The polio sugar cube: why families got their vaccine on a Sunday, in a paper cup

The sugar cube carried Albert Sabin’s oral polio vaccine, a live, weakened virus you swallowed instead of getting a shot. It was licensed in stages from 1961 to 1963, handed out at mass “Sabin Oral Sunday” clinics, and used in the U.S. until Jan. 1, 2000, when the country switched to the shot alone.

On six Sundays in the summer of 1962, Cleveland volunteers handed out 5,000,000 sugar cubes, each one in its own tiny paper cup. That’s about three cubes for each of the more than 1.5 million Clevelanders who took the vaccine, because it came as three separate types of vaccine, Type I, Type II and Type III, given weeks apart, and you came back for each one.

The cube in that cup had three drops of the vaccine on it, a weakened virus that was still alive, and you swallowed it with the sugar. Jonas Salk’s vaccine from 1955 did the same job but it used a killed virus and came in a shot.

What a Sabin Oral Sunday looked like

On the nights before Phoenix’s first two Sabin Oral Sundays, SOS for short, an airplane flew over the city from dusk until 10 p.m. with a flashing neon sign. On the first of them, in January 1962, as PHOENIX magazine told it in 2026, 250,000 people got the vaccine. Four National Guard helicopters moved supplies around, guided by ham radio operators, and the vaccine still ran out. The 59 clinics had to send about 100,000 people home without it.

The doses came in order. Pfizer, which made Maricopa County’s vaccine, recommended Type II four to six weeks after Type I, and Type III eight to 12 weeks later. So a Phoenix family that started in January wasn’t done until spring.

Over in Ohio, Cleveland’s medical academy decided on its own drive when Sabin came to town on April 3, 1962, and the academy had seven weeks to get ready. Signing for a program estimated at $500,000 took nerve, mind you, for an academy with $900 in its treasury, as its own history tells it.

The clinics ran from noon to 6 p.m. Pharmacists put three drops on each of tens of thousands of cubes, “the important and fatiguing task,” in the academy’s words, while policemen from each town directed traffic. And the SOS phone line, CE 1-8000, known as the “polio” number, got so many calls that seven phone sets went in, with nine lines on each.

As far as I could find nobody wrote down why the clinics were held on Sundays, so this part is my own reading of the record. Sunday was the day a school building stood empty, and every clinic in the Arizona drive was scheduled for a Sunday, and school buildings were the clinic sites. Cleveland’s opened at noon, and the first two and a half hours brought about 40% of the people each clinic served, which fits families coming on from church. Rusty Foley’s family went to Arcadia High School, in Phoenix, after church.

Whatever the reason for the day, it worked in Phoenix, judging by what the Maricopa County Medical Society’s director told The Arizona Republic. The only yardstick they had was the Salk program of a year and a half before, and “the SOS program had five times that response within four hours.”

Phoenix gave the vaccine free and asked for a voluntary donation of 25 cents. Bismarck and Los Angeles asked a quarter a dose, and Los Angeles promised that nobody would be refused. A quarter in 1962 is about $2.78 in today’s money, or about 13 minutes of work at the $1.15 federal minimum wage.

Jim Tucker, who grew up to be a pediatrician in Pittsburgh, was 10 when his turn came, at a Saturday clinic in Elkins Park, Pa. Card tables, with colorful balloons tied on with string. Several mothers brought the cookie sheets they used for chocolate-chip cookies the rest of the year. “Hundreds of sugar cubes were lined up on them in tidy little rows,” he wrote in the Pittsburgh Post-Gazette in 2021. “Several drops of the pink polio vaccine were dripped onto each one.”

A Fort Worth Star-Telegram caption from July 1962 gave readers the whole drill. Everyone would get three drops of vaccine on a sugar cube, and “all you do is chew it up.” That August a 6-year-old, Jim Krum, was at the Central Fire Station and watched a pharmacist, J.R. Kilman, put the vaccine on the cubes.

A father gives his daughter her sugar cube at a high school clinic in Decatur, Ga., 1961. Photo by George Stenhouse, CDC Public Health Image Library, public domain.

Why a sugar cube instead of a shot

The vaccine itself tasted bitter and salty, Cincinnati Children’s notes. That’s why it could be given on a sugar lump, or in a spoonful of a sweet syrup known as Sabin Syrup.

The Los Angeles County health officer went through the new vaccine’s advantages in the Torrance Herald in August 1962. “Perhaps the chief one as far as most people are concerned,” the officer wrote, was that it was “given by mouth (usually on a lump of sugar) instead of by injection.” A 2022 profile of Sabin in the CDC’s journal, Emerging Infectious Diseases, adds that the oral vaccine was easier to give and cost less than the shot.

Charmaine Brock Schlick got hers at Ritter Elementary School in Tempe, Ariz. “Everyone was excited about getting the sugar cubes in a small white disposable cup,” she told PHOENIX magazine. “It was such a relief for me because those old vaccine guns had terrified me, and I was a pretty tough little kid.”

The boy in the 1962 Atlanta photo at the top of this page wasn’t so sure. In the CDC’s own caption, he is “eyeing the sugar cube apprehensively.”

Salk’s shot had been licensed on April 12, 1955, three years after the worst polio year, 1952, when the country had more than 21,000 paralytic cases. Having had it didn’t keep you out of the Sunday line. “My brother and I had already had the Salk vaccine, but my parents believed adding Sabin’s was important,” Rusty Foley said.

How many came, town by town

Boys at the paperwork table of a mass vaccine clinic, Georgia, 1961. CDC Public Health Image Library, public domain.

Cincinnati, where Sabin had worked since 1939, went first, before any oral vaccine had been licensed. People lined up outside Cincinnati Children’s Hospital and at schools and churches.

Arizona’s count comes from the doctors who ran the drive, writing in JAMA in January 1963. The CDC kept its own count, state by state, of the mass programs it knew about. It came out in Poliomyelitis Surveillance Report No. 278 in July 1963. From licensing through June 1963, those programs gave about 43 million doses of Type I, 30 million of Type II and 26 million of Type III. September 1962 was the busiest month for Type I, with 9.86 million doses.

The states differ on how many came back for the later doses. California held nearly level from Type I to Type III, while Texas gave less than a third as many Type III doses as Type I. The report doesn’t say why. It counts mass programs only, so some of those children may have finished the series at a doctor’s office instead, and the table can’t tell us how many.

Doses given in mass programs from licensing through June 1963, rounded. CDC, Poliomyelitis Surveillance Report No. 278, Table II.

Not everyone got a cube

Omaha drank its vaccine in cherry-flavored syrup, and History Nebraska titled its account “What happened when a million Nebraskans drank Polio Punch.” Local TV ran it like a telethon, with tote boards tallying the numbers as they were phoned in. KMTV’s own look back says the station “covered it like an election,” live during a baseball game, and Sabin joined the broadcast from Ohio.

In Palm Beach County, Fla., in 1964, some of the clinics were drive-in theaters. The Boynton Beach Historical Society collected memories of the one in Delray Beach. Robin Raborn was one of the people the families got their cups from. “I remember running back and forth, delivering tiny paper cups with the sugar cubes to the families driving through,” she said. Some cups didn’t have a cube at all, just three drops in a little water, cherry-flavored for some.

Thomas Bruce Smith remembers that “they sent the cars into three lanes, you pulled up and they gave you little paper cups.” The account goes on: “The lanes were segregated with two lanes for white families and one lane for black and brown residents.”

Type III and the 11 cases of 1962

Was it safe? That same August piece in the Torrance Herald put the number of people around the world who had probably taken Sabin’s vaccine at more than 100 million. “As far as is known,” the officer wrote, “not a single case of poliomyelitis has been caused by its administration.”

In Nebraska that year, nine people “developed an illness compatible with” polio within weeks of taking the Type III vaccine. In September the Public Health Service pulled back on Type III while it investigated. The CDC’s report of Oct. 5 says Type III was to go on for preschool and school-age children “but not for adults at this time.” Los Angeles had planned Type III for two Sundays in December, and by late November those Dec. 2 and 9 clinics were set to give Type II instead.

On Dec. 20 the Omaha World-Herald reported 11 confirmed polio cases nationwide after Type III, eight of them in people over 30. The Public Health Service had found those 11 among 15 million doses, History Nebraska writes. It lifted its hold with the advice that the vaccine be “used for adults only with the full recognition of its very small risks.” So the answer in 1962 was yes for children, and for adults a very small risk that doctors were told to weigh.

Why the U.S. stopped using the oral vaccine

The last wild polio caught in the United States was in 1979. From 1980 through 1999 the country had 162 confirmed cases of paralytic polio. The weakened Sabin strains in the oral polio vaccine, or OPV, caused 154 of them, about one case for every 2 to 3 million doses.

In the late 1990s the country first moved to shots followed by drops. On June 17, 1999, the Advisory Committee on Immunization Practices voted for shots only, starting Jan. 1, 2000. The last vaccine-associated case caught on U.S. soil was reported in 1999. Since 2000 only the shot has been given here, “to eliminate the risk of polio variants that can occur with OPV,” in the CDC’s words.

The cube and Mary Poppins

Robert Sherman co-wrote the songs for the 1964 film Mary Poppins. As Cincinnati Children’s tells it, he said the words to “A Spoonful of Sugar” came to him not long after Jeffrey, his 5-year-old, told him how he’d taken the Sabin vaccine with some sugar at school one day.