Dodging a bullet

Back in the 1950s, Sabin and Salk developed polio vaccines. Salk’s vaccine was inactivated. Sabin’s vaccine was live, but used a weakened strain, strong enough to cause an immune reaction, but weak enough not to cause polio. The live version was also infectious, which amplified its protective effect in the community.

The virus was weakened by passage through a number of cell cultures (live monkey, monkey testicular cultures, monkey kidney cells, etc).

Being a virus, it was grown in cell culture, derived from rhesus monkeys. The problem with all those live cell cultures was the possibility of picking up some other monkey virus. And that happened: 10-30 million Americans received vaccine contaminated with SV40 (Simian vacuolating virus 40) between 1955 and 1963. It is suspected that versions of the vaccine produced produced in the East Bloc may have been contaminated far longer, as late as 1980, which could have exposed several hundred million more people to SV40.

SV40 is pretty good at causing cancer in hamsters: there it causes sarcomas.

Does it cause cancer in humans? Some people claim to have found it in some cases of osteosarcoma, non-Hodgkins lymphoma, and mesothelioma (similar to the kinds of cancer in infected hamsters).

Currently it’s not clear whether SV40 causes cancer in humans – but it is clear that at worst, it causes very few such cancers.

It could have been worse. What if the contaminant had been HIV, instead of SV-40?

It wouldn’t have killed everybody. A fair fraction of people contracting HIV have flu-like symptoms a few weeks after. Usually the serious immune deficiency does not develop for at least three years – if the contaminant had been HIV, presumably the powers that be would have realized that something had gone wrong within a couple of years after the beginning of mass administration, because of the relatively few but dramatic early immunodeficiency cases. Even allowing for frantic defensive nonsense emitted by those people that stood to look bad from such a disaster. It might have been detected in the Francis Field Trial, in 1954 and 1955, where about 440,000 people were injected. I doubt if it would have killed more than a million people – mostly kids. No more than 10, 20 million killed, tops. I’m not counting later cases resulting from transmission via needle-sharing and sodomy.

The risk of picking up an unknown virus from cell culture had been discussed. Salk and Sabin were not as careful as they should have been. Overeager. Ambitious. Polio was scary and well worth fighting, but the potential downside went way, way down.

This does show that the price of insufficient medical vigilance can be very high.

Probably the largest existing example of death-by-medical-oopsie is the very high incidence of Hepatitis C in Egypt, which was spread by a mass anti-schistosomiasis campaign between 1960 and 1980, in which a goodly fraction of everyone in Egypt (~15%) seem to have been inoculated with the same needle, setting them up for cirrhosis and liver cancer.

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31 Responses to Dodging a bullet

  1. pyrrhus says:

    The good Doctors Salk and Sabin didn’t always dodge the bullet, or rather, their subjects didn’t.
    ” In the race to develop a safe and effective polio vaccine, accidents occurred with both types. In 1955, for instance, insufficiently killed virus in the vaccine from Cutter Laboratories in Berkeley, California, infected some 200 children; many were paralyzed and several died.”

  2. Old fogey says:

    Well, you have frightened me enough for one day, Dr. Cochran, especially since in the previous post’s comments section there were some voices who seemed to be saying that any effort to examine present vaccine regimens provided to children might give credence to “conspiracy theories.” Of course, I’m just an old fuddy-duddy, and therefore might not have read the commenters correctly, but I for one would like to see more attention paid to what substances are being injected into infants and young children.

  3. James says:

    Dang, I had the shot and two boosters and then when the sugar cubes came out I ate those too. Haven’t got cancer yet although I did get the “Asian flu” in 1958. Polio was a terrible thing back then, I remember classmates with heavy braces on their legs that had to use crutches to drag their legs around. I know one gal who suffered badly in the 1970’s from a post polio syndrome even though it had been 25 years since she had the disease. Still, even as imperfect as the vaccines might have been the net effect was far, far to the good.

  4. MawBTS says:

    Don’t forget haemophiliacs. In the 70s at least 10,000 of them were infected with HIV from infected clotting concentrate. Blood was considered safe in those days, and nobody screened donors. In the scenario you describe it would have been far worse.

    I doubt if it would have killed more than a million people – mostly kids. No more than 10, 20 million killed, tops. I’m not counting later cases resulting from transmission via needle-sharing and sodomy.

    Phrasing!

  5. JayMan says:

    Oh boy don’t let the anti-vaxxers hear this one…

    • Old fogey says:

      You can’t possibly be suggesting that the truth should be hidden – not on Dr. Cochran’s blog!

      • JayMan says:

        Certainly not. But I know how they’re going to react.

      • Ziel says:

        Trunp,inaugural address: “..and these vaccines, I’m not saying don’t give them, but we have to be really careful – there’s this guy, really smart, an expert – one of the best – his name’s Cochran, very smart guy, terrific genes – says the polio vaccine infected millions with a bad monkey virus, dangerous stuff, believe me, and these are the experts…”

        WaPo, Jan 21,2017:
        “TRUMP CITES ALT-RIGHT EXTREMIST IN ADDRESS”

      • gcochran9 says:

        If someone discovered a simple way of making hydrogen bombs out of old TV dinners, I would not support general dissemination of that info.

        • dearieme says:

          I cite the response of a research student to an idea I had: “but if that worked it would have been invented already”.

          • gcochran9 says:

            I once ran into an idea like that: surely it had already been tried, and we would have heard if it worked. But we tried it anyhow and had it working that day. Later, looking at some old proposal work, I remembered that I myself had already suggested it a few years earlier, but had never gotten around to trying it out.

  6. DdR says:

    Dr. Cochran,

    Do you think that the benefits of a stringent and critical regulatory environment for medicine outweigh the negatives connected with impeding drug development?

  7. Marcus Sextus says:

    130 Million Chinese have Hepatitis B probably due to re-use of needles of during the Cultural Revolution. They had a recent outbreak of HIV in Henan from the same problem.

    • MawBTS says:

      Interesting. Wikipedia says a third of the world’s Hep B carriers are Chinese, but China has 20% of the world’s population, so it isn’t ridiculously higher than you’d expect.

  8. zmil says:

    It’s widely suspected in the HIV field that mass vaccination campaigns and other medical use of unsterile needles in West Africa played a major role in the early stages of the HIV pandemic. A lot of genetic adaptation had to occur before the progenitor SIV species could efficiently infect humans, and it seems somewhat implausible that the still weakly infectious intermediate strains would be effectively transmitted through sexual contact, which leaves dirty needles as the obvious candidate.
    See here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1088484/
    And here: http://perspectivesinmedicine.cshlp.org/content/1/1/a006841.long

  9. Mark F. says:

    Re-use of needles is a public health nightmare. And yes, it contributed to the spread of AIDS, especially in Africa. That’s one reason why they have so many heterosexual cases as compared to the West.

  10. Anonymous says:

    Luckily, Egyptians are getting the new Hepatitis C cure: https://www.nytimes.com/2015/12/16/health/hepatitis-c-treatment-egypt.html?_r=0

  11. dave chamberlin says:

    Africa is a public health nightmare, it is just a matter of time until that God forsaken place loses the epidemic lottery. Like a slot machine all the right characteristics have to line up. Ebola and Aids nearly took that place down and those diseases are easy to control compared to others.

    A devastating infectious disease does not have to start there, it just has to end up there. What I am thinking about is a repeat of The 1918 Flu Pandemic. People think Flu? Flu? Like it’s nothing but a few days in bed. The 1918 Flu pandemic as per Wiki infected 500 million people around the world and resulted in the deaths of 50 to 100 million people. Read about it, read John Barry’s book “The Influenza Pandemic of 1918.” 3 to 5 percent of the world’s population dead from it.

    Whatever money the CDC thinks it needs, give it to them. World War is remote (for now). A fast spreading Infectious disease that we don’t have an effective vaccine for is just a matter of time.

    If The 1918 Flu Pandemic spread all the way around the world in matter of months back then when people traveled by ships, it would get everywhere today in weeks. There might be a very effective vaccine for the next BIG ONE, but something tells me it won’t get to third world countries in time.

    • Old fogey says:

      After reading the frightening material in the link that Pyrrhus provided about the CDC’s work with flu vaccines, it doesn’t seem as if throwing large sums of money at them would be of any use in preventing an epidemic of the sort that raged in 1918. Perhaps it would be best to concentrate on building up the population’s immune system as a first order of attack against pathogens.

    • MawBTS says:

      While it’s true that Africa’s a giant petri dish of a continent, remember that many/most of history’s worst pandemics have come from other places.

      Cholera is apparently from India.
      Nobody knows where the 1918 flu pandemic came from, but there’s no reason to think it was Africa.
      The Black Death originated in central Asian rodents
      Typhus was first documented in Moorish Grenada, Spain. Not sure where it came from.

      Africa can lay claim to malaria, smallpox, and the ol’ Anally Injected Death Sentence. Ebola has never reached pandemic status as far as I know.

      The good news is that we seem to be beating malaria in Africa. It’s always been the Mike Tyson of diseases. If we can knock out malaria, we can knock out anything. It isn’t down for the count, but it’s at least on the ropes.

  12. RCB says:

    You should write a book.

    • dave chamberlin says:

      I think so too. Not just any book but the greatest story never told. The highly probable but poorly substantiated story of evolution, human intelligence and the unwanted truth. The problem as I see is it isn’t going to be the kind of book Cochran likes to read, long on facts and short on speculation. But I still think with those short comings Greg Cochran ought to hole up for however long it takes and do the best job he can.

      Because no one else is going to write it, not in my lifetime, not in Greg’s. Some people will accuse him of making hydrogen bombs out of old TV dinners, screw them.

      Back in 2005 a scientist named Bruce Lahn made a fabulous discovery that a gene that played an important role in brain development was so old it likely came from Neanderthals and it had not spread to sub Saharan Africans. I read that paper and I knew it’s significance. I went to the internet to see who was talking about it and i only found one person who was excited and knew the full implications of it. Razib Kahn. People asked him at his blog, “why are you so excited about that paper?”

      No one cared and Bruce Lahn got a lovely reward for his brilliant paper, he lost his job. Now it is 12 years later and not much has changed. Everybody still pretends that evolution with humans has stopped. Not only has it stopped now but it stopped right about the time those first modern humans and neanderthals cavorted.

      It’s all bullshit. Most readers at this blog know it, and the evidence showing the variation in human intelligence is THE REASON for boom and bust economies around the world.

      I have a gifted 10 year old grand daughter who still believes in Santa Claus. She is smarter than the average adult but she wants to believe in Santa Claus so she does. Santa Claus is a lovely pipe dream but believing in pipe dreams in the real world when you are an adult doesn’t work, it leads to bad ends.

  13. benespen says:

    My wife the microbiologist says that she is more sympathetic to Sabin than the Egyptian needle re-users. According to her, the techniques available to Sabin would have made it genuinely very difficult to prevent viral contamination. For example, there weren’t a lot of techniques to visualize viruses at the time. You would need to do a lot of complicated work to ensure the cells were “clean”.

  14. Ben Gunn says:

    You are saying Salk and Sabin were negligent? You said the Salk version was inactive; so was it was safe or not?

    • gcochran9 says:

      It seems to have been contaminated as well.

      • Ben Gunn says:

        A bit more in depth here. It appears they would not have known sv40 when the vaccines were developed. It was known virus’s occurred in monkeys. I suppose it was a risk worth taking. The response when sv40 was discovered is another matter. I knew a girl who had polio and walked with a brace; horrible disease. http://www.sv40foundation.org/cpv-link.html

        • gcochran9 says:

          They didn’t know about that particular monkey virus, but some were worried about the possibility of picking up some virus from cell culture.

          Could this mistake have been more serious, been a catastrophe? Yep. We tend not to think very hard about risky moves we got away with – mistake.

        • James Richard says:

          The entire world was in abject terror of the repeated polio epidemics. The March of Dimes was a major charity. There was no question that parents throughout the nation fully supported polio vaccination even though it was known at the time that the Sabin vaccine could induce the disease in about 3 people per million doses. We used the schools to make sure every child was inoculated and when I was a kid coughing up a dime was a major expense (you could still get a vending machine Coke for 5¢.) And there are far worse fates than leg braces:

  15. Hugh Mann says:

    What were they injecting the Egyptians with against Schistosomiasis? Ah, just found it – tartar emetic.
    https://en.wikipedia.org/wiki/Antimony_potassium_tartrate

  16. Gilbert Ratchet says:

    Nice Strangelovian reference there.

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