WHO WILL GET THE VACCINE

THE heartening report from Ann Arbor last week raised an urgent question for every U.S. parent: "Can my children get shots this year to keep them safe from polio?" For about 30 million (more than half the U.S. population under 18), the answer will be yes. Among them, a vast majority of children up to ten years of age will get the shots in one way or another. Originally, the National Foundation for Infantile Paralysis had intended to offer the vaccine in a series of three closely spaced shots within five weeks of each other, as was done in last year's nationwide test. On that basis, the foundation ordered 27 million cc. of vaccine last winter (TIME, Nov.1). This amount was to be given free to some 9,000,000 (children and pregnant women) most threatened by polio. At the same time, the manufacturing companies also decided to make an identical amount of vaccine on their own account, to be sold commercially. But last week, Dr. Salk upset everybody's calculations by reporting that it is better not to give all three shots within five weeks. More effective to build up immunity, Dr. Salk has found, will be two shots this spring, within a month, and a third after at least seven months. As a result, with only two rather than three shots needed for the first big inoculation, there is a surplus left from the amount originally ordered by the foundation--a surplus that can be used to inoculate half again as many subjects as originally planned. The foundation has decided to let the manufacturing companies sell this surplus commercially. (The foundation is thus actually buying one-third less vaccine, will use the savings of $3,000,000 to help pay for the care of victims still crippled from last year's and previous years' polio epidemics.) Who Gets It Free? The foundation will distribute the vaccine free to these groups: P:Children (7,000,000) in the first and second grades. P: 210,000 "polio pioneers" of 1954 in eleven states who got a useless salt solution as a placebo instead of real vaccine in last year's test. P:1,180,000 pioneers in 33 states, in the first and third grades last year, who were "observed controls" but got no injection. P:440,000 pioneers who received vaccine last year but on a less effective, condensed schedule (they will get one shot as a booster). These groups will get their shots from volunteer doctors and nurses at inoculation centers now being set up across the nation in schools and other public buildings. As soon as each batch of vaccine is checked by federal health authorities, it is being shipped to the centers--first to Southern states, where the polio season starts earliest. In many states the vaccinations began this week. Parents' permission is needed for all shots. Who Can Buy It? The surplus turned back to the manufacturers, plus the companies' own supplies, forms a probable pool of 42 million cc. for commercial distribution, or enough for two-ishot inoculations for 21 million individuals. How this pool is to be distributed is at present left to state and local officials. Priorities are being drawn up and the order suggested in most states is something like this: Kindergarten pupils. Children in the third through eighth grades. Pregnant women. Children aged one to five. Youths from 14 to 20. Theoretically, these groups will have to pay for the vaccine and have it administered by private physicians ($2 a shot, plus a probable doctor's fee of $3 to $5). Actually, many states will buy vaccine and give it to at least part of these groups free, e.g., Florida and California legislators introduced bills to cover some indigent or susceptible children; New York's Governor Harriman found $500,000 to extend the free distribution to 250,000 third and fourth graders, and New York City planned to give it to all under 20 who are in school. What Controls? In an effort to ensure that these local and state measures will in fact divide the vaccine equitably across the nation, Health Secretary Oveta Culp Hobby called a conference of medical men and manufacturers for this week. The Administration is reluctant to get involved in a rigid system of controls. Washington hopes that the manufacturers can head off a vaccine black market, probably by allocating it directly to doctors--pediatricians first, then gynecologists, general practitioners last. The doctors would then administer the shots in accordance with the suggested priorities (most of them voluntary, not designed to be enforced by law). Some doctors are already under pressure from parents to vaccinate youngsters out of turn, although as of this week few private physicians had any vaccine. The Third Shot. There are no definite provisions yet for a regulated third shot after seven months. If the follow-up is left to parents, many will forget it or will not have the doctor's fee for an office call. If the schools assume the responsibility of arranging a formal program, which would assure wide participation, the states and subdivisions will have to pony up the money. Who Will Not Get Vaccine. In most of the U.S., youths aged 14 to 20 have slim chances of getting the vaccine this year, and adults (except pregnant women) should not be able to get any. Next year there should be enough for all.

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