The First Flu Shot | University of Michigan Heritage Project

In Tommy Francis and Jonas Salk, the Army had two medical scientists as good, perhaps, as any in the world — both brilliant, both utterly devoted to the work at hand, and both deeply ambitious on behalf of their own way of seeing scientific problems.

But one worked for the other. That could last for the duration of the war, maybe longer. But anyone who knew both men could tell it wasn’t going to last forever.

Salk was often a maverick in the lab, trying innovations that Francis thought unwise. Francis was a classic academic scientist, Salk something of a natural philosopher. “Damn it all, Salk,” Francis would say, “why can’t you do things the way everyone else does?”

Once Salk asked Francis to review the manuscript of a scientific article he had just drafted for publication.

Francis, an arch-stickler for precision in scientific matters, read the draft, then told Salk his conclusions weren’t supported by his evidence.

Salk said: “The inferences were warranted by reason, if not by hard data.”

Francis said that wasn’t the way U-M’s Department of Epidemiology did things. Salk said he supposed he’d send the article out for publication anyway.

“If you do,” Francis said, “you’d better go with it.”

Salk stayed. But he was increasingly frustrated by Francis’s high profile while he, Salk, labored on in the lab, unrecognized by the scientific establishment.

“Jonas was doing all the work and Tommy was getting all the fame,” said a colleague of both, “so that caused an obvious friction.”

When the war was over and the first big Army vaccination was complete, Salk applied for openings at the University of California and Western Reserve University. No offer came. Then, in 1947, he went for a talk with the new dean of medicine at the University of Pittsburgh. It was no great medical school, but the dean had big plans and wanted Salk to help achieve them.

Salk accepted Pitt’s offer. He would build a new program in virology.

“Tommy Francis thought I was making a mistake,” he said later. “So did everyone else. I can remember someone asking me, ‘What’s in Pittsburgh, for heaven’s sake?’ and I answered, ‘I guess I fell in love.’ What I was in love with, of course, was the prospect of independence.’”

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Seven years later, Jonas Salk had developed a vaccine for polio, a disease even more dreaded than influenza, since it killed and crippled children in savage summertime epidemics that were growing worse by the year.

To be proven effective, Salk knew, his new vaccine must be tested in the largest field trials ever attempted, all in the glare of worldwide publicity. And they must be conducted with absolute integrity, or his breakthrough would fall to pieces.

The bill for the trials was to be paid by the National Foundation for Infantile Paralysis, which had underwritten Salk’s pursuit of the vaccine. Critics balked. The Foundation had too great a stake in the outcome, they said. How could it guarantee an unbiased result?

So the Foundation asked Tommy Francis to design and oversee the trials. His appointment laid to rest any questions about bias and integrity.

As a model, Francis used the influenza trials conducted with Army trainees on college campuses. He resisted pressure to complete the trials before the onset of the summer polio season of 1954. And he insisted on a double-blind trial. Nearly two million children, ages six to nine, took part.

This time, the principle of informed consent prevailed. The parents of every child signed their approval.

On April 12, 1955, a decade to the day after the death of Franklin Roosevelt, whose polio case had led to the campaign for a cure, Salk and Francis stood shoulder to shoulder on the stage of the Rackham Auditorium in Ann Arbor and announced the results of the polio field trials.

“SALK POLIO VACCINE PROVES SUCCESS; MILLIONS WILL BE IMMUNIZED SOON,” proclaimed the front page of the next day’s New York Times. The accompanying photo shows Salk and Francis, both smiling broadly, Salk slightly upstage of his old boss.

* * *

Polio was virtually eradicated in the United States and around the world by a combination of Salk’s injected “killed-virus” vaccine and its successor, an attenuated live-virus vaccine developed by Albert Sabin of the University of Cincinnati. (Taken orally instead of by injection, the Sabin vaccine proved to be easier to give and longer-lasting than the Salk vaccine.) The disease has mounted a comeback in places where parents refuse to allow their children to receive the vaccine.

Meanwhile, influenza marches on. In 2017-2018, it was blamed for the deaths of nearly 80,000 Americans, the largest toll in many years.

The U.S. Centers for Disease Control and Prevention recommend that virtually every American over the age of six months receive an annual vaccine to guard against the flu strains expected to circulate in the U.S. in the coming year. The vaccine is estimated to prevent infection in about two-thirds of those who receive it.

But in 2018, nearly half of Americans surveyed said they planned to skip the shot.

Sources included “Thomas Francis, Jr.: An Appreciation” by Myron E. Wegman; “The Restless Spirit of Thomas Francis, Jr., Still Lives” by Jonas Salk; “Thomas Francis, Jr., as a Clinician, 1900-1969” by John R. Paul; and “Thomas Francis, Jr., M.D. 1900-1969” by Colin M. Macleod, in Archives of Environmental Health; Jonas Salk: A Life by Charlotte Decroes Jacobs; Breakthrough: The Saga of Jonas Salk by Richard Carter; Thomas Francis, Jr., 1900-1969: A Biographical Memoir, by John R. Paul; “DeKruif’s Boast: Vaccine Trials and the Construction of a Virus,” by John M. Eyler, Bulletin of the History of Medicine; “Vaccine Innovation in World War II,” by Kendall Hoyt, Journal of Public Health.