Narrativas vacunales y políticas de vacunación contra la poliomielitis en el contexto de la provincia de Alicante (1963-1978) / Vaccine narratives and polio vaccination policies in the context of the province of Alicante (1963-1978)

El análisis a pequeña escala es una vía de abordaje historiográfico que abrió, en su momento, nuevos caminos en la investigación. La proximidad del objeto de estudio, permite profundizar en los determinantes propios y específicos y en las realidades y prácticas, por ejemplo, de las campañas de inmunización masiva contra la poliomielitis diseñada a nivel nacional pero implementadas localmente, como en el estudio de caso que abordamos. Utilizando como modelo el ámbito sanitario provincial de Alicante, el trabajo añade datos para completar la información de proximidad sobre estas campañas y de ese modo, completar una visión de conjunto y un análisis comparado tanto en un ámbito externo como en un ámbito interno interterritorial, nacional y provincial, así como el seguimiento de las directrices dadas por los organismos nacionales e internacionales. En segundo término, dotar de significado al conjunto de actividades llevadas a cabo por diferentes actores, instituciones y medios de comunicación, implicados en el proceso de implantación, cobertura y seguimiento de las campañas de vacunación contra la polio en el ámbito provincial alicantino. El uso de narrativas de personas afectadas por la enfermedad permite añadir elementos relevantes sobre experiencias personales en el contexto de las campañas vacunales

Small-scale analysis is a path of historiographical approach that opened, at the time, new paths in research. The proximity of the study object allows us to delve into our own and specific determinants and the realities and practices of, for example, mass immunization campaigns against polio, designed at the national level but implemented locally, as in the case study that we discuss. Using as a model the provincial sanitary area of Alicante, the work adds data to complete the proximity information on these campaigns and thus, complete an overview and a comparative analysis both in an external and in an internal interterritorial, national scope and provincial level as well as the follow-up of the guidelines given by the national and international organisms. Secondly, to give meaning to the set of activities carried out by different actors, institutions and media, involved in the process of implementation, coverage and follow-up of polio vaccination campaigns in the province of Alicante. The use of narratives of people affected by the disease allows to add relevant elements about personal experiences in the context of the vaccine campaigns

[Poliomyelitis in the Spanish press (1960-1975)]. / La poliomielitis en la prensa española (1960-1975).

OBJECTIVE: Vaccination has been one of the most effective preventive measures to reduce the number of diseases that affect humans. The primary objective of this study is to describe the informative treatment of polio in the written press at a time when it was of great importance. METHODS: From the digital newspaper archive of the ABC and La Vanguardia newspapers, all the information in which the concept "polio", published during the period between 1960 and 1975 was selected. RESULTS: In total there have been 961 units of analysis, 557 for the ABC newspaper and 404, for La Vanguardia. The year of greatest publication was the year 1963, coinciding with the authorization for the use of the Sabin vaccine. The need to intensify vaccination campaigns is highlighted as the number of annual cases continued to increase. CONCLUSIONS: There are no significant differences in the coverage of the newspaper ABC and La Vanguardia, following a pattern of publication very similar between them, where the Sabin vaccine appears as one of the most important scientific advances, thanks to which they allowed to protect children against to this dreaded disease, thus avoiding a major epidemic.

OBJETIVO: La vacunación ha sido una de las medidas preventivas más eficaces para disminuir el número de enfermedades que afectan a los seres humanos. El objetivo primordial de este estudio fue describir el tratamiento informativo de la poliomielitis en la prensa escrita de una época donde tuvo gran importancia. METODOS: A partir de la hemeroteca digital de los periódicos ABC y La Vanguardia se seleccionaron todas las informaciones en las que apareciera el concepto "poliomielitis", publicadas durante el periodo de tiempo comprendido entre 1960 y 1975. RESULTADOS: En total hubo 961 unidades de análisis, 557 para el periódico ABC y 404 para La Vanguardia. El año con más publicaciones fue 1963, coincidiendo con la autorización para la utilización de la vacuna Sabin. Se destaca la necesidad de intensificar las campañas de vacunación, ya que el número de casos anuales seguía aumentando. CONCLUSIONES: No existen diferencias significativas en las coberturas del periódico ABC y la de La Vanguardia, siguiendo un patrón de publicación muy parecido entre ellos, en donde la vacuna Sabin aparece como uno de los avances científicos más importantes. Gracias a ella se pudo proteger a los niños y niñas frente a esta temida enfermedad, evitando así una epidemia mayor.

Two centuries of immunisation in the UK (part II).

The centrally coordinated response that controlled the polio epidemics of the 1950s through immunisation led to the development of a national immunisation strategy in the UK and the formation of the Joint Committee on Vaccination and Immunisation (JCVI) in 1963, which oversees the immunisation programme and advises the UK Department of Health on new vaccine introductions. As a result of technological advances in vaccine development and scientific advances in immunology and microbiology over the 56 years since then, and the formation of a comprehensive public health surveillance system for vaccine-preventable disease, the National Health Service immunisation programme now covers 18 serious diseases of childhood, with an astonishing impact on child health. Here we consider the formation of the JCVI and the development of the national immunisation programme and review the introduction of vaccines over the past half century to defend public health.

La batalla de Madrid por las vacunas antipoliomielitis (1963): ciencia, ideología y poder en la primera campaña de inmunización masiva en España / The battle in Madrid over poliomyelitis vaccines (1963): science, ideology and power in the first mass immunization campaign in Spain

Durante el sexenio de 1958 a 1963 se vivió en España el periodo de mayor incidencia de poliomielitis (2000 casos y 200 fallecidos por año). Aunque la vacuna inactivada de Salk había llegado al país en 1957, no hubo una decidida acción gubernamental para aplicarla a toda la población susceptible. La vacuna atenuada de Sabin, disponible en Europa desde 1960, tampoco se implementó. Mientras en el contexto internacional se adoptaba una u otra, en España se reprodujo la rivalidad entre ambas vacunas con un confuso resultado. Se vacunaba un bajo porcentaje de susceptibles con vacuna Salk a cargo del Seguro Obligatorio de Enfermedad (SOE), a la vez que un grupo de investigadores de la Escuela Nacional de Sanidad, encabezados por Florencio Pérez Gallardo (1917-2006), realizaban un modélico estudio epidemiológico que señalaba la conveniencia de utilizar la vacuna oral de Sabin. Llegados a 1963, el SOE puso en marcha una campaña nacional con vacuna Salk inspirada por el pediatra Juan Bosch Marín (1902-1995), representante de la estructura más conservadora del franquismo. La pugna por dilucidar qué tipo de vacuna era más conveniente se escenificó en Madrid durante los primeros meses de 1963 en distintas conferencias científicas. El grupo de Bosch Marín defendió su campaña y la vacuna Salk, mientras Pérez Gallardo hacía lo propio con la vacuna oral y obtuvo un golpe de efecto al invitar a Albert Sabin como conferenciante. A finales de año, tras una campaña piloto, se instauró la primera campaña masiva de vacunación oral contra la poliomielitis en España

Between 1958 and 1963, Spain witnessed the highest ever incidence of poliomyelitis (2000 cases and 200 deaths per year). Although Salk's inactivated vaccine had arrived in Spain in 1957, the government took no decisive action to administer it to the entire population at risk. Neither was Sabin's attenuated vaccine administered, available in Europe from 1960. While other countries adopted one or the other, in Spain rivalry arose over the two vaccines, with mixed results. The Salk vaccine was administered to a small percentage of the population at risk through the Compulsory Sickness Insurance scheme (Spanish initials: SOE), while at the same time a research team at the National School of Health led by Florencio Pérez Gallardo (1917-2006) carried out a model epidemiological study that demonstrated the superiority of the Sabin vaccine. In 1963, the SOE launched a national campaign with the Salk vaccine promoted by the paediatrician Juan Bosch Marín (1902-1995), a representative of the most conservative structure of the Franco regime. The dispute over which vaccine was best reached its peak in early 1963 at various scientific conferences in Madrid. Bosch Marín's group argued in favour of his campaign and the Salk vaccine, while Pérez Gallardo did the same for the oral vaccine, achieving a substantial impact by inviting Sabin himself to speak. By the end of the year, following a pilot study, the first mass oral vaccination campaign against polio was introduced in Spain

Nota Histórica / Historical Note

Resumen Una de las grandiosas experiencias a nivel mundial ha sido la vacunación contra la poliomielitis así como también lo fue en su momento la vacunación contra la viruela. Posiblemente con la ayuda de mejores condiciones sanitarias de las poblaciones (al ser una enfermedad de transmisión oral-fecal) estamos en las puertas de la erradicación, pero sobre todo gracias a la intervención con las vacunas contra la polio, tanto la inactivada como la oral. No serán tratados los temas técnicos de las vacunas utilizadas, ambas han sido extraordinarias herramientas para llegar a este momento. No puede ser más oportuna la cita de William Shakespeare: "el pasado es el prólogo", colocada en un mármol a la entrada de un edificio público en Washington DC.

Human Experimentation in Public Schools: How Schools Served as Sites of Vaccine Trials in the 20th Century.

Schools have long been critical partners for public health authorities in achieving widespread vaccination. In the mid-20th century, however, public schools also served as sites of large-scale experiments on novel vaccines. Through examining the experimental diphtheria, polio, and measles vaccine trials, I explored the implications of using schools in this manner, as well as the continuities and discontinuities among the three cases. Common to all of them was that the use of schools brought decision-making into the public sphere, subjecting parents to social pressures and the influences of school officials and community members. However, the effects of using schools varied as well, as their social and institutional significance interacted differently with the narratives surrounding each disease, the public's changing perception of medicine and science, and society's changing values. These insights show not only the power of public institutions to influence opinions and perceptions, but also the subtle forces that one's authority figures, peers, and community members may bring to a seemingly private decision-making process. These considerations are relevant to health interventions today, such as the complex debate over community consent in global health research. (Am J Public Health. 2018;108:1015-1022. doi: 10.2105/AJPH.2018.304423).

A Brief History of Vaccines Against Polio.

Poliomyelitis, a dreaded disease of the last century that had already crippled millions of people across the globe, is now on the verge of eradication thanks mainly to two polio vaccines, inactivated polio vaccine (IPV) and oral polio vaccine (OPV). Ever since their development in late 1950s and early 1960s, the journey of their early development process, clinical trials, licensure and ultimately widespread clinical use in different countries provide a fascinating tale of events. Oral polio vaccine has been the mainstay of global polio eradication initiative (GPEI) in most of the countries. With the advent of 'polio endgame', the focus has now shifted back to IPV. However, there are certain issues associated with global cessation of OPV use and universal implementation of IPV in routine immunization schedules across the globe that need to be dealt with some urgency, before proclaiming the global victory over polio.

What you don't know about vaccines can hurt you.

As physicians, we've all learned in detail about the science behind vaccinations, but I suspect few of us have been taught about the history of vaccinations. Sure, we all know that Dr. Jonas Salk developed the poliovirus vaccine, but I wasn't aware that he inoculated himself, his wife, and his three children with his then experimental vaccine. When our editorial committee decided to focus on vaccinations as our theme for this month's Greene County Medical Society's Journal, I perused the internet for interesting topics. I came across a fascinating website, historyofvaccines.org; this website is a project of the College of Physicians of Philadelphia, touted as being the oldest professional medical organization in the United States. I credit the majority of the information in this article to the above website and the rest to the National Institutes of Health (nih.gov) website; I trust that the information is valid and true, based on the agencies behind these websites. Below are some interesting tidbits about vaccine preventable diseases that I found noteworthy to pass on to our readers.

Endgame for polio eradication? Options for overcoming social and political factors in the progress to eradicating polio.

In 1988, the Global Polio Eradication Initiative (GPEI) was launched with the goal of eradicating polio by the year 2000. After 25 years, several dynamics still challenge this large public health campaign with new cases of polio being reported annually. We examine the roots of this initiative to eradicate polio, its scope, the successes and setbacks during the last 25 years and reflect on the current state of affairs. We examine the social and political factors that are barriers to polio eradication. Options are discussed for solving the current impasse of polio eradication: using force, respecting individual freedoms and gaining support from those vulnerable to fundamentalist 'propaganda'. The travails of the GPEI indicate the need for expanding the Convention on the Rights of the Child to address situations of war and civic strife. Such a cultural and structural reference will provide the basis for global stakeholders to engage belligerent local actors whose local political conflicts are barriers to the eradication of polio. Disregard for these actors will result in stagnation of polio eradication policy, delaying eradication beyond 2018.