Limited government role in polio vaccine development & trial

1. Limited government role in polio vaccine development & trial Funded by NFIP philanthropy oversaw & promoted vaccine trial simultaneously Public Health Service labs helped evaluate vaccine safety for trial but not required to do so • PHS legal powers had not been altered since 1902 Federal Health dept. licensed commercial vaccine production after trial merely required safety protocol documentation—did not test vaccine Assumption: industry would want to produce safe vaccine thus limited oversight needed “Cutter incident” disproved this: >250 polio cases from live virus

2. U.S. government funding for health insurance Veterans hospitals following WWI viewed as entitlement for services performed Medicare, 1965 for retired Americans focused on hospital care at first SSA (est. 1935) administered program in 1972 other categories of disabled adults were added e.g. dialysis patients Medicaid, similarly structured, for poor, also 1965 paid in grants to states, like other “welfare” provisions eligibility complex & bureaucratic (vs. age-based Medicare)

3. Clinton on U.S. health care problems, 1993 • Health care lost if job is lost • “Medical indigence” from serious illness • Pre-existing condition renders patients ineligible for new insurance • High health expenses, by global standards • No preventive care for the many uninsured • Massive, varied paperwork for insurers major cost for hospitals

4. AIDS timeline, 1980-1996 1980 unusual disease outbreaks among gay men 1982 disease linked to IV drug use as well 1983 virus ID’d: allowed for donor blood screening 1986 referred to as HIV 1986 anti-retroviral drugs (AZT) developed slows virus reproduc’n & progress of disease 1996 inexpensive drug regimen to prevent mother-to-child transmission, if administered prenatally

5. CDC/Dept. of Health posters, 1989

6. A global view of HIV infection 38.6 million people [33.4‒46.0 million] living with HIV, 2005 2.4

7. Estimated number of adults and children living with HIV by region, 1986–2005 45 40 Oceania Million 35 North Africa & Middle East 30 Eastern Europe & Central Asia 25 Latin America and Caribbean Number of people living with HIV 20 North America and Western Europe 15 Asia 10 Sub-Saharan Africa 5 0 1985 1990 1995 2000 2005 Year

8. AIDS vulnerability in Africa • Depleted immune-system, increasing vulnerability to transmission Malnutrition (skin, mucous membranes also break down) Parasites (chronic immune system response, exhausts it) Other illnesses (cofactors): malaria, TB • Needle use iatrogenic transmission: 30-70% in Africa, says one study Due to limited needles and resources for sterilization Untreated needle abscesses an avenue for AIDS transmission. Compounds exposure of those with STDs, due to medical treatment

9. % of 15-19 yr olds, never married, who have had intercourse Great Britain 62M 49F .1% AIDS U. S. 55M 42F .6% AIDS Haiti 44F 12F 5.6% AIDS Tanzania 38M 24F 8.8%AIDS Zimbabwe 31M 9F 24.6%AIDS

10. From Thomas McKeown, The Modern Rise of Population, New York: Academic Press, 1976.