Industry Insights

scientist working in a laboratory and using a pipette to transfer solutions

Twenty Considerations for a Successful BSL-3/ABSL-3 Laboratory Design

The pathway to a successful Biosafety Level 3 (BSL-3) and Animal Biosafety Level 3 (ABSL-3) laboratory project lies in the approach and attention to detail during the design process. The following are twenty suggestions for achieving a research program-driven design: 1. Team approach: Completing a BSL-3/ABSL-3 project is a team effort. It involves the creativity of the designer, the forthcoming of the users, the wisdom of the regulator, the ingenuity of the contractor, the experience of the BSL-3/ABSL-3 laboratory certifier, and the restraint of the financier. Developing a design that meets the needs of the research program and then following that plan is a team effort. The team needs to include the Principal Investigator and Biosafety Officer who focus the team on the intended use of the laboratory now, tomorrow, and in the future. The team needs to be aware of the project budget and operating maintenance costs associated with each major design decision. The financier not only needs to be vigilant about projected construction costs but needs to be cognizant of the impact of design decisions on operating costs. Time spent in planning and analysis is money saved in design and construction. Projecting operating and maintenance costs provides for a sustainable design. 2. Checklists: Developing checklists for compliance with applicable guidelines and regulatory requirements, facility standards, biosafety policies and practices, and equipment preferences will identify issues that the designer needs to address. These are tools for ensuring that the design will meet the needs and concerns of the users, stakeholders, regulators, and certifiers. If you have received grants, make sure that your BSL-3/ABSL-3 laboratory is compliant with these guidelines and regulatory requirements as well. The following are key US guidelines and regulations to consider: Biosafety in Microbiological and Biomedical Laboratories (BMBL) CDC/NIH publication, 6th Edition – November 2020 Design Requirements Manual, Division of Technical Resources, The National Institutes of Health, Revised Version 812A 2012, 200 ANSI/ASSP Z9.14-2020, Testing and Performance-Verification Methodologies for Ventilation Systems For Biosafety Level 3 (BSL-3) And Animal Biosafety Level 3 (ABSL-3) NIH Guidelines for Research Involving Recombinant or Synthetic Nucleic Acid Molecules (NIH Guidelines) – April 2019 CDC/USDA Select Agent Policy Statements 3. Pathways drawings: Architectural drawings should show the pathways for personnel, materials, and waste. They should also include emergency exit pathways and gathering points. This analysis will unearth inefficiencies and bottlenecks which can be resolved as part of the design process. 4. Decontamination provisions: Typically, laboratories are surface-decontaminated. Gaseous/vapor decontamination is infrequently utilized. Defining when and how often a laboratory will need gaseous/vapor decontamination is necessary to determine if there is a need to purchase decontamination equipment or if contract services will defray this type of capital investment. A decision to own decontamination equipment is not only a capital investment decision, but it is also an operational decision which requires funds for annual training and validation of the decontamination system. The users need to decide the method of decontamination so the designer can develop provisions in the design. 5. Adequate storage space: Provisions for storage in the anteroom should include space for PPE storage and maintenance (charging of power packs), waste containers, sign-in books, storage/securing of personal items, toweling, hand-washing soap, cleaning materials, and hanging of lab coats where applicable. Space for storage of the autoclave cart needs to be provided. Laboratory storage should be limited to what is needed for the research program. Shelving should be fixed or be the friction-lock adjustable shelving type. Adjustable shelving with hole-type adjustments are pest management and decontamination issues. Cardboard should not be stored in the laboratory, therefore provisions for plastic containers should be considered for storing loose items. 6. Cleanability of surfaces: Ceilings, walls, and floors need to be smooth and cleanable. Design details need to address how surfaces mate together, how they are sealed and finished, specify type of caulk, its color (for maintenance and inspection), and shrinkage requirements. Performance standards for acceptability of caulked joints need to be defined. Surfaces need to be selected for their resistance to chemicals, organic solvents, acids, alkalis, and most importantly, to surface decontamination disinfectants and gas/vapor decontamination processes. 7. Casework: Surface decontamination is the primary method by which most labs are decontaminated. Selecting wall-hung counters and moveable casework to facilitate cleaning should be considered. 8. Doors and frames: Doors need to be self-closing. Doors for change rooms need to provide privacy. Laboratory doors need to have vision panels so one can see if anyone is on the other side of the door. Door frames need to be rigid so the airflow around the door remains constant with door usage. Hardware needs to be filed so there are no sharp edges which can cut a person and/or their PPE on entry into the laboratory. 9. Penetrations: Sealing of penetrations is important from energy consumption, air pressure differential, HEPA filtration, pest management, and decontamination perspectives. The design must provide details for sealing penetrations and performance standards for acceptability of sealing work. Sprinklers often present a challenge if they are not pendant type. 10. Room airflow distribution: Placement of diffusers and exhaust grilles can affect the airflow of the biosafety cabinet and can cause indoor air quality issues. A reflected ceiling plan must take into account the location of the biosafety cabinet and sedentary work stations in relationship to placement of diffusers. The engineer should work closely with the architect in coordinating these locations and selecting the supply airflow terminal devices. Diffusers, exhaust grilles, and exhaust inlets of caging are penetrations in the ceiling and need to be sealed. These details need to be provided in the reflected ceiling plan and in drawing details. 11. Directional airflow: Directional airflow must be designed so that under any laboratory condition the air does not reverse. A drawing should be developed which shows the pressure differentials at each door. The designed airflow balance needs to create directional airflow measured by pressure differentials at each containment barrier door. The design of the laboratory needs to take into consideration building effects from elevators, stack effects, adjoining independent HVAC/exhaust systems, and loading docks. In an HVAC/exhaust system failure scenario, building effects can reverse the airflow in containment if not addressed in the design process. Deep negative conditions can be programmed out using the Building Automation System (BAS). 12. HEPA filtration: If the program or regulations require exhaust HEPA filtration then consideration needs to be given to either central or local HEPA filtration. Local HEPA filtration is either at the exhaust intake or in the branch duct from the exhaust intake at the room level. The issues with room level HEPA exhaust are decontamination and testing of the HEPA filter costs. With local HEPA filtration, the issue is the number of units that need to be tested annually. This cost needs to be evaluated against the cost of decontamination and testing of a central HEPA filtration unit. 13. Redundancy: Unless there is a Class III cabinet being used for aerosol experiments, two redundant exhaust fans is all that is necessary for a BSL-3/ABSL-3 laboratory. These fans perform best during failure scenarios if they are operated together at reduced speed. Redundant air handling units are typically reserved for containment laboratory facilities housing animals. Air pressure differential gages at the entry to the anteroom and at the entry to the laboratory provide laboratory personnel the assurance that the laboratory is working properly. Redundant HEPA filtration units are only necessary if an animal laboratory needs to operate continuously. Laboratories can be tested and inspected while in operation, therefore not requiring an annual shutdown. 14. Maintenance provisions: Space for maintenance of equipment, removal/replacement of components, and decontamination of system components need to be provided as design details. Control exhaust valves are of particular concern and their placement is a decontamination/maintenance issue if they are upstream of the HEPA filter. 15. Sinks: In order to prevent aerosols generated by the water impacting the sink bottom, the designer needs to consider specifying deep well sinks in combination with controlling water pressure. Selection of hands-free devices for faucet operation (elongated wall attached foot pedals, infrared sensor, rod-operated valve, knee valve, or floor pedal) should be based on maintenance requirements as well as the experience of the facility’s maintenance personnel. Regardless of the designer’s choice, the faucet should not have handles of any type which personnel could touch. If a hose bib is attached to the faucet, it should have a hose attached which does not extend below the sink’s rim if not protected by a backflow preventer. Backflow preventers are usually required on laboratory faucets and are recommended provided that they will be maintained. 16. Gas cylinders: Gases should be piped into the laboratory as part of the design. Piping penetrations should be sealed around the pipe. Escutcheon plates are not recommended. Provisions for bottled gases should be made outside the laboratory so bottles can be changed from outside of containment. 17. Lighting and sound levels: Proper lighting levels are necessary for performing tasks, data entry, and cleaning. Energy-efficient lighting technology should be the basis of the lighting design. Light-emitting diode (LED) is today's most energy-efficient lighting system. A lighting consultant can select the proper color temperature and light fixture photometric data to achieve the needed light levels for the tasks to be performed throughout the space. Lighting levels need to be evaluated for security camera selection. Glare on biosafety cabinets needs to be minimized. Provisions for emergency lighting for securing research materials and safe egress are required. Alarm strobing lights in animal facilities need to consider their placement and effect on animal research. Limitations on noise should be part of the design criteria. The noise criteria levels specified by the designer should account for ventilation noise, and owner-specified equipment noise such as biosafety cabinets, freezers, and centrifuges. 18. Communications and security: Design of wiring for communication and security devices needs to have the same detail as for electrical wiring devices. Penetrations need to be sealed and devices caulked to be smooth and cleanable. Provisions for computer stations that are ergonomically designed and placed in close proximity to the data generation point is a time-saving design element. Another consideration is the placement of the computer’s fan so it doesn’t cause a disturbance to the biosafety cabinet. Also, the cords for the computer, monitor, keyboard, and other peripherals need to be harnessed so they are not draped on the floor and can be easily cleaned. The design must address the biosafety vulnerabilities of the facility. A multi-disciplinary approach (biosafety professional, security professional, facilities director, human resources representative, and an executive management representative) should view security from a holistic perspective. 19. Circuit breakers: Electrical panels should be located outside of containment so maintenance personnel do not need to enter containment. Additionally, the receptacles within containment need to be marked with breaker identification so in the event of a tripped breaker the researcher can direct the maintenance personnel from within containment to which breaker needs resetting. 20. Emergency power: Choices for emergency power systems are usually left to the designer. The users need to provide direction as to their emergency power needs, either total or partial emergency power. Consideration should be given to a dedicated emergency generator for the laboratory rather than utilizing the building emergency generator for reliability reasons. Reliability rules when specifying the automatic transfer switch. With emergency power you can, on larger campuses, have redundancy but a transfer switch is a single failure point. Regardless of these choices, the equipment serving the room-level equipment including HVAC control components may need uninterruptible power supplies. A holistic approach is recommended for selection of an emergency power system that also accounts for shutting down or not shutting down the entire building to test the containment laboratory within the building. Testing disruptions cannot be tolerated in some instances because of other 24/7 critical functions which cannot not be interrupted. In analyzing the final design, emphasis needs to be placed on the details. Constant referral to the research program requirements, containment guidelines, lessons learned, project construction and operating budgets, and the completeness of the design documents are essential to a successful design that meets the users and the stakeholders’ needs and provides sustainability. Efforts spent in design by an integrated team of users, professionals, and stakeholders will culminate in a safe, sustainable, and secure research facility. Are you planning to build or renovate a BSL-3/ABSL-3 laboratory? No matter what project phase you are in, contact World BioHazTec (WBHT) to schedule a free 30-minute consultation or send us an email. You are a conversation away from starting down a successful pathway to meet containment compliance and sustainability!

biohazard sign posted outside of a laboratory

Looking for a BSL-2 Laboratory Space?

Five things to consider when scoping out a BSL-2 lab space to keep your workers safe. More and more commercial building landlords set aside laboratory space to lease. When scoping out possible options for existing laboratory space, beyond the research experiment, you need to consider worker safety. Being risk averse is a good practice when walking through potential laboratory spaces for your next research project. Here are 5 things to consider when scoping out a BSL-2 laboratory. 1. Establish Your Criteria Through Safety Guidelines Safety in a laboratory is paramount! There are guidelines available to you that can serve as your criteria or provide a checklist to ensure that when evaluating a space, it “checks the boxes.” When looking for a new home, most people have their “dealbreakers” (e.g., must have 3 bedrooms and a walk-in pantry) versus their “bonuses” (e.g., pool and wood-burning fireplace). The same idea can be applied when looking at a potential BSL-2 laboratory space. What are your dealbreakers? Establishing your safety guidelines before you even call a landlord to inquire about a space is a good way to communicate what kind of laboratory space is needed. The Biosafety in Microbiological and Biomedical Laboratories (BMBL) published by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) provides guidance on the laboratory space requirements. The World Health Organization (WHO)’s Laboratory Biosafety Manual is another source that will guide you how to approach your laboratory with a balanced risk assessment. Please be informed, the BMBL is a guideline and not a regulation. If a laboratory space does not meet all of the statements within the guidelines, you can conduct a risk assessment to evaluate the potential risk and impact to your research, workers and the surrounding environment. A workaround solution such as an administrative control can provide an easy resolution. Workaround administrative control solutions will require training and monitoring so factor that into your decision-making. Preplanning will expedite decision-making and protect your most valuable personnel as well as the tenants who share the building. If you are an employer or landlord and in need of a space evaluation, risk assessment or a second opinion if whether a space or building qualifies for a biological containment laboratory, contact us for more information. 2. Adequate Inward Directional Airflow Inward directional airflow that does not recirculate outside of the BSL-2 laboratory is highly recommended by the BMBL to ensure that sufficient air is being drawn into the BSL-2 laboratory and to prevent aerosol transmission from the laboratory into another part of the building. Inward directional airflow draws air into the laboratory from the “clean” areas (e.g., corridor outside of a laboratory) and toward “potentially contaminated” areas (e.g., a biological safety cabinet [BSC]). Although not a requirement, the BMBL and WHO Laboratory Biosafety Manual recommends that a BSL-2 laboratory has inward directional airflow. The rationale is to eliminate the risk of others in the building from being exposed to the biological and/or chemical materials that could be released into the space inadvertently. Verification of directional airflow can be accomplished and documented by a Testing and Air Balance (TAB) Report or by an engineer’s testing and certification. A pressure differential target value is at least .05 In. H2O (15 Pascals) which approximates 100 CFM passing through the crack area of the entry door. Ask the landlord for a TAB Report so you can verify if there is directional airflow. Not sure where to start or how to read a TAB Report? Contact us and we can help you. 3. Biological Safety Cabinet (BSC) Placement The BSC is a key area where your manipulations will occur in the BSL-2 laboratory. When walking through the laboratory, consider where the BSC will be placed. You want to make sure that people walking by do not disrupt the air inflow into the BSC. Rule of thumb is to place the BSC away from doors and common pathways within the laboratory. If you have limited options, put a demarcation line on the floor (red tape works well) as a visual aid as to where not to walk. Train and periodically observe your laboratory personnel to ensure they do not cross the demarcation line when walking past the BSC. Ideally, the BSC should be placed as far as possible from the entryway. The objective of directional airflow is to draw air from the “clean” areas toward the potentially contaminated areas. The BSC is the most potentially contaminated space within the laboratory. Having your BSC placed far from the entryway reduces the risk of exposure and minimizes BSC airflow disruption. One last point about BSCs and their required annual testing. There needs to be at least 12 inches between the HEPA filter of a Class II type A2 BSC for scanning the HEPA filter. Make sure to check floor-to-ceiling clearance for the height of the BSC you will be using. Although BSC stands are adjustable, you do not want to have the BSC so low that it impacts the worker’s ergonomics. BSC heights are generally about 8 feet so you will need at least a floor-to-ceiling height of 9 feet. 4. Look Down At The Floor Slips, trips, falls and spills are always a great risk in the workplace. The BSL-2 laboratory floor should be smooth, slip-resistant flooring. Sealed flooring is recommended. Watch out for manufactured floors with grooves or grouted floors that cannot be easily cleaned. We suggest verifying that the flooring material is chemical resistant and antimicrobial. Carpets and rugs are unacceptable. 5. Let This Sink In You would be surprised how many times our experts evaluated laboratories that do not have sinks at the entry/exit ways. Good laboratory practice is to wash your hands before leaving the laboratory to minimize potential contamination of door hardware. Ideally, the sink should be located close to the laboratory exit so that after doffing PPE, the worker can wash their hands. 6. It Doesn’t Hurt To Ask Surprise! We have a 6th tip. Discuss with the landlord and document what needs to be installed, repaired, or replaced before you take occupancy. Any annual maintenance items should also be discussed (e.g., filter changes, lighting relamping, etc.) and discuss deliveries to the facility (e.g., laboratory samples, bottled gasses, etc.). This effort will pay off in the future with you being a long-term tenant and establishing an amicable tenant and landlord relationship. Next Steps Are you interested in scoping out a biological containment (BSL-2 or BSL-3) laboratory? Consider inviting one of World BioHazTec’s experts along. We can evaluate the space and perform a risk assessment to determine if the containment laboratory space can accommodate your laboratory needs. Our services can include any or all needs for reviewing the TAB Report, assisting with equipment placement and evaluating the overall layout of the laboratory. Our report will provide you and the landlord a basis for discussion on lease modifications and tenant upgrades to move forward with leasing the space.

Members of World BioHazTec including the President, Kerstin Haskell holding the proclamation

How a Simple Click Turned Into Maryland’s First “Biosafety Day”

By Kerstin Haskell, President, World BioHazTec and 2024–2025 President, Chesapeake Area Biological Safety Association (ChABSA) Back in January, I was on the State of Maryland’s website—why, I honestly can’t remember—but there on the homepage I saw a link: “Request a Proclamation.” Something about that link sparked a thought: What if ChABSA's annual symposium had an official proclamation to recognize biosafety and the professionals who safeguard our labs and communities every day? As the President of World BioHazTec and the 2024–2025 President of ChABSA (Chesapeake Area Biological Safety Association), I’m constantly thinking about how we can raise awareness and elevate the biosafety profession—not just within our community, but in the broader public sphere. This felt like a unique opportunity to do just that. So I clicked. What followed was a journey that reminded me of the power of persistence, collaboration, and simply asking. After clicking through, I realized I had to write the proclamation myself. I turned to artificial intelligence, which helped me shape the language, structure, and tone—guiding me through examples and best practices for proclamation writing. With that support, I drafted the text and submitted it through the official portal. Then I waited. A week went by. Silence. I started wondering if it had gone into a bureaucratic black hole. That’s when I remembered my colleague and friend, Brian Castleberry at the Maryland Department of Commerce. I had met Brian through World BioHazTec’s participation in the 2023 Arab Health Show, which was supported by a Maryland export promotion grant for small businesses. I reached out, shared the proclamation request, and Brian kindly forwarded it to a deputy director at the Governor’s Office. Another month passed. Still nothing. Brian followed up again on my behalf (thank you, Brian!), and I continued to wait. Then came a stroke of serendipity. I was in Annapolis testifying before the Maryland House Ways and Means Committee on a proposed tax on life sciences services. Sitting beside me on the panel was Kelly Schulz, President of the Maryland Tech Council. I had long admired Kelly’s work supporting the state’s life sciences community, and this was my chance to finally meet her. After the hearing, we exchanged contact information and started texting. I told her about the proclamation and asked if she might be willing to help. Without hesitation, she said yes. Kelly advised me to follow up after the state’s budget cycle closed at the end of March. I did—and when we met in person, she followed up with the Governor’s Office...right there in front of me. Around the same time, Tracey Brown, World BioHazTec’s Training Manager, who also serves as ChABSA’s Treasurer, reached out to our long-standing partners at the Universities at Shady Grove (USG). ChABSA has proudly supported USG’s Biosafety and Biosecurity Scholarship Program, and the relationship has grown through collaborative events and shared goals. In response to the outreach, Tom Clifford and Joyce Fuhrmann submitted a formal letter of support to the Governor’s Office, strongly advocating for the proclamation to recognize Biosafety Day. Then, just a week before the symposium, I received the news: Governor Wes Moore had officially proclaimed June 4, 2025, as “Biosafety Day” in Maryland. This would not have happened without the advocacy and belief of people like Brian, Kelly, Tom, Joyce, Tracey and others who understand the value of biosafety to Maryland’s workforce, research institutions, and public health system. It’s a reminder that biosafety professionals are making a difference every day—and that our work deserves to be seen and celebrated. Sometimes, all it takes is a click. And a follow-up. And a little courage to ask. Proclamation: Biosafety Day June 4, 2025 WHEREAS, The field of biosafety plays a critical role in protecting public health, scientific research, and the environment by ensuring the safe handling and containment of biological materials in laboratories and research settings; and WHEREAS, Biosafety professionals work diligently to establish and maintain policies, procedures and physical containment measures that prevent accidental exposure to harmful biological agents and promote the responsible use of biotechnology; WHEREAS, Maryland is home to one the nation’s strongest life sciences industries, employing more than 54,000 people across a wide range of roles in research and development, manufacturing, and laboratory operations; and WHEREAS, The Chesapeake Area Biological Safety Association will hold its 35th Scientific Symposium at the Universities at Shady Grove in Rockville, Maryland; and WHEREAS, Through ongoing training, inspections, risk assessments and containment measures, biosafety professionals uphold rigorous standards that protect against biological risks and support safe scientific progress; WHEREAS, The establishment of Biosafety Day serves as an opportunity to highlight the achievements of biosafety professionals, encourages collaboration across disciplines and raise awareness about the importance of effective biosafety programs and protocols. Now therefore, I, Wes Moore, Governor of the State of Maryland, do hereby proclaim June 4, 2025 as Biosafety Day in Maryland, and do commend this observation to all of our citizens.

TB and America’s First Public Health Campaign: A Look Back at Early Efforts to Combat Tuberculosis

Early History of Tuberculosis in the U.S. Tuberculosis (TB) has a long, devastating history in the United States. Once known as “The Captain of Death” and the “White Plague,” this deadly disease shaped not only the public’s health but also everyday behaviors and how we as a society responded to infectious threats. Though its grip on the nation has loosened with modern medicine, TB’s early impact on the U.S. led to the creation of some of our first organized public health campaigns. A Devastating Disease: TB’s Early Years in America In the 1700s, tuberculosis earned ominous nicknames like “The Robber of Youth” and “The Captain of Death.” In the 1800s, it became known as the “White Plague,” referencing the pale appearance of its sufferers. It was also commonly called “Consumption” because of its high mortality rate and how victims were consumed by hacking, bloody coughs, debilitating pain in their lungs, and fever, making it impossible to get out of bed. The disease, caused by the bacterium Mycobacterium tuberculosis, spread primarily through the air when an infected person coughed or sneezed. The disease became rampant, thriving in overcrowded urban areas where poor sanitation and malnutrition were common. Without effective treatments, TB was often fatal, leading to widespread fear and stigma. (Stolley & Spector, 1966). 80% of those individuals who developed active tuberculosis died of it. At the time, there was little understanding of how the disease was transmitted, and medical knowledge regarding its treatment was limited. Public health infrastructure was still in its infancy, and many people with TB were left untreated, which further contributed to the spread of the disease. A Public Health Crisis At the beginning of the 19th century, tuberculosis had killed one in seven of all people that had ever lived. During the nineteenth and early twentieth centuries, it was the leading cause of death in the United States, and one of the most feared diseases in the world. It was estimated that, at the turn of the century, 450 Americans died of tuberculosis every day, mostly between the ages of 15 and 44. The death rate in 1900 measured 194 per 100,000 persons. Comparatively, the death rate in America during the COVID-19 pandemic was 61.3 per 100,00 persons. At the turn of the century, TB was a ubiquitous component of American society and culture. While it was a disease that typically impacted lower socio-economic classes who often resided in overcrowded cities, living and working in poorly ventilated structures, more prominent Americans were not beyond TB’s reach. Among the list of well-known Americans who succumbed to TB included former Presidents James Monroe and Andrew Jackson, two of Abraham Lincoln’s sons, two of Richard Nixon’s brothers, First Lady Eleanor Roosevelt, authors Henry David Thoreau, Edward Bellamy, George Orwell, Stephen Crane, and Thomas Wolfe, actor W.C. Fields, business tycoon Jay Gould, musicians Chick Webb and Jimmy Blanton, and Clara Barton, founder of the American Red Cross, just to name a few. Early Infectious Disease Control: America’s First Public Health Campaign The Sanatorium Movement By the late 1800s, public health leaders in the U.S. recognized the need to address TB through organized medical and social interventions. One of the earliest responses to TB was the establishment of sanatoriums, specialized treatment centers designed to isolate and care for people with tuberculosis. The idea behind sanatoriums was simple: fresh air, rest, and good nutrition were believed to help patients recover. By the late 1800s and early 1900s, doctors and health officials discovered that TB was most contagious during the active stages of the disease. Isolating patients in sanatoriums reduced the risk of spreading TB to the general population. These institutions were typically located in rural areas or places with clean air, and patients were encouraged to spend most of their time outdoors. These facilities not only provided physical care but also helped reduce the stigma surrounding TB, as they became recognized as centers for both healing and hope. Many sanatoriums were funded by a combination of public funds, charitable donations, and private contributions, reflecting the community-wide effort to address the epidemic. Image from the University of Virginia's Claude Moore Health Sciences Library as appeared in the digital exhibit, "The American Lung Association Crusade" at http://exhibits.hsl.virginia.edu/alav/tu Life in the Sanitorium In the first decades of the 20th century, one out of every 170 Americans lived in a sanatorium, some for many years. For many, these institutions were their last hope. While sanatoriums were not a cure for TB, they provided some relief, particularly for patients in the early stages of the disease. However, life in the Sanitoriums was not easy. Patients often left for sanatoriums in the middle of the night, without telling people. They quit their jobs, or they just left to protect their families. Entering a sanatorium required complete submission. Physicians and nurses regulated every moment of the day. When people first came to a sanatorium, many were put on 24-hour rest. All their meals were brought to bed on trays. They were required to use bedpans. Many facilities were segregated by race, and some African Americans, barred from whites-only sanatoriums, helped start their own. Despite the hardships, sanatoriums offered a sense of community for those afflicted by the disease. They were isolated from the fear of infecting others and often found solace in the companionship of fellow patients. For all the freedoms they lost, patients were able to embrace the idea of healing and hope in a place that was devoted to their care. The success of these early sanatoriums served to influence later public health policy in the U.S. The idea of isolating infected individuals, as seen in the sanatoriums, laid the groundwork for quarantine practices, which were later used for controlling other infectious diseases, including influenza, smallpox, and even COVID-19. TB Public Health Campaign: The Foundation for Modern Infectious Disease Control By the early 20th century, public health officials realized that isolating TB patients was just one part of the solution. The other part was educating the public about TB transmission and prevention. The establishment of the National Tuberculosis Association in 1904 (now the American Lung Association) marked an important milestone in raising awareness about TB. The association’s work centered around educating the public on the importance of early detection, promoting hygiene practices like covering one’s mouth when coughing, and encouraging people to seek medical treatment as soon as symptoms appeared. Public health campaigns also emphasized the importance of improving living conditions. Poor nutrition, overcrowded housing, and lack of access to healthcare were known to exacerbate TB, and improving these factors became a key focus for public health advocates. As TB research progressed and medical treatments were developed, quarantine and isolation protocols continued to be important public health tools. The early emphasis on isolating individuals with active TB in sanatoriums eventually led to more formal quarantine measures for individuals diagnosed with the disease. This practice of isolation not only reduced the risk of transmission but also contributed to the eventual creation of specialized infectious disease units in hospitals. Conclusion Early public health responses to tuberculosis in the United States laid the foundation for modern practices in infectious disease prevention and management. The establishment of sanatoriums, public health campaigns to educate the public, and advances in medical research helped reduce TB-related mortality. Additionally, the development of isolation protocols and laboratory biosafety measures, informed by TB research, established the groundwork for how the U.S. manages infectious diseases today. Though TB is no longer the threat it once was, the lessons learned during this time continue to influence how we approach modern public health crises. References Ahmad FB, Cisewski JA, Xu J, Anderson RN. (2022). COVID-19 Mortality Update — United States, Retrieved from https://www.cdc.gov/mmwr/volumes/72/wr/mm7218a4.htm American Experience. (2015). The Forgotten Plague. Retrieved from https://www.pbs.org/wgbh/americanexperience/films/plague/#transcript American Lung Association. (2020). A Brief History of Tuberculosis in the United States. Retrieved from https://www.lung.org/research/trends-in-lung-disease/tuberculosis Centers for Disease Control and Prevention (CDC). (2021). Tuberculosis (TB) History and Timeline. Retrieved from https://www.cdc.gov/tb/about/history/default.htm Fennell, M. L. (2018). The Rise and Fall of the Tuberculosis Sanatorium: The Role of Sanatoriums in Early Public Health Responses. Journal of the History of Medicine, 73(2), 130-142. Mackenzie, R. W. (2002). Public Health and Tuberculosis Control in the United States. Health Affairs, 21(3), 182-192. Rosen, G. (1993). A History of Public Health. Johns Hopkins University Press. Rothman, Sheila M. Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in American History (New York: BasicBooks, 1994) Snider, G.L. (1997). Tuberculosis then and now: a personal perspective on the last 50 years. Retrieved from https://pubmed.ncbi.nlm.nih.gov/9027277/ Stolley, P. D., & Spector, W. S. (1966). Tuberculosis in the United States: The Role of Medical Interventions and Public Health Efforts in Reducing Tuberculosis Mortality. The Journal of Infectious Diseases, 118(3), 184-197.

“Like Patenting the Sun”: America’s Fight Against Polio and the Power of a Vaccine

In the early 1950s, as the United States relaxed in the post-WWII glow, a terrifying disease threatened to disrupt the safety and peace that families had fought so hard to secure. Polio, a virus that cast a shadow over families for decades, surged to alarming levels, with a peak of 57,879 reported cases in 1952, resulting in 3,145 deaths. This terrifying epidemic, which primarily struck children, shattered the idealized vision of suburban life and posed an existential threat to the very idea of family safety in a modern, scientifically advanced world. A Nation Gripped by Fear For middle-class American families, polio was an unwelcome intrusion into a life they believed they could control. The postwar years had promised safety—victory over the Great Depression, success in World War II, and the newfound comforts of suburban living. But polio, which could paralyze or kill seemingly without reason, introduced a sense of vulnerability and helplessness. The random nature of its spread left families in constant fear. An otherwise healthy child could be struck down in an instant, leaving parents to wonder where they went wrong. The polio virus could take anywhere from six to twenty days to incubate and remained contagious for up to two weeks. Its long incubation period, coupled with the fact that the virus was highly stable in the environment, made it nearly impossible for experts to track how it was spreading. Some believed it was spread through water, leading to public pools and beaches being closed during the summer months. In fact, one book about the epidemic is aptly titled The Summer Plague, emphasizing how the virus seemed to return each year, adding to the dread. The Impact of Polio on Daily Life During the height of the epidemic, life as usual was put on pause. Swimming pools, movie theaters, and even playgrounds were shut down to protect children from the virus. Parents, gripped by the fear that their children could "catch polio" at any given moment, kept them isolated, away from friends, and away from public spaces. Rumors abounded, blaming soft drinks, weather patterns, or even the use of paper money for spreading the disease. Health officials, overwhelmed by the unpredictability of the virus, took extreme measures—such as isolating children suspected of being infected and quarantining them in sanitariums. By the time the polio epidemic reached its peak, fear was ingrained into American life. Each summer, when the virus was most active, the country seemed to hold its breath, waiting for the next wave of infections. Counterintuitive Culprit: Hygiene and Clean Water Polio had existed in obscure forms before the twentieth century, with occasional outbreaks in the 18th and 19th centuries. But it wasn't until the early 1900s that the disease became a widespread epidemic. The clue to its terrifying rise was hidden in something presumably beneficial: improving sanitation and clean water systems. Before the 20th century, the virus was rampant in water supplies. When a very young child was exposed, it would often cause a mild reaction, such as diarrhea, that would lead to lifelong immunity. But as public health efforts improved sanitation and water systems, children no longer had the mild exposure that would naturally build immunity. As a result, polio began to affect older children and young adults who were not immune. With no understanding of the virus’s transmission or how to prevent it, epidemics like the one in 1916, and later ones in the 1940s and 1950s, were disastrous. Polio's victims were disproportionately from the middle class, which struck fear into this emblem of American global superiority. The virus struck at a time when modern society had assumed it had mastered infectious diseases. Polio was the cruel reminder that not even the most advanced systems could protect against everything. The Search for a Vaccine: A Triumph of Science and Collaboration In the midst of this public health crisis, hope emerged in the form of a vaccine. Dr. Jonas Salk, a name now synonymous with polio eradication, developed the inactivated polio vaccine (IPV), which would change the course of history. By 1955, the vaccine had been tested and found to be both safe and effective. This was a monumental breakthrough. For Salk, the success of the vaccine was not about personal profit—he famously refused to patent it, saying it would be like “patenting the sun.” The introduction of the vaccine led to a massive public health campaign. Between 1955 and 1962, over 400 million doses of the vaccine were distributed, dramatically reducing cases by 90%. Polio, once the most feared disease in America, began to fade into memory. The collective effort that brought the vaccine to fruition—through the leadership of President Franklin Roosevelt, the work of scientists like Salk, and the bravery of volunteers who tested the vaccine—was a triumph of cooperation and public trust in science. The Cold War Twist: The Sabin Vaccine and Global Cooperation While Salk’s vaccine was taking hold in the U.S., another breakthrough emerged. Dr. Albert Sabin developed an oral polio vaccine, which could be taken in a simple pill rather than requiring an injection. However, by the time Sabin was ready to test his live-virus vaccine in the U.S., many children had already received the Salk vaccine, so he turned to Eastern Europe for testing. In one of the most remarkable stories of Cold War collaboration, Sabin tested his vaccine on millions of children in the Soviet Union, Hungary, and other Eastern European countries, where the results were overwhelmingly positive. The success of the Sabin vaccine in these countries demonstrated the power of international cooperation during a time of immense political tension. Hungary, in particular, became a pioneer in polio vaccination, beginning its nationwide vaccination campaign in 1959—four years before the United States adopted the Sabin vaccine. This global effort to eradicate polio marked a rare moment of unity in an era defined by the ideological divide of the Cold War. A Faint Memory: Polio's Legacy and the Ongoing Struggle By the end of the 20th century, the specter of polio had receded into the background of public consciousness. With vaccination programs and public health campaigns, polio became a disease of the past in many parts of the world. However, the legacy of this disease lives on, not only in the memories of those who lived through the epidemic, but also in the ongoing fight to eradicate it completely. In some ways, polio is now a victim of its own success. Today’s parents, who have never seen the disease’s devastating effects, may take vaccines for granted. But the history of polio serves as a reminder of the power of science, collaboration, and public trust. It also underscores the importance of remaining vigilant in the face of new and evolving health threats. References Janssen, Volker. (2023). When Polio Triggered Fear and Panic Among Parents in the 1950s. Retrieved from https://www.history.com/news/polio-fear-post-wwii-era Kurlander, Carl. (2020). How the deadly polio epidemic changed American life for decades before a vaccine was found. Retrieved from https://www.milwaukeeindependent.com/syndicated/deadly-polio-epidemic-changed-american-life-decades-vaccine-found/ Lienhard, John H. Polio and Clean Water. Retrieved from https://engines.egr.uh.edu/episode/1527 Rochford, Rosemary. (2022). A virologist explains polio’s history as fears of a resurgence grow. Retrieved from https://arkansasadvocate.com/2022/09/08/a-virologist-explains-polios-history-as-fears-of-a-resurgence-grow/ Vargha, Dóra. (2018). Polio Across the Iron Curtain: Hungary’s Cold War with an Epidemic. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK565345/ Weeks, Linton. (2015). Defeating Polio, The Disease That Paralyzed America. Retrieved from https://www.npr.org/sections/npr-history-dept/2015/04/10/398515228/defeating-the-disease-that-paralyzed-america

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