The polio years

The March of Dimes has always approached its mission with a spirit of adventure. Born on the eve of World War II as the National Foundation for Infantile Paralysis (NFIP), the Foundation achieved an instantaneous popularity that reflected the contemporary popularity of its founder, Franklin D. Roosevelt. FDR’s polio disability – he was never able to walk again on his own after contracting polio – translated into a systematic program to uncover the mysteries of polio and to lend a helping hand to Americans suffering from the disease. The war years were a time of titanic struggle, and efforts to launch the March of Dimes were boosted by radio, Hollywood, and the personal appeal of the president. Basil O’Connor, a close associate of FDR through his entire presidency, became the leading light of the March of Dimes for over three decades, and his immediate task in 1938 was to build an organization that could quickly respond to polio epidemics anywhere in the nation. As president of the NFIP, Basil O’Connor set out at once to create a network of local chapters that could raise money and deliver aid – an adventurous program that paid off substantially just as polio was on the rise.

Little was known about polio then, but the scientific committees established by the NFIP to fund virus research found opportunities to assist the war effort by investigating diseases affecting those in uniform. In 1943, the NFIP awarded a grant to the U.S. Army Neurotropic Virus Commission to study polio in North Africa; Albert Sabin, MD was dispatched to conduct parts of this study. The end of the war ushered in new complexities to effective fund-raising, though FDR was memorialized on the U.S. dime in 1946 thanks to a polio patients’ club of the Norfolk Hospital Association Chapter of the NFIP. This assured the remembrance of FDR’s intrinsic connection to the March of Dimes in perpetuity. March of Dimes-funded medical research accelerated as the patient aid program was taxed to its limits, particularly in the huge polio epidemic of 1949. Entering the 1950s, the 3,100 chapters of the NFIP operated almost completely by volunteers who proved that the March of Dimes was a grass-roots movement, captured nicely in the ubiquitous slogan “Join the March of Dimes.”

The NFIP closed in on a solution to polio thanks to not only countless medical researchers supported by March of Dimes grants, but also to energetic staffers like Elaine Whitelaw, who cultivated volunteers nationwide, and Charles Bynum, an African-American educator who recognized that polio care was also a civil rights issue. The greatest promise, however, came in a breakthrough at the University of Pittsburgh by a young physician whose name soon became a household word as a symbol of hope. A March of Dimes grantee, Jonas Salk, MD, pressed forward from a routine virus typing project to the creation of a vaccine that spelled the end of polio in a matter of years. Tested in a massive field trial in 1954 that involved 1.8 million schoolchildren known as “polio pioneers,” the Salk vaccine was licensed for use on April 12, 1955, the very day it was announced to the news media as “safe, effective, and potent.” Many had labored diligently to reveal how poliovirus functioned and how to stop it, but no accomplishment seemed as dramatic and instantly newsworthy as the Salk vaccine. From this point, polio declined rapidly from tens of thousands of new cases per year to a mere handful; a fearsome disease had been put to rest by the sustained efforts of millions of volunteers, coordinated by the NFIP.

A new mission: Birth defects

Basil O’Connor had been preparing the next move for five years. On July 22, 1958, at a press conference held in the grand ballroom of New York’s Waldorf-Astoria, he announced the Foundation’s new mission: birth defects prevention. This choice was in keeping with a continued focus on disabilities and disorders appearing in infancy and childhood. Through careful study and rigorous public opinion polls, the Foundation shifted gears into wholly new territory, seeking to become a “flexible force” in the field of public health. Developing a strategy to cope with birth defects, however, was quite unlike fighting epidemic polio, but before long the “New March of Dimes” was funding genetics research and establishing birth defects treatment centers in hospitals across the country. At this juncture the Foundation also played a major role in the creation of the Salk Institute for Biological Studies in La Jolla, California, bringing to fruition Jonas Salk’s scientific vision of an interdisciplinary research center that would reveal the hidden mechanisms of disease. In 1964, the March of Dimes held its first Volunteer Leadership Conference in La Jolla to inaugurate the Salk Institute and to celebrate the gains of the first years of birth defects prevention.

If any individual stands as a pivotal figure at this time of transition, it was surely Virginia Apgar, MD. Widely known for the “Apgar Score,” a clinical system of evaluating the physical condition of newborns at birth, Dr. Apgar joined the March of Dimes in 1959, eventually to become Vice President for Medical Affairs and a leading publicist for the new mission. In fact, Dr. Apgar could be hailed as the “founder” of our interest in prematurity, for it was she who first brought attention to the problems of premature birth, as early as 1960. Virginia Apgar was a charismatic and tireless advocate for those affected by birth defects, and she never missed an opportunity to focus on the well-being of the newborn in the delivery room in her educational outreach. In her March of Dimes career she orchestrated a campaign for immunization against rubella, promoted the establishment of birth defects registries, and insisted that genetic history and pregnancy history be made a routine part of medical record-keeping for pregnant women. By the time of her death in 1974, Dr. Apgar had helped pave the way for yet another transition that culminated in the publication of Toward Improving the Outcome of Pregnancy in 1976.

A shift of focus: Healthy pregnancy

As the March of Dimes developed its programs of research and education in initial efforts to fathom the universe of birth defects, it became apparent that these conditions and disorders were inextricably linked to the medical, social and epidemiological circumstances of pregnancy itself. With Dr. Apgar’s lead, the March of Dimes broadened its approach to improving birth outcomes by incorporating perspectives in perinatal health that appropriately considered the health of all pregnant women and babies. By the 1970s, the March of Dimes focus on prevention of birth defects and infant mortality began to encompass the problems of premature birth and low birthweight to integrate these fully into our mission. March of Dimes grants for medical services shifted to neonatal intensive care, genetic counseling and perinatal networks; and funds for statewide networks of intensive care for high-risk infants led in turn to grants for the training of medical professionals in prenatal evaluation and care of high-risk pregnancies. The March of Dimes slogan, Be Good to Your Baby before It Is Born, embodied a philosophy about proactive prenatal care in programs such as Operation Stork and Stork’s Nest to educate women about healthy pregnancy at the community level. Dr. Apgar played an instrumental role in convening the Committee on Perinatal Health that published Toward Improving the Outcome of Pregnancy, a model for the regionalization of perinatal health care.

The turn toward perinatal health dovetailed with an initiative to map the human genome through a series of international gene mapping workshops as the Foundation appeared to have reinvented its mission once again. The promise of reinvention was evident no less in the fund-raising arena as March of Dimes chapters began to hold local “walk-a-thons” as community fund-raisers in 1970. The idea caught hold, took off, and soared; before long WalkAmerica (rebranded as March for Babies in 2008) became the premier walking event that matched the widespread popularity of the original “March of Dimes” fund-raisers of the 1940s. The 1980s brought cataclysmic challenges in the form of HIV-AIDS and substance abuse, and the March of Dimes addressed such problems wherever they impacted the health of mothers and babies, just as it would do through assistance to newborn intensive care units (NICUs) in hospitals of the Gulf Coast states in 2005 in the aftermath of Hurricane Katrina. Our research grantees during this period ranged from David Smith, MD, and Kenneth Lyons Jones, MD, who identified fetal alcohol syndrome as a clinically defined birth defect to T. Allen Merritt, MD, who developed an early pulmonary surfactant used to treat respiratory distress in premature babies. The Foundation articulated these breakthroughs into wide-ranging public health messages about avoiding alcohol during pregnancy and vigorous support for surfactant therapy.

The crisis of prematurity

The March of Dimes has had but four presidents. Joseph Nee and subsequently Charles Massey succeeded Basil O’Connor after his death in 1972. In 1990, Dr. Jennifer L. Howse began her tenure as president and launched the Campaign for Healthier Babies as a platform to promote cost effective prenatal care programs focusing on reducing low birthweight and infant mortality. In its multi-faceted approach to birth defects, the March of Dimes redoubled its efforts to open every window of opportunity to improve infant health and reduce premature birth. The 1990s saw the advent of a workplace wellness initiative, Healthy Babies Healthy Business; our Office of Government Affairs spearheaded several public health policy initiatives, including the Birth Defects Prevention Act of 1998; and the establishment of our Office of Global Programs led to worldwide partnerships bringing immediate benefits in prenatal education and care to communities in Latin America, Europe and Asia. An unusual occurrence of neural tube defects (NTDs) in Brownsville, Texas, coupled with new evidence that folic acid was instrumental in fighting this scourge, led to the March of Dimes Folic Acid Campaign in 1998. Based on a U.S. Public Health Service recommendation that women of child-bearing age take 400 micrograms of the B vitamin folic acid daily to reduce the likelihood of NTDs in newborns, the campaign succeeded in its goal of raising awareness and reducing the incidence of this class of birth defect with the help of grain fortification mandated by the U.S. Food and Drug Administration.

For the past thirty years, well into the 21st century, the rate of premature birth in the United States has risen steadily. In 2003, the March of Dimes launched its Prematurity Campaign to confront this alarming trend, the nation’s most serious perinatal health problem. Initial Prematurity Campaign goals were to increase public awareness of the problem and to decrease the preterm birth rate by at least 15 percent by 2010. While awareness has measurably increased, the preterm birth rate itself has continued to climb; e.g., more than 520,000 babies were born prematurely in 2005. In that year, the Foundation formally added prematurity to its mission statement and three years later extended the Prematurity Campaign to the year 2020 in an effort to apply additional scientific, clinical and public policy advances to solve this problem. Our work continues on all fronts. The March of Dimes NICU Family Support program provides information, comfort and support to families during NICU hospitalizations. Our longstanding advocacy for newborn screening has led to nearly complete mandated coverage in all states for 30 serious disorders. And our recent focus on late preterm birth – infants born between 34 and 36 weeks gestation – has alerted health care providers, mothers and mothers-to-be that every week of pregnancy up to full term is critically important. From Prematurity Awareness Month (November) to the annual March for Babies, from our national Prematurity Research Initiative to countless local community grants across the United States, the March of Dimes is proud to uphold its commitment as the champion for all babies.

August 26, 2010 / David Rose / March of Dimes Archives