Throughout history, mass vaccine rollouts have been beset by problems

Three people from one family were given polio shots in San Diego in 1955.Bettmann/Bettmann Archive

The 1955 arrival of Jonas Salk’s polio vaccine is still hailed as one of modern medicine’s crowning achievements, a lifesaving intervention that some deemed nothing short of miraculous.

For those of a certain age, the mass distribution of a safe vaccine signaled the end of a dark and disturbing period, one of locked school buildings and swimming pools, iron lungs and lifelong paralysis. Many of those who went through the process of being inoculated still recall the sense of elation the vaccine brought, even if the reality wasn’t as smooth as memory might suggest.

“It’s sort of assumed this mythological status as a hugely successful campaign,” said James Colgrove, a public health professor at Columbia University. “But there was a lot of confusion, there was a lot of chaos, and the federal government was actually widely criticized for its failure to anticipate the public demand for the vaccine — and to make plans for rolling it out.”

If that sounds familiar, it should.

Today, as the country scrambles to distribute a pair of promising COVID-19 vaccines, the process has been hindered by many of the same issues — supply shortages, public confusion, delays — that impeded other mass vaccination rollouts throughout US history.

The federal government fell well short of its goal of giving 20 million people an initial dose of the vaccine by the end of 2020. By Dec. 31, the reported number of Americans vaccinated stood at just 2.8 million, and in the CDC’s most recent figures, from Jan. 8, only 6.68 million people had received their first dose, even as deaths and new cases climb at a record pace.

Dr. Frank Mirabello administered the new polio vaccine to a child during the Everett Board of Health 1954 Field Trial Vaccines.Everett Public Library

In Massachusetts, 151,430 residents — or about two percent — have so far received a first dose of the vaccine, according to the CDC. Governor Charlie Baker last week criticized Washington politicians for a lack of attention paid to the vaccine’s rollout, and some public health experts have suggested reducing recommended dosages temporarily to provide more people with some level of protection.

Public health experts are quick to note that the current vaccination effort differs significantly from previous attempts to inoculate large numbers of people. Never before has there been an attempt to produce and distribute a vaccine on such a wide scale in such a short amount of time.

Still, some of the problems with the vaccine’s distribution have clear historical precedent.

Perhaps the closest contemporary comparison to today’s effort is the administering of the polio vaccine in the 1950s and 1960s.

Much like COVID-19, the polio virus, which would infect 57,879 and kill 3,145 in 1952 alone, sent the country into a panic. Public spaces closed, and many people were afraid to leave their homes, as those who contracted the virus often ended up hospitalized or permanently paralyzed.

Dr. Jonas Salk, a developer of the polio vaccine, examined a rack of test tubes in his lab in Pittsburgh in 1954.Associated Press

“People were afraid,” said Rahul Gupta, chief medical and health officer at the March of Dimes. “People were afraid to go out because of this disease.”

At the time, the March of Dimes, then known as the National Foundation for Infantile Paralysis, led a massive fund-raising charge to combat the virus. Celebrities, including Elvis Presley, rallied support for the cause. In a show of unity rarely seen during the current pandemic, Americans jumped to support the effort. Within a few weeks’ time in 1938, some 2.68 million dimes had been sent to President Franklin D. Roosevelt, who had been stricken with polio, to fund research aimed at developing a vaccine.

The effort paid off. In 1954, the March of Dimes organized and funded one of the largest clinical trials in history, which included 1.8 million children. And when it was announced the following April that a vaccine from University of Pittsburgh scientist Jonas Salk was both safe and effective at protecting against the virus, Americans were understandably elated.

But the rollout of the vaccine soon proved challenging on a number of fronts. Americans who had expected a coordinated federal distribution effort were frustrated to learn that there wasn’t one. With the Centers for Disease Control and Prevention still in its infancy, the federal government turned to an array of pharmaceutical companies for help.

“What the government did was simply to hand the formula over to [six] companies, with virtually no oversight, and say, ‘Go produce it for everybody who wants it,’ ” said David Oshinsky, author of the Pulitzer Prize-winning book “Polio: An American Story.” “And it turned out to be a disaster.”

Confusion over how to get the vaccine abounded, said Colgrove of Columbia University. Private physicians were unsure when they would receive doses and when they’d be able to deliver them to patients. There were rumors, too, of black-market sales.

In a particularly tragic episode, one of the companies enlisted by the federal government to manufacture the vaccine — California-based Cutter Laboratories — produced a defective batch that effectively resulted in tens of thousands being injected with the polio virus, a fiasco that led to a reported 40,000 cases, 50 children suffering paralysis, and five deaths.

The contamination temporarily halted the vaccine distribution, though it eventually returned and, along with a second vaccine from scientist Albert Sabin, resulted in a sharp decline of polio cases across the country. The disease was eventually eliminated in the United States.

Massive lines formed outside Manheim Township High School on June 4, 1979, as people flocked to receive vaccinations against polio in Lancaster, Pa. Associated Press

The country would see its distribution system tested again just two decades later in 1976, when an influenza reminiscent of the 1918 influenza pandemic emerged.

Even with the lessons of the mass polio vaccination still relatively fresh in the national consciousness, things quickly went awry, as the government rushed out a vaccine and more than 400 people who received it went on to develop Guillain-Barré syndrome, a rare neurological disorder that can result in paralysis.

Some of the effects of the 1976 debacle still linger today, said Dr. Howard Markel, a professor and medical historian at the University of Michigan School of Public Health. They are often seized upon by the antivaccination movement as evidence of the government’s inability to safely inoculate its citizens.

There have also been occasional success stories in campaigns to vaccinate large numbers of people quickly.

In 1947, for instance, a middle-aged businessman arrived in New York City feeling under the weather. The man had previously received the smallpox vaccine, which had first been developed in the late 1700s. But when he died days later, and smallpox was determined to be the cause, it led to a successful campaign to vaccinate — or re-vaccinate — a vast majority of the city’s population.

First- and second-graders at St. Vibiana's school were inoculated against polio with the Salk vaccine in Los Angeles in April 1955.SYSTEM/Associated Press

“In the span of less than two months, they vaccinated close to 5 million people,” Oshinsky said, who noted that the city’s compact area aided in the campaign’s effectiveness.

In some ways, too, the country has learned from its failures. Soon after the coronavirus arrived, for instance, the federal government invested billions into the development of a vaccine, no doubt speeding up development. The safety breaches that plagued previous rollouts also resulted in an increasingly regulated process, with the Food and Drug Administration adopting much stronger oversight in the development and licensing of vaccines.

And despite the current distribution “hiccups,” the tremendous strides made over the past year should not be ignored, Gupta said.

“We’ve had a number of vaccines developed within a year, remarkable work by the global community to come together and serve the most vulnerable people across the world,” he said. “In so many ways, I think it’s a remarkable success.”