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The forgotten link between Candy Land and polio and why it still matters

The history of the classic board game holds an important lesson about disease.

Photo credits: Amazon (left), Bror Brandt (right)

Candy Land was created for kids in the hospital with polio.

Candy Land has been adored by preschoolers, tolerated by older siblings, and dreaded by adults for generations. The simplicity of its play makes it perfect for young children, and the colorful candy-themed game has endured as an activity the whole family can do together.

Even for the grown-ups who find it mind-numbing to play, there's some sweet nostalgia in traversing the Peppermint Forest and avoiding the Molasses Swamp that tugs at us from our own childhoods. There are few things as innocent and innocuous as a game of Candy Land, but many of us may not know the dark reality behind how and why the game was invented in the first place.

candy landCandy Land has been a family favorite for decades, but it was originally created for kids with polio.m.media-amazon.com

Candy Land was invented by retired schoolteacher Eleanor Abbott while she recovered from polio in 1948. She was convalescing in a San Diego hospital surrounded by children being treated for the disease and saw how isolating and lonely it was for them. The game, which could be played alone and provided a fantasy world for sick children to escape to, become so popular among the hospital's young patients that Abbott's friends encouraged her to pitch it to game manufacturer Milton Bradley. The post-World-War-II timing turned out to be fortuitous.

“There was a huge market—it was parents who had kids and money to spend on them,” Christopher Bensch, Chief Curator at the National Toy Hall of Fame, told PBS. “A number of social and economic factors were coming together for [games] that were released in the [post-war era] that has kept them as evergreen classics." Candy Land soon became Milton Bradley's best-selling game.

Since the game doesn't require any reading or writing to play, children as young as 3 years old could enjoy it when they were feeling sad or homesick in the polio ward. As the polio epidemic ramped up in the early 1950s, the game gained even more popularity as parents often kept their kids indoors during polio outbreaks in their communities.

The polio vaccine changed the game—both for the disease and for Candy Land. Jonas Salk’s inactivated polio vaccine (IPV) was licensed in the spring of 1955 and a widespread vaccine campaign was launched. By 1961, polio cases had dropped from 58,000 to only 161. The disease was considered eradicated from the Americas in 1994, and, as of 2022, the only countries in the world to have any recorded cases were Pakistan and Afghanistan.

graph of polio cases from 1988 to 2021Vaccine GIF by World Health OrganizationGiphy

In the 70 years since the polio vaccine came out, Candy Land's connection to the disease has been lost, and it's now just a classic in the family board game cabinet. The fact that polio has so successfully been controlled and nearly eliminated makes it easy to forget that it used to be a devastating public health threat that spurred the need for the game in the first place. Children are routinely vaccinated for polio, keeping the disease at bay, but anti-vaccine messaging and fear threatens to impact the vaccination rates that have led to that success. Vaccination rates took a hit during the COVID-19 pandemic, and with the appointment of one of the most popular vaccine skeptics as the U.S. Secretary of Health and Human Services, public health specialists are concerned.

There is no cure for polio, so the vaccine is by far our best weapon against it. According to infectious disease experts, it's not impossible for polio to make a comeback. “It’s pockets of the unimmunized that can bring diseases back," Patsy Stinchfield, former president of the National Foundation for Infectious Diseases, told Scientific American. "If you have a community of people geographically close to each other and they all choose not to vaccinate, that community immunity is going to drop quickly. And if a person who has polio or is shedding polio enters that community, the spread will be much more rapid.”

Without herd immunity, vulnerable people such as babies who are too young to be vaccinated and people with compromised immune systems are at risk in addition to the unvaccinated. And since up to 70% of polio cases are asymptomatic, there can be a lot more disease circulating than it appears when symptomatic disease is detected. No one wants the serious outcomes that can come with polio, such as paralysis, the inability to breathe without assistance, or death, especially when outbreaks are entirely preventable through vaccine-induced community immunity.

The fact that kids have been able to enjoy Candy Land for decades without thinking about polio at all is a testament to vaccine effectiveness, but it's also a reminder of how easy it is to take that carefreeness for granted.

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History

America has vaccines thanks in part to an African slave who saved Boston from smallpox

Image ownership: public domain

A 1776 book about the eradication of smallpox in New England.

The early colonists of Boston were terrified—and nearly wiped out—by a rapidly spreading virus. As our modern society panics over incoming COVID-19 variants, I’m sure you can imagine the climate.

But instead of being taken by the deadly disease, Boston took part in a bold new experiment. As a result, smallpox was stopped in its tracks.

And it was thanks to the brilliant idea of an enslaved man, who really should be a household name for his contribution, one that remains a foundational principle in modern medicine.

Though an ancient affliction (as in, even the Egyptians knew about it), smallpox didn’t appear in the Western Hemisphere until 1507. But when it did, it killed an estimated 2 million among the native population alone.

Smallpox incited fever, fatigue, a nightmare-ish rash and worst of all, it was extremely contagious. The once-prosperous town of Boston had residents fleeing to avoid possible exposure.

smallpox, black history month, vaccine history

Smallpox under the microscope.

upload.wikimedia.org

But fate was changed in 1721, when a man named Onesimus shared how he once had smallpox. And that he overcame it.

Onesimus was a slave to Puritan minister Cotton Mather (major player in the Salem witch trials, swell guy), and was given his name from another enslaved man in the Bible whose name meant “useful.” Mather also referred to Onesimus as “wicked,” but something tells me Mather liked to dish out that descriptor a lot. And moreover, Onesimus proved to be indeed quite useful.

Onesimus told Mather the story of how he, too, contracted smallpox in Africa but “had undergone an operation, which had given him something of the smallpox and would forever preserve him from it...and whoever had the courage to use it was forever free of the fear of contagion.”

That operation would later be widely known as variolation, where a healthy person could make a small cut in their skin, then insert infectious material (in this case, pus from smallpox blisters) into the cut. You’re welcome for the visual.

Not being entirely trusting—shocker—Mather decided to research further. Lo and behold, this method had not only been used in Africa, but China and Turkey as well.

Wisdom did not beat racism so easily. Even Mather was accused of “Negroish thinking” while trying to promote the idea. Not to mention that, ironically, the very religion Mather idolized proved to be an obstacle, as other preachers claimed the practice to be “against God’s will.”

That tune changed after more than 14% of Boston's population was decimated, and one physician showed his support. Zabdiel Boylston inoculated his son, and the slaves in his possession, and the results were impossible to ignore: of the 24 people inoculated, only six died.

history of medicine, black heroes

1802: a comparison of smallpox (left) and 16 days after being administered with cowpox (right)

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Without Onesimus introducing this form of disease prevention, we very likely might still be facing smallpox today … if we survived, that is. The success of variolation planted the seed for new hope, and not much later, a vaccine based on cowpox would be developed.

Not much is known about what happened to Onesimus, other than partially purchasing his freedom from Mather. But we owe him a debt of recognition. This is a valuable story not only for the power of science, but for the amazing insight to be gained by respecting other cultures.

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Wellness

Vaccine mandates work, most people support them, and it's maddening that we even need them at all

Photo by Tim Gouw on Unsplash, @kimmaicutler/Twitter

As debates over vaccine mandates raged this summer, United Airlines took the decisive step to require all employees to get vaccinated for COVID-19. Employees who applied and were approved for a medical or religious exemption would be placed on medical leave and risk losing income. Those who refused the vaccine and did not receive an exemption would be terminated.

The not-messing-around approach worked smashingly. Prior to the deadline, only a fraction of a percent of United's staff—320 out of 67,000 employees—ended up choosing termination. That left United Airlines with an astounding 99.5% vaccination rate.

United took a risk and it paid off. Not only did the company retain the vast majority of its workforce, but applicants started clamoring to work for the airline. According to The New York Times, the airline received 20,000 applications for approximately 2,000 flight attendant positions after the vaccine mandate was announced.


United kicked off a trend. Other airlines followed suit, and we saw more and more companies requiring employees to be vaccinated.

Vaccine mandates have proven successful, but not without controversy. Within an already understaffed health care industry, the risk of losing employees who refuse to be vaccinated is real. So is the risk of unvaccinated health care workers treating patients.

In California, mandates for health care workers resulted in a huge uptick in vaccinations. The same thing happened in Texas. Despite predictions of a mass exodus of New York and New Jersey health care workers, only a small number chose to quit when mandates took effect. In fact, many of those who chose to stay on and take the alternative weekly testing option decided to get vaccinated after just a few weeks of being swabbed.

Mandates clearly work—but it's maddening that we have had to resort to them. Some success stories have proven that mandates aren't always necessary to reach a high vaccination rate. After being the only team in the NFL to have zero COVID-19 cases during last season, the Seattle Seahawks made a strong push to get their staff and players vaccinated. The NFL asked for teams to try for an 85% vaccination rate; with just one player declining, the Seahawks hit a whopping 99% vaccination rate weeks before the football season even began. By the time the season officially started, the NFL reported that 93% of players across the league had been vaccinated—a far higher percentage than the general population.

Perhaps that's due to the stringent protocols players who aren't vaccinated have to go through. Perhaps it's the sense of competition within the league and the knowledge that COVID-19 outbreaks can derail a team's chances of a winning season. Perhaps it's because NFL players are supportive of science and common sense than the average American. Whatever it is, the NFL has proven it's possible to create a culture that results in a high vaccination rate without mandates.

If only we could figure out how to create that culture in this country as a whole.

There are legitimate debates to be had about the government mandating vaccines (despite public schools having mandated vaccinations for more than a century), but it's harder to argue against private businesses and organizations requiring them as a condition of employment or participation. People sure do try, though. Anti-vaxxers and "freedom fighters" who disagree with all manner of mandates in the name of personal liberty are loud and proud in their stance. But that doesn't mean they're right.

According to Gallup, the majority of Americans support COVID-19 vaccine mandates. Other polls, including one from Fox News, have found the same thing. If mandates are going to help us stop losing tens of thousands of Americans every month, bring them on.

In a global pandemic that has taken the lives of more than 700,000 Americans in a year and a half, vaccines that lower the risk of infection and transmission and greatly lower the risk of hospitalization and death are a gift. Mandate or no mandate, getting vaccinated is objectively the right thing to do. It would be fabulous if we could get to a high vaccination rate without creating requirements, but with few exceptions (like the NFL), that ideal has proven to be unrealistic.

If it weren't for the massive misinformation machine derailing reality for millions, far fewer people would refuse the vaccine. We're battling a crisis of viral conspiracy theories in addition to the actual viral pandemic, and something has to give.

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A news crew got rare access to a hospital's ICU and revealed the actual toll of COVID-19

4 News Now/YouTube

When we hear about hospitals running out of ICU beds and having to ration care, we may erroneously picture Hollywood movie scenes with frantic healthcare workers hustling constantly with patients and crash carts being frantically wheeled around.

That kind of hectic scene might happen in a single mass tragedy event in an emergency room, but a real ICU isn't like that, even when it's full. The ICU (Intensive Care Unit) is where patients go when they are severely ill or have sustained injuries that require ongoing, life-saving care. Saving lives in the ICU is a days, weeks, and sometimes even months-long endeavor, where nurses and doctors get to know patients a little before sending them home (which is always the hope) or saying goodbye (which has happened far too often in the past 18 months).

A crew from 4 News Now in Spokane was granted rare access to the ICU at Providence Sacred Heart Medical Center, where COVID-19 is taking a toll on doctors and nurses.

"We have 54 beds for adult critical care at Sacred Heart; 26 are in our general medical neuro-trauma ICU and 28 are in our cardiac ICU, but we have had to use the cardiac ICU beds also for COVID patients," ICU nurse manager Deb Gillette told 4 News Now. The hospital has also designated two additional floors for COVID patients who aren't sick enough to need ventilators.

You can hear the weariness in the voices of the doctors and nurses as they explain what they do to keep COVID patients alive and how hard the pandemic has been, even for people who are accustomed to critical care.

Watch this rare glimpse inside an ICU:

Inside the ICU: An exclusive look inside Providence Sacred Heart Medical Center's intensive carewww.youtube.com

The nurses interviewed pointed out that the age of those being admitted to the ICU has dropped from earlier in the pandemic, when it was mostly older patients. Now they're mostly seeing people in their 30s to 60s.

And the message they are sending is the same one we are hearing from ICU staff across the nation: "Get vaccinated."

"We're really trying here and the best thing our community can do is get vaccinated. We really have nothing else," nurse Emily Crews said. "That's our only solution and the more that people do that, the less time we'll spend in here, and the less time at home I'll be thinking about these people who are never going home."

This is the kind of coverage we need to see more of. When the overwhelming tragedy of the pandemic is happening inside hospital rooms where average Americans don't have access, it's far too easy to ignore numbers and pleas because it feels like it's not that bad.

It is that bad. Hospitals across the country are telling us it's bad. ICU workers are telling us it's bad. The past year and a half has been exhausting, but we can relieve some of the burden on healthcare workers by getting vaccinated as soon as we are able.

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