2014.10.28 反疫苗运动正在忘记小儿麻痹症的流行

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The Anti-Vaccine Movement Is Forgetting the Polio Epidemic
On the 100th anniversary of Jonas Salk's birth, his son Peter talks about the backlash against vaccines and other human factors that make it difficult to eradicate deadly viruses.

By Jennie Rothenberg Gritz

Peter Salk gets a polio shot from his father in the spring of 1953, as his mother looks on. Jonas Salk assured the public that he’d vaccinated his own family first, adding, “I will be personally responsible for the vaccine.”  (March of Dimes)
OCTOBER 28, 2014
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It started out as a head cold. Then, the day before Halloween, 6-year-old Frankie Flood began gasping for breath. His parents rushed him to City Hospital in Syracuse, New York, where a spinal tap confirmed the diagnosis every parent feared most in 1953: poliomyelitis. He died on his way to the operating room. “Frankie could not swallow—he was literally drowning in his own secretions,” wrote his twin sister, Janice, decades later. “Dad cradled his only son as best he could while hampered by the fact that the only part of Frankie’s body that remained outside the iron lung was his head and neck.”

At a time when a single case of Ebola or enterovirus can start a national panic, it’s hard to remember the sheer scale of the polio epidemic. In the peak year of 1952, there were nearly 60,000 cases throughout America; 3,000 were fatal, and 21,000 left their victims paralyzed. In Frankie Flood’s first-grade classroom in Syracuse, New York, eight children out of 24 were hospitalized for polio over the course of a few days. Three of them died, and others, including Janice, spent years learning to walk again.


Then, in 1955, American children began lining up for Jonas Salk's new polio vaccine. By the early 1960s, the recurring epidemics were 97 percent gone.

Salk, who died in 1995, would have turned 100 on October 28. He is still remembered as a saintly figure—not only because he banished a terrifying childhood illness, but because he came from humble beginnings yet gave up the chance to become wealthy. (According to Forbes, Salk could have made as much as $7 billion from the vaccine.) When Edward R. Murrow asked him who owned the patent to the vaccine, Salk famously replied, “Well, the people, I would say. There is no patent. Could you patent the sun?”

I recently spoke with Salk’s oldest son, Peter, an accomplished medical researcher in his own right who spent years working alongside his father at the Salk Institute for Biological Studies. Peter told me about his father’s late-in-life HIV research and the ethical concerns he explored in such books as Man Unfolding and The Survival of the Wisest. Peter also spoke with impressive thoughtfulness about today’s anti-vaccine movement and reflected on why so many Americans came to distrust life-saving vaccines such as the one his father helped bring to the world.

Jennie Rothenberg Gritz: What sort of person was your father?

Peter Salk: He was a kind person. He really cared about people. In his personal interactions, he did everything he could to uplift whomever he was interacting with. As things went on with polio, there was obviously a great deal of controversy. But he wasn’t one who wanted to engage in battles, even when people attacked him for the approach he was taking.


Jonas Salk at the National Institutes of Health
in May 1955 (AP)
Rothenberg Gritz: What gave him the confidence to keep working on his vaccine when so many people were telling him it couldn’t be done?

Salk: That was sort of his nature. He just didn’t accept dogma if he didn’t understand it. When he was in medical school, taking a course in microbiology, the professor spoke about two bacterial diseases—tetanus and diphtheria—that are caused by toxins that bacteria produce. You can inactivate those toxins chemically and use them to produce a protective immune response. In the next lesson, the professor said that when came it to viral illnesses, you couldn’t do that. You needed to have a living virus to induce immunity that would protect against the disease. My father didn’t understand why one thing would be true for a couple of bacterial diseases but not for viral ones. He thought you ought to be able to do same thing with a virus: inactivate it and then induce an immune response without any risk of the vaccine causing the disease itself.

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Rothenberg Gritz: A lot of people thought Albert Sabin’s live-virus vaccine was the better way to go, right?

Salk: Yes, Albert Sabin was an established figure in the field. He was not one to welcome someone with different views about things. And indeed, most people felt that his oral vaccine, where you use a weakened version of the live virus, was going to be the most effective.

Polio gets into the body through the mouth and then grows in the intestines. Sometimes it will travel into the blood stream, then into the nervous system. It’s there—in the spinal cord or the brain—that the virus causes paralysis. To be protected against paralysis, all you need are antibodies circulating through the bloodstream. That’s the kind of protection my father’s injectable vaccine provides.

But in 1962, the Sabin oral vaccine was introduced on a wide scale. It ultimately replaced the injected vaccine in this country entirely. The problem with the Sabin vaccine is that the weakened virus can revert back to a dangerous form in some people. As a result, the wild polio virus was completely gone at the end of the 1970s, but for decades we continued to have somewhere between 8 and 12 cases each year that were caused by the vaccine itself.

In this country, the decision was finally made in 2000 to go back to the injectable vaccine. On a global level, there was an eradication initiative that started in 1988. They primarily used the oral vaccine. By 2012, the number of reported, naturally occurring polio cases was down from about 350,000 in 1988 to 223. But the WHO estimates that something on the order of 250 to 500 cases of polio are caused every year by the live vaccine itself.


In 2007, protesters in London hold signs
claiming that the vaccine for measles, mumps,
and rubella causes autism and even death.
(AP)
Rothenberg Gritz: People have been concerned by the idea that vaccines can cause disease in healthy children.

Salk: There are some subtleties to this. With pertussis, for instance, the old vaccine was based on using the whole killed organism. That was very effective, but because there were a whole lot of different kinds of proteins that were all mixed up, there were some side effects. Later on, they developed a so-called acellular pertussis vaccine, where you use purified materials from the bacterium. It doesn’t produce as strong or long-lasting an immune response—people need to have booster shots when they’re adults, for instance. But it doesn’t cause the same side effects.

When my own son Michael was born 31 years ago, the whole-cell vaccine was still in use. Whooping cough was essentially gone in this country by that time, so from one perspective, why should we take the risk of causing a high fever or other side effects in our own child? I know I certainly thought about this a lot. But I just couldn’t bring myself to take advantage of the good that other people had done by immunizing their kids—to take a free ride, so to speak. Michael did end up developing a fever. But I couldn’t have lived with my decision if we hadn’t given him the vaccine.

Rothenberg Gritz: Some vaccine opponents argue that as long as children live healthy lifestyles, they can either avoid illnesses like polio or recover quickly and develop “natural immunity.”

Salk: No. I wouldn’t hesitate to use very strong words about that. Of course it’s a good thing to live a healthy life, to keep the body strong and well-rested. I won’t rule out that it can help to protect against some types of disease. But when it comes to these organisms that can be very damaging to people, I think it’s wishful thinking to imagine that a healthy lifestyle can protect against infection.

And what we see is that many diseases are starting to come back. Measles is recurring; whooping cough is recurring. The kids whose parents are choosing not to immunize them are at risk, but so are babies and kids who might not be able to be vaccinated for one reason or another. These kids are no longer having the same benefit of herd immunity. Their level of protection is now eroding.

Rothenberg Gritz: Do you remember when you first started hearing about widespread opposition to vaccines?

Salk: I don’t remember exactly when, but it first came to my attention through some of my friends. I read some of the materials they sent me, and it just was really hard for me to follow some of the logic—particularly when it came to the polio vaccine, which I knew something about. People were claiming that it was all a myth, that the disappearance of polio had nothing to do with vaccines.

Once the fear of these diseases began to subside, people started looking at the Vietnam War and so on and wondering, Can we trust large institutions?
The reality is that back in 1954, there was a huge double-blind study involving 1.8 million schoolchildren. The results were clear-cut: If you got the polio vaccine, you were protected; if you didn’t, you were not. When you have that kind of data, you just can’t say that the disappearance of polio is due to other things. What strikes me is—I don’t know quite how to put this, but it’s like there’s an epidemic of misinformation, and we’ve got to inoculate the public against it.

Rothenberg Gritz: Why do you think this misinformation has spread so widely?

Salk: Part of it is that people have become complacent because these diseases aren’t rampant anymore. During the polio epidemic, people were really frightened. This was a disease they didn’t understand, whose appearance they couldn’t predict, and it had terrible effects on kids. Swimming pools and movie theaters were closed. It’s easy to forget this now. Also, these days, there are a lot of concerns about living naturally and not wanting to be exposed to things that are made in a laboratory.

But there are probably other forces at work. Back in the 1950s, people really looked to science and medicine as something that would make their lives better. But once the fear of these diseases began to subside, people started looking at other large-scale forces in the world—the Vietnam War, the government, and so on—and wondering, Can we trust large institutions? Can we trust pharmaceutical companies? I think that that’s something that’s driven people also: a sense of alienation.


The March 29, 1954, cover of Time featured a
photo of “Polio Fighter Salk” above the caption,
“Is this the year?”
Rothenberg Gritz: Do you think it would help if there were more scientists like your father—celebrity researchers who communicated directly with the public and appeared on the covers of major magazines?

Salk: My father was a public figure, but his peers didn’t always like that. It wasn’t part of the scientific tradition to communicate directly with the public the way he did. Scientists were supposed to communicate only through meetings and publications. But there were some points where my father felt it was really important for him to communicate directly with people, to help them understand what was taking place, to have their expectations appropriately in line. This wasn’t something his fellow scientists really appreciated.

Rothenberg Gritz: He also decided not to patent the vaccine. Why not?

Salk: I don’t think it ever really crossed his mind. He was totally driven to create a vaccine that would protect kids against polio. Indeed, the March of Dimes looked into a patent. I don’t think they had any evil reasons. I’ve seen records of some of correspondence that took place, and I suspect that they wanted to ensure that the drug would be manufactured correctly. They kept trying to get my father’s attention because they needed to get information to patent it, and it was incredibly frustrating for them when he didn’t want to put his attention on it. It was just a different world back then.

Rothenberg Gritz: In your own experience, how have patents and profits affected the pharmaceutical industry?

Salk: I can recall my experience with AIDS treatments. Back at the end of the previous century and the beginning of this one, I was involved in helping introduce treatments in Africa and Asia—that’s back when AIDS drugs were $10,000 or $15,000 a year. There were countries where the health budget would be something on the order of $4 per person per year. With prices in this range, how would it be possible for these drugs to be used in such countries?  Finally, the Global Fund to Fight AIDS, Tuberculosis, and Malaria came along and helped put some money in the picture. President Bush came in with PEPFAR. And finally, some generic manufactures in India and Brazil drove the price down with cheaper versions of the drugs.

These complex forces have brought things to where at least you’ve got a manageable system. But those systems were put in place without any provision for beefing up the health care infrastructure in these countries. They pay for drugs, but they don’t pay for the training of medical professionals. You see it with Ebola; the currently affected countries in Africa have totally inadequate health care systems. What are they supposed to do? They’re not able to protect their people from these diseases spreading. And now, because we’ve not helped sufficiently to get them on their feet, we’re being exposed ourselves to the consequences.


Peter Salk, left, talks with Bill Gates in January 2011, at a New York press conference announcing the Gates Foundation’s push to eradicate polio worldwide. (AP)
Rothenberg Gritz: You and your father spent a number of years working on an AIDS vaccine. Why is it so much harder to create than a polio vaccine?

Salk: There are only three versions of the polio virus. With HIV, the virus is rapidly changing, as happens with influenza also. The flu shot you get one year isn’t the same as the next one. It’s the same sort of thing with HIV. If you develop an immune response, the virus can mutate rapidly to evade that.

Also, polio is an acute illness. You have the infection and then it’s gone. With HIV, once you’re infected, it gets into your cells. Its genetic material is now integrated into your own genetic material. Once the virus has gotten a foothold like that, so far it hasn’t turned out to be possible to get rid of it.

Rothenberg Gritz: So what was your father trying to do?

Salk: As a first step, he wanted to take advantage of the fact that there’s such a long period between the time when a person is infected with the virus and the time the immunodeficiency symptoms develop. Over the months, over the years, the virus is chipping away at your CD4 T-cells. Eventually, they get depleted to such an extent that you no longer can defend yourself against different pathogens, etc.

What he wanted to try was a very simple approach: As with polio, he used a killed virus. The idea was that you might be able to boost the activity of a particular part of the immune system in people who were already infected with the virus to help kill off the cells that were infected with HIV, thereby slowing the progression of the disease.

The first clinical trial in infected patients began in 1987. The project continued until somewhere around 2007. Nothing practical has come of it, but I later went back and did a statistical analysis, based the subset of the data I had on my computer or in my paper files. It turned out the vaccine had highly statistically significant effects on slowing the progression of disease, on the decline of these CD4 T-cells. So it seems to me that more could be done based on this approach. A good starting point might be to do an independent meta-analysis in a more official and comprehensive way.


The tied feet of an anti-polio worker at a morgue
in Karachi, Pakistan. In 2012, a gunman killed
five women who were in the process of giving
polio vaccinations to children. (Reuters)
Rothenberg Gritz: Polio itself still hasn’t been totally eliminated in some countries. What’s holding that up?

Salk: The people who are working on polio eradication are doing everything they can, but there are still countries where there are conflicts, religious differences, cultural differences, political differences—and these are the countries where some kids haven’t been able to be reached with the vaccine that’s been used. India finally eliminated the wild virus a few years ago. Pakistan is the greatest problem right now, with all its internal turmoil. The disease still persists in Afghanistan, but that’s largely a result of what’s happening across the border in Pakistan. Nigeria has also so far never eliminated the wild virus.

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It’s so interesting to me. We’ve now got vaccines that should be able to get rid of this virus forever. But until we can deal with these human interactions in a more constructive way, we’re not going to get there. That’s what holding things up. It’s not the scientific level; it’s the social level.

Rothenberg Gritz: Your father spent a lot of time thinking about those problems.

Salk: Yes. After the polio vaccine was introduced, he decided to establish a new institute. But from his earliest writings, it was clear that he wasn’t just interested in researching vaccines, diabetes, and so on. He was interested in dealing with the problems that arise from man’s relationship to man—problems that can’t be solved in the laboratory.

The way he saw it, the universe has gone through three stages of evolution. First, there was the pre-biologic realm, where you had the evolution of matter: atoms, molecules, stars, galaxies. Then life appeared: Biological evolution was driven by a need to survive. Finally, humans came on the scene. Look at us—where is the evolution happening now? The world around us is so hugely complex, and that complexity comes from us.

The fundamental element that is evolving now in our sphere of existence is not matter, not life—it’s consciousness. The unit here is the mind. My father called this the metabiologic realm; it’s driven by choice. He often said that we are the products of the process of evolution, and we have become the process itself. It’s our responsibility to be making wise choices.

Jennie Rothenberg Gritz, a former senior editor at The Atlantic, is now a senior editor at Smithsonian magazine.



反疫苗运动正在忘记小儿麻痹症的流行
在乔纳斯-索尔克诞辰100周年之际，他的儿子彼得谈到了对疫苗的反弹以及其他使致命病毒难以根除的人为因素。

詹妮-罗森伯格-格里兹报道

1953年春天，彼得-索尔克从他的父亲那里获得了小儿麻痹症疫苗，他的母亲在一旁看着。乔纳斯-索尔克向公众保证，他首先为自己的家人接种疫苗，并补充说："我将亲自为疫苗负责。"  (March of Dimes)
2014年10月28日
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一开始是头部感冒。然后，在万圣节的前一天，6岁的弗兰基-弗拉德开始喘息。他的父母急忙把他送到纽约州锡拉丘兹市医院，在那里进行的脊髓穿刺检查证实了1953年每个家长最担心的诊断：脊髓灰质炎。他在去手术室的路上就死了。"弗兰基无法吞咽，他真的被自己的分泌物淹没了。"几十年后，他的双胞胎妹妹珍妮丝写道。"爸爸尽其所能地抱着他唯一的儿子，但由于弗兰基身体唯一留在铁肺外的部分是他的头部和颈部，因此受到了阻碍"。

当一个埃博拉病毒或肠道病毒的病例就能引起全国性的恐慌时，我们很难记住脊髓灰质炎流行的巨大规模。在高峰期的1952年，全美有近6万个病例；3000个是致命的，21000个受害者瘫痪了。在纽约州锡拉丘兹市弗兰基-弗拉德的一年级教室里，24个孩子中有8个在几天内因小儿麻痹症住院治疗。其中三人死亡，其他人，包括珍妮丝，花了几年时间学习重新走路。


然后，在1955年，美国儿童开始排队等候乔纳斯-索尔克的新脊髓灰质炎疫苗。到20世纪60年代初，反复出现的流行病已经消失了97%。

索尔克于1995年去世，10月28日将满100岁。他仍然作为一个圣人的形象被人们记住--不仅因为他驱逐了可怕的童年疾病，而且因为他出身卑微却放弃了致富的机会。(据《福布斯》报道，索尔克本可以从疫苗中赚取高达70亿美元的利润）。当爱德华-R-默罗（Edward R. Murrow）问他谁拥有疫苗的专利时，索尔克著名地回答说："嗯，人民，我想说。没有什么专利。你能为太阳申请专利吗？"

我最近与索尔克的长子彼得进行了交谈，他本身就是一位有成就的医学研究者，曾在索尔克生物研究所与他父亲一起工作多年。彼得向我讲述了他父亲晚年的艾滋病研究以及他在《人的展开》和《最聪明的人的生存》等书中探讨的伦理问题。彼得还以令人印象深刻的深思熟虑谈到了当今的反疫苗运动，并反思了为什么如此多的美国人开始不信任拯救生命的疫苗，比如他父亲帮助带给世界的那种疫苗。

詹妮-罗滕伯格-格里兹：你的父亲是个什么样的人？

彼得-索尔克。他是一个善良的人。他真的很关心人。在他的个人交往中，他尽其所能地提高与他交往的人的地位。随着小儿麻痹症的发展，显然存在着大量的争议。但他并不是一个想参与战斗的人，即使人们因为他所采取的方法而攻击他。


乔纳斯-索尔克在美国国家卫生研究院。
1955年5月（美联社）。
罗森伯格-格里兹：是什么让他有信心在这么多人告诉他不可能完成的情况下继续研究他的疫苗？

索尔克。这是他的天性。如果他不理解教条，他就不会接受它。当他在医学院学习微生物学课程时，教授谈到了两种细菌性疾病--破伤风和白喉，它们是由细菌产生的毒素引起的。你可以用化学方法使这些毒素失活，并利用它们来产生保护性的免疫反应。在下一课中，教授说，当涉及到病毒性疾病时，你不能这样做。你需要有一个活的病毒来诱发免疫力，以保护人们免受疾病的伤害。我父亲不明白为什么一件事对一些细菌性疾病是正确的，而对病毒性疾病则不是。他认为你应该能够对病毒做同样的事情：使其失活，然后诱发免疫反应，而没有任何疫苗导致疾病本身的风险。

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罗森伯格-格里兹：很多人都认为阿尔伯特-萨宾的活病毒疫苗是更好的方法，对吗？

索尔克。是的，阿尔伯特-萨宾是该领域的知名人士。他并不欢迎对事物有不同看法的人。事实上，大多数人认为他的口服疫苗，即使用弱化版的活病毒，将是最有效的。

小儿麻痹症通过口腔进入人体，然后在肠道内生长。有时它会进入血流，然后进入神经系统。正是在那里，在脊髓或大脑中，病毒导致瘫痪。为了防止瘫痪，你所需要的是通过血液循环的抗体。这就是我父亲的注射疫苗所提供的保护。

但在1962年，萨宾口服疫苗被广泛引入。它最终在这个国家完全取代了注射式疫苗。萨宾疫苗的问题是，被削弱的病毒在某些人身上可以恢复到危险的形式。因此，野生小儿麻痹症病毒在20世纪70年代末已经完全消失，但几十年来，我们每年仍有大约8到12个由疫苗本身引起的病例。

在我国，2000年终于决定重新使用注射式疫苗。在全球范围内，1988年开始了一项根除计划。他们主要使用口服疫苗。到2012年，报告的自然发生的小儿麻痹症病例数量从1988年的约35万例下降到223例。但世卫组织估计，每年大约有250至500例脊髓灰质炎病例是由活疫苗本身引起的。


2007年，伦敦的抗议者手持标语
声称麻疹、腮腺炎和风疹的疫苗会导致自闭症，甚至是风疹。
和风疹疫苗会导致自闭症，甚至死亡。
(美联社)
罗森伯格-格里兹：人们一直对疫苗可能导致健康儿童患病的观点感到担忧。

索尔克。这其中有一些微妙之处。以百日咳为例，旧的疫苗是基于使用整个被杀死的生物体。那是非常有效的，但因为有一大堆不同种类的蛋白质被混在一起，所以有一些副作用。后来，他们开发了一种所谓的无细胞百日咳疫苗，在那里你使用来自细菌的纯化材料。它没有产生那么强或持久的免疫反应--例如，人们在成年后需要进行强化注射。但它不会引起同样的副作用。

31年前我的儿子迈克尔出生时，全细胞疫苗仍在使用。那时百日咳在这个国家基本上已经消失了，所以从某种角度来说，我们为什么要冒着给自己的孩子带来高烧或其他副作用的风险呢？我知道我当然想过很多这个问题。但我就是不能让自己利用别人对孩子进行免疫的好处--可以说是搭便车。迈克尔最后确实发烧了。但如果我们不给他注射疫苗，我就无法接受自己的决定。

罗森伯格-格里茨：一些疫苗反对者认为，只要孩子们生活方式健康，他们就能避免像小儿麻痹症这样的疾病，或者迅速康复，形成 "自然免疫力"。

索尔克。不，我会毫不犹豫地用非常强烈的字眼来形容这一点。当然，过健康的生活，保持身体的强壮和良好的休息是一件好事。我不排除它可以帮助预防某些类型的疾病。但是当涉及到这些可能对人造成很大伤害的有机体时，我认为想象健康的生活方式可以保护人们免受感染是一厢情愿的。

而我们看到的是，许多疾病都开始复发了。麻疹在复发；百日咳在复发。那些父母选择不给他们接种疫苗的孩子处于危险之中，但是婴儿和那些可能因为某种原因不能接种疫苗的孩子也是如此。这些孩子不再有同样的群体免疫力的好处。他们的保护水平现在正在被削弱。

罗森伯格-格里兹：你还记得你第一次开始听到人们普遍反对疫苗的时候吗？

索尔克。我不记得确切的时间了，但它第一次通过我的一些朋友引起我的注意。我读了他们寄给我的一些材料，我真的很难理解其中的一些逻辑，特别是当它涉及到脊髓灰质炎疫苗时，我对它有所了解。人们声称，这一切都是神话，小儿麻痹症的消失与疫苗无关。

一旦对这些疾病的恐惧开始消退，人们开始审视越南战争等等，并想知道，我们能相信大型机构吗？
现实情况是，早在1954年，就有一项巨大的双盲研究，涉及180万学童。结果是明确的：如果你接种了小儿麻痹症疫苗，你就受到了保护；如果你没有接种，你就没有受到保护。当你有这样的数据时，你就不能说小儿麻痹症的消失是由于其他因素造成的。让我印象深刻的是--我不知道该怎么说，但这就像有一种错误信息的流行，而我们必须给公众打预防针。

罗滕伯格-格里兹：你认为这种错误信息为什么会传播得如此广泛？

索尔克。部分原因是人们已经变得自满，因为这些疾病不再猖獗了。在小儿麻痹症流行期间，人们真的很害怕。这是一种他们不了解的疾病，他们无法预测它的出现，而且它对孩子们产生了可怕的影响。游泳池和电影院被关闭。现在人们很容易忘记这一点。而且，这些天来，人们对自然生活有很多担忧，不希望接触到实验室制造的东西。

但可能还有其他力量在起作用。早在20世纪50年代，人们真的把科学和医学当作能使他们生活得更好的东西。但是，一旦对这些疾病的恐惧开始消退，人们开始关注世界上其他大规模的力量--越南战争、政府等等，并想知道，我们能信任大型机构吗？我们能相信制药公司吗？我认为这也是驱使人们的东西：一种疏离感。


1954年3月29日，《时代》杂志的封面上有一张 "小儿麻痹症战士索尔克 "的照片。
"小儿麻痹症斗士索尔克 "的照片，上面写道：
"今年是个好年份吗？"
罗森伯格-格里兹：你认为如果有更多像你父亲那样的科学家--直接与公众交流并出现在主要杂志封面上的名人研究人员，会有帮助吗？

索尔克。我父亲是一个公众人物，但他的同行们并不总是喜欢这样。像他那样直接与公众交流并不是科学传统的一部分。科学家们应该只通过会议和出版物进行交流。但在有些时候，我父亲觉得直接与人们沟通真的很重要，以帮助他们了解正在发生的事情，使他们的期望值适当地保持一致。这并不是他的科学家同事们真正欣赏的东西。

罗滕伯格-格里茨：他还决定不为疫苗申请专利。为什么不呢？

索尔克。我不认为他真的想过这个问题。他完全是为了创造一种能够保护儿童免受脊髓灰质炎侵害的疫苗。事实上，"三月 "组织曾研究过专利问题。我不认为他们有任何邪恶的理由。我看过一些通信的记录，我怀疑他们想确保药物的生产是正确的。他们一直试图引起我父亲的注意，因为他们需要获得信息来申请专利，当他不想把注意力放在这上面时，这让他们感到非常沮丧。那时候，这只是一个不同的世界。

罗森伯格-格里兹：根据你自己的经验，专利和利润对制药业有什么影响？

索尔克。我可以回忆一下我在艾滋病治疗方面的经验。早在上个世纪末和本世纪初，我就参与了帮助非洲和亚洲引进治疗方法的工作--那是在艾滋病药物一年为1万美元或1.5万美元的时候。有些国家的卫生预算是每人每年4美元左右。在这个范围内的价格，这些药物怎么可能在这些国家使用？ 最后，全球抗击艾滋病、结核病和疟疾基金出现了，并帮助投入了一些资金。布什总统带着PEPFAR来了。最后，印度和巴西的一些仿制药制造商以更便宜的药物版本推动了价格下降。

这些复杂的力量使事情发展到至少你有一个可管理的系统。但是这些系统的建立并没有为加强这些国家的卫生保健基础设施提供任何规定。他们支付药物，但他们没有支付医疗专业人员的培训。你在埃博拉病毒上看到了这一点；目前受影响的非洲国家的卫生保健系统完全不完善。他们应该怎么做？他们没有能力保护他们的人民免受这些疾病的传播。而现在，由于我们没有提供足够的帮助，使他们站起来，我们自己也面临着后果。


2011年1月，彼得-索尔克（Peter Salk）在纽约举行的新闻发布会上与比尔-盖茨交谈，宣布盖茨基金会将在全球范围内消除脊髓灰质炎。(AP)
罗森伯格-格里茨：你和你父亲花了好几年时间研究艾滋病疫苗。为什么它比小儿麻痹症疫苗更难制造？

索尔克。脊髓灰质炎病毒只有三个版本。对于艾滋病毒，病毒正在迅速变化，就像流感一样。你一年打的流感疫苗和下一年的不一样。艾滋病的情况也是如此。如果你产生了免疫反应，病毒会迅速变异以逃避免疫反应。

另外，脊髓灰质炎是一种急性疾病。你受到感染后就会消失。对于HIV，一旦你被感染了，它就会进入你的细胞。它的遗传物质现在被整合到你自己的遗传物质中。一旦病毒有了这样的立足点，到目前为止，还不可能摆脱它。

罗滕伯格-格里兹：那么你父亲想做什么？

索尔克。作为第一步，他想利用这样一个事实：从一个人感染病毒到出现免疫缺陷症状之间有这么长的时间。在这几个月里，在这几年里，病毒正在侵蚀你的CD4 T细胞。最终，它们被耗尽，以至于你不再能够抵御不同的病原体，等等。

他想尝试的是一种非常简单的方法。与小儿麻痹症一样，他使用了一种被杀死的病毒。他的想法是，你也许能够提高已经感染了病毒的人的免疫系统的某一部分的活性，以帮助杀死感染了艾滋病毒的细胞，从而减缓疾病的发展。

1987年开始在受感染的病人身上进行首次临床试验。该项目一直持续到2007年左右。没有任何实际的结果，但我后来回去做了一个统计分析，基于我在电脑上或纸质文件中的数据子集。结果发现，该疫苗对减缓疾病的进展，对这些CD4 T细胞的下降有高度统计学意义。因此，在我看来，在这种方法的基础上可以做更多的工作。一个好的起点可能是以更正式和全面的方式做一个独立的元分析。


在巴基斯坦卡拉奇的一个停尸房里，一名抗击小儿麻痹症的工作人员被绑住的脚
在巴基斯坦的卡拉奇。2012年，一名枪手杀害了
五名妇女在为儿童接种脊髓灰质炎疫苗的过程中
为儿童接种小儿麻痹症疫苗。(路透社)
罗森伯格-格里茨：小儿麻痹症本身在一些国家仍未被完全消除。是什么阻碍了它的发展？

索尔克。从事消除小儿麻痹症工作的人正在竭尽所能，但仍有一些国家存在冲突、宗教差异、文化差异和政治差异--这些国家的一些孩子还不能用已使用的疫苗来接种。几年前，印度终于消灭了野生病毒。巴基斯坦是目前最大的问题，其内部动荡不安。这种疾病在阿富汗仍然存在，但这在很大程度上是由巴基斯坦边境上发生的事情造成的。尼日利亚到目前为止也从未消除过野生病毒。

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这对我来说太有趣了。我们现在已经有了疫苗，应该能够永远摆脱这种病毒。但是，除非我们能以更有建设性的方式处理这些人际交往，否则我们不会达到这个目的。这就是阻碍事情发展的原因。这不是科学层面的问题，而是社会层面的问题。

罗滕伯格-格里兹：你父亲花了很多时间来思考这些问题。

索尔克。是的。脊髓灰质炎疫苗问世后，他决定建立一个新的研究所。但从他最早的著作中可以看出，他不只是对研究疫苗、糖尿病等感兴趣。他感兴趣的是处理人与人之间的关系所产生的问题--这些问题在实验室里是无法解决的。

在他看来，宇宙已经经历了三个阶段的进化。首先，是前生物领域，在那里你有物质的演变：原子、分子、恒星、星系。然后出现了生命。生物进化是由生存的需要驱动的。最后，人类出现了。看看我们--现在的进化发生在哪里？我们周围的世界是如此巨大的复杂，而这种复杂性来自于我们。

在我们的生存领域，现在正在进化的基本元素不是物质，不是生命--而是意识。这里的单位是思想。我的父亲把这称为生物界；它是由选择驱动的。他经常说，我们是进化过程的产物，而我们已经成为这个过程本身。做出明智的选择是我们的责任。

Jennie Rothenberg Gritz，曾是《大西洋》杂志的高级编辑，现在是《史密森尼》杂志的高级编辑。