From 1910 to 2019, polio infected more than 585,000 people in the United States alone,1 1 in 200 of which became paralyzed by the disease. Paralysis, when spread to the lungs, is deadly, resulting in polio’s 2% to 5% fatality rate among children and up to 15% to 30% among adolescents and adults.2 Poliovirus is a single-stranded ribonucleic acid (RNA) virus that is encased in a capsid made of multiple protein structural units. On the surface of the capsid is a protein that recognizes the human CD155 receptor and allows the viral RNA to be released into the cytoplasm of a human cell. In the cytoplasm it can be translated by the ribosome to make new viral proteins, which self-assemble into new viruses that will escape the host cell to infect a new host. Because of wild poliovirus’s inability to infect any animals other than humans, eradication of the disease within the human population would result in the complete elimination of the virus. When the poliovirus infects a human, it does so predominantly in the gastrointestinal tract and is therefore passed on via the oral-fecal route. In some cases, the virus reaches the nervous system and causes paralysis or even death. Despite claims that the harmful disease is eliminated, polio has never been eradicated in Africa and has reemerged in New York City in 2022.3
From the virus’ initial arrival in the United States during the late 1890s, until the first effective vaccine was developed in 1953, the U.S. faced many epidemics of polio, including those in 1916 New York and 1924 Detroit.4 Despite the prevalence of polio in the U.S., people of color with polio were underdiagnosed in the early decades of the disease. In the 1920s and 30s, regardless of the growing numbers of epidemics in the Northeast and Midwest, few cases of Black polio victims were reported.4 Fundamentally, low diagnostic rates were a result of Black families and households having limited access to doctors and hospitals. Even when accessible, less-experienced, contemporary Black medical professionals were unable to diagnose the ambiguous early symptoms of polio. According to the Black orthopedist, Chenault, “the statistics to argue for a lower incidence of this disease among Black individuals are due to the notoriously poor treatment facilities available and […] the failure of so many of our men to recognize the disease.”4 This statement is backed by the existence of institutions like the “Georgia Warm Springs polio rehabilitation center, which Franklin Roosevelt had founded in the 1920s, […] had maintained a Whites-only policy of admission.”4 It was only after the late 1940s that the view of polio as a disease only affecting Whites had been effectively challenged. Consequently, in 1941 the Tuskegee Infantile Paralysis Center, the first polio center for Black individuals, was opened.4 Since then, national funding has started to support health facilities to care for Black polio victims and train more Black medical professionals. With the increase in visibility of Black polio cases, the theory of polio’s racial susceptibility has shifted.
Evaluating the above facts, Naomi Rogers, a tenured Associate Professor in the Program for the History of Science and Medicine at Yale University, labeled polio a “white disease.”3 Polio is one of many examples of racism in the history of the medical field. The Tuskegee Institute, for instance, performed a study from 1932-1972, where they observed the progression of syphilis in untreated Black males only. Even when penicillin became widely available by 1943, the patients were not offered treatment.5 Additionally, doctors of color still remain underrepresented, and BIPOC individuals still have the lowest insurance rates in the United States today.6 It is also not factual to refer to racism in medicine in the past tense, as the Covid-19 pandemic reminds us . When the first doses of the Covid-19 vaccines were available, people of color had less access to information and routine clinical care which resulted in a big gap in vaccinations administered to White compared to African Americans.7
References
1 Dattani, S.; Spooner, F.; Ochmann, S.; Roser, M. Polio. Our World Data 2022. https://ourworldindata.org/polio
2 Pinkbook: Poliomyelitis | CDC. https://www.cdc.gov/vaccines/pubs/pinkbook/polio.html (accessed 2022-10-18). https://www.cdc.gov/vaccines/pubs/pinkbook/polio.html
3 Goldstein, J.; Otterman, S. Polio Has Been Detected in New York City Wastewater, Officials Say. The New York Times. August 12, 2022. https://www.nytimes.com/2022/08/12/nyregion/polio-nyc-sewage.html
4 Rogers, N. Race and the Politics of Polio. Am. J. Public Health 2007, 97 (5), 784–795. https://doi.org/10.2105/AJPH.2006.095406. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1854857/
5 Tuskegee Study – Timeline – CDC – NCHHSTP. https://www.cdc.gov/tuskegee/timeline.htm (accessed 2022-11-03). https://www.cdc.gov/tuskegee/timeline.htm
6 Health Disparities by Race and Ethnicity. Center for American Progress. https://www.americanprogress.org/article/health-disparities-race-ethnicity/ 7 The Racial Disparities, Systemic Racism Behind Who Has Received Vaccines. NPR. March 18, 2021. https://www.npr.org/2021/03/18/978496045/the-racial-disparities-systemic-racism-behind-who-has-received-vaccines