In the first installment of this series, we noted the explosive growth in the human and financial costs of Alzheimer’s Disease and asked, “Does the Right have anything to say?”
Mindful of the importance of the Constitution and the appropriate rule of law, we noted the views of past presidents James Madison and Abraham Lincoln as they wrestled with the question of what is, and what is not, a permissible role for government in confronting a crisis situation.
We can recall Lincoln’s famous quote from 1862, in the middle of the Civil War; he understood that while our principles must be timeless, our responses to emergencies must adapt to the need at hand. As the Sixteenth President declared in a message to Congress:
It is not “can any of us imagine better?” but, “can we all do better?” The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty, and we must rise – with the occasion. As our case is new, so we must think anew, and act anew. We must disenthrall ourselves, and then we shall save our country.
The Civil War, of course, was perhaps the greatest crisis our country has ever faced. Yet public health can be a crisis, too. Epidemics can kill thousands, even millions, without regard to due process, precedent – or, even, property rights. Yes, the prospect of a plague is one of those times when we have to come together to think anew and act anew.
So now we can take a look at how other presidents have dealt with public-health crises.
In the 19th century, the federal government could do little about epidemics; the scientific understanding of causes and remedies just did not exist. And so, for example, 20,000 Americans along the lower Mississippi River died from a breakout of yellow fever in 1878. The 1938 movie Jezebel, set in 19th-century Louisiana, starring Bette Davis and Henry Fonda, vividly depicts the ravages of what was then called “yellow jack.”
In a few places, forward-looking local leaders saw the enormous social and economic value of better public health. The city fathers of Chicago, for example, could see that the outflow of sewage into Lake Michigan was causing a public health hazard – deadly diseases that included typhoid fever, cholera, and dysentery. And so they launched a remarkable public works project; they resolved to reverse the flow of the Chicago River, so that it flowed in from the lake, not out to it. They further created the Chicago Sanitary and Ship Canal so that sewage would drain into a special reservoir far from the city’s population. The effort took 35 years, finally completed in 1922. But it was all worth it: Chicago rose to become the second largest city in America.
Interestingly, national security imperatives finally forced the beginnings of a national solution to these plagues.
In 1904, President Theodore Roosevelt resolved to dig the Panama Canal, and the issue of malaria and yellow fever came to the forefront of American politics. Roosevelt knew that the French had tried and failed to dig the canal several decades earlier, stymied by mass fatalities from tropical illness. The precise mechanism by which those diseases were transmitted was not yet understood, but Dr. Walter Reed, an officer in the U.S. Army Medical Corps, suggested that the culprit was the ubiquitous mosquito. The key to eliminating deadly disease, he argued, was eliminating the standing pools of water in which the insects proliferated. Roosevelt, always the bold leader, made sure that Reed’s strategy was implemented. That is, Americans hacked out and pushed back the jungle on both sides of the “Big Big.” No “environmental impact statements” were filed, nor even dreamed of – the issue was getting the canal built, period.
As a result of this jungle-clearing, the incidence of disease among work crews was reduced dramatically, allowing canal construction to go forward. And so Army doctors joined with the Army Corps of Engineers to create the legendary path between the seas. The Canal was completed in 1914, and the US, in firm control of the zone that straddled the Atlantic and Pacific Oceans, instantly established itself as the world’s leading strategic power. It was “Can Do” America at its best.
Was the mosquito-abatement project expensive? Of course. But did its huge cost force Roosevelt to curtail the Panama Canal project? Not at all. TR understood that the mission had to succeed, and that was that. Moreover, it was cheaper to wipe out the mosquito than to see the canal’s workforce wiped out.
And the lessons of the project paid dividends for the United States domestically as well. Once the Panama Canal effort proved the practicality of mosquito abatement, the same idea was brought home to the US; all across the South, standing water was drained, and countless lives were improved and saved.
We can cite another outstanding public-health mission, completed by another Republican President: polio. As historian David M. Oshinsky chronicles in his 2006 book Polio: An American Story, the disease was a relative newcomer to the U.S.; the first recorded epidemic occurred near Rutland, Vermont, in 1894, in which eighteen people died and fifty were permanently paralyzed. Unpredictable but unpreventable epidemics would recur in the following years. In New York City, for example, 2,000 cases were reported in 1907. In Newark, New Jersey, a 1916 polio epidemic caused 1,360 cases and 363 deaths. And so on, every few years, the deaths continued around the country. One such epidemic struck down Franklin D. Roosevelt in 1921.
In January 1938, two years after he had been reelected to a second presidential term, FDR helped establish the National Foundation for Infantile Paralysis to fight the dread disease.
The foundation took to the radio airwaves and filled the national consciousness with a sense of urgency for conquering the disease. Fund-raising, even in tiny increments, became crucial to the strategy: “Send Your Dime to President Roosevelt!” urged thirty-second radio spots. Although the foundation was headquartered in New York City, the Washington, D.C., connection was vital: The White House received nearly 2.7 million letters within days of the first announcement. The singer and comedian Eddie Cantor coined the phrase “March of Dimes” as a play on the “March of Time” newsreels, and that moniker was soon on everyone’s lips. The ultimate goal, alongside continuing treatment and rehabilitation, was the creation of a vaccine.
Even World War Two did not deter Roosevelt’s enthusiasm for the project. As he wrote to a March of Dimes official: “The fight being waged against infantile paralysis… is an essential part of the struggle in which we are all engaged. Nothing is closer to my heart than the health of our boys and girls and young men and women. To me it is one of the front lines of our National Defense.”
Meanwhile, absent a medical solution, the ravages of the disease worsened. The number of reported cases during the war years more than doubled, from 9,000 to over 19,000. In his 2010 novel Nemesis, the writer Philip Roth, born in 1933, recalled life in his hometown of Newark in the ’40s:
During the annual fund drive, America’s young donated their dimes at school to help in the fight against the disease, they dropped their dimes into collection cans passed around by ushers in movie theaters, and posters announcing “You Can Help, Too!” and “Help Fight Polio!” appeared on the walls of stores and offices and in the corridors of schools across the country, posters of children in wheelchairs – a pretty little girl wearing leg braces shyly sucking her thumb, a clean-cut little boy with leg braces heroically smiling with hope – posters that made the possibility of getting the disease seem all the more frighteningly real to otherwise healthy children.
The disease was indeed “frighteningly real.” In 1952, polio was still bringing fear nationwide. A particularly virulent epidemic struck in that year; of the nearly 58,000 cases reported, 3,145 died, and 21,269 were left paralyzed, most of the victims being children.
Meanwhile, beginning in 1948, the March of Dimes supported the research of many scientists, including Jonas Salk, a young doctor from New York City who was researching the idea of a “killed virus” vaccine for influenza as well as for polio. Operating from two floors at Pittsburgh’s Memorial Hospital, Dr. Salk could look out his window and see polio cases being admitted to the hospital every day. As one nurse recalled of Dr. Salk’s facility: “To leave the place you had to pass a certain number of rooms, and you’d hear a child crying for someone to read his mail to him or for a drink of water or why can’t she move, and you couldn’t be cruel enough just to pass by. It was an atmosphere of grief, terror, and helpless rage.”
The American people avidly followed news reports of the progress of the Salk vaccine and other polio research. Dr. Salk was on his way to becoming a national hero. In 1953, a Gallup poll found that more Americans were aware of polio research than knew the full name of the new President of the United States, Republican Dwight D. Eisenhower.
Thanks to all this attention, March of Dimes funding for Dr. Salk and his colleagues increased steadily, rising from an initial $1.8 million in 1948 to $67 million by 1955, an increase of 3,700 percent.
Moreover, the American people were responding to the March of Dimes and other polio-related appeals in a spirit of widespread cooperation. Nationwide testing of the Salk vaccine began in the spring of 1954. Nearly one-and-a-half million school children, dubbed “America’s Polio Pioneers,” took part in these trials, with the help of another seven million adult volunteers. According to the March of Dimes, this effort was “the largest peace-time mobilization of volunteers in U.S. history.” Some powerful critics railed against the effort, including famed newspaper and radio gossip Walter Winchell, who in April 1954 warned his audience against the vaccine: “It may be a killer!” But cooperation, volunteerism, and teamwork were winning the day as each child in the Pioneer program received three shots, some with a placebo, others with the real vaccine.
The effort, according to historian Oshinsky, “involved a mobilization reminiscent of a country preparing for war.” Amidst isolated reports of side effects (some thirty-eight children who received the vaccine suffered paralysis) and even death (several hundred of the Pioneers died during this time, most from unrelated causes, but perhaps five percent from the vaccine), the vaccinating and evaluating continued.
On April 12, 1955, seventeen years after the founding of the March of Dimes, victory was finally proclaimed: The Food and Drug Administration pronounced the Salk vaccine to be “safe and effective.” Dr. Thomas Francis of the University of Michigan, the project’s official monitor, made the triumphant announcement before an audience that included some 150 press, radio, and television reporters. Fifty-four thousand physicians sitting in movie theaters across the country watched the announcement on closed-circuit television; the pharmaceutical giant Eli Lilly had spent $250,000 to broadcast the event. By the time Dr. Francis had stepped down from the podium, according to medical historian Dr. Paul Offit, “Church bells were ringing across the country, factories were observing moments of silence, synagogues and churches were holding prayer meetings, and parents and teachers were weeping… ‘It was as if a war had ended,’ one observer recalled.”
Indeed, a war had ended. The war against polio had effectively been won. On April 22, Dr. Salk was a guest of honor at a White House ceremony in his honor. President Eisenhower declared the young doctor, just forty years old, to be “a benefactor to mankind.”
Yes, Salk was a benefactor to mankind. But so, too, was Eisenhower, who went on to a landslide re-election in 1956. And so, too, were all the millions of Americans – volunteers, donors, clinical-trial participants – who had been part of the great cure crusade over the previous two decades. As with the Panama Canal, the victory over polio stands as a shining and inspiring example of what “Can Do” America can, in fact, get done.
Both TR and Ike proved, in their different ways, that leadership toward a great goal is not only a life-saver; it can also be a political game-changer.
Game-changing for the GOP is needed today, especially at the national level, where Republicans have sunk into distinct #2 status. GOPers looking for inspiration might start by looking back to the successful history of Republican Presidents Theodore Roosevelt and Dwight Eisenhower.