk vaccine program by an app ropriate body be conducted. Despite the attempt of the editors to initiate a debate on the crucial issue of 

safe ty testing, proponents of Salk vaccine remained silent. Professor Greenberg is head of the department of biostatistics of the Uni­ versity of North Carolina School of Public Health and former chairm an of the Committee on Evaluation and Stan dard s of the American Public Health Association. In the past he has presented several papers on metliodologic 

problems in the determination of the efficacy of the Salk vaccine. The reason for this panel on the present sta tus of polio vaccines is best expressed by a quote from Dr. Alexander Langm uir. lie is in charge of polio surveillan ce for the USPHS, and has been an ard ent proponent of the Salk vaccine even prior to the Francis repo rt of 1955. In a symposium on polio in New Jers ey last month he stated tha t a current resurgence of the disease, particularly the paralytic form, provides “cause for immediate concern” and that the upward polio tren d in the United States during the past 2 years

1

 R ep rint ed fro m Il lino is Medica l Jo urn al , Aug us t 196 0.
INTENSIVE IMMUNIZATION PROGRAMS 91

“has been a sobering experience fo r overenthusiastic health officers and epidemiologists alike.”

In the fall of 1955 Dr. Langm uir had predicted that by 1957 there would 

be less than 1(H) cases of para lytic polio in the United States. As you know, 

4 years and 300 million doses of Salk vaccine later, we had in 1959 approximately 6,000 cases of paralytic polio, 1,000 of which were in persons who had 

received 3, 4, and more shorts of the Salk vaccine. So you see, expectancy 

of the Salk vaccine has not lived up to actuality, and Dr. Langmuir was right 

when he said the figures of 1959 were sobering.

In preparation for the discussion, it was thought best to review some basic 

facts of polio: incidence, natural history, the disease, and immunity, all important to the understa nding of the vaccine problem. Table 1 presents current 

data on incindence of paralytic polio. Figure 1 presents the natural var iations in incidence of polio and infectious hepatitis. Both diseases were in 

a natur al decline when the Salk vaccine was introduced in 1955. Since the 

wide acceptance of the Salk vaccine was based prim arily on the sharp decline 

in polio incidence, it is important to keep in mind that infectious hepatitis 

equally declined following the Salk vaccine.

Figure 2 shows what the incindence of paralytic polio would have been from 

1951 through 195!) if the figures were corrected for the radical changes in 

diagnostic c rite ria since the introduction of the Salk vaccine. Dr. Greenberg will 

discuss some of these changes later. The solid columns in figure 2 represent a 

conservative estimate of what the incidence of paralytic i>olio would have been 

in former years if the diagnostic criteria of 1959 had been used. This permits a more accurate comparison. It also helps us evaluate the progress or 

lack of progress made since the introduction of the Salk vaccine.

T able 1.—Paralytic polio cases in- the United States in 1957, 1958, 1959,

including paralytic polio cases in Salk vaccines

Tota l

Increase 

over 1957 

(pe rcent)

Salk vaccinated

1 or more 

doses

3 doses 4 doses 3 or more 

doses

1957............................... ............................... i 2,158 

i 3,122

1

 658 »206 1958...................................... ......................... 45 3 571 ’ 237 ’ 10 ’ 247 1959.................. ........... ............................... i 5,694 164 « 1.870 « 750 ‘ 178 4

 928

1

 National Office of Vital Statistics figures: Mo rbidity and Mortality. USP HS vol. 8, No. 52, Jan. 8, 1960.

» Polio surveillance figures: Th rup p, Lauri D„ et a t: Poliomyelitis in the United States, 1957. Public 

Health Reports 74:535-545, Ju ne 1959.

’ Polio surveillance figures: Polio Surveillance Unit Report No. 160, Dec. 5,1958. These figures are only 

throu gh Nov. 20,1958. Also omitted are cases of paralytic polio among 179 cases for which age and/or vaccination sta tus are unknown . The true figures are higher.

‘ Polio surveillance figures: Polio Surveillance Rep ort No. 197, May 16,1960.

Note.—These figures do not include cases of paralytic polio among 237 cases for which PSU did not re' 

ceive any separate reports, in 184 cases in which the vaccine status was unknown, and in an unknown number of cases whose original diagnosis was changed as a result of “a 60-day followup report which included a 

verification of the diagnosis, (and) an estim ate of the severity of residual paralysis.” “ The paralytic category (now] includes 4,783 cases with residual paralysis at 60 days plus 689 cases with a preliminary diagnosis 

of paraly tic poliomyelitis for which no followup d ata were received.” Th at the switch from paralytic cases 

to nonp aralytic cases on the basis of the absence of residual paralysis in those with 3 or 4 doses of Salk vaccine 

is considerable may be gathered by comparing the final report on 1959 (Report 197), which includes followup data through Feb. 29, 1960, with the prelim inary report in an earlier PSU Report No. 193, which includes followup data through Jan. 11, 1960. This should be understood in the light of Ur. Langmuir’s 

remark to State epidemiologist in his letter of Sept. 29,1959, that, “ In the final analysis, even a small number of corrections may make crucial differences in the evaluation of effectiveness of vaccine. A revoked 

diagnosis or a switch of diagnosis from paralytic to nonparalytic, or vice versa, in only 5 to 10 percent of 

cases could change basic conclusions rem arka bly.”
92 INTENSIVE IMMUNIZATION PROGRAMS

Poliomyelitis

A 

9 \

>* .

• Poliomyelities Reported Cases

--------- Infectious Hepatitis Reported

Cases*

Arrow marks introduction of Salk

vaccine

National Office of Vita l Statistics

kData

Infectious Hepatitis

Note drop of 61% in incidence of both diseases from

1954 to 1956. 3

$

•*» •**

Tear

Figure 1.—The natu ral rise and fall of two diseases, poliomyelitis 1942-59, 

infectious hepatitis, 1949-59.

*17
INTENSIVE IMMUNIZATION PROGRAMS 93

I*xc.vee 2.—Com parison of the incidence of poliomy elitis, total cases 1951-59.

84420—0 2------7
94 INTENSIVE IMMUNIZATION PROGRAMS

The low incidence of the disease also complicates evaluation of a vaccine. 

Presently, a community is considered to have an epidemic when it has 35 

cases of polio per year per 100,000 population.2

 In Oak Park with a populatio n of 01,0(X), 21 or more cases constitu tes an epidemic. Since Oak Park 

has about 500 blocks, this means 1 case of polio per year to 25 blocks. We 

have had only one epidemic of polio in the recorded history of Oak Park. 

In a high incidence disease like measles, on the other hand, it is common to 

have 21 cases in a single block. The difficulty in evaluatin g the efficacy of 

a vaccine against polio as contrasted to measles is obvious.

Because of the low incidence of i>olio, neither the priv ate physician nor 

the local public health physician is in a position to judge the value of polio 

vaccine from personal experience alone. One cen tral source must collect and 

evaluate the data . The result will be only as good as the thoroughness, objectivity, and statistical skills of the central source. Pa rt of the difficulty in the 

evalu ation of the Salk vaccine has been that the responsible author itie s have 

not refined the techniques for evaluating high incidence diseases so th at they 

can be applied to low incidence diseases.

We must also distinguish between polio infection and the clinical disease. 

Tuberculosis, where we have the tuberculin reactor which signifies infection 

as contraste d to the reportable clinical disease, is the prototype. For every 

one case of known paralytic polio we have about a thousand cases of subclinical polio infections. The latter accounts for the high degree of natur al 

immunity in adults. Crucial to the understa nding of the contemporary vaccine 

problem is that you can get infection of the gut with or without disease.

The theory of the killed vaccine is th at circulating antibodies in sufficient 

amounts will neutralize polio virus l>efore it reaches the ce ntral nervous system. 

One of the major disappointm ents of the killed vaccine is that circulating 

antibodies alone do not protect against alim enta ry infection. Only when the 

local immunity follows an alim enta ry infection are we capable of achieving a 

more consistent immunity against the disease. Circ ulating antibo dies produced 

by a killed vaccine do not prevent the multiplication of enormous numbers of 

polio virus in the gut, nor their brea kthrough into the circulato ry systems. 

Protection depends on the presence of circulating antibo dies in sufficient titer 

to offset virus entering the circulatory systems. Immunity of this type is 

predominantly relative.

This concludes our review. Dr. Greenberg will launch us into our panel 

discussion.

Dr. Bernard Greenberg. I agreed, as a partic ipant of this panel, to discuss 

the present status of the Salk vaccine as a statistician. As such, my prim ary 

concern, my only concern, is the very misleading way that most of this 

data has been handled from a statistical point of view.

There has been a rise during the past 2 years in the incidence rates of 

paralytic poliomyelitis in the United States. The rat e in 1958 was about 50 

I»ercent higher than th at for 1957, and in 1959 about 80 percent higher than 

in 1958. If 1959 is compared with low year of 1957, the increase is about 

170 percent. At the same time, the rates for nonparalytic polio have been 

declining in relation to the 1957 base.

As a result of this trend in paralytic poliomyelitis, various officials in the 

Public Health Service, official health agencies, and one large voluntary health 

organization have been utilizing the press, radio, television, and other media 

to sound an alarm bell in a heroic effort to i>ersuade more Americans to take 

advanta ge of the vaccination procedures available to them.

Although such a program might be desirable until live virus vaccines are 

available to us on more than an experimental basis, the misinformation and 

unjustified conclusions about the cause of this rise in incidence give concern to 

those interested in a sound program based on logic and fact rather than 

personal opinion a nd prejudice.

2

 Prior to the introduction of the Salk vaccine the National Foundation defined an epidemic ns 20 or more cases of polio per year per 100,000 population. On this bnsis there 

were many epidemics througho ut the United States yearly. The present higher rate has 

resulted in not a real, but a semantic elimination of epidemics.
INTENSIVE IMMUNIZATION PROGRAMS 95

One of the most obvious pieces of misinformation being delivered to the 

American public is that the 5O-p^rcent rise in paralytic poliomyelitis in 1958 

and the real accelerated increase in 1959 have been caused by persons failing to be vaccinated. This represen ts a certain amount of “doubletalk” and 

an unwillingness to face facts and to evaluate the tru e effectiveness of the Salk 

vaccine. It is doubletalk from the stan dpoint of logical reasoning: If the 

Salk vaccine is to take credit for the decline from 1955 to 1957, how can 

those individuals who were vaccinated several years ago contribute to the 

increase in 1958 and 1959? Are not these persons still vaccinated?

The number of persons over 2 years of age in 19<>0 who have not been 

vaccinated cannot be more, and must be considerably less, than the number 

who had no vaccination in 1957. Yet, a recent Associated Press release to 

warn about the impending thr eat referre d to the idea that the “main reason 

is th at millions of children and adults have never been vaccinated.” If they 

were never vaccinated, undoubtedly many more than were reported were unvaccinated during 1955, 1956, and 1957 when the same officials were claiming 

that reduction in rates was due to t he vaccine.

Could it be that the vaccine has been only a temporary stopgap and tha t 

the effect is now wearing off because the vaccinated individuals are not maintaining the ir antibody sta tus through subclinical exposures and booster doses?

One cannot answer this question in the negative with real assu rance because 

such a possibility is certainly a real one. The reduction of antibody titer 

with time is well documented and may explain why some individuals vaccinated 5 yea rs ago have lost the ir immunization status. On the other hand, 

officials urging vaccination have take n the stand that the rate increased because 

large segments of the American population, about 49 percent, have had no 

vaccine at all.

A scientific exam ination of the data, and the manner in which the data were 

manipulated, will reveal that the tru e effectiveness of the present Salk vaccine 

is unknown and greatly overrated.

The rem ainder of this paper documents this statement.

EFF ECTIV ENE SS OF SAL K VACCINE

All here will remember that the field tri als in 1954 showed that the vaccine 

used was 72 percent effective in preventing paralytic poliomyelitis within 

1 year, but completely ineffective in preventing nonparalytic poliomyelitis. It 

must be remembered that these figures apply to the vaccine used in 1954, and, 

therefore, all the Fra ncis report really tells us is that the Salk vaccine of 

1954 was 72 p ercent effective in preventing paralytic i»oliomyelitis for that one 

season.

For the 1955 vaccine, certain changes in the man ufacture and testing for 

safety were introduced. The vaccine did not contain merthiolate as did the 

1954 product. Live viruses were found in several lots, and the foundation of 

Salk’s theory of inactivation was questioned. We were alarm ed by the varia ­

tion in antigenic potency of different lots from different man ufacturers especially for a product that was to be administered on a mass basis. The Cutter 

incident and the white paper are clearly remembered by those of us who, at 

that time, questioned the wisdom of the program as it was being conducted. 

To insure “absolu te safety,” an extra filtration step was introduced in November 1955. Perhaps Dr. Cox will comment on what this extra filtra tion step 

may do to the antigenic potency of the vaccine.

The result of that change, as well as the preceding ones, upon the effectiveness of the present vaccine is unknown. At that very time—November 1955— 

the Poliomyelitis Surveillance Unit of the Communicable Disease Center published a paper which purported to show that in 1955 the vaccine was still as 

effective as in 1954. In fact, a report from that unit on December 7, 1955, 

went so fa r as to claim that a single inoculation of the vaccine was about 

78 percent effective in preventing paralytic poliomyelitis.

In care and precision, the method of stu dy in this Public Health Service repo rt 

was not at all comparable to th at of the field trials of 1954. There were 

no controls, the data were retrospective, and there were no rigid diagnostic 

criteria that could be supervised on a national basis. The claim that one 

inoculation was 78 percent effective was too much for anyone to accept.

We were able, fortunately, to conduct a more intensive study in North Carolina, but it was subject to the same limitations of no real controls, and of 

retrospective design. Our purpose was simply to lear n the magnitude of the
96 INTENSIVE IMMUNIZATION PROGRAMS

bias introduced by faulty stat istical manipulation s in the Poliomyelitis Surveillance Unit study. We found that one dose was practically ineffective and 

two doses would produce a figure of only about 60 i»ercent reduction among 

children 5 to 9 years old. The Poliomyelitis Surveillance Unit study had 

reported about 80 perc ent effectiveness in North Carolina for a single shot. 

Why this discrepancy of figures in the two studies?

In a paper on the results of o ur study delivered before the Biometric Society 

and Ins titu te of Mathematical Statistics in April 1956, I pointed out that the 

discrepancy was purely a stat istical one. There were two biases in the way 

the Public H ealth Service had calculated its rates of attack among the vaccinated 

and the unvaccinated.

First of all, the unvaccinated population figure for 5- to 9-year-old children 

used in the Public Health Service report was the number given in the 1950 

census minus the number of children vaccinated. The number of children aged 

5 to 9 in 1955 was estimated, however, to be 101,000 more than it was in 1950. 

The Public Health Service did not take this increase into account. The omission of 101,000 children from the unvaccinated population would have increased 

the latte r roughly from 236,000 to 337,000 children. Hence, the attack rate 

for unvaccinated children was overestimated by about 40 percent.

The second bias in the way the Public Health Service had calculated rates 

involved the period of exposure for the vaccinated children. As the children 

were vaccinated each month, they were transferred to the vaccinated group 

piecemeal. Before children can be moved to the vaccinated status, however, 

one must consider the length of time they remained in the nonvacclnated 

group before transference. In the adjustm ent process, the seasonal incidence 

of the disease also must be considered. To obtain correct estim ates of the 

population who had “one and only one” inoculation of vaccine, this adjustm ent 

process must be used, not only to tra nsfer first vaccinees into that group, but 

also to transf er out those children who obtained second inoculations. Failure to do so by the Public Health Service accounted for the rema inder of 

bias between the two studies. Hence, as far back as 1955 and before the extra 

filtration step was introduced, the question of whether the Salk vaccine was 

really as effective as it was in 1954 could not be answered.

REASONS FOR RECENT INCREA SE

If the vaccine was not as effective, one might wonder why the tremendous 

reduction occurred in the 1955, 1956, and 1957 reported rates. Here, again, 

much of this reduction was a statistical artifact.

Prior to 1954 any physician who reported paralytic poliomyelitis was doing 

his patient a service by way of subsidizing the cost of hospitalization and 

was being community-minded in reporting a communicable disease. The cri ­

terion of diagnosis at that time in most health departm ents followed the World 

Health Organization definition: “Spinal iairalytic poliom yelitis; sign and symptoms of nonparalytic poliomyelitis with the addition of partial or complete 

para lysis of one or more muscle groups, detected on two examinations at least 

24 hours apart.”

Note that “two examinations at lea st 24 hours ap art” was all tha t was 

required. Laboratory confirmation and presence of residual para lysis was not 

required. In 1955 the criteria were changed to conform more closely to the 

definition used in the 1954 field trials: residual para lysis was determined 

10 to 20 days aft er onset of illness and again 50 to 70 days after onset. The 

influence of the field trials is still evident in most health departm ents; unless 

there is residual involvement at least 60 days after onset, a case of poliomyelitis 

is not considered para lytic.

This change in definition meant that in 1955 we started repo rting a new 

disease, namely, paralytic poliomyelitis with a longer lasting paraly sis. Fu rthermore, diagnostic procedures have continued to be refined. Coxsackie virus 

infections and aseptic meningitis have been distinguished from paralytic poliomyelitis. Prior to 1954 larg e numbers of these cases undoubtedly were mislabeled as paralytic poliomyelitis. Thus, simply by changes in diagnostic 

crit eria , the number of paralytic cases was predetermined to decrease in 1955- 

1957, whether or not any vaccine was used. At the same time, the number of 

nonp araly tic cases was bound to increase because any case of poliomyelitislike disease which could not be classified as paralytic poliomyelitis according 

to the new criteria was classified as nonparaly tic poliomyelitis. Many of these 

cases, althou gh reported as such, were not nonpara lytic poliomyelitis. If this
INTENSIVE IMMUNIZATION PROGRAMS 97

inac curate number of cases of nonparaly tic poliomyelitis rei>orted in 1957 is 

accepted as accurate and considered as a base for subsequent comparisons, it 

is no wonder tha t we now say nonparalytic cases went down in 1958.

There is still another reason for the decrease in the reported paralytic poliomyelitis cases in 1955-57. As a result of the publicity given the Salk vaccine, 

the public questioned the possibility of a vaccinated child developing paralytic 

poliomyelitis. Whenever such an event occurred, every effort was made to 

ascertain whether or not the disease was truly paralytic poliomyelitis. In 

fact, I am certain that many health officers and physicians here will ask 

routinely if a child has been vaccinated when signs of poliomyelitis are present during the summer months. We have been conditioned today to screen 

out false lmsitive cases in a way that was not even imagined prior to 1954.

As a result of these changes in both diagnosis and diagnostic methods, the 

rates of paralytic poliomyelitis plummeted from the early 1950’s to a low 

in 1957.

Why then has there been a recent increase since 1957?

Why have the improved methods of diagnosis not prevailed during 1959 

and 1960?

The improved methods of diagnosis have prevailed. The present increase, 

I believe, is caused by a long-term, increasing tren d in the incidence of the 

condition or disease we now call paralytic poliomyelitis. Without doubt, the 

increasing trend has been reduced to some extent by the Salk vaccine. Nevertheless, the Salk vaccine has limited effectiveness in its ability furth er to 

reduce this trend. The reduction at the outset appeared to be much more 

effective than it was, because the early years of the vaccine’s use were clouded 

by reduction in rej>orted incidence by the elimination of the false positives. 

However, any fut ure substan tial reduction in this tren d will require a more 

potent vaccine, not simply vaccinating more people. If there were no other 

vaccine, complete vaccination of all susceptible persons in the population with 

Salk vaccine would be justifiable.

Delays in accepting the new live virus vaccines may result in a continuation 

of the trend observed in 1959. Today it may be a serious mistake to be ul traconservative in accepting the new live virus vaccines under the impression 

that there is no hurry because an almost equivalent immunizer exists in the 

Salk vaccine. A delay in accepting and promoting better vaccines will be a 

costly one. There must be immediate pressure applied to determ ine whether 

or not the new vaccines are more effective, so that we do not cling, for sentimental or personal reasons, to an older vaccine whose true effectiveness is 

today unknown.

Question. Are antibody levels any indication of the reliability of th e effectiveness of the vaccine?

Dr. Cox. The only way you really can determine vaccine effectiveness is by 

direct challenge. Obviously, in polio you cannot make a direct challenge on 

man. We know, however, from experience with other vaccines th at the most 

accurate indirect method we have is measuring the levels of neutralizing antibodies in the blood, and t ha t’s what we’re checking.

It is well accepted now tha t this method represents a spillover of antibodies 

produced in the tissue. We do not know, however, the exact level of neu tralizing antibodies necessary to protect against paralytic polio. There is increasing 

evidence tha t antibody levels as low as 1:4 are significant. Complement-fixing 

antibodies, on the other hand, are not a reliable index of effectiveness, nor do 

they necessarily correla te with neutralizing antibodies.

Dr. Kleinman. Dr. Ratner has put me in the position of Devil's advocate, 

being the only one on the panel who at one time committed himself in writing 

tha t the Salk vaccine was quite effective. Back in 1958 we showed, or thought 

we showed, that two doses of Salk vaccine was 83 percent effective in preventing 

paralytic jnilio. We thought this was done rather carefully using a life table 

method of analysis which recognizes tha t the population at risk changes week by 

week and month by month. We did not. however, as Dr. Greenberg suggested, 

give sj>ecial weight to those months of the year in which the risk of contracting 

l>olio is greatest.

We repeated this study of 1955 and 1956 by projecting the same type of 

statistical analysis into 1957. Lo and behold, we found tha t two doses of Salk 

vaccine was not nearly as effective in 1957 as we thought it w as in 1956. Instead 

of 83 percent effectiveness, we found only about 24 percent. Fur ther, in 1957 

we found that it took three doses to come close to the effectiveness that we 

had demonstrated with two doses in 1956.
98 INTENSIVE IMMUNIZATION PROGRAMS

But let’s leave that aside. Let me tell you why, aside from the statistical 

standpoint, I’m getting nervous about the Salk vaccine. My first reason is 

the definite increase in paralytic i>olio. In Minnesota we have found th at 20 

perc ent of our 1959 paralytic experience has occurred in trip le and quadruple 

vaccinates. At present, I am an agnostic as far as the efficacy of the Salk 

vaccine is concerned because I do not know how effective it is. I believe it 

has some degree of effectiveness, but I do not know the extent because I cannot 

get proper denominators. A denominator which consists of a point determination of the number of vaccinates as compared to the unvaccinates is absolutely 

useless because it ignores the changing cha racter of the risks involved. These 

risk s vary from day to day depending upon the seasonal i>eeuliarities of polio 

infection and the changing cha rac ter of the Salk vaccinated population.

Laboratory findings are another reason why I am getting nervous. If polio 

antibodies mean anything in respect to protection, then I am forced to conclude 

that much of the Salk vaccine we have been using is useless. For 2 years now 

we have done antibody titratio ns on children who have received three or more 

doses of Salk vaccine. These titr ati ons show th at over 50 percent do not have 

antibo dies to types I and II I and th at 20 percent lack antibodies to type II 

polio virus. This is a very disturbing fact. When a phenomenon like this occurs 

2 yea rs in a row, one has reason to believe th at the material we are injecting 

is not an antigenic prep aration.

I should also like to emphasize I)r. Greenberg’s remarks on the changing 

concepts of polio. It is now extrem ely difficult to get a Minnesota physician 

to make a preliminary diagnosis and report of nonpara lytic polio. We now 

know that aseptic meningitis has a much broader etiology tha n polio virus. In 

1956 in much of our so-called nonpara lytic polio, the etiology turn ed out to be 

Coxsackie B-5 virus, and in 1957 a staggering outbreak turn ed out to he Echo 

9 virus. It is no wonder then that the average doctor does not want to make 

a diagnosis of polio in the absence of frank lower motor neuron flaccid paralysis. 

As a result, the only polio th at ’s being reix>rted today are cases with fran k 

paraylsis.

I would also like to agree with Dr. Greenberg that the insistence upon a 

60-day d uration of para lysis for paralytic polio is absolutely silly. There isn’t 

a doctor in this room who hasn’t seen a case of frank p ara lytic polio which has 

not recovered with in 60 days, or at least recovered sufficiently so th at you could 

not estimate with clinical certainty th at there was some residual paralysis.

I would like, then, to have my position understood, at lea st on this panel, 

as th at of an agnostic so far as the Salk vaccine is concerned. I am not against 

it. I thin k it is the only medium we have which has some degree of r eli ab ility; 

but I think the re are better methods, and I think we should take advantage of 

these methods if it seems at all reasonable.

Dr. Ratner. Dr. Cox, what has been your experience with antibody findings 

in triple or quadruple Salk vaccinates?

Dr. Cox. Fi rst let me say th at I am convinced tha t living virus vaccine is going 

to be the final answer. I base this statem ent on my experience in the virus field 

since 1928. I am not against killed virus vaccines. I was the first person to 

prove that they could be made. This was at the Rockefeller Institu te, where I 

developed a killed vaccine aga inst eastern equine and western equine encephalomyelitis. Later, as a bacteriologist at the USPHS, I produced other killed 

vaccines.

I wan t to emphasize, however, th at everything done in the field of virology has 

to be qu antitative. This applies to living as well as killed virus vaccines. Unless 

you have quantita tive methods and know what you are putting into a vaccine 

product, you have nothing. The reason our company refused to make the killed 

Salk vaccine was because we knew it was impossible to produce enough virus by 

known tissue culture methods to make a good killed poliovirus vaccine. We 

knew the quantita tive requirements for vaccine as far back as 1934. Dr. Salk 

has adm itted this past year that this principle is true. This basic qua ntitati ve 

principle is precisely applicable to polio. I am an xious to tell you w hat we know.

There are very few things that you can generalize upon in this field, but one 

thing you can depend on is that you’ve got to have at leas t 100 million particles 

per dose to make a killed vaccine tha t’s worth anything. The only single exception is Rocky Mountain spotted fever vaccine, which has by fa r the best antigen 

that anybody has every found, either in rickettsiology or virology. With spotted 

fever you can make a good killed vaccine with between 10 and 30 million rickettsial partic les, but in the case of viruses you must have 100 million virus 

particles, as a minimum, and preferably a higher concentration.
INTENSIVE IMMUNIZATION PROGRAMS 99

We have found that in production—all the manufacturers have found this— 

you never get much above 10 to 30 million poliovirus particles per cubic centimeter by tissu e culture methods. Accordingly, we told our company that to make 

a good killed virus product we would have to concentrate the vaccine from fivefold to tenfold for a product that would meet our standa rds. Otherwise, we 

would be producing a product that a tru e scientist could not be proud of, and 

we didn’t w ant to be in a position where we could not back the product. It costs 

the manuf acturer around 39 cents a cubic centimeter to m ake the present killed 

vaccine. If you multiply that by fivefold to tenfold and include the additional 

labor costs, you can see that the product would be costly. We predicted this 

back in 1950 when we decided not to produce Salk vaccine.

We ar e now learning, not only in the United States but in Israel, England, and 

Denmark, that the killed product does a fairly good job of producing antibodies 

aga inst type II poliovirus. But tyjie II represen ts only about 3 percent of p ara ­

lytic cases througho ut the world. The killed vaccine does a poor job against 

type I, however, which causes 85 iiercent of paralytic cases, and against type III , 

which causes about 12 percent. In other words, the killed vaccine is doing its 

best job aga inst the least imp ortant type. It took time to find this out. It was 

proven in Israel in 1958, when it had its big type I epidemic. They did not see 

any difference in protection between the vaccinated and the unvaccinated. Last 

year in Massachusetts during a type II I outbreak, there were more paralytic 

cases in the trip le vaccinates than in the unvaccinated. Actually, there is a very 

good but little known immunological explanation for this.

Dr. Kleinman, in refe rring to the Minnesota studies, did not specify that in 

the trip le Salk vaccinates 57 iiercent had antibo dy titers of less tha n four to 

type I poliovirus, 20 iiercent had the same lack of antibody titers to type II 

poliovirus, and 77 percent had titers of less than four to tyiie II I poliovirus, as 

of Janu ary and February 1958. We found the same thing in Pearl River iiersonnel. The amazing thing is th at when you analyze these 1,100 people scattered 

in northern New Jersey and southern New York, you find no appreciable difference between the response of the unvaccinated and the vaccinated, following three 

or four injections, to type I or II I poliovirus.

Question. At w hat inte rvals after the last injuection did you make these antibody studies?

Dr. Cox. These vary, but they’re all within a period of 18 months. Of course, 

the claim has been made th at a good killed Salk vaccine should give a longer 

duratio n of immunity. I don’t know of any killed vaccine that gives a longer 

dur ation of immunity. I do know that in Rocky Mountain spotted fever, which 

has a mortality ra te of 95 percent, the vaccine has eliminated mortality, provided 

booster doses are take n once a year. The same thing is tru e with epidemic 

typh us vaccine. Both of these are very good killed vaccines. I know of none 

bet te r; yet the immunity they provide is of short duration and requires yearly 

boosters.

Dr. Ratner. Dr. Cox, would you rela te the effect of the additional filtration 

step, which was introduce d as a necessary safety measure in November 1955, 

on the production of a potent Salk vaccine?

Dr. Cox. The extra filtra tion step was introduced because the amount of formalin used in preparing th e vaccine did not inactivate the poliovirus. We found 

residual live viru s for as long as 42 consecutive days of inactivation. It is common knowledge in the industry that the regulations requ iring incubation for 

10-day intervals did not elim inate residual live virus. The manufacturers, 

through difficulties encountered in production, soon learned of this and, to be 

sure there was no live virus, extended the period of cooking to 30 days or more. 

Even then they had to throw out batches, because polio is one of the most difficult 

viruses to inactivate with formalin.

The second filtration step was picked out of thin air with no experimentation 

to back it up. Because i t was thought that residual live virus particles encased 

in a mass of killed particles were getting through, the filtration step was introduced in the hope that it would remove this aggregate. We’ve known for years, 

however, that any time you introduce an additional filtration step you lose 

antigen. Actually, the Isra elis found they lose from tenfold to thirtyfold in 

virus content by a second filtration step. If you have a small amount of antigen 

to st ar t with, additional filtration will only reduce it still further. Certainly, 

this vaccine has been most confused because of many vested interests, but on a 

scientific basis any virologist will agree that I’m telling you the absolute gospel.

Question. Do you know the variation of the potency of the Salk vaccine on 

the market?
100 INTENSIVE IMMUNIZATION PROGRAMS

I)r. Cox. Unfortunately , tha t varies considerably. The man ufacturers are unable to quantify virus particles in the killed vaccine because it is too costly. A 

good killed vaccine requires a standard, consisting of the number of virus particles of the strain being used. This standard, of course, will vary with the 

str ain used in both killed and live vaccines. From experience we know that it is 

wise to have a highly virulent stra in for good antibody response. Th at’s why 

the Mahoney strain, which is highly virulent in monkeys, was chosen as the type 

I component of the Salk vaccine. As little as live virus particles of Mahoney 

injected intramuscularly will paralyze monkeys.

This virulent strain, however, was responsible for the vaccine-induced outbreaks in the spring of 1955. In Idaho, where the people were polio virgins, 

the vaccine caused numerous cases of polio. In New Mexico, Arizona, and elsewhere, where natural immunity was present, there were few or no cases.

I)r. Ratner. Some si»ecific data on the variation in potency may be of interest. 

New York State Health Department investigators reported in September 1956 

that there was a 600-fold variation in the potency of commercial Salk vaccine 

on the market. Other unpublicized USPHS data showed a sixtyfold variation. 

Today many inoculations of the Salk vaccine are needed to accomplish the same 

results that were claimed in 1955 with one inoculation. In the history of drug 

therapy there are few drugs, if any, which become progressively inferior with 

increasing years.

Dr. Cox. I would like to repeat tha t good vaccine, whether living or killed, 

has to be quantified. Our living poliovirus vaccine, which I h<»i»e to tell you about 

very soon, is quantified. We keep very careful control of the exact amount of 

viru s in every drop we produce.

In virology you have to deal with both qua ntity and quality. If both a re under 

control, you're on solid ground. If they are not under control, you don’t know 

where you are.

Dr. Ratner. To close the discussion on potency, back in May 1957 the largest 

producer of Salk vaccine in the United States had several million dollars worth 

of vaccine on hand which did n ot pass the minimum potency requirements of the 

USPHS. Subsequently, the Division of Biological Standa rds reinterpreted the 

minimum requirements to make possible the commercial utilization of this vaccine.

We would now like to sj>end a little time on the sa fety factor.

Dr. Meier. The thing tha t impresses me most about this question of polio vaccine is a problem that has been discussed only by indirection. How is it that 

today you hear from members of this panel that the Salk vaccine situation is 

confused ; yet w hat everybody knows from reading the newspapers, and has known 

since the vaccine was introduced, is that the situatio n as far as the Salk vaccine 

is concerned was and is marvelous? The reason for this discrepancy lies, I think, 

in a new attitude of many public health and publicity men. It is hard to convince 

the public th at something is good. Consequently, the best way to push forw ard 

a new program is to decide on what you th ink the best decision is and not question it thereafter, and further, not to raise questions before the public or expose 

the public to open discussion of the issues.

My own contact with this attitu de came when I was a member of the depar tment of biostatistics at Johns Hopkins, where I had an opportunity to ta lk with 

some of the people who were connected with the vaccine. My interest was 

stim ulated by several papers on the safety of the vaccine written by Salk preparatory to the 1954 field tria ls.

The general theory tha t Salk was working on was a very simple and old on e: 

Th at the inac tivation of poliovirus by formalin would proceed in a straig ht-line, 

first-order reaction. This means that in x hours of contact with formalin, half 

the virus particles would be inactivated, that an equal number of additional 

hou rs would inactivate ano ther half of the remaining live virus particles and 

so on. By extending the period of inactivation, a product would result in which 

the amount of living virus remaining was necessarily so minute as to have no 

practic al significance. Thus was Dr. Salk’s built-in safe ty factor to insure 

complete safety.

Although this theory applies to many cases, whether it applies to the Salk 

vaccine rema ins an empirical question. What troubled me greatly was that it 

appeared from actual data which Salk presented that the theory did not apply. 

Assuming there was some error in my understanding or in Salk’s, I inquired 

of the people who knew about this. The answer I consistently received was “I 

see what you mean. I haven’t thought about it very carefully myself, but there 

are many imp ortant and competent people who are taking care of this. Don’t
INTENSIVE IMMUNIZATION PROGRAMS 101

wor ry . A ft er all , th is is me rely a paper fo r th e pu blic an d not th e re al te ch ni ca l 

goods.” Th e an sw er as it em erge d la te r, of cours e, was no one was ta kin g 

ca re of it.

Th e prob lem of mak in g a new vaccine, or ad op ting an y pu blic hea lth mea su re, 

wi ll al w ay s be difficult. We ha ve to be pre par ed to mov e ah ea d in fa ce of th e 

ri sk of err or. In th is p art ic u la r iss ue, w hat trou bl ed me was mo vin g ah ea d 

whe n th e err o r w as th er e be fore us in th e paper th a t un de rtoo k to dem onst ra te 

sa fe ty .

Th e re as on fo r th is un ha pp y si tu ati on lie s first in th e att it u d e I re fe rr ed to 

e a rlie r: th a t di ss en t an d disc us sion in pu blic are unwelcome . Second , I th in k 

it lie s in th e diffu sio n of resp on sibi lity th a t has re su lte d fro m th e co mm itt ee 

system of p ro m otin g new mea su res. In th is ca se a larg e co mmitt ee was inv olv ed, 

but no sing le mem be r too k it up on hi m se lf to check th e prob lem all th e way 

thro ug h. Alth ou gh I) r. Sa lk fe lt he ha d, no one els e do ub lec he ck ed him . Ev en 

mo re se riou s ev iden ce th an th a t which Sal k prov ided in pu blic em erge d la te r: 

th e pres en ce of live vi ru s in va cc ine m an ufa ct ure d in st ri ct ac co rd an ce w ith 

th e protoc ols. To be su re, th es e lo ts of va cc ine were no t dis trib ute d fo r th e 

field tr ia ls in 1954. Not w ith stan di ng , th is ex pe rien ce de m on st ra te d un eq uivo ­

ca lly th a t th e metho d itse lf w as no t sa fe . Furt her m ore , mos t of you know th a t 

th e tr ip le sa fe ty ch ecking of th e vacc ine us ed in th e field tr ia ls by th e m an ufa ctu re r, Dr. Salk ’s la bo ra to ry , an d th e Pub lic H ea lth Se rvice w as drop pe d in 

the lic en sing proc ed ur e. Mo st of th e lo ts dis trib ute d in 1955 were te st ed only 

by th e m anufa ct ure r. It w as no su rp rise , then , th at we ha d a sp ring ou tb re ak 

of va cc ine-indu ce d cases. Th e only su rp ri se was th a t th er e w er en ’t mo re.

PA RT I I 3

VACCINE SAFETY

Que st ion. H ow man y lots were ac ce pt ed as sa fe fo r lic en sing on m an uf ac ­

tu re r’s protoc ol alo ne ?

Dr. Herald Cox. No t all lo ts wer e ch ec ke d by la bora to ri es oth er th an th e 

m an ufa ct ure rs '. Th ey were ra nd om sampled . Th e D irec to r of th e L ab or at or y 

of Biolog ica l Con tro ls was aw ar e of sa fe ty te st in g prob lems but was un su cc es sfu l in ob ta in in g a clar ificatio n from Dr. Sa lk.

Que stion. D id n’t th e D irec to r g ra n t th e lic en se?

Dr . Cox. He di d no t w an t to g ra n t th e license, but his decis ion was ov erru led.

Dr. H erbert R atner. In March 1954, 10 of th e 48 lots of va cc ine pr od uc ed 

fo r field tr ia l us e w er e po sitiv e fo r liv e vir us by tiss ue cult ure or mo nkey tests. 

In on ly 2 of th es e 10 was liv e vir us de te ct ed by al l th re e la bora to ri es: th a t of t he 

m an ufa ct ure r, th e N at io na l In sti tu te s of H ea lth , an d Dr. Sa lk. In seven of the 

po sitiv e lo ts liv e vi ru s was foun d by a sin gle la bora to ry bu t no t by th e oth er two. 

As Kru mbi eg el po inted ou t a t th is so ci ety’s annual mee tin g in 1956, "T he re al 

ca us e fo r ala rm was th e kn ow led ge th a t th ere w as no co rr el at io n of po sit ive 

te st re su lts am on g th e diffe re nt la bora to ri es * * * an d pra ct ic al ly none w ith in 

the sa m e la bora to ri es in so fa r as re su lts of tiss ue cu lture an d mo nkey in oc ulation 

te st s w er e co nc erne d * * * th e re su lts of th e te st s se rv ed to prov e th e in ad equ ac y an d unre liab ility of th e te st in g pr oc ed ur e.” N ot w ith stan di ng , on the 

ba sis of Dr. Salk ’s re port in Apr il of no ad ve rs e eff ects follo wing the va cc in ation 

of 7,507 ch ildr en w ith co mmercially pre par ed vaccine s, th e 1954 field tr ia ls we re 

all ow ed to pro ceed.

In 1955 tw o ra th e r th an th re e gr ou ps part ic ip at ed in sa fe ty te st in g: th e man ­

ufa ctu re rs an d th e N at io na l In sti tu te s of H ea lth . Th e m anufa ct ure rs ra n both 

tiss ue cu lt ure an d mo nkey te st s on th e va cc ine they su bm itt ed fo r lic ensin g. At 

th e N IH la bora to ri es only 14 pe rc en t (s ev en -fiftiet hs ) of th e lo ts su bm itted fo r 

lic en sing w er e su bj ec ted to bo th te sts : th e m aj or ity, 64 jie rcen t (thi rty- tw ofi ft ie th s) , were su bj ec ted to only on e te st— th e tiss ue cu lture test. This was 

do ne de sp ite th e fa ct th at it w as kn ow n from the 1954 te st in g ex pe rie nc e th a t 

mo nkey te st s on som e tr iv al en t m ate ri al w er e po sit ive even wh en each of th eir 

mon ov alen t co mpo ne nts (tyi» es I, II , an d I I I ) , be fore pooling , ha d been foun d 

ne ga tiv e by tiss ue cu lture te sts. Twen ty -tw o jte rcen t (e leve n- fiftieths) of the 

lots su bm itte d fo r lic en sin g were no t te st ed by NIH a t all. Th ese fig ure s in di ca te 

th at th e va cc ine us ed in 1955 w as in ad eq uate ly tested . The refo re , it is no t 

su rp ri si ng th a t th er e were ca ses of va cc in e-indu ce d polio in th e sp ring of 1955.

To bri ng th is issu e of th e sa fe ty of th e Sal k vaccine to a close, th e follo wing

3

 Rep rint ed fro m Il lino is Medical Jo urn al , Se pt em be r I9 60 . 

84426 — 62------8
102 INTENSIVE IMMUNIZATION PROGRAMS

information is pertinent. In 1953, experienced investig ators from the Michael 

Reese Hospital in Chicago failed to produce a safe vaccine by the Salk formula. 

Their findings were dismissed by the backers of the Salk vaccine.

In tlie sprin g of 1955 one of the man ufacturers using safety tests more rigid 

tha n those required by the USPHS found live virus in its own vaccine, in 

ano ther manuf acturer’s vaccine on the open market, and in one of Dr. Salk’s 

vaccine preparatio ns used as a standard for commercial vaccines. This manufac tur er discontinued production of Salk vaccine and did not resume until an 

altern ative method (ultraviolet irra dia tion) was developed in the fall of 1955. 

Some of the released vaccine of this manufacturer, however, had alre ady been 

used in Massachusetts, which experienced an epidemic, and some of the same 

lots were used in New York, and in Minnesota, where, as Dr. Kleinman has said, 

he found 83-percent effectiveness. Of course, many of us thou ght the effectiveness of the 1955 vaccine was due prim arily to the fac t th at it did contain live 

virus.

One other manufacturer found live virus in another of Dr. Salk’s standa rd 

vaccines. A member of the USI’IIS also found live virus in commercial vaccine 

other than that adm itted by the USPHS to have induced cases. The findings 

were not published. The Massachusetts Sta te Polio Advisory Committee, which 

included among others, John F. Enders, Thomas H. Weller, and Maxwell F inland, 

temp orarily banned the vaccine despite USPHS licensing because of its knowledge of these findings. Epidemiologic evidence of unsafe vaccine from manufac turers not named by the USPHS has been reported by Anderson, Redeker, 

and others.

It should also be stressed that safety testing was inadequate when Dr. Salk 

develoi>ed his vaccine and when the vaccine was commercially prepared for the 

field tr ial s of 1954 and for licensing and use in 1955. The claim of long duration 

of effectiveness, then, as measured by antibody levels reported by Salk, Brown, 

and others, really applies to a vaccine which did not exclude the presence of 

live virus. It does not apply to cur ren t vaccine in which potency has been 

sacrificed for safety. There is intern al evidence in the pape rs of Salk and 

Brown that some of the antibody response to the vaccine was too pronounced 

to be explained by a killed virus.

At present, epidemiologic methods employed by the USPIIS to assure safety 

of the vaccine are ina dequate : First, because of the failure to thoroughly survey untoward reactions, and secondly, because of unrefined criteria for the 

determination of sa fe ty ; for instance, insistence on correlation of initial 

paralysis at the site of inoculation, and discontinued reporting of sate llite cases.

Question. Has any State health departm ent recommended that Salk vaccine 

not be used?

Dr. Ratner. I know of no State health departm ent th at refuses to issue it now, 

altho ugh earlie r this was not the case. This is a question of whether a State 

health departm ent is in a position to oppose mass propagan da and the public 

opinion that has been formed by it.

Dr. Herman Kleinman. There is only one thing we can do in Minnesota and 

th at we are doing. There is no known way of preventing polio with a licensed 

prod uct at the present time except through the use of the Salk vaccine. While 

I am an agnostic about the effectiveness of the Salk vaccine, I still believe it 

does something in preventin g paralysis. So we owe it to the public to recommend its use. On the other hand, if we are going to act not only as public health 

physicians but as scientists, we must continue our investigations into the tru th 

about the Salk vaccine. On the basis of the fac ts as I know them, we must look 

for something better.

Dr. Paul Meier. It seems to me that the Sta te and local health officers are at 

levels different from USPHS and in much the same position as my child ren’s 

pediatrician. He said, “We are very disappointed in the Salk vaccine; we are 

very unhappy with it ; but w hat can we do? The people who have the evidence, 

who have the knowledge, who should be able to judge, say use it. I am in no 

position to second guess them and to make a different decision. I have to 

recommend it and I have to use it.”

This is no position for public health officers to be in, but there isn’t any question that is the position. All the facts have never been discussed. The great 

pressure of publicity has been exerted. It would be a hea lth officer with great 

self-confidence who would say that on the basis of the litt le he knows he is prepared to make a judgment different from that of the USPH S and to decide not 

to give it. On the other hand, I don’t consider it convincing evidence of the
INTENSIVE IMMUNIZATION PROGRAMS 103

efficacy of Salk vaccine that all, or almost all, health officers have gone along 

with it.

Dr. Bernard Greenbero. I would like to second th at comment to make sure 

that my position is understood. I’m an agnostic like Dr. Kleinman. I am sorry 

that I do not know what the effectiveness of the Salk vaccine is. Since nothing 

else is available, there seems to be no alternativ e but to push the use of it. 

I don’t think we should do so in ignorance, nor too complacently, believing th at 

as long as we have something par tially effective there is no need to have something better. The USPIIS is, in effect, saying, “Let’s face it : we were burned 

the last time by getting into this business too quickly ; so this time we are going 

to be more cautious.” By being more cautious, we may make a mistake by 

accepting a better polio vaccine too slowly. And th at ’s what I am trying to 

emp hasize: They must realize they are making this mistake possible. The issue 

must be pursued.

Question. Dr. Cox, are we doing any harm by using a low antigen tit er Salk 

vaccine?

Dr. Cox. I have data which I have never published, because at the time I 

didn’t fully understand the significance of it. While working with the USPHS 

in Montana many years ago on the development of killed vaccines for Rocky 

Mountain si>otted fever and epidemic typh us fever, I observed that vaccinated 

guinea pigs challenged with Rocky Mountain spotted fever or typhus would 

sicken and die before the controls. I couldn’t find anything about this in the 

lite rature , and it bothered me for about a year. I learned that by increasing 

the antig en fivefold to tenfold into the range of 100 million to a billion orga nisms i>er cubic centimeter of vaccine, this adverse effect was corrected and an 

effective product obtained.

We had the same experience at Lederle with Japanese B vaccine. Lots of 

vaccine which had less than 100 million viru s particles invariably would cause 

the vaccinated mice to die before the controls when challenged. The same thing 

happened to us when we trie d to produce a vaccine aga inst lymphocytic 

choreomeningitis. During the war the Division of Biological Standa rds made 

the same observation w ith Japanese B encephalitis vaccines.

I mentioned this observation and correlation in a paper in 1054; namely, 

that with a low antig en killed vaccine you stand the danger of actually doing 

more harm than good.

The first field evidence we’ve had th at there may be something to this clinically 

was the type II I polio epidemic in Massachusetts last year, where 47 percent 

of the paralytic cases occurred in those who had thre e or more injec tions of 

the Salk vaccine. The lower incidence of paralytic polio (37 percent) in the 

unvaccinated group raises the question as to whether we have produced a greater 

sensitivity in the vaccinated individual. If the investigators have correctly 

estim ated the numbers of vaccinated individuals, the clinical finding confirm's 

what we’ve seen in the laboratory. It is hard to be sure that this is the case. 

But we have supporting laboratory experience that susceptibility is increased 

by sensitization with low antigen vaccines. This is an immunologic fac t supported by USPHS findings. I advised against the manufacture of the Salk 

vaccine because I knew from experience that 1,000 to 4.000 formalin would not 

kill the poliovirus and that high concentrates of antigen are necessary for an 

effective killed vaccine. With low concentrates of antigen you may do more 

harm tha n good.

IJV E POLIOVIRUS VACCINE

When measured aga inst its killed counterpart, a live virus vaccine is always a 

superior vaccine. It invariably cost about half of that of a killed vaccine. The 

only reason for not making a live typhus vaccine, for instance, is that technical 

problems of ste rility would be difficult to overcome on a production basis.

We chose the oral route for live poliovirus vaccine because polio infects 

through the oral route. We also knew from our work with other viruses that 

the best way to immunize is to follow natur e where possible. Since nature 

was immunizing 999 persons out of a 1.000 against polio without any trouble, 

the idea was to follow nature’s example but to cut the risk down as much 

as possible.

The work we did on Newcastle disease in chickens was a perfect model in 

every respe ct for polio. Although the Department of Agricultu re had previously stated that they would not license a single live virus product, today it 

is hard to find a killed virus product in veterin ary medicine. They too found 

out that living viru s vaccines are superior. They give a higher degree of longer 

lasting immunity. They cost less to make and administer.
104 INTENSIVE IMMUNIZATION PROGRAMS

Polio is unique because many more people get the infection than the disease. 

When you think about it, theoretically it should be the easiest of all viruses 

to modify. Rabies, by comparison, is 100 percent fatal when introduced into 

the brain tissu e of any warm blooded animal. Yet, we are able to modify the 

rabies virus so tha t we can inoculate it directly into the brain of warm blooded 

animals with no sign of the disease. When challenged with virulent strains 

of rabies, these anim als will with stand 100,000 lethal doses inoculated directly 

into the brain. If we can do this with rabies, we certainly should be able to 

modify polio, which produces clinical signs of the disease in so few people.

A complicating factor in polio was that we were dealing with three different 

types, each of which had to be modified. Furtherm ore, we felt that we had to 

modify these viruses by adaptation to a foreign host. In making yellow fever 

vaccines, we learned th at when you take a virus and adapt it to a n unn atural 

host, it loses its virulence for the original host. This cen tral basic principle 

was observed by Jenner also, when he found that cowpox had the ability to 

immunize against smallpox. In yellow fever, therefore, scientists purposely 

adapted these strains to new hosts, first, by ada ptation to the brain tissues of 

suckling mice, then to mixed tissues of suckling mice in tissue culture, then to 

chick embryo tissue cultures, and finally to the chick embryo in the egg itself. 

Even though it has been claimed that you cannot grow polio in chick embryo, 

we succeeded in growing all thre e stra ins in chick embryos. The reason we 

desired this was that experience has shown the absence in chick embryo of 

extraneous virus contamin ants which cause illness. Chick embryo for all 

practical purposes is a p retty sterile package.

The only thing that balked us after we got the polio str ains in chick embryo 

was the ir poor antigenicity. Type I was completely non antigenic; tyi>e III 

was so poor that its cost would have been proh ibitive; the only one that was 

half-way antigenic was tyi>e II. In other words, we learned tha t it is unwise 

to continue passage in nonmammalian tissue for long periods of time. The big 

danger in modifying live virus is not stopping at the right point. If you carr y 

it too far, you overmodify and lose what you’re after. It ’s safe but it won't 

immunize.

We have developed our strains of virus so that they are nonvirulent to 

monkeys in the range of 100,000 to a millionfold. We know that in some 

insta nces as little as two tissue culture particles of some wild strain s of polio 

when placed in the brain, or as little as five tissu e particles inoculated in tramuscularly, will paralyze monkeys. It ’s most unusual, however, for our modified strains in undiluted form with a concentration range from 30 to 40 million 

virus particles per cubic centimeter to paraly ze monkeys by direct intracerebral 

inoculation.

Since the chance of getting paralytic polio from a natural infection of wild 

virulent viruses is only one in a thousand, modified poliovirus adds an additional safety factor of at least 100,000, reducing the risk to about one in 

100 million or 10 in a billion. Furth ermore, we don’t need 30 million virus 

particles for an infecting dose. We need only somewhere in the range of a 

1.5 million to 3 million virus particles. We do not have to concentrate anywhere from five to tenfold, as in the killed vac cine; instead we dilute.

A live poliovirus vaccine needs many more virus particles to establish an 

immunizing infection than any other live viru s vaccine I know. This may 

be due in part to the destruction of virus by gastric juices. It could be 

because our strains may be modified more tha n they need to be. 2\.t any rate, 

all of these factors must be worked out quantitatively, for we have to know jus t 

how many virus particles we’re feeding if we are to come out with a better 

product.

The type I and II I components of our vaccine are now standardized to contain at ‘least 1,200,000 to 1,500,000 live virus particles. In our type II, which 

has been overmodified, we need 3 million virus particles for a 90 i>ercent immunizing dose. Now we are in the process of increasing type I l ’s power to infect. 

We do this by feeding the virus to man, having him shed the virus as long 

as possible, recovering the virus in the stool, and obtaining pure strain s 

through tissue culture. Then we test the recovered viruses in monkeys and 

isolate those with minimal virulence. Such str ain s then have the ability to 

infec t human cells, which is what is needed, because you cannot immunize 

unless you can infect.

It must be remembered th at you cannot immunize the gas trointe stinal tra ct 

with killed vaccine, even in large amounts. Although the killed vaccine does
INTENSIVE IMMUNIZATION PROGRAMS 105

induce antibodies in the blood, this does not prevent the person from becoming 

a carrier and shedding poliovirus. One can recover wild poliovirus str ains as 

well as modified virus strain s in Salk-vaccinated persons.

The principle of the live virus vaccine in i>olio is analagous to protecting 

your house aga inst the weather. You don’t till the rooms with concrete. All 

you do is paint the outside walls because they are the site of exposure. In 

the case of a natur al polio infection, if you are one of the 999 lucky ones out 

of a thousand who does not get the disease, the virus grows in the cells of 

the gut, and viruses are shed anyw here from 10 days to as long as 6 months 

with out symptoms. During this process antibodies appear in the blood. As 

a result of this infection the cells of the gut become res ista nt for varying 

periods of time, depending on the number of cells infected. I have an example 

of this in my three grandsons. The older ones, who had been vaccinated 

more than once, did not shed type II on refeeding. The youngest one, however, 

who was immunized only once, a year earlier, shed virus for several consecutive 

days and then stopped.

If you proceed gradually , and quantitativ ely, and imitate the norms of 

natur e as a model for improvement, you are on solid ground. In this connection we have benefited from experience with 10 or 12 live virus vaccines used 

routinely in the United States in veter inary medicine.

Using live virus vaccine is the only possible way to eliminate wild viru lent 

strain s in nature. The gastrointestinal tra ct must be made so res istant th at 

wild strain s cannot get a foothold. This cannot be done with a killed vaccine. 

We know this from hog cholera. In the 35 States th at have prohibited the 

use of anything but live virus vaccine, the wild strain s of hog cholera have 

disappeared because the swine have become resistant to infection.

In the beginning we moved slowly and cautiously. We started with my 

immediate family—my daughter was the first pregna nt woman ever immunized. Then we included neighbors, then employees at our Pearl River pla nt 

and their families. At present we have immunized over 900,(MX) i>eople in 

something like 20 different countries on four continents with monovalent feeding and over 1.5 million people with trivalent vaccine. The vaccine now has 

over a 90 percent take, and over 90 percent of those missed, whether it be 

type I, II, or III, can be immunized by a second feeding.

We do not claim that this product will result in life-long immunity. One 

does not even get life-long immunity on a mild exposure to a natur al poliovirus infection. This is something we have to continue to study. In this 

country it is unusu al to find antibody titers as high as 1,000 to 2,000; but in 

South America it is not unusual to find pregnant women with titers in excess 

of 8,(MM) to 10,(M)0, because they are constantly being battere d by reinfectin g doses.

Live polio vaccine will be cheap enough so th at you can afford it once a 

year, however, if it turns out that it ’s needed that often. This is imp ortant 

because the United States is not the only country in the world that needs polio 

vaccine, and in other countries low cost is more important. Polio vaccine is 

needed par ticu larly in the Tropics where there is plenty of polio even though 

it has been said for years that the Tropics are not affected by this disease. 

One of the most severe epidemics of type I polio in medical history occurred 

in Costa Rica in 1954. They had over 1,000 cases in a total population of 

approximately 1 million.

We began our basic clinical investigations in Minnesota partic ula rly because 

University of Minnesota and State health departm ent physicians felt as we 

did that killed vaccine was not the answer. We began in 1957 and are now 

in our fourth year. We gave them all of the facts of our product. We held 

back nothing. We let them know the unanswered questions.

We learned from our initial studies on 25 babies that babies shed virus in 

quantities as high as a million viru s particles per gram of stool. Some of 

these babies shed virus as long as 3 months. Pra ctic ally every member of 

the family picks up this polio infection whether they’ve been Salk-vaccinated 

or not. The important thing is that there were no signs of illness, neither in 

the babies fed, in th e family contacts, nor in the community.

In 1958 we did a larger scale double-blind study in the univ ersity community 

of Como Village in Minneapolis with coded vaccine. Only the State statistician knew the code. Neither the doctor, nor the patient, nor those at the State 

laboratories who ran the bloods and stools of these 550 people knew who had 

received the vaccine and who the placebo. When the code was broken, we found 

tha t we had about a 90 percent antibody resjionse in vaccinated individuals 

and about a 14 percent increase in antibodies in the placebo group. We dis-
106 INTENSIVE IMMUNIZATION PROGRAMS

covered that the infection caused hy modified viruses is essentially a household 

disea se ju st as polio is normally.

We went into two epidemics, a type I in Colombia in 1958, and the tail end 

of type II (surprisingly enough it was type II) in Managua, the capital of 

Nicaragua, in 1958. The type I epidemic was caused by an exceptionally viru ­

len t str ain—two virus particles paralyzed monkeys. Fifteen verified cases had 

alread y been reported. We vaccinated over 7,000 children with monovalent 

type I followed by types II and III. Within 8 days no more cases were reported, 

and not a single case has been reported since then. But we cannot make the 

claim that we broke the epidemic because we have no way of knowing what 

the fu ture of tha t outbreak would have been.

In Nicarag ua in a highly virulent type II epidemic 254 paralytic cases had 

been reported. Of the 251 cases in children under age 10, 217 were under 

age 2. We went into Managua and vaccinated over 42,000 children under 

age 10 during a 12 day period with type II, and then later fed type I and III . 

Even though polio had been reported in Managua every month since 1949, 

with the exception of 3 months following the 1953 type I epidemic, they had 

a 10^ month period without a single case reported. Polio has come back 

to Nicaragua this year in the outlying districts, but it has spared Managua. 

This yea r we moved into the outlying distric ts and fed 35,000 doses of triv alent 

vaccine. Within 0 days there wasn’t a single case of polio reported.

Here again we may have been hittin g the tail end of an epidemic, but it 

seemed to break right in the middle. We can’t conclusively say one way or 

the other that we did or did not stop the epidemic, but we do know that a 

l>erson who is fed this vaccine will begin to show the presence of virus in the 

stools on the third or fou rth day after feeding indicating th at the cells in 

the gut are infected. Type II sheds for a maximum period of two weeks; 

type I for about a month; and type II I stays within the norm of 6 weeks. 

We find circulating antibodies in the blood on about the 9th or 10th day, and 

they reac h a maximum peak in about 30 days. By the end of 1 yea r they 

st ar t to decline gradually.

We have fed this vaccine under all kinds of conditions. We fed it in Finland, 

and in West Germany where prese ntly we are immunizing West Berlin. We 

sta rted the latte r on May 12. I checked this morning and they have alre ady 

fed 271,000 children and estimate that by the middle of Jun e they will have 

fed about 450,000 under 11 years of age. We’ve worked in France, Spain, 

Italy, Israel, slightly in Argentina, on a rather good scale in Montevideo, in 

Peru, Colombia, Nicaragua, Costa Rica, Haiti, heavily in Cuba, in California, 

Minnesota, New York, New Jerse y, and Florida, and in Canada, Japan, and 

Taiwan.

In Latin America we have worked with the approval of the local health 

officer and the Pan-American San itary Bureau. This year the entire country 

of Costa Rica has been singled out to be vaccinated because of the severe epidemic they experienced in 1954. About 3 weeks ago I heard from the Costa 

Rican Minister of Health that they have succeeded in feeding triv alent vaccine to 281,000 children of an estim ated 460,000 under the age of 11. There’s 

no point in going above that age, because by the time Costa Rican children 

are 10 or 11 years old, they have all had experience with the three types of 

polio. He reports a conversion rate of about 93 percent to types I and III, 

which independently confirms our conversion figures.

Other findings are of interest. In Cuba we carried ou t a study with Dr. Jua n 

Embil, Jr., who fed triv ale nt live poliovirus vaccine to children with acute 

infectious diseases such as, measles, mumps, influenza, and even typhoid fever 

to determin e contrain dications to the use of the vaccine. We found none.

Out of 360 pairs of blood (pre- and j>ost-vaccination) th at we tested from 

Cuban children of school age, we found 76 children who lacked antibodies to one 

type or another. Actually they had 91 antibody gaps in their type I, II, and II I 

antibody structures. A single feeding of triv alent vaccine filled in 80 of the 91 

gaps for a conversion rat e of 88 i>ercent, and converted 65 of the 76 children to 

a trip le positive sta tus for a conversion rat e of 86 percent.

In western Massachu setts where we tested 123 paired bloods, 67 individuals 

sta rte d out with 115 antibody gai>s. A single feeding of tr iva len t vaccine filled in 

104 of the 115 gaps for a conversion rate of 90.4 percent, and 56 out of the 67 

persons were converted to a trip le positive stage for a conversion rate of 84 

percent.

As you may know, in February this yea r Dade County including Miami began 

a countywide mass vaccination program with our trivalent vaccine. The data
INTENSIVE IMMUNIZATION PROGRAMS 107

from there are actua lly the best we’ve seen. Th at’s p artly because we corre cted 

the type II component, which has been giving us comparativ ely poorer results, 

by doubling the q uan tity of type I I virus in the vaccine. To give us an idea of the 

results, they sent us 300 coded pairs of blood. We received them in lots of 20, 

and all Ave knew was that each lot included 10 matching pairs.

Afte r the code was broken, we found they were all from young adults at the 

University of Miami. Of these 300 students, 101 were not trip le positives and 

25 (8 percent) were actually trip le negatives—they had no antibodies at all. 

This was a surpris ing fac t because in Flo rida’s subtropical climate they should 

have had plenty of experience with na tural polio infections, as well, perhaps, as 

exposure to Salk vaccine.

In the polio virgins we tilled in 25 of the 25 gaps for type I, the type responsible for 85 percent of paralytic polio cases. We tilled in 19 of the 25 gaps for 

type II, which accounts for 3 p ercent of p aralytic polio, for a conversion rate of 

76 percent. And we tilled in 23 of the 25 gaps for type III, which accounts for 

about 12 percent of paralytic polio, for a conversion rate of 92 percent. These 

gaps in the antibo dy structure of 25 triple negative, polio virgins were tilled in 

by a single feeding of trivalent vaccine.

In the group of 161 students not trip le positives, the conversion rates w’ere as 

follows: In type I 97 of 99 gaps tilled, 98 p ercent; in type II 70 of 79 gaps filled, 

89 percent; and in type III, 80 of 85 gaps, 94 percent. We tilled in a total of 

247 out of 263 antibody gaps for an overall conversion rat e of 94 percent on a 

single 2 cubic centimeter oral dose of triv ale nt modified live i>oliovirus vaccine.

I’ve talk ed long enough. The only other thing I can say is th at the live poliovirus vaccine is coming. It takes time. The one thing I am sure of in this 

life is th at the tru th always wins out.

Dr. Ratner. Dr. Cox’s vaccination figures deserve comparison with the 1954 

field tri als of the Salk vaccine. The Cox live poliovirus vaccine has now been 

used by many investigators in over 2.5 million people with millions more in the 

process of being vaccinated. The other two live virus vaccines under study have 

been used in additional millions. The question of safety has been paramoun t in 

the minds of these investigators. On the other hand, the Salk vaccine was used 

in only 400,000 i>ersons in a single field tri al in a study which assumed safe ty 

and was prim arily designed to determine effectiveness. These figures reinforce 

Dr. Greenberg’s thesis that the USPH S was premature in licensing the Salk 

vaccine and is now excessively overcautious in licensing the live virus vaccine.

Dr. Kleinman, will you bring this discussion to a close? Dr. Kleinman has 

recently spen t several months in Latin America studying firsth and the results 

of field tri als there.

Dr. Kleinman. I want to make a few points by taking you out of the laboratory and away from the sta tistician ’s computer without raking up the ghosts of 

long dead monkeys and waving the ir shrouds in your faces. In the final analysis 

the import-ant issue is, What does thi s vaccine do to people and among people? 

Our Minnesota studies demonstrate a number of things. I would like to bring 

these to your atte ntion because I feel w ork such a s this must go on on the American scene with in groups of people who have the same way of life to which you 

and I are accustomed.

First of all, the Minnesota studies are American in the sense that we’re using 

the vaccine in people who ar e living in a way we are accustomed to describe and 

and to understand. Secondly, the Minnesota studies were the first to put these 

modified poliovirus strain s into a community whose nature approximated our 

normal way of living. Prior to this, these strain s were used in isolated individuals and in institu tional environments. Thirdly, the Minnesota studies prove 

what has previously been d enied : that it is possible to do a controlled study w ith 

the oral live poliovirus vaccine. Finally, the Minnesota studies dem onstrate that 

it is possible to secure definitive results in a population which has had considerable experience with the Salk vaccine.

The importance of the Minnesota studies does not lie in their number, but 

rather in the ir design. I want to emphasize the word study. Even though we 

have involved 100,000 people in 1960, we still firmly believe we are studying 

the oral polio vaccine stra ins. Although the numbers are large, we are not 

carryin g out a mass immunizatio n program.

Important cha racteristics of our design ar e: (1) Our studies are placebo controlled. This includes the 100,000 people we are studying in 1960. (2) Our 

subjects receive complete public hea lth nursing and medical surveillance. We 

do not feed and forget. We feed and follow through. (3) Our sludies are
108 INTENSIVE IMMUNIZATION PROGRAMS

double-blind. Only one person, the stat istician, knows who is getting the vaccine and who is getting the placebo. On th e basis of our experience I can assure 

you that in your own community you can make a scientific and controlled 

study.

Now, briefly, what have we found in Minnesota?

We have found that these strain s are good antigens. They will produce a 

conversion from titers of less than four to an appreciably higher titer in 90 

percent of cases. Tyi>e II is the poorest. Type I and II I are both excellent.

We have found, within the limits of our numbers, that these vaccines are 

perfectly safe to use. Because our studies have been controlled, we can unequivocably state that there have been no reactions. Before I left Minnesota 

for Russia, more than 50,000 persons had been fed the vaccine in Minneapolis 

and St. Pau l, and we had checked out all re ports of illnesses that occurred shortly 

after feeding. I did this personally. In Minneapolis, where more than 30,000 

were fed, I had to make only 15 housecalls. What I saw was run of the mill. 

There was no central nervous system disease, just prodromes of measles, follicular tonsillitis, atopic derm atitis, and other conditions you normally And in a 

community.

We have found there is no great community sprea d of these viruses. Concern 

for spread has been a bugbear to many individuals. While these viruses will 

spread fairly rapidly and thoroughly within any one family, they will spread 

from household to household within the neighborhood only to the extent of 

5 to 14 percent, depending upon the type. So you don’t have to worry about 

creatin g an epidemic secondarily through the spread of viruses you originally 

fed.

We have found, by takin g time out to study their natural behavior, t ha t these 

modified viruses do everything that wild viruses do except produce the disease. 

In a certain percentage of vaccinees the virus can be recovered from the stool, 

of course. The fed stra ins can also be recovered from the pharynx, even through 

the person has circulating polio antibodies in the blood to begin with. And the 

virus can be recovered in the blood, which indicates a viremia following the 

feeding of these vaccines. Those persons with virus in the pharynx and in the 

blood have no subjective symptoms, however, and the examiner can see nothing 

objectively.

How long does the immunity last? We don’t know. In those that we have 

studied we know that after a year, even though there is a general drop in titer 

from the originally induced titer, the antibodies persisted in 50 to 80 percent 

of the adults, and in (53 to 75 percent of the children tested. This is in individuals in whom we are certain that it was we who produced the original antibody change. We are not including those who sta rted with either natural 

antibodies or Salk-produced antibodies. Other data show that the presence of 

the latte r have no additional effect.

My experience in Latin America is th is: Nobody can say th at an epidemic was 

stopped. There were no controlled studies there. But over a million people 

have been completely vaccinated without any incident at all and, in the countries 

of Latin America where temperaments are mercurial, emotions excitable, and 

hea lth departm ents political, I’m sure th at if an incident had occurred it would 

have come to our notice and to everybody else’s notice. The conversion rates 

in Colombia and other places are remarkably close to the conversion rates we 

achieved in Minnesota. I’ve gone over the Costa Rica data carefully. J am 

satisfied th at they have done a good job of surveillance, because the central 

nervous system disease tha t they have categorized at the end of a year’s observation is remarkably the same in content to w hat we have found in Minnesota.

There are a lot of imp ortant things we don’t know about this vaccine. Although we know that it’s a good antibody producer, we can’t actually say it will 

protect aga inst polio until we can measure it aga inst a direct challenge by the 

disease. This has not yet been done. Reasoning by analogy, however, we can 

assume, because of the antib ody responses, tha t it should protect aga inst the 

direct challenge by polio itself.

I am not sure that we yet know the optimum dosage schedule. It may be 

th at one feeding is not sufficient, ju st as one wild polio infection may not completely immunize a child. I don’t think we are quite su re how long the immunity 

is going to last. As I)r. Cox stated , it is not going to be lifelong, but what it ’s 

going to be in terms of years I don’t think anybody can tell. These are things 

for the fu ture to disclose.
INTENSIVE IMMUNIZATION PROGRAMS 109

In th e m ea nt im e, le t me as su re yo u from my dir ect ex pe rien ce in M in ne so ta 

and from my vi ca riou s but clo se co nta ct in Dad e Co un ty, Fl a., an d from my 

ex pe rien ce in Sou th an d C en tral America, th a t th es e st ra in s are sa fe . Fr om 

th e la bo ra to ry st an dpoin t they are jx ite nt an tig en s. T he Cox live po lio vi ru s 

va cc ine is w or th y of th e co ns id er at io n of peop le wh o are w or ki ng in pr ev en tive 

med icine an d pu blic he al th . I do hope th a t more peop le will pa y mor e an d mo re 

att enti on to th eir us e in th is co un try, be ca us e it is th e d ata gat her ed in th is 

co un try th a t will ul tim at el y co un t in gra nti ng th e lic en se an d in ga in in g un iver sa l us e o f h is p art ic u la r pr ep ar at io n.

Dr. R atn er. We ha ve at te m pt ed in th is pa ne l disc us sion to pre se nt you w ith 

a sober, ca nd id ex po sitio n of th e fa cts as we know them an d as th ey re la te to 

curr ent qu es tion s su rr ou nd in g de cision s to be mad e in th e us e of Sa lk, an d or al 

liv e vi ru s vaccines. I hope you reco gn ize th a t th e pan el is ts ha ve show n un us ua l 

fre ed om fr om e xtra -sci en tif ic co nsi der at io ns an d pr es su re s.

D ur in g th e 1960 jxd io seaso n, ep idem ics may occur. To d ra m ati ze th e u rgen cy 

of th e de cis ion inv olv ed, remem be r th e fu ti li ty of u sing th e Sa lk va cc ine to c om ­

bat ep idem ics de sp ite it s pro ven ineffectiven es s in ep idem ics simply be ca us e it 

is th e on ly vacc ine av ai la bl e to us. An ob ject ive an d fe ar le ss ev al uat io n of the 

Sa lk va cc ine is needed, fo r th is is th e ne ce ss ar y in gre di en t of an in te llig en t decision as to wh en th e liv e vir us va cc ine sh ou ld be lic ensed . Obv iously, if th e 

Sa lk va cc ine is simul tane ou sly sa fe and high ly eff ective, th e U.S. Pu blic H ea lth 

Se rvice ca n ta ke it s tim e ab ou t lic en sing th e liv e vir us vaccine . If, on th e 

oth er ha nd , i>olio and polio ep idem ics re m ai n w ith us, an d ch ildr en become p ara ­

lyz ed de sp ite th re e, fo ur , five, an d six in oc ul at io ns of Sa lk vaccine , an d va ccinees 

die, we ca nn ot t ak e o ur tim e.

[R ep ri nte d fro m th e Jo urn al of th e American Me dic al As sociation, Feb. 25, 196 1] 

P ol iomy elitis I mm un iza tio n

To tii e E dito r: If we as su m e th a t a yea rl y bo os te r in jectio n of po lio mye lit is 

va cc ine is ne ed ed be ca us e of th e lack of po tenc y in th e pr es en t in je ct ab le va ccin e, ar e we no t in co ns iste nt in pr in ci pl e to s ay th a t th e pat ie nt who had th e l ast 

in je ct io n—b e it th e th ir d or th e fo urt h—2 to 4 year s ago can ge t th e same pr otect io n by on ly on e bo os te r in je ct io n as th e one wh o ha d th e la st in je ct io n 1 

year ag o? Furt herm ore , is it tr ue th a t by next yea r th e or al va cc ine wi ll ha ve 

solved th is prob lem .

M.D., Wiscon sin.

A n sw er: T he qu es tion righ tly reco gn izes th a t reco mmen da tio ns of ad di tional 

in je ct io ns of th e Sal k va cc ine re la te to it s low an d va riab le poten cy. On 

Apr il 19, 1955, on ly 7 da ys aft e r th e F ra ncis rei>ort an d th e pr om ul ga tio n of 

m in im al re quir em en ts fo r th e lic en sing of th e vaccine, th e U.S. Pub lic H ea lth 

Se rv ice foun d it ne ce ss ar y to redu ce p oten cy st an d ard s by tw o- th irds . Th e prob ­

lem worsene d la te in 1955 wh en, to in su re sa fe ty , it was ne ce ss ar y to in trod uc e 

ad dit io nal fi lt ra ti on duri ng in ac tiva tion . Thi s additio nal filtra tion re su lte d in a 

10- to 30- fold loss in an tigen (I llin ois Med. J. 118 : 83 -9 3, 19 60 ; an d 118 : 160-1 68). 

Kelly an d D al ld orf (A mer. J. H.vg. 64 : 243-258 , 1956 ) reix>rte<l a 600-fold vari ation in th e po ten cy of th e Sa lk va cc ine on th e ope n m ar ket fro m negli gib le 

po tenc y up w ar d. The dif ficulty ltecam e en ha nc ed wh en, on May 17, 1957, th e 

Division of Biologica l S ta ndard s per m itte d lo ts of va ccine wh ich ha d fa ile d to 

mee t minim um po tenc y re qu ir em en ts to be re te sted , so th at if th e m an ufa ct ure r 

th en ob tain ed a po sitive po tenc y te st , earl ie r ne ga tive te st s could be di sr eg ar de d. 

I t is now ge ne ra lly reco gn ized th a t mu ch of th e Sal k vaccine used in th e Un ite d 

S ta te s ha s been w or thle ss.

J t fol low s, th en , th a t th e tr u e issu e fo r th e ph ys ician an d pat ie nt is no t how 

m an y in je ctio ns , or how often, but w het her th e va cc ine giv en or to l>e giv en 

co nta in s de pe nd ab le a m oun ts of viral a nt ig en . W ith th e Sa lk vaccine th is ca nn ot 

be de te rm in ed be ca us e it is an uns ta ndar diz ed pr od uc t of an unst an dan lize d 

pro cess. The re fo re , fo r th e ph ys ician wh o pre fe rs to know w hat h e is giv ing , th e 

choic e re st s w ith eit h er th e re ce nt ly lic en sed kille d po lio vi ru s va ccine wh ich is 

co nc en trat ed to a kn ow n an d op tim al w ei gh t of in ac tivat ed vir us an tig en , an d 

which ha s su bst it ute d th e P ark er st ra in fo r th e dan ge ro us Ma ho ney st ra in , or 

w ith th e st andar diz ed at te nuate d liv e po lio vi ru s va cc ine prom ise d fo r nex t 

sp ring . In eit her in stan ce , a comp let e co ur se of va cc in at io n is in di ca ted, ir re ­

sp ec tive of the n um be r o f in je ctio ns of th e Sa lk va cc ine g iven.

H erbert R atner, M.D.
110 INTENSIVE IMMUNIZATION PROGRAMS

[Pr om the Chicago Sunday Tribun e magazine, Mar. 5, 1961]

T h e T ruth About t h e P olio Vaccin es

D o Salk Shots Really Prev ent Polio? Should We Keep Using Salk Inoculations? 

How Good Are the New Oral Vaccines? Here Are the Facts 

(By Joan Beck)

Behind glowing reports of the Salk polio vaccine’s success and even rosier 

predictions about the new, live, oral Sabin vaccine rages a storm of medical controversy th at seldom reaches the ears of parents.

Many serious criticisms have been leveled at the Salk vaccine. These are 

now being acknowledged—at least indirectly—in announcements praising and 

promoting the new oral vaccines.

Yet all is not yet sweetness and accord among developers of the live, oral 

vaccines, either. At leas t three different types have been developed and— 

according to their producers—proved safe and effective in tests, chiefly in foreign countries, but also in th e United States.

One of these new oral vaccines, developed by Dr. Albert Sabin with National 

Foundation research funds, has been OK'd by the U.S. Public Health Service 

for manufacture. But there are problems remaining to be solved in its production and, according to aeommittee of experts headed by Dr. Roderick 

Murray, of the National Ins titu tes of Health, dangers to be considered in its 

use by the general public (altho ugh it has been given to a reported 77 million 

Russians and to at least 300,000 Americans. Russian Prof. Mikhail Chumakov, 

who directed a 2-year program of inoculations with the Sabin vaccine, says 

he is convinced polio epidemics have been eliminate d in the Soviet Union). 

Licensing is not expected until this spring. Quantities of the vaccine are not 

expected to be available for communitywide use until November.

“Both ‘live’ (Sab in) and ‘killed’ (Salk) polio virus vaccines will be needed 

to combat poliomyelitis in the near future, U.S. public health officials declared 

at the AMA clinical meeting,” the Jou rna l of the American Medical Association reported in Decemlier 1960. “The new oral poliomyelitis vaccine developed 

by Dr. Albert Sabin and approved for futur e use in this country will not be 

the complete solution as fa r as can be predicted now, the Public H ealth Service 

experts said.”

Evaluating the tru e effectiveness of the Salk vaccine and the new oral 

vaccines has been difficult for several reasons. Polio is a relatively rare 

disease in the United States. Because so few persons get it in its paralyzing 

form, success of an immunizing agent is ha rd to determine.

The definition of polio also has changed in the last 6 or 7 years. Several 

diseases which were often diagnosed as ]>olio are now classified as aseptic 

meningitis or illnesses caused by one of the Coxsackie or Echo viruses. 

The number of polio cases in 1961 cannot accu rately be compared with those 

in, say 1952, because the criteria for diagnosis have changed.

Even the Salk vaccine itse lf is not a constant, sta ndard product. Since the 

first field trials of 1954, the vaccine has been changed several times. The 

first alte rnations were aimed at increasing the vaccine’s safety by changing 

the method of killin g the polio virus and by adding an extra filtration step. 

Newer changes are intended to increase the vaccine’s effectiveness. The success 

of the Salk vaccine necessarily varies, depending upon which Salk vaccine 

is being considered.

Ever since the public was first informed about the Salk vaccine in the 

Francis repo rt of April 12, 1955, the Natio nal Foundation has praised its 

effectiveness and urged par ents to have themselves and the ir children vaccinated. Although some physicians remained skeptical about the original theories 

behind the vaccine, about the techniques used in its evalu ation, and about its 

success in combating polio, these objections seldom reached the general public. 

With the resurgence of paralytic polio in 1958 and 1959, the criticism s increased.

These views were summed up by five experts in a panel discussion on the 

“Pre sent Status of Polio Vaccines” presented before the Illinois Sta te Medical 

Society in Chicago, in May 1960, and published in the August and September 

issues of the Illinois Medical Journal. To make paren ts aware of the controversy about the Salk vaccine and the problems involved in developing an 

effective oral vaccine against polio, here is a report of th at discussion:
INTENSIVE IMMUNIZATION PROGRAMS . _ W 6 2

SJU V 2

Moderator of the panel was Herbert Ratner, M.D., director \of public hea lth 

in Oak Park, and associate clinical professor of preventive niedh-ine an d public 

health, Stritch School of Medicine, Chicago.

Dr. Ratner noted the upward tren d in polio, particularly i 11 r h t f f i a - 

form, in the United States during 1958-59. lie quoted Dr. Alexan der 'IJfligmuir, in charge of polio surveillance for the U.S. Public Hea lth Sendee, as 

saying this resurgence is “cause for immediate concern.”

“In the fall of 1955, Dr. Langmuir had predicted that by 1957 there would 

be less than 100 cases of paralytic polio in the United States,” commented 

Dr. Ratner. “Fo ur years and 300 million doses of Salk vaccine later, we had 

in 1959 approximately 6,000 cases of paraltic polio, 1.000 of which were persons 

who had received three and more shots of Salk vaccine. Salk vaccine hasn’t 

lived up to expectations.”

Dr. Sabin says the number of cases in 1960 was less than in 1959, hut tha t 

23 percent are now occurring in persons who have had three or more doses 

of Salk vaccine.

Dr. Ratner next reviewed some basic facts about polio. Paralytic polio 

occurs in cycles and was in a natural decline when the Salk vaccine was 

introduced in 1955, he pointed out.

Prior to the introduction of the Salk vaccine, the National Foundation 

defined an epidemic as 20 or more cases of polio per year, i>er 100,000 population. Now, an epidemic is defined as 35 cases per year per 100,000. This 

change has resulted in a statistical—but not necessarily a real—drop in polio 

epidemics.

For every case of known paralytic polio, there are about a thousand “subclinical i>olio infections,” so mild they pass unnoticed, Dr. Ratner explained. 

These mild cases account for the high degree of natural immunity in adults 

You can have a polio infection in the intestines without having paralytic polio 

or nonpara lytic polio with enough symptoms to be diagnosed.

The theory of the Salk vaccine, made with killed i>olio virus, is that it will 

produce enough antibodies circ ulating in the blood to neutralize polio-virus 

before it can reach the central nervous system. But “one of the major 

disappointments of the killed vaccine” is that these circulating antibodies do 

not protect an individual aga inst getting a polio infection in the intestines, 

nor its brea kthrough into the circulatory system, said Dr. Ratner. Protection 

against paralysic polio depends upon the presence of enough circulating antibodies to offset the virus, he explained.

Discussing the “very misleading way” in which the Salk vaccine data has 

been handled, was Bernard G. Greenberg, Ph. D., head of the Departm ent of 

Biostatistic s of the University of North Carolina. School of Public Health, and 

former chairman of the Committee on Eva luation and Standa rds of the American Public Health Association.

“There has been a rise during the last 2 years in the incidence rates of p aralytic poliomyelitis in the United States,” stressed Dr. Greenberg. “The rat e 

in 1958 was about 50 percent higher than tha t for 1957, and in 1959 about 

80 percent higher than tha t in 1958. If 1959 is compared with the low year 

of 1957, the increase is about 170 percent.

“As a resu lt of this trend in paralytic poliomyelitis, various officials in the 

Public Health Service, official health agencies, and one large volu ntary health 

organization have been utilitizing the press, radio, and television and other 

media to sound an alar m bell in an heroic effort to persuade more Americans 

to take advanta ge of the vaccination procedures available to them,” said 

Dr. Greenberg.

“Although such a program might be desirable until live viru s vaccines are 

available to its on more than an expe rimental basis, the misinform ation and 

and unjustified conclusions about the cause of this rise in incidence give 

concern to those intereste d in a sound program based on logic and fac t rather 

than personal opinion and prejudice.

“One of the most obvious pieces of misinformation being delivered to the 

American public is that the 50-percent rise in paralytic poliomyelitis in 1958 

and the real accelerated increase in 1959 have been caused by persons failing 

to be vaccinated. This represents a certain amount of doubletalk and an unwillingness to face facts and to evaluate the tru e effectiveness of the Salk vaccine,” 

said Dr. Greenl>erg.

The number of persons over 2 years of age in 1960 who have not been vaccinated cannot be more and must be c onsiderably less than the number who had no
112 INTENSIVE IMMUNIZATION PROGRAMS

vaccination in 1957, I)r. Greenberg pointed out. Then how can it be claimed 

that it is the large number of unvaccinated persons who are causing the increase 

in polio, when there were a larg er number of unvaccinated individuals in 1957 

when the vaccine was given cred it for reducing r ate s of the disease?

“A scientific examination of the da ta and the man ner in which the data was 

man ipulated will reveal that the true effectiveness of tlie present Salk vaccine 

is unknown and greatly overrated ,” I)r. Greenberg stressed.

Why was there such a tremendous reduction in reported rates of para lytic 

polio in 1955-57? Much of this highly publicized decrease was a statistical 

illusion, said Dr. Greenberg.

Prior to 1954, any physician who reported a case of paralytic poliomyelitis 

was doing iris patient, a favo r because funds were ava ilable to help pay his medical 

expenses. At, t hat time, most health departments used a definition of paralytic 

poliomyetis which specified “partia l or complete paralysis of one or more muscle 

groups, detected on two examinations at least 24 hours ap art.” Laboratory 

confirm ation and the presence of residual paralysis were not required.

In 1955, these criteria were changed. Now, unless there is paralysis lasting 

at leas t (50 days after the onset of the disease, it is not diagnosed as para lytic 

polio.

During this period, too, “Coxsackie viru s infections and aseptic meningitis 

have been distinguished from paralytic poliomyelitis,” explained Dr. Greenberg. 

“Pr ior to 1954 large numbers of these cases undoubtedly were mislabeled as 

paralytic ix>lio.”

Thus, because the definition of the disease was changed and two similar diseases 

virtually ruled out, the number of cases of polio reported was sure to decrease 

in the 1955-57 period, vaccine or not. Then, too, physicians are relu ctant today 

to diagnose paralytic poliomyelitis in a vaccinated child without thorough laboratory tests, thu s elim inating most of the false positive cases commonly 

reported in the pre-1954 period.

“As a result of these changes in both diagnosis and diagnostic methods, the 

rates of paralytic poliomyelitis plummented from the early 1950’s to a low in 

1957,” said Dr. Greenberg. The recent increase in the disease, despite improved 

diagnostic methods, lie believes, is due to a long-term, increasing trend in the 

occurrence of polio.

“Without doubt, the increasing trend has been reduced to some extent by the 

Salk vaccine ” explained Dr. Greenberg. “Nevertheless, the Salk vaccine has 

limited effectiveness in its ability furth er to reduce this trend. * * * Any fu ture 

substan tial reduction in thi s trend will requ ire a more potent vaccine, not 

simply vaccinating more people.

"Today it may be a serious mistake to be ultra conservative in accepting the 

various new live vaccines under the impression th at there is no hurry because 

an almost equivalent immunizer exists in the Salk vaccine. A delay in accepting 

and promoting better vaccines will be a costly one. There must be immediate 

pressure applied to determine whether or not the new vaccines a re more effective, 

so tha t we do not cling, for sentimental or personal reasons, to an older vaccine 

whose true effectiveness is today unknown.”

The most accurate way we have of determining the effectiveness of vaccine 

(except by direct exposure to the disease) is to measure the levels of neutralizing 

antibodies in the blood, explained Herald R. (’ox. Sc. I)., director of viru s 

research at Lederle Laboratories and president-elect of the Society of American 

Bacteriologists. We do not know, he said, the exact level of antibodies necessary to protect against p aralytic polio.

Herman Kleinman, M.D., an epidemiologist from the Minnesota Depa rtment 

of Health, pointed out that in antibody studies on children who have received 

three or more doses of Salk vaccine, he has found more than half do not have 

antibodies to two of the thre e types of i>olio strain s used in the Salk vaccine. 

Twenty i>ereent lack antibodies to a third tyj>e.

“This is a very distu rbing fact,” said Dr. Kleinman. “If ix>lio antibodies 

mean anything in respect to protectiion, then I am forced to conclude th at much 

of the Salk vaccine we have been using is useless.”

Dr. Kleinman also commented on the “changing concept to polio” and said 

physicians were reluctant to diagnose the disease without overwhelming evidence. He called the insistence on a 60-day duration of paralysis in defining 

paralytic polio “silly.”

Dr. Cox, who has worked in the virus field since 1929 and was the first person 

to prove that a killed vaccine could be made, commented on some of the problems 

of producing a potent, killed-virus vaccine.
INTENSIVE IMMUNIZATION PROGRAMS 113

“W e are now lear ning , no t only in th e U nited Sta te s, but in Is ra el, Eng land , 

an d Den mark, th a t th e kille d pr od uc t does a fa ir ly good Job of pr od uc in g a n ti ­

bodie s ag ai nst ty pe II po lio viru s,” sa id Dr. Cox. “B ut ty pe II re pre se nts on ly 

ab ou t 3 pe rc en t of par aly ti c ca ses th ro ugho ut th e wo rld . The ki lled va cc ine 

does a j>oor job agai nst ty pe I, howe ver, wh ich ca us es 85 pe rc en t of para ly ti c 

cases , an d ag ai nst type I II, wh ich c au se s a bout 12 pe rc en t.

“I n ot her words , th e kille d vacc ine is do ing it s be st job again st th e le ast 

im po rt an t typ e. It too k tim e to find th is ou t. It was prov en in Is ra el in 1958, 

when it ha d its big ty pe I epidemic. The y did no t see an y differen ce in pro te ctio n betw ee n th e va cc in ated an d th e un va cc in at ed . L ast yea r in M as sa ch us et ts 

du ring a ty pe II I out br ea k, th er e were mor e para ly ti c ca se s in th e tr ip le va cci na te s th an in th e u nv ac ci na te d. ”

The re ha ve been prob lem s, too, in th e pr od uc tion of th e ki lled Sal k va cc ine. 

An extr a fi ltra tion st ep w as ad de d in No ve mb er 1955, Dr. Cox said, “b ec au se 

th e am ou nt of fo rm al in used did not in acti vate th e po lio viru s. W e foun d 

re si du al l ive vir us fo r as l on g as 42 c on se cu tiv e da ys of in ac tivat io n. ”

Dr. Cox w en t on to ass ert th at th e sec on d filtra tion st ep w as “p ick ed ou t 

of th in a ir w ith no ex pe rim en ta tion to ba ck it up ,” an d th a t th e ex tr a fi ltra tion 

cu t dow n on th e effecti ve ne ss of t he va ccine.

Mass va cc in atio n w ith th e Sa lk pr od uct sta rt e d in Apr il 1955 an d by April 

2G th er e were re port s of para ly ti c po lio am on g va cc in at ed ch ild re n, w ith dea th s 

oc cu rring in Id ah o an d C alifor ni a. Th en ca me ca se s of po lio am on g fam ily 

mem be rs of va cc in at ed ch ild re n. Li ve vir us w as discov ered in th e supp osed ly 

ki lle d vaccine, alth ou gh it ha d been pr od uc ed by th e Sa lk proc ed ur e.

Dr. R atn er cit ed nu mer ou s in st an ce s in whic h liv e vi ru se s w er e foun d in 

va cc ine whic h w as pr es um ab ly safe, even i n Dr. Sal k’s own st andard vaccines. 

“It shou ld be st re ss ed th a t sa fe ty te st in g was in ad eq uate whe n Dr. Sa lk develop ed th e va cc ine an d wh en th e va cc ine w as co mmercially pre pare d fo r th e 

field tr ia ls of 1954 an d fo r lic en sing an d us e in 1955,” sa id Dr. R at ner . H e 

ad de d th at in curr ent vaccine , po ten cy has bee n sacrifi ce d fo r sa fe ty an d th a t 

“a t pr es en t, ep ide miol og ic metho ds em ploy ed by th e U.S. Pu blic H ea lth Se rvice 

to a ss ure sa fe ty of th e va cc ine are inad eq ua te .”

Sh ou ld th e Sa lk v accine c on tin ue t o be us ed ?

“T her e is no kn ow n way of pre ve nt in g polio w ith a lic en sed pro du ct a t th e 

pr es en t tim e ex ce pt th ro ug h th e us e of th e Sa lk va cc in e,” an sw er ed Dr. Klein - 

man. “W hile I am an ag no stic ab out th e effecti ve ne ss of th e Sa lk vaccine, I 

st il l believe it does so m ethi ng in pr ev en ting par al ysi s. So we owe it to th e 

pu blic to reco mmen d it s use. On th e oth er ha nd , if we are go ing to a ct not only 

as pu blic he al th ph ys ic ia ns but a s sc ie ntist s we m ust c on tin ue ou r in ve st ig at io ns 

in to th e tr u th ab out th e Sa lk vaccine. On th e ba sis of t he fa ct s as I know the m, 

we m us t loo k fo r so m ethi ng bet te r. ”

O th er pa ne l mem be rs ag reed , po in ting out th a t be ca us e al l of th e fa cts ab ou t 

th e Sa lk va cc ine ha ve n ot b een mad e publi c, ph ys ic ia ns an d pu blic h ealt h officials 

find it difficult to re si st th e g re at pr es su re s of pu bl ic op ini on buil t up th ro ug h 

an un pr ec ed en ted pu bl ic ity ca mpa ign ur gin g th e pu blic to be va cc in ated .

“Sin ce no th in g else is av aila bl e, th ere seem s to be no alt ern ati ve but to pu sh 

th e us e of it .” co mmen ted Dr. Green be rg. “ I do n’t th in k we shou ld do so in 

igno ranc e, no r too co mp lac en tly , be lie ving th a t as lon g as we ha ve so mething 

part ia ll y eff ective, th er e is no need to ha ve so m ethi ng be tter . By be ing mo re 

ca ut io us , we may m ak e a m is ta ke b y ac ce pt in g a bett er po lio va cc ine too s lowl y.”

"W he n m ea su re d again st its kille d co unte rp ar t, a liv e virus va cc ine (u sing 

modified vi ru s which st im ula te th e pr od uc tio n of an tibo di es bu t do not ca us e the 

di se as e) is al w ay s a su per io r va cc ine,” as se rt ed Dr. Cox. H e sa id it in va riab ly 

co sts mu ch less. And it give s a hig her de gr ee of lo ng er la st in g im m un ity . Dr. 

Cox ha s develop ed a liv e va ccine wh ich was te st ed on th ou sa nd s of sc ho ol ch ild ren 

an d adults la st year in Dad e Co un ty, Fl a., an d al so on th ou sa nd s of pe rson s 

in foreign co un tries.

A no ther live , or al polio va cc ine has been develop ed by Dr. H ilary Kop rowsk i, 

of Philad el phia ’s W is ta r In st it ute , an d has bee n te st ed on ap pro xi m at el y 9 

million in di vi du al s.

Dr. Ko prow sk i has ch all en ge d th e U.S. Pub lic H ea lth Se rvice decis ion la st 

Aug us t to gra nt ap pr ov al only to th e Sa bin va cc ine. In a le tt er in th e Ja n u ­

ary 14 Jo urn al of th e American Medica l Assoc iatio n, he said, “A lth ou gh it is 

a st ep fo rw ar d th a t th e pr in cipl e of liv e vir us im m un iz atio n in po lio mye lit is has
114 INTENSIVE IMMUNIZATION PROGRAMS

at las t been officially accepted, I am taking stron g exception to this exclusive 

endorsement of one set of strains. In my opinion, such an endorsement should 

evoke a p rotest from individuals who believe that f air scientific ju dgment should 

be the basis for decisions affecting the physical welfare of man.”

Amplifying his letter, Dr. Koprowski said, “I t is my belief th at Government 

decisions, which are not based on prop er evaluatio n of scientific data, are 

prompted by eith er poor choice of scientific advisers or by cryptic reasoning 

and that such ill-advised decisions could lead to development of an unhealthy 

climate in which scientists will see their contributions tram pled upon by 

adm inistra tive agencies.”

Discussing the development of live, oral vaccines, Dr. Cox explained, “Polio 

is unique because many more people get the infection tha n the disease.” The 

problem in producing a live vaccine is to modify, or tame, the virus so t ha t they 

will produce a mild infection strong enough to stim ulate the form ation of an tibodies, but not the disease itself. A complicating factor in taming polio virus, 

is that thre e separate, tamed strains have to be developed to produce antibodies 

aga inst the thre e chief types of polio.

A killed vaccine, such as the Salk, does not immunize an individual aga inst 

an infection of polio viru s in the intestines and, although it can induce antibodies 

in the blood, this does not prevent the individual from becoming a car rier and 

spreading poliovirus, explained Dr. Cox.

Individuals receiving the live, modified, oral vaccines also eliminate poliovirus 

from their bodies for several days or several weeks after vaccination, but these 

are the tame, modified strains. Family contacts and even other indiv iduals in 

the neighborhood can also acquire an immunity from these tame virus, althou gh 

they have never received the vaccine themselves.

However, some expe rts still fea r that one of these strain s may rev ert to its 

virulent type as it is passed from one individual to another, according to a report 

by Dr. Roderick Murray’s committee, quoted in the October 15, 1960, issue of 

Modern Medicine. One solution, the committee suggested, might be to give the 

oral vaccine to entire communities in a brief time. This is a problem which 

must be solved before the Sabin vaccine is licensed.

Dr. Cox stated th at using a live vaccine is the only way to elim inate wild, 

virulent polio strain s in nature. Immunization with live vaccine probably 

would not protect a person for life, he added, but it would be cheap enough so 

you could afford it once a year.

Dr. Ratne r compared Dr. Cox’s vaccin ation figures with the 1954 field trials 

of the Salk vaccine. “The Cox live poliovirus has now been used by many investigato rs in over 2.5 million people, the other two live virus vaccines under 

study have been used in additional millions,” he said. “Safety has been paramount in the minds of these investigators.”

“On the other hand, Salk vaccine was used in only 400,000 persons in a single 

field tri al which assumed safety and was prim arily designed to determ ine 

effectiveness.

“An objective and fearless evaluation of the Salk vaccine is needed, for this is 

the necessary ingredient of an inte lligent decision as to when the live virus 

vaccine should be licensed,” Dr. Ra tne r continued. “Obviously, if the Salk vaccine is safe and highly effective, the U.S. Public Health Service can tak e its 

time about licensing the live virus vaccine.

“If, on the other hand, polio an d polio epidemics remain with us and children 

become paralyze d despite three, four, five, and six inoculations of Salk vaccine 

and vaccinees die, we cannot take our time.

What should parents do?

Take the advice of the ir pediatricia n or family doctor and not be stampeded 

by TV commercials or overly enthus iastic claims for vaccines. It is the individual physician who must decide which vaccine is safe and effective in what 

circumstances. Bu t physicians must have honest, impartial, fully scientific 

information available to make this decision.

Currently, most physicians are still giving Salk vaccine shots. A few doctors 

do not Some give them only if patients insist.

Once a live, oral vaccine is fully approved, it will be more effective tha n the 

killed Salk vaccine. Because of the doubt about the potency and effectiveness 

of the Salk vaccine in the past, a full course of the new vaccine will undoubtedly 

be recommended for everyone, regardless of how many Salk shots each individual 

has had.
INTENSIVE IMMUNIZATION PROGRAMS 115

[R ep rin ted from the Apr. 1, 1961, Issue of the Sa tu rd ay Review]

A Note on P olio

During the month of March 1961, the President of the United States, Joh n F. 

Kennedy, announced th at in the name of the American people he had a uthorized 

a gift of Salk “killed virus” polio vaccine to the people of Cuba to fight a polio 

epidemic on that unhappy island.

At least one physician who hea rd of the Pre sident’s action wired the White 

House an immediate warning that the Salk vaccine is known to be ineffective in 

stopping the spread of a going epidemic.

The warning wire pointed out that the Russian wooers of Cuba’s Fidel Castro 

are well acquainted with the superior effectiveness of oral live virus vaccines 

(the Sabin vaccine is only one of three) developed in this country and used 

widely in the U.S.S.R. but not yet available here.

It was after that wire was delivered that President Kennedy asked the Congress to app ropriate special funds for a standby supply of oral live viru s polio 

vaccine.

Who gave the President the poor advice th at led to the meaningless gift 

to Cuba?

SR’s science editor does not pretend to know. Bu t normal routes of responsibility in such ma tters lead to the U.S. Public Hea lth Service, which, along with 

the National Foundation for Inf antile Paralysis, has been pushing the Salk 

vaccine.

Around the same time that the President was being take n off balance, the 

Jou rna l of the American Medical Association published, in answer to a doctorreader ’s question, a statem ent by Dr. Herbe rt Ratner, public hea lth officer of 

Oak Park, Ill. (“la rge st village in the world” ), th at “it is now recognized th at 

much of the Salk vaccine used in the United States has been worthless * * * 

because it is an unstandardized product of an unstand ardized process.”

In a later issue of the Jou rna l there appeared a serie s of article s in which 

thre e U.S. Public Hea lth officials chorused th at (1) the Salk vaccine’s value had 

been greatly overestimated, and (2) the vaccine was still highly effective. 

Among the documents offered was the following graph, which shows the Salk 

vaccine’s effect on type 1 polio—the type th at causes most polio epidemics— 

below “the desired level” most of the time since the vaccine was issued in 1955:
116 INTENSIVE IMMUNIZATION PROGRAMS

[Fr om the Chicago Sun-Times, Apr. 16, 1962]

Polio Vaccine Virus P uzzles Scientist s

(By Earl Ubell)

(Special to the Sun-Times)

Atlantic City, N.J.—Those strange viruses found floating alive in both live 

and killed polio vaccines display increasingly disturbing peculiarities.

The viruses, called SV-40, come from monkey kidney cells grown in test tubes. 

The cells produce polio virus for the vaccines. The name stands for Simian 

Virus No. 40.

A year ago, it was reixirted for the first time th at something in the monkey 

cell cultures broth could cause cancer in hamsters. A few months ago, scientists 

at Merck & Co., identified that “something” as SV-40.

Now these same Merck researchers have found th at SV-40 will grow in human 

tissu e kept alive in a test tube. They will make the cells in those tissu es multiply 

at a greater rate.

Sunday another report said SV-40 can get into human tissue cells growing in 

test tubes and change the microscopic chromosomes, destroying one of the 46. 

Chromosomes chemically control the growth, shape, and function of all animal 

and plant cells. In some cancers scientists have found a chromosome missing.

For the last 3 days, virus and cancer exp erts attending the annu al session of 

the American Association for Cancer Research have pondered the meaning of 

this strange behavior. While the implications are obvious, there is no proof any 

of the conjectures are true.

conjecture no. i

SV-40 may cause cancer in human beings. This, of course, is the most frightening idea. Millions of persons have received Salk injections (killing the ]K)lio 

virus does not mean killing SV-40.

Now the latest work shows that SV-40 can grow in the tissue of human beings 

and cun make cells grow faster. But many viruses can do this with out causing 

cancer. However, the rei>ort on the chromosomes makes the cancer possibility 

somewhat stronger.

conjecture no. 2

SV-40 will be harmless. This is a strong possibility since many viruses which 

cause cancers in one animal will not do so in other animals. In fact, scientists 

have to set up special conditions in th eir anim als to make a virus produce cancer. 

Most often it means injecting the viruses at birth and sometimes before birth. 

The cancer then appears in the anim al’s middle age and old age.

Furtherm ore, there are hundreds of viruses circ ulating between animal and 

human populations. Some a re harmless to humans while they cause disease in 

animals.

conjecture no. 3

SV-40 may protect or vaccinate aga inst cancer. Since most cancer-causing 

viruses do the ir dirty work when injected into newborn anim als and since most 

persons received the ir polio inoculations after this period the effect of SV-40 

may be to vaccinate rather than to produce the tumors. However, this is a 

far-o ut idea, since nobody knows what SV—10 has to do with human cancer, if 

anything.

Mr. Miller. Th e National He alth Fe de ratio n is a national or ga nization of ind ivi duals th at are intere sted in free dom of choice in m at ­

ter s of health where the exercise of th at freedo m does no t en danger 

the life or health of anoth er and the reb y deny him the same righ t or 

freedom.

As an org ani zation , we neither end orse no r oppose vaccinatio n as 

a method of bu ild ing imm unity. Ma ny of ou r members believe in 

vaccination. Bu t all of our mem bers are opposed to com pulsory 

vaccination of those who do not believe in it where th ere is not a clea r 

and present danger to the health of those who are vaccina ted.

We dela re th at every vaccina tion law, na tio na lly or locally, sho uld 

have a pro tection o f conscience clause.
INTENSIVE IMMUNIZATION PROGRAMS 117

Yesterday a witness told this committee tha t compulsory vaccination 

had not prevented epidemics of diphtheria in his home State. I 

believe he testified that there had been two epidemics of diphtheria 

in his State in the past 6 years. In some States without compulsory 

vaccination law’s there have been no epidemics of diphtheria in the 

past 6 years.

There was no testimony that the epidemics broke out among unvaccinated segments of the population. If there is a compulsory vaccination law and if there is an epidemic, then w’e are left with the possibility tha t by itself vaccination may not be the whole answer to the 

prevention of communicable diseases in our country. There may be 

other factors such as sanitation and diet or unknown factors th at influence immunity.

Certainly under the light of these facts, no one should insist on 

compulsion in a matter of vaccination. The present bill should emphatically protect the rights of those who do not want to be vaccinated 

if it is contrary to their belief, which belief should include but is not 

limited to religious belief. We are happy to note that in the testimony yesterday and today, not a single proponent of the bill has 

recommended that compulsion be required. We were gratified to hear 

the testimony and amendment suggestions by I)r. Stokes representing 

the Christian Scientists. We support their stand, that it is not enough 

to have the verbal assurance of the committee that no compulsion is 

intended or implied or needed, but that this guarantee should be clearly 

stated in the bill.

We endorse the testimony and support the amendment introduced 

by the Christian Scientists. We believe, however, it should extend 

to those who do not believe in vaccination even though it is not a 

part of their religion.

We respectfully suggest that on page 3, line 12, after the word 

“population,” the follow ing amendment be added :

Provided, Th at no one shall be requ ired to be vaccinated or have the ir children 

or wards vaccinated if it is con trary to the ir belief, which belief may include 

but is not limited to religious beliefs.

In mass vaccination programs, it is common practice to omit or 

ignore information that, is contraindicated in preventing the case 

for vaccination to the public. There is a tendency to let the experts 

make the decisions afte r which they summarize the evidence in such 

press release statements as, “absolutely safe,” and other statements 

designed not to educate but to inspire confidence.

We point out tha t the tendency of the mass vaccination program 

is to “herd” people. People are not cattle or sheep. They should 

not be herded. A mass vaccination program carries a built-in temptation to oversimplify the problem, to exaggerate the bentfits, to 

minimize or completely ignore the hazards, to discourage or silence 

scholarly, thoughtful, and cautious opposition, to create an urgency 

where none exists, to whip up enthusiasm among citizens that can 

carry with it the seeds of impatience if not intolerance, to extend the 

concepts of police power, of the state in quarantine far beyond its 

proper limitations, to assume simplicity when there is actually great 

complexity, to continue support of a vaccine long after it has been 

discredited, to make a choice between two or more equally good vaccines and to promote one at the expense of the other, and to ridicule 

honest and informed dissent.

84426— 62----- 9
118 INTENSIVE IMMUNIZATION PROGRAMS

In conclusion, J oh n Stu ar t M ill has s ai d:

It often happens th at the universal belief of one age—a belief from which no 

one was free, nor with out an extraordin ary effort of genius could, at that time, 

be free —becomes to a subsequent age so palpable an absurdity that the only 

difficulty is to im agine how such a thing can ever have appe ared credible.

I t is conceivable th at a fu ture age may disdainfully look at our 

pre occupation wi th vaccinatio n. Indeed, the entire concept may be 

rep laced with anoth er app roach. In such an eventua lity , it would 

rec ord as statesm en or ty rant s the law makers who pro tected or 

tra mpled the r ight s of those who opposed the concepts fo r one reason 

or an othe r in th is age.

Tha nk you, Mr. Chairma n.

Th e Chairman. Th an k you very much , Mr. Miller, fo r your 

statem ent.

Mr. Sta ggers?

Mr. S taggers. I ha ve no questions.

Th e Chair man. Mr. Younger, any qu estions?

Mr. Younger. Yes.

Mr. Miller, th at amend ment th at you proposed, wherein does th at 

differ from the one th at D r. Stok es proposed here t he o ther day ?

Mr. Miller. I do no t hav e Dr. Stokes’ ame ndm ent. Bu t I believe 

th at it carried the requirem ent th at “i f it was con tra ry to the religio us 

belief.”

Now, ou r state me nt is, “ if it was con tra ry to thei r be lief.”

Mr. Younger. In other words, where they say, “nothin g in this 

section shall be con stru ed to require a St ate or a com munity to have 

a compulsory intensive vaccina tion p rogra m or to p rev ent t he ex emptio n of any person an d the child, infant, or wa rd of a ny person who 

object to immu nizatio n on religious gro unds. ” You ju st say, “who 

objects to imm unization.”

Mr. Miller. Tha t wou ld cover it or because “of th eir belief.”

Mr. Younger. Because of t he ir belief. In o ther words, you would 

insert “because of th ei r belief” instead of “on religious gro unds.”

Mr. Miller. I th ink we have it ph ras ed “because of their belief, 

wh ich belief m ay include b ut is no t lim ited to religious be lief,” because 

of t he tendency of m any people to assum e th at th ey are synonymous. 

“B eli ef” in a matter of this kind is assumed to be almost syno nymous 

wi th “reli gious belief” an d we wish to make the distinctio n.

Mr. Younger. Do yo u know wh eth er th at clause is used anywhere?

Mr. Miller. Th ere is a preced ent as some States are passing this 

amendment. In Califo rn ia in 1961 the leg islatu re passed assembly 

bill No. 1940.

Now, this is fro m 3384 of the b ill which was passed in th e last legislat ure, I presume, in Ca lifornia .

Mr. Younger. I s th at in connection wi th public he alth legi slation ?

Mr. Miller. Th is is immunizatio n. Maybe if I rea d the whole 

th in g it will be more clea r. Th is is polio immu niz ation fo r schoolchildren, No. 207. The bill was to pr oh ibit any mino r or adu lt fro m 

being admitted to a public or private ele me nta ry or secondary school 

unless the person had been immunized ag ains t poliom yelitis. I t c ar ­

rie d the ex emption that was gra nted if “ such immu niz ation is c on tra ry 

to his or h er beliefs.” I t does no t lim it the belief to a religious belief.

Mr. Younger. I t applies to schoolchildren.
INTENSIVE IMMUNIZATION PROGRAMS 119

Mr. Miller. Right.

Mr. Younger. It is not in general on public health but refers to a 

requirement to enter school.

Mr. Miller. Here, of course, the compulsory issue does not arise 

until they introduce their child in school. Might I point out th at in 

New Jersey we had a very unfortunate situation arise because the 

amendment tha t we are suggesting was not included in the New 

Jersey compulsory law.

A boy’s parents wanted to have him go to school. They didn’t believe in vaccination. I don’t know why they didn’t oelieve. It 

wasn’t reported in the paper, and they weren’t members of the National Health Federation, but it was reported they didn’t believe in 

it. The child couldn’t go to school and finally a fter several months 

the parents forced the issue by taking the child to school and insisting 

tha t he stay.

Without any legislative precedence to go by, the board gave them 

the fantastic alternative of signing a statement th at if it was contrary 

to their religious belief, the child could come to school. Well, they 

pointed out to the board it was not contrary to their religious belief. 

In a way they were being forced to sign a statement tha t was completely false as to their religious belief.

Now, were the amendment made to just include beliefs, then this 

very rare instance of opposition according to conscience would be 

solved so tha t the administrator on a local level wouldn’t be faced 

with this decision because it would be clear tha t it is a matter of conscience and not religion.

Mr. Younger. That is all, Mr. Chairman, except that I have a letter 

here which came to me this morning from Mr. and Mrs. Magee of 

Joshua Tree, Calif., in opposition. I wonder if I could ask tha t it 

be entered into the record? Would it be all right to put it in?

The Chairman. Yes.

Mr. Younger. They are members of Mr. Miller’s organization. 

Apparently that is the National Health Federation ?

Mr. Miller. Tha t is correct.

Mr. Younger. They are members of your organization, apparently. 

It is not from my district, but they wrote to me as a member of the 

committee and asked that their letter be made a part of the record.

The Chairman. Let it go in the record following this testimony of 

Mr. Miller.

(The letter referred to follows:)

J oshua Tree, Calif., May 11,1962.

Representative J . Arthur Younger,

House Office Building, Washington, D.C.

Dear Mb. Younger : Re, bill, H.R. 10541, red light bill. Representative Oren 

Ha rris , Arkansas.

Please list us as looking with disfavor on this bill, known as Vaccination 

Assistance Act of 1962 for control of polio and against other diseases.

The good of such procedure is controversial and the cost excessive.

Yours truly,

Charles B. and F emie Magee.

The C hairman. Mr. Hemphill ?

Mr. Hemphill. Thank you, Mr. Chairman.

Suppose it were in the national interest to vaccinate everybody in 

a given area. Would your organization oppose tha t ?
120 INTENSIVE IMMUNIZATION PROGRAMS

Mr. Miller. I believe, Representative Hemphill, that our statement is that we believe in freedom of choice in matters of vaccination 

where that freedom does not endanger the life or health of another.

Now, your analogy is not clear enough so that 1 could determine 

whether the national interest would be an arbitrary decision of some 

person in office or whether the national interest would be, th at if by 

refusing to be vaccinated, this group of people were endangering, 

clearly, the life and health of those who were vaccinated.

Now, we believe tha t freedom should be the rule up to the point 

where safety is endangered and at this point we would favor the national interests, I think, as you expressed it.

Mr. Hemiuiill. Well, you seek to hide behind the theory of an 

arbitrary decision, but I think that, you say on the one hand it might 

be an arbitrary decision. On the other hand, you say that the national 

theory of safety. I am thinking of the fact tha t the area seems to be 

getting and epidemic and the health authorities move in and say 

everybody ought to be vaccinated and someone says, it is against my 

religion. You wouldn’t carry it that far, would you, where other 

people would be affected, their lives and health, if an epidemic was 

allowed perhaps to continue?

Mr. Miller. Now I think you are getting fa r more specific and this 

I can answer very clearly.

The power of the State to quarantine is an obvious proper function 

of the State. We have no quarrel with this. The power of the State 

to vaccinate is a questionable power and a questionable extension of 

the power of quarantine which is a proper power.

Now, there has been no testimony before this committee and to my 

knowledge there is no testimony available which indicates that an 

unvaccinated person in any epidemic area is a hazard to those tha t are 

vaccinated.

Mr. Hemphill. No; and there has been no testimony before this 

committee either tha t the foods tha t you people say you want to substitute for this health preventative we are studying here can be gotten 

to the people. I am very much interested in your theories because I 

think you have something, but I think you have carried it to (lie extreme in saying tha t this is a substitute for something like the vaccination because the people—the reason we have to have a vaccination, 

that if, if you heard the testimony, a lot of people can’t even afford 

the vaccination, can’t afford the food which we would like them to 

have, diet. There I agree with you on the diet. Here we have a 

problem of stamping out disease and there has been nothing said here 

that says it cannot be accomplished.

Mr. Miller. Congressman, I am not quite sure what you intend 

by “we people” and our belief in foods. In my testimony there is 

no statement on foods which I think indicates the stand we take 

on food. My introduction of Dr. Sandler’s book, “Diet Prevents 

Polio,” and the other articles I listed on page 17 was to point out 

that there is a far from unanimous view within the medical profession on the subject of vaccination. We do not as an organization 

endorse the views of Dr. Sandler any more than we endorse or 

oppose the views of vaccination. We felt tha t his booklet with his
INTENSIVE IMMUNIZATION PROGRAMS 121

thesis would be helpful. It is one of the most enlightened books 

tha t has been written in the matter of diet in relationship to polio, 

and we submitted it for the record with that intent in mind, not with 

the idea of defending his theory.

Mr. Hemphill. 1 thank the gentleman. I am going to read this 

with a great deal of interest because I am very much interested in 

what you have to say.

Mr. Miller. I appreciate your questions.

Mr. Hemphill. Thank you, Mr. Chairman.

The Chairman. Mr. Nelsen?

Mr. N elsen. No questions.

The Chairman. Mr. Miller, thank you very much for your testimony to this committee on this subject.

The next witness will be Dr. Miles II. Robinson.

Dr. Robinson, we will be glad to have your statement.

STATEM ENT OF DR. MIL ES H. ROBINSON, POTOMAC, MD.

Dr. Robinson. Mr. Chairman and members of the committee, I 

am Miles II. Robinson, a graduate of the University of Pennsylvania 

Medical School in Philadelphia, and for the last 20 years I have 

been in the practice of internal medicine in Washington State and 

in Maryland with the exception of 4 years teaching and doing medical research in physiology and pharmacology at Vanderbilt Medical 

School in Nashville, Tenn., and at the University of Pennsylvania 

Medical School.

I am appearing in the capacity of an independent physician in 

support of this bill, H.R. 10541. I believe the country needs this 

bill not only because our public health officers have a long and distinguished record of public service and can be trusted with additional 

Federal funds to do their good work, but also because we have 

reached a point where the Federal Government is justified in playing a more active role in health matters, especially in furnishing 

unbiased information to the public.

Private medical enterprise, generally speaking, has become too 

narrow in its outlook, in both the prevention and treatment of disease, and the Federal Government is the only agency with enough 

power and enough inherent responsibility to the people to coordinate 

properly what is known about health and disease, to educate the 

public, and to control a number of abuses increasingly inflicted on 

the public by various private interests.

The most recent strong evidence to show what the national government of a nation can do, and which only it can do, for health is 

described in Time magazine for April 20, 1962. On page 37 it is 

reported that Great Britain has just levied a 15-percent tax on candy, 

ice cream, and soft drinks specifically aimed at bringing in $140 million a year which, the article states, is just the amount of money 

Brita in's National Health Service pays the dentists in their effort 

to check the damage to English teeth caused by the consumption of 

candy and other sweet stuffs.

I am attaching a photocopy of this Time article to this statement.
122 INTENSIVE IMMUNIZATION PROGRAMS

(The d ocu ment follow s:)

[F ro m Time mag az ine, Ap r. 20, 19621

Great Britain

T H E LO LL IPOP BUDGET

Britons gobble more candy per capita (8 oz. weekly) than any other people 

in the world. As a result, they also have more toothaches tha n most—which 

has no appar ent effect on candy consumption but causes a perp etua l headache 

in the higher echelons of government, since the gre at majority of Br ita in’s 

population gets its teeth fixed for nominal fees by the National Health Service. 

Though it collects taxes on every other luxury from dancing to death, the 

Government has never levied a tax on sweets, as the British call the ir favo rite 

vice.

Last week Chancellor of the Exchequer Selwyn Lloyd, a man never hitherto 

famed for political audacity, slapped a 15-percent tax on candy, ice cream, 

and soda pop. Britons, shocked to their cavities by what many soon called the 

lollipop budget, protested that it was a “tax on children,” though craving for 

candy knows no age limits. The Government will collect $140 million a year 

from the sweet-tooth tax —which makes it a classic bit of budget balancing, 

since the Government now pays exactly $140 million yearly to den tists to repair 

the damage.

Dr . Robinson. Lest the committee surm ise th at this Br itish legislatio n is merely a sho t in the d ark, I sta te with confidence th at every 

well-info rmed denti st and doctor in this cou ntry has k now n fo r many 

years th at the high intake of su ga r in food is fa r and away the 

most im po rta nt cause of tooth dec ay; th at experime nta lly, the stan dar d method for producing too th decay in animals is merely to feed 

the m sugared food. Recen t studies at the Na tio nal In stitu tes of 

Hea lth have also implicated our high sugar con sum ptio n with our 

high inciden ce of he alt h disease.

Th e significance of the Britis h achievem ent in striki ng at the real 

cause of a disease, in this case disease of the teeth, in contr ast to 

the sit ua tio n in thi s country where the public is given pra ctically 

no adequ ate inf orma tio n on this pa rti cu lar disease, the significance 

is th at only the Government is pow erful eno ugh to oppose a pow erfu l pr ivate group like the suga r indu str y which has immense fun ds 

to advertise its pro ducts an d to sup press the fac ts of hea lth.

In othe r words, the Fe de ral Governme nt sho uld pa rticipate in 

he alth matters in any area where private med ical enter pri se has 

exhib ited unreasona ble dela y, as it has in this case abo ut sugar over 

ma ny yea rs, and lack o f inter est in ge tting done the tasks which m ust 

be done to make the peop le of this c ountry he alt hy and stro ng.

W ith rega rd to the amend ment to this bill specifically exc luding 

com pulsory immu nizatio n, I believe thi s should be done in order to 

preserv e to some exten t a bala nce o f power between the orthodox and 

unorthodox elements of our population , the com pet ition between 

which is one of our best gu ara nte es of progress. In fac t, I am not 

certa in ju st which is rea lly the more orthodox or the more con servative, the Ch ris tia n Scien tist who depends upo n the anc ient str ength 

of pr ay er to keep himself in t une w ith the u niv erse or th e m edical docto r who gives the tra nq uilizers which constitu te over one-t hir d of all 

the drugs consumed in t his c ountry today.

Peo ple such as the Ch ris tia n Scientists, or the hygie nis ts, who are 

determ ined to depend as m uch as possible on simple, wholesome me thods to insure health should hav e the privilege of demo ns tra tin g the 

wo rth of their system to th eir followers and to others. They cannot
INTE NSIV E IMMUNIZATION PROGRAMS 123

do this i f they are forced to submit to medical procedures, which procedures can then take more or less credit for successes which these 

people may achieve by their own methods. So long as their abstinence 

from immunization does not imperil the safety of others, it should be 

protected for the sake of progress, find as a check upon the natural 

tendency to abuse the principle of mass medication which, incidentally, may become very expensive in the future.

Such amendment specifying no compulsion will, 1 believe, actually 

strengthen the bill because it will make very clear to the public, as 

nothing else could, that the Government intends to win its case for 

immunizations by fair persuasion and argument while holding out at 

all times the hand of tolerance to the independent citizen.

Such a policy is our strength, by which we gain the allegiance of 

hearts and minds both at home and abroad.

I had one additional word to mention. It should be emphasized 

tha t the hazards of these new vaccines like the first one for polio have 

turned out to be much greater than anything we have experienced 

before, at least in recent times. I recently received a form letter from 

the Cutter Laboratories in California which has been mailed to every 

physician in the country (the essential contents of the letter were 

also published in Business Week Magazine, Feb. 24, 1962, pp. 139- 

146), stating that they have now settled out of court over $3 million 

in damages for deaths and paralyses tha t followed their defective 

vaccine. This lends added weight to the beliefs of any individuals 

who have reservations about being given these vaccines.

Thank you very much.

The Chairman. Dr. Robinson, thank you very much.

Mr. Hemphill?

Mr. H emphill. No questions, thank you, Mr. Chairman.

The Chairman. Mr. Younger?

Mr. Younger. Just one question, Mr. Chairman.

On the first page, th ird paragraph, you say—

to control a number of abuses increasingly inflicted on the public by various 

private interests. *

Outside of the sugar industry interests, I gather from your statement that you include the sugar interests. Now, what other interests 

did you have in mind ?

Dr. Robinson. Yes, sir. I am glad to answer that. The other 

serious situation in this country is the degermination of the flour; that 

is, taking the vitamins and the minerals out of the flour, which is done 

by the flour industry because the flour then keeps on the shelf and they 

make a double profit selling all those vitamins to the livestock industry 

in order to keep the animals healthy.

Now, th at has a very serious effect on the health of the Nation and 

has for years. Dr. Harvey Wiley, the first administrator and the 

founder, practically, of our Food and Drug Administration, did his 

unsuccessful best to stop the further emasculation of Hour by bleaching processes.

The reason that Nutrilite and these other vitamins have such a tre ­

mendous business is because they help put back B vitamins into the 

population. We have greater nervousness in this country, among 

other results, and heart disease is also related to the lack of B complex 

due to the injury to this flour.
124 INTENSIVE IMMUNIZATION PROGRAMS

So that is another thing. I don't mean that it is an intentional, 

deliberate harm inflicted by the flour industry. It is just a thing they 

drift into. The same as the Coca-Cola people and the sugar people, 

they dri ft into this and find tha t they cannot afford to care and do 

not care what the effect is on the health of the Nation.

Mr. Hempiiill. Will the gentleman yield to me at this point?

Mr. Y ounger. I will be happy to, sir.

Mr. Hempiiill. Then under the theory would cornbread be more 

nutritious and have more vitamins than white loafbread?

Dr. Robinson. Well, if you get your cornbread made in the South 

where a tradition still exists for preserving the germ in the corn meal, 

or have it ground by a mill which does not take the germ out, it is 

infinitely more nutritious. For example, there is a company in North 

Wilkesboro, N.C., that makes small electric mills especially for people 

who want real corn meal. But you go to any store in this country and 

try to buy corn meal and almost every bit of it is degerminated. It 

has had—it is like taking the yolk out of the egg. It has had the good 

taken out, and that is given to the animals and we get what is left.

Mr. II emphill. Thank you, sir.

The Chairman. Will the gentleman permit interruption?

Mr. Y OUNGER. Yes.

The Chairman. Do you mean by that that they take the kernel out 

of the grain?

Dr. Robinson. Well, sir, they take out what the mice especially 

prefer to eat, which can be seen when you look through the corn crib 

and look at the little kernels of the corn. He eats that little nugget 

at the point of the corn kernel which contains all the best of the coni. 

This is what the millers take out, and they have l>een doing this for 

90 years since the roller mill was invented in Austria.

The C hairman. Since when ?

Dr. Robinson. About 90 years, since the roller mill was invented 

in Austria, which allows high-speed separation of the different comjxments of the grain.

The Chairman. Tha t is very interesting information indeed. I 

don’t think I knew that before. •

M r. Younger. That is quite an addition to our testimony. You 

would advocate whole wheat flour, then.

Dr. Robinson. Yes, sir, and there is ample precedence for this. 

In World War I Dr. Hinhede, of Denmark, was given power to 

save the Danish people from starvation and he told them to sell their 

animals to the Germans and to eat the whole grain themselves. It 

is in the record of the medical annals that the health of the Danes 

was never higher at any time than when they went on whole grain 

during th at war.

Furthermore, during the last war in England, because the British 

had less in the way of food, they increased the amount of vitamins 

tha t were left in the flour purposely to sustain the strength of the 

nation but then when the war was over, they dropped back.

Mr. H empiiill. Will the gentleman yield to me ?

How about hominy grits? They serve hominy grits down here 

and I eat them about every morning. Is yellow hominy better than 

white ?

Dr. Robinson. No, sir. It would not matter as to the color. What 

matters is, did they or did they not take the germ out of th at kernel of
INTENSIV E IMMUNIZATION PROGRAMS 125

com? You cannot tell that by looking at it, but you can tell by 

tasting it.

Mr. Hemphill. What is the difference in the taste?

Dr. Robinson. Well, it just has a better taste, a nutty flavor.

Mr. Hemphill. I agree cornbread is a lot better than any other 

bread, but 1 didn't know about hominy. You can taste the difference 

in hominy grits, too?

Dr. Robinson. Well, sir, if you have them both together, those 

made from natural whole corn and those made from degerminated 

corn, you can.

Mr. Hemphill. I thank the gentleman. I am very much interested 

in what he has to say. Thank you, sir.

Mr. Younger. Thank you very much for your contribution which 

is something new in what we have had in the committee prior to this 

time.

Thank you, Mr. Chairman.

The Chairman. Well, I suppose the thing we should do is go back 

to the old gristmills where we carried the corn for a mile and let them 

take so much out of each bushel for grinding it up for us.

Dr. Robinson. Well, sir, T think we will come to that because electric 

power in every home makes it possible. There is also the factor of 

having the flour freshly ground, in which state it is more nutritious 

and has a better flavor. We have been grinding our own grain for 

10 years and making all our own bread also, and quite a few other 

people have.

The Chairman. Where do you get your grain ?

Dr. Robinson. You can get it everywhere. You can have 100 

pounds of grain shipped from California, or any State, to any other 

State for $5. You buy the straight wheat or straight coni.

The Chairman. 1 am talking about cornbread now. I am talking 

about taking the germ out of the grain of corn.

Off the record.

(Discussion off the record.)

The Chairman. Well, thank you very much. It was a very interesting discourse. We are glad to have had you with us.

Dr. Robinson. Thank you.

(The following additional material was later submitted by Dr. 

Robinson:)

Sup pl em en ta l Statem ent of Miles H. R obinson, M.D., in Supp ort of

II.R . 10541

Mr . C ha irm an an d mem be rs of th e co m m itte e; In ord er to su bst anti ate f u rt h e r 

th e testim on y I pr es en te d to y ou y es te rd ay th a t ou r Fed er al G ov er nm en t is fu lly 

ju st ifie d in pl ay in g a la rg er ro le in hea lth m at te rs , I enclo se ad ditio nal ph otost ati c evide nc e.

In my first st ate m ent I cited, as an ex am ple, di se as es of th e te et h, an d ca lle d 

att enti on to th e le gi slatio n ju s t en ac te d by th e B ritish Gov ernm en t to cu rb 

th es e di se as es a t th eir sou rce by a ta x on sw ee tstuffs.

I po inted out th a t we in th is co un tr y are ham st ru ng by th e nar ro w ou tlo ok 

of ou r p ri vate med ical en te rp ri se s as a wh ole an d by th e all-p ow erfu l adv er tisi ng 

dollar of th e s ugar an d oth er i ndust ri es affe ctin g he al th .

To do cu men t th e ch ar ge of nar ro w pr of es sion al outlo ok , I now off er th e en ­

closed photo st at of a ne ws art ic le from th e W as hi ng ton P ost pu blishe d 

M arch 14, 1961, de sc ribing a re port m ad e by a tr ust ee of th e American Den ta l 

Assoc iatio n a t th e denti st s’ annual co nv en tio n he re in W as hi ng ton. T his re po rt 

cite d a “$500,000 su rv ey ” of the N ation’s den ta l hea lth m ad e by th e American 

Counc il on Edu ca tio n.
126 INTENSIVE IMMUNIZATION PROGRAMS

This council, not a Federal agency, inform ed me this morning that the foregoing survey was jointly financed by the American Dental Association and by 

the American dental schools. According to the article, the survey found that 

our Nation’s dental health was in dire sta te for four chief reasons, all of them 

concerned with not going to dentis ts for enough treatment.

Yet the real cause of the majority of tooth disease, our high sugar intake, well 

known to the dentists who financed this survey, is completely ignored.

This survey, initiated, financed, and publicized by organized dentistry, demonstra tes, as I testified yesterday, tha t it is high time for the responsible power of 

the Federal Government to intervene and to control irresponsible private enterp rise in the field of health. The situatio n is the same in the broader medical 

field, evidence for which, I would be glad to submit.

H.R. 10541, which emphasizes a Federal program of information about vae> 

cines to the public, is a step in the righ t direction. The public today certainly 

cannot expect to get unbiased inform ation about health from organized dentistry, 

organized medicine, the food industry, or the drug industry.

We do not need to go to state medicine like the British. Our resources should 

make it possible to devise a program as good as or better than theirs, under 

which we can have both freedom and quality in medical care.

Wherever a private indu stry irresponsibly promotes products detrimenta l to 

health, it should be curbed by some combination of regulation and tax ati on; 

and we should set up an effective balance of power between private and public 

medical enterprise which will allow tru th about health to raise its head again, so 

people can see it and can know how to strengthen the ir physical and mental 

vitality.

(The article from the Washington Post referred to is as follows:)

[F ro m th e W as hing ton Pos t, Mar. 14, 196 1]

Seven H undred Mill ion Cavitie s—T eeth of Americans in Dire State, 

Survey Report Tells Den ti st s H ere

(By Nate Haseltine, Staff Reporter)

The d ire sta te of the Nation’s dental hea lth as uncovered by a 3-year, $500,000 

survey, was reported here yesterday to local and visiting dentists in annu al 

convention.

The still-to-be-published report shows th a t:

The U.S. population has about 700 million untrea ted cavities, an average of 

about 4 each for every man, woman, and child.

By age 50, almost half of all Americans suffer gum disease in some form.

By age 65, almo st everyone has gum troubles.

Two of every five Americans visit their dentist but once a year, for care 

ranging from adequate to barely minimum.

The survey findings were reported by Dr. Paul K. Musselman, of Newark, 

Del., member of the board of trustees of the American Dental Association, fo urth 

district, which includes the District of Columbia. Dr. Musselman’s report was 

made to an opening general meeting of the 3-day scientific sessions of the 29th 

postgraduate clinic of the Dis trict of Columbia Dental Society, at the Shoreham.

The special survey, Dr. Musselman said, was made by a professional team for 

the American Council on Education.

The experts, Dr. Musselman said, assigned four chief reasons fo r the c ountry’s 

poor dental health. These included (1) a low prio rity given dental care, even 

by those who can afford it ; (2) an insufficient number of d ent ists; (3) inab ility 

to pay, and (4) reluctan ce of d entists to adopt known means of increasing the ir 

work productivity.

The special survey was proposed by the ADA in 1957. Dr. Musselman said 

the survey is the most extensive study of dentistry ever conducted in the United 

States.

More than 3,000 den tists and the ir guests are participating in the scientific 

sessions.

The Chairman. At this time we will hear our colleague. Mrs. Leonor 

K. Sullivan. Mrs. Sullivan, we are glad to have you appear before 

the committee.
INTENSIVE IMMUNIZATION PROGRAMS 127

STATEMENT OF HON. LEONOR K. SULLIVA N, A RE PR ES EN TA TIVE 

IN CONGRESS FROM TH E STA TE OF MISSOU RI

Mrs. Sullivan. Chairman Harris and members of the committee, 

I want to make this brief statement wholeheartedly endorsing the 

concept of H.R. 10541, which carries out one of the important pro ­

visions of the health message sent to Congress by President Kennedy 

earlier this year. If we pass this legislation and appropriate the 

funds necessary to carry out the purposes of the bill, I am sure we 

can just about eradicate many diseases which medical science is able 

to conquer if only the children are vaccinated.

The bill mentions particularly poliomyelitis, diphtheria, whooping 

cough, and tetanus. Funds would be available to the States and 

communities for purchase of vaccines to inoculate all children under 

the age of 5, and for related expenses in maintaining surveillance 

over the effectiveness of the programs of mass vaccination. In addition—and this, I believe, is tremendously important for the future— 

the bill also provides for the grant of Federal funds to pay similar 

costs—

in connection with intensive community vaccination programs aga inst any 

other diseases of an infectious natur e which the Surgeon General finds rep resents a major public health problem in term s of high mortality, morbidity, 

disability, or epidemic potential and to be susceptible of practic al elimination 

as a public health problem through inten sive immunization activity over a 

limited period of time with vaccines or other preve ntive agents which may 

become available in the future.

If this program had been in effect 10 years ago, prior to the dramatic announcement in 1955 of the success of the Salk vaccine, we 

would have been set up to handle the polio immunization program 

in an intelligent and effective manner. Looking back on the atmosphere of the time 7 years ago when the Salk vaccine first became 

available for general use, we can all remember the near hysteria and 

the administrative fumbling which characterized the handling of this 

great medical achievement.

I still think t hat the bill I introduced tha t year would have solved 

the administrative and distribution problems quickly and effectively. 

As the members of this committee who served in the 84t.h Congress 

may remember, my bill would have authorized the Federal Government to purchase the entire available supply of Salk vaccine as it 

was produced and turn it over to the National Foundation for Infantile Paralysis for the free immunization of every child in the country 

under the age of 20, under priorities to be determined by the foundation—which had been responsible for developing the vaccine and 

which knew more about the relative needs and priorities than any 

other group in the Nation.

Because of the foundation’s reluctance to appear to be in the position of seeking Federal funds, the most I could obtain from that 

organization in the way of an endorsement of my bill was a statement 

tha t it would be willing to handle such an assignment if Congress 

so directed. The Eisenhower administration, on the other hand, felt 

tha t Federal grants for mass vaccination of children against polio 

should be used only for the indigent. It was a terribly contused 

and confusing situation at the time, and, as a result, we spent several
128 INTENSIVE IMMUNIZATION PROGRAMS

years before finally achieving an effective Federal-State program for 

use of the marvelous new vaccine against polio.

There is no emergency now—no hysteria—no crisis—in the availability of the various vaccines for combating diseases which strike 

primarily at children. Wha t we need now is a program which will 

assure tha t every child in the country, as a matter of right, is protected against polio, whooping cough, diphtheria, and tetanus—and 

any other serious diseases for which new vaccines may be developed.

Of course, none of these programs will work unless the parents 

participate and cooperate, or unless the communities find ways of 

reaching children who are being denied vaccination because of parental neglect. Every time a child is paralyzed from polio in this day 

and age, and it turns out th at the child did not receive polio vaccine, 

I think the adults responsible deserve public censure, if not criminal 

prosecution. We know how to end these diseases—but vaccines in 

test tubes and warehouses do not immunize children.

Therefore, I strongly support this bill.

The Chairman. Thank you for your testimony, Mrs. Sullivan.

Mrs. Sullivan. Thank you, Mr. Chairman.

The Chairman. A statement will be included in the record from 

Mrs. Iva Perdue, 6131 Webster Lane SE., Washington, D.C.

(The document follows:)

Statem ent of Mrs. I va P erdue

I am Mrs. Iva Perdue of (5131 Webster Lane SE., Washington, D.C. I am 

presiden t of the N atural Hygiene Society of Washington, D.C.

I am aga inst the proposed legislation known as the hill II.It. 10541, hy Mr. 

Harris of Arkansas.

I believe th at even though in a mino rity group each individual citizen 

of America is entitled to select his or her own way of living so long as it 

does not h ur t or jeopardize others in action or words.

I believe in the principles known and upheld by Natural Hygiene in regard 

to hea lth and disease.

I believe that every citizen has the right to select according to their own 

conscious convictions the method of life for the preservation of themselves and 

their underage children.

To perm it this bill—II.R. 10541, by Mr. Ha rris of Arkansas—to become a law would mean the loss of American liberty to all natural hygienists and 

all health -minded people who oppose various injections and vaccinations to 

be made upon the human body.

The natur al hygienists began over a century ago. One of our early leaders 

was Dr. Robert T. Trail, M.I)., who gave a 2%-hour address on the subjec t of “Tru e Healing Art” in the U.S. Smithsonian Institute, Washington, 

D.C., over 100 years ago.

Dr. Robert Walter, M.D., speaking in rega rd to disease said : “Disease is a 

na tural process of purification, and should not be stopped, but aided. Its 

remedies are na ture’s health preservatives, obedience to nature is its greatest 

panacea. Remove the cause and the effect will cease, is hygienic science.”

“Hygiene is th at branch of biology which investigates and applies the conditio ns upon which life and hea lth depend, and the means by which health 

is sustain ed in all its virtue and purity, and restored when lost.” (Form 

Hygienic Review, Herbert Shelton, M.I)., editor.)

Na tur al hygienists have many cha pters in American name ly: New York, 

N.Y., Detroit, Mich., Pittsburgh, I’a., Chicago, Ill., Washington, D.C., Buffalo 

N.Y., Los Angeles, Calif., San Diego. Calif., St. Louis, Mo.. Newark, N.J., 

Cleveland, Ohio, Escondido, Calif., San Diego, Calif., Toronto, Canada, Tampa, 

Fla., Philadelphia, I’a., Boston, Mass., West Palm Beach, Fla., and many 

others.

The na utral hygienists have a natural convention each year. In 1955 it 

was held in Washington, D.C. (July 5 -9), a t Shoreham Hotel.
INTENSIVE IMMUNIZATION PROGRAMS 129

I re gre t th a t man y hy gi en ists w er e no t aw are of th is heari ng u n ti l too 

la te be fore th e (le adlin e fo r fili ng a st at em en t. I am co nfiden t th ere a re 

th ou sa nd s of he alth -m inde d ci tize ns who wo uld oppo se th e bil l II.R . 10541, 

by Mr. H arr is of A rk an sa s. We hope th a t no ac tion wi ll be m ad e on th is 

bil l un til al l in te re st ed citiz en s of our la nd may be ale rt ed in ord er th a t th ey be 

per m itte d to voice th eir co nv ictio ns on th is also .

The Chairman. A statement from I)r. Irvin Dunsky, president of 

the Cincinnati Pediatric Society, the Children's Hospital, Cincinnati, 

Ohio, with numerous names attached thereto. Tha t shall be included 

in the record.

(The document follows:)

T he Child re n’s H ospit al, 

Ci nc inna ti, Ohio, A pri l 23, J962.

Co ng ressman Wilb ub I). Mil ls ,

Ch airm an , Hou se W ay s and Me an s Com mitt ee ,

Hou se Office Build ing, W as hing ton, D.C.

Dear Congress man : The Cin ci nn at i P edia tr ic So cie ty view s w ith gra ve conce rn pe nd ing le gi slatio n prop osed by th e adm in is trat io n th a t wou ld st ep b etwee n 

th e in fa n t an d ch ild , an d th e do ct or entr ust ed w ith th eir ca re. A G ov er nm en t 

im mun izatio n pr og ra m th a t wo uld w re st from th e ph ys ician th e re sp onsi bility 

fo r th e pr ev en tio n of di se as e wo uld de ny , o r se riou sly comp romi se, th e co nc ur ­

re nt su pe rv isor y hea lth ca re th a t at te nds such im m un izatio n in th e doct or’s 

ha nd s.

The high lev el of medica l ca re re nd er ed in fa nts an d ch ildr en in th e U ni te d 

Sta te s to da y is bo rn ou t of a co nc ep t of a p ri vate pa tien t- doct or re la tionsh ip 

th a t st re ss es co mpreh en siv e car e of th e wh ole ch ild , an d no t simply p a rt of 

th a t ch ild . Pr ev en tion of di se as e by al l m ea ns know n, includ ing im m un iz atio n, 

se t again st a ba ck grou nd of a pe rs on al an d co ntin ue d vigilanc e sh ou ld be th e 

ro le an d th e resp on sibi lity of th e do ctor , ve sted w ith th e t ota l care of th e ch ild . 

It shou ld, lik ew ise , co ntin ue to be th e pr iv ileg e of th e pati ent to rece iv e su ch 

im m un iz atio n from his own ph ys ician, an d not fro m a bu re au of Gov ernm en t.

Th e Cin ci nn at i Ped ia tr ic So cie ty, ac co rdingly, ur ge s yo ur op po sitio n to th e 

Ke nn ed y ad m in is tr ati on plan to in augura te a Gov ernm en t-s po ns ored na tion wid e, 

m as s va cc ine pr og ra m to im mun ize al l ch ildr en ag ai nst dip hth er ia , who op ing 

cou gh, te ta nus, an d polio—re ga rd le ss of are a of nee d. Th ese dis ea se s have 

been br oug ht unde r ex ce lle nt co nt ro l by th e pri vate ph ys ician an d do no t ca ll 

fo r su ch a m as s pr og ra m of Fed er al Gov ernm en t in te rv en tio n. Medica l se rv ic e 

an d im m un iz atio n fa ci lities ar e, moreover, av aila ble, thro ug h exis ting lo ca l 

hea lth ag en cies in si tu ati ons w her e unf or tu na te ly , a pri vat e doct or- pat ie nt 

re la tion sh ip may no t ex ist.

The at ta ched si gna tu re s, re pr es en ting do ctor s de vo ted ex clus ively to th e care 

an d w el fa re of ch ildr en , look fo r yo ur aid, by vo tin g ag ai nst th e afor em en tion ed 

Gov ernm en t prop os al.

Si nc erely yo urs,

T he Cin ci nnati P edia tric Society, 

I rvin Dunsk y, M.D., Pre side nt .

(Note.—The attached signatures referred to have been placed in 

the committee files.)

The Chairman. The American Medical Association desires to have 

a statement for the record with some suggestions, and they may have 

that privilege at this point in the record.

(The document follows:)

American Medical Asso cia tio n,

Chicag o, III., M ay 31, 1962.

Ho n. Oren H arr is,

Cha irm an , C om m itte e on In te rs ta te an d For eign Comm erc e,

Hou se o f Rep re se nta tive s, W as hi ng to n, D.C.

Dear Mr. Harris : The follo wing st ate m ent is su bm itte d on beh al f of th e 

American Med ica l Assoc iatio n w ith re sp ec t to H.R . 10541, 87 th Co ng res s, which 

is now be fo re yo ur co mm itt ee fo r co ns id er at io n.

T he pri m ar y pu rp os e of th is bill, a s in di ca te d in it s title, is to ass is t S ta te s 

an d co mm un iti es to carr y out in te ns iv e vac ci na tio n pr og ra m s again st po lio ­

mye lit is, dip hth er ia , who op ing cough, an d te ta nus .
130 INTENSIVE IMMUNIZATION PROGRAMS

The American Medical Association, which has for many years take n the lead 

in supporting and fur thering measures aimed at preventing as well as curing 

diseases, endorses the principle embodied in H.R. 10541.

Our house of delegates has on many occasions adopted policy resolutions 

urging immunization against polio, tetanus, and other communicable diseases 

for which vaccines exist. Although trad itionally it has been the policy of the 

American Medical Association to urge that the best mean s of administering 

vaccines is in the doctor’s office, with the family physician vaccinating his 

patients, we also have recognized that intensive immunization against communicable disease is a public health matter.

Sta te and county medical societies throughout the Nation have worked closely 

with local and county health departments in conducting immunization programs 

for many years. Tens of thousands of physicians have contributed the ir time 

and skill to such programs. The AMxV, in conjunction with the U.S. Public 

Health Service and voluntary health agencies, has also conducted and cooperated 

in vigorous campaigns to encourage community immunization aga inst communicable diseases.

Despite the rapidly declining incidence of poliomyelitis, diphtheria, pertussis, 

and teta nus under the impetus of years of intensive work on the part of the 

American Medical Association, State and county medical societies, public health 

officials, voluntary health organizations, and private physicians, there still is 

need for more complete immunization of the public, especially in polio and 

teta nus.

In the inte rest of improving the specific legislative proposal before you, the 

American Medical Association urges that II.It. 10541 be modified in certain 

respects.

First, in recognition of the well-established and accepted relationships between 

the U.S. Public Hea lth Service and the States, we believe th at it is prefe rable 

for Sta te health departm ents to work with local communities rathe r than for 

the local communities to deal directly with the Federal Government. In our 

opinion State and local authoritie s working together are in a better position to 

recognize and evaluate local needs for immunization and to develop balanced 

program s within the State. Likewise, in recognition of the effectiveness and 

desirab ility of existing and well-proven financing mechanisms, we believe tha t 

inten sive community vaccination programs should be financed through a matching grant formula under which the State provides a portion of the cost of the 

program and whereby Sta te determ ination and adm inistration is preserved.

Second, although the American Medical Association recognizes the scientifically established desirability of community immunization aga inst poliomyelitis, 

whooping cough, diph theria, and tetan us, we seriously question the desirability 

of vestin g the Surgeon General of the U.S. Public Health Service with plenary 

au tho rity to extend such community program to any and all infectious diseases 

witho ut the necessity of seeking congressional approval. When and if other 

infectious diseases are proven to be susceptible to practical elimination, as a 

public hea lth problem, through intensive immunization activities over a limited 

period of time, the Congress of the United States and the several States should 

have the opportunity to determine the necessity and appropriaten ess of a new 

Feder al program.

In summary, the American Medical Association endorses the principle of H.R. 

10541 as applied to the four infectious diseases named in the bill—poliomyelitis, 

diphtheria , whooping cough, and teta nus —but urges th at (1) the bill be limited 

to the four named diseases; (2) the bill be financed as a grant-in-aid program 

with th e States par ticipating on a matching formula basis : and (3) the programs 

be adm inistered by State h ealth departments, prese rving the well-established and 

accepted relationships between the U.S. Public Health Service and the States 

in m atte rs pertain ing to health.

We thank you for giving us the opportunity to express the views of the physicians of America concerning this important and vita l legislation. We respectfully request th at thi s statem ent by the American Medical Association be 

included in the prin ted record of the hearings on H.R. 10541, 87th Congress.

Sincerely yours,

F. J. L. Blasingame, M.D.

The Chairman. The record will remain open for a period of 1 week 

for the inclusion of such statements or other statements appropriately 

tha t should go in the record.
INTENSIVE IMMUNIZATION PROGRAMS 131

This concludes the hearing on this bill and with the thanks of the 

committee and the chairman, the committee is adjourned.

(The following material was submitted for the rec ord:)

McAllen, Tex., May 8, 1962.

Hon. Oben Harris,

Chairman, House Interstate and Foreign Commerce Committee,

House Office Building, Washington, D.C.

Dear Mb. Harris : The administration-backed proposal known as the mass 

vaccination bill or the Vaccination Assistance Act of 1962, H.R. 10541, is apparently a companion bill to S. 2910. These bills are, “to ass ist States and communities to carry out intensive vaccination programs designed to protect the ir 

population, especially all preschool children, aga inst poliomyelitis, diptheria, 

whooping cough and tetan us, and aga inst other diseases which may in the 

future become susceptible of practic al elimination as a public health problem 

through such programs.”

Mr. Harris , in this the county of Hidalgo, Tex., every community, and some 

of these are very small, has at lea st one immunization clinic per month for 

the above-mentioned diseases as well as for typhoid and small pox. In fact, 

there are 20 places in this county where clinics are located. The larges t town 

in the county, McAllen, has six immunization clinics a month. The 20 clinics 

meet a tota l of 45 times per month. No one in this county is over a few 

miles away from any of these clinics. Mr. Ha rris , the dep artm ent of public 

hea lth is doing an adequate job on this problem. The Hidalgo County Public 

Hea lth Departm ent carr ies out immunization, in addition to the above mentioned 

20 locations, in local schools a t times when such circumstances seem advisable. 

There are 44 employees, the ir salaries and the medicines are provided for by 

the local county and State of Texas. There is no need for a Fed era l program 

or assista nce in this county.

The bill leaves a large opening for future expansion of immunizations and 

control over local health situ ations by the Feder al Government, and if it is 

allowed to pass, you know more will follow.

You folks take care of the Potomac Fever there in Wash ington and we will 

take care of our own problems.

Sincerely,

Elinor E. Marsh, M.D.,

Acting Director of Hidalgo County Health Department.

P. D. Terrell, M.D.,

Pediatrician.

City of Cincinnati,

Office of Board of Health,

Cincinnati, Ohio, May 16, 1962.

Mr. Oben Harris,

Int ersta te and Foreign Commerce Committee,

House of Representatives, Washington, D.C.

Dear Mr. H arris : As a city hea lth commissioner, I write in suppo rt of H.R. 

10541, a bill, to assist States and communities to carry out intensive vaccination 

programs.

Although much has been done in the United States to prevent such diseases 

as smallpox, diphtheria, poliomyelitis, and the other dangerous communicable 

diseases for which preventive agents are available, there is no doubt whatsoever that there remain large numbers of children and adu lts unprotected, eith er 

because of economics or ignorance, or both.

Campaigns to educate the public as to the importance of having such protection are useless unless that section of the public which financially is unable 

to buy such protection can be provided by public means. It is true th at many 

communities have not been remiss in providing immunizations for the indigent, 

and Cincinnati has not been remiss in so doing, yet there is no doubt th at there 

are many communities which are not so fortunately placed for some reason 

or another.

Effective immunization programs ought to reach the larges t number of children and adu lts possible. Yet we speak of an effective level of immunization 

being attained when we att ain a figure of 75 percent or more. This merely 

underscores the point that 25 percent or more are not being immunized. If 

great publicly sponsored drives are made with private physicians doing their 

part in the ir offices, and health dep artm ents doing the ir pa rt for those who
132 INTENSIVE IMMUNIZATION PROGRAMS

cannot afford private care, then we may be able to do even better. This is 

what we did here in Cincinnati during the Sabin oral antipoliomyelitis vaccination program, which was a great success and has kept Cincinnati polio free for 

nearly 3 years. If Cincinnati can do it so can other communities. Bill II.R. 

10541 will help those communities who have been remiss to catch up.

Very truly yours,

Kenneth I. E. MacLeod, M.D., M.P.H.,

Commissioner of HeaMfo^

American Nurses’ Association, In«-1$jc

Vew York, V.Y., J/«// StlStyfdL

lion. Oren Harris, A

Chairman, Inters tate and Foreign Commerce Committee, \

House of Representatives, Washington, D.C. \$ f

Dear Mr. Harris : The American Nurses’ Association wishes to submifl 

the record its supp ort of II.It. 10541, to assist States and communities to cai^is 

out intensive vaccination programs designed to protect their populations, especially all preschool children, against poliomyelitis, diphtheria, whooping cough, 

and tetan us, and against other diseases which may in the futur e become 

susceptible of practic al elimination as a public health problem through such 

programs.

Some parents do not make protection aga inst these diseases available to 

the ir children, eith er because of ignorance or the- inability to pay. An intensive campaign of this nature could serve a dual purpose—th at of providing 

the immunization for the children and as an educational measure for the 

paren ts.

We would recommend, however, that all plans be made through the State 

health departm ent in each State and that gra nts to local or other subdivisions 

of a Sta te be made through the Sta ate health departmen t. This method of 

operation would contribute to an orderly program in each State that chose to 

par ticipate in the campaign.

Although the death rates from the diseases for which serums and vaccines 

are available have declined, there is still a large number of children who 

must go through life suffering handicaps as a result of survival. These are 

the children who have not been immunized. We believe that this legislation 

could have lasting value in the prevention and in the eventual erad ication of 

certain of the childhood diseases.

Sincerely,

Mrs. Judith G. Whitaker,

Exe cutive Secretary.

[Telegram]

Richmond, Va., May 11, 1962.

Chairman,

House Inter sta te and Foreign Commerce Committee,

House of Representatives, Washington, D.C.

Dear Sir : II.R. 1051 must lie defeated because it is socialized medicine; unnecessary Fed eral spending is ban kruptin g this country. It encourages compulsary medication laws. Recent research at the University of Utah Medical 

School indicates the tetan us, diph theria, and pertussis shots given babies has 

increased leukemia in 4-year-olds. Please insert this into hearings.

Mrs. Leslie Zodun.

[T el eg ra m ]

Quinton, Va., May I} , 1962.

Chairman,

House Inter sta te and Foreign Commerce Committee,

House of Representatives, Washington, D.C.

Kill II.R. 10541. It is socialized medicine and un-American. Please insert

this in hearing.

Mrs. J ulia Renai.ds.

(Whereupon, at 4 :20 p.m., the committee was adjourned.)