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Stuck in an iron lung, a Louisville man still voted. What's your excuse? | Louisville Courier Journal | USA Today.

[Published 10:08 AM EDT Nov 2, 2018]

Joe Gerth writes:

The firefighters arrived at the home at 10017 Silverwood Lane on Nov. 5, 1968.

They rolled the man out of the Valley Station house, into the street and up the ramp into the back of a moving van. It took nine men to do it.

They plugged into one portable generator on the back of the van. A second one was nearby in case the first went on the fritz.

And then, lying in the iron lung that kept him alive while amyotrophic lateral sclerosis, or Lou Gehrig's disease, wasted his muscles, Billy Dare Ashley went to vote.

Once a common device in American hospitals, especially as polio ravaged the nation’s children, iron lungs were heavy metal tubes that used negative pressure to force their inhabitants to breathe.

Pleasure Ridge Park firefighters and others loaded Bill Ashley, who was confined to an iron lung, into a moving van that took him to vote in the 1968 election. By Charles Fentress Jr., The Courier-Journal. Nov. 5, 1968
By Charles Fentress Jr., The Courier-Journal

Those who needed them to live were encapsulated in the iron lungs, their head the only part of their bodies sticking out. A collar would tighten around their necks to ensure a proper seal.

The election that November pitted Republican Richard Nixon against Vice President Hubert Humphrey and then-former and future Alabama Gov. George Wallace.

It would be the last presidential election that Ashley, a World War II veteran, government biochemist and Boy Scout leader, would live to see. But it showed an amazing dedication to an act that too many people so cavalierly dismiss these days.

In 2014, the last midterm election, just 37 percent of eligible voters cast ballots nationwide. It was the lowest voter turnout since World War II. In recent midterm elections, Kentucky voter turnout has hovered between 46 percent and 49 percent.

Who's on your midterm ballot: Here's how to find your candidates

Michael McDonald, a professor who studies voter turnout at the University of Florida, recently told NPR that voter turnout nationwide may rise to between 45 percent and 50 percent this year. Kentucky Secretary of State Allison Lundergan Grimes has predicted that 46 percent of Kentucky voters will show up at the polls on Tuesday.

Dorothea Ashley stands next to her husband, Bill, at their home in Valley Station. Bill Ashley voted in the 1968 election despite the fact that he was confined to an iron lung. By Charles Fentress Jr., The Courier-Journal. Nov. 5, 1968
By Charles Fentress Jr., The Courier-Journal.

For Ashley, it was an act of patriotism and one that he cherished, said his granddaughter, Ashley Hostetter, who was born a decade after Billy Ashley died.

"He felt a very strong pull to have a voice," said Hostetter, 36, a nurse who lives in Louisville.

Josh Douglas, a law professor at the University of Kentucky and a voting rights expert, said that voter participation in the United States is low for a number of reasons, ranging from impediments like voter ID laws that make it more difficult to register, to simple voter apathy. 

There has never been a "good old days" for voting in this country, he said.

"We have always placed barriers to voting for some people and there has always been apathy," Douglas said. 

While some people have made extraordinary efforts to vote — like people going to the department of motor vehicles five or six times to get registered or one of Douglas' students, who is blind, who waited 45 minutes for poll workers to figure out how to use a handicapped-accessible voting machine — he said he had never heard of anyone like Ashley.

Most iron lungs went out of use as technology improved. Some, like Ashley, had to be in them permanently. Others required them only when they slept.

Brian Tiburzi, executive director of Post-Polio Health International, in St. Louis, said the iron lung waned as more portable breathing devices became available.

Related: Actor Michael Shannon comes home to Kentucky to 'get out the vote'

At first there were smaller units that used negative pressure like the iron lung, and then more recently devices were developed that used positive pressure, similar to CPAP machines. Today, Tiburzi said, the number of iron lungs in use in the United States is in the single digits. 

"I only know of three," he said. 

Outside Ashley’s family, the day that Billy Ashley went to vote would likely be forgotten, if not for a single picture that appeared on page A7 of the Courier Journal on the day after the election that saw Nixon win his first term in a tight race.

In the photo, the tube that Ashley lived in until his death in 1972 could be seen, head-end stuck behind the voting booth's dark curtain. An unidentified man stood, one hand on the horrible, life-saving machine.

There was no story. Just the picture, with a caption below it. 

"FROM AN IRON LUNG, Bill D. Ashley votes at Stonestreet Elementary School in Valley Station. Two Jefferson County election judges entered the booth with Ashley to pull levers at his direction," the newspaper said. 

Bill Ashley, who was confined to an iron lung, voted at Stonestreet Elementary School in Valley Station. Two Jefferson county election officials went into the voting booth to pull the levers for him. By Charles Fentress Jr., The Courier-Journal. Nov. 5, 1968
By Charles Fentress Jr., The Courier-Journal

"I'm almost certain that B.D. Ashley voted for Hubert Humphrey in the 1968 election," Hostetter said.

He was of an age that many in Kentucky were staunch Democrats — as he was — and supported the party of Franklin Delano Roosevelt, who just a few decades earlier led the effort to defeat the Nazis.

Ashley served in the Army during World War II. He was a corporal in a medical training battalion in Texas before he was sent to Italy where, among other things, he helped evacuate people affected by the eruption of Mount Vesuvius in 1944, Hostetter said.  

Alison Lundergan Grimes: Voter turnout is the problem to solve

After he returned to the states, Ashley taught biochemistry at the University of Louisville for a while, and he went to work as a civilian biochemist studying toxins and anti-venoms at the Army Medical Research Laboratories at Fort Knox, according to his obituary and his granddaughter. 

There were always exotic animals, the poisonous kind, around the house, Hostetter said.

"There are pictures of my grandmother, in a beehive hairdo, holding a cobra," she said. 

Billy Ashley became ill in his late 40s and had to quit work, ultimately becoming tied to the iron tube where his weakened body lay. He was able to remain at home thanks to the U.S. Veterans Administration, which loaned him the iron lung, Hostetter said.

When he wanted to vote in 1968, it was again the VA that came to his aid. The agency arranged for a moving van and made sure he was moved safely without endangering his life, she said.

"They let him vote and do what he thought was his most God-given right," Hostetter said. 

At the time, Kentucky law allowed only those who would be absent from their home precincts on Election Day to vote by absentee ballots. People who were old and very sick were required to vote in person.

Dorthea Ashley signed her husband, Bill Ashley, in to vote in the 1968 election. By Charles Fentress Jr., The Courier-Journal. Nov. 5, 1968
By Charles Fentress Jr., The Courier-Journal

Photo negatives of his trip to the polls still exist in Courier Journal archives, many of them better than the one that ran in the newspaper on Nov. 6, 1968. 

One shows Dorothea Ashley standing next to her husband in the iron lung at the couple's home. Another shows her signing him in at the polls.

There's a photo of the iron lung being loaded onto the moving van, another of him in the truck, an earnest young firefighter looking at the power generator while Ashley's iron lung sat among stacks of pads that were intended to prevent furniture from banging together. 

From 2017: Kentuckians with disabilities had lowest voter turnout in US for 2016 election

Hostetter didn't recognize anyone in the photos other than her grandparents. Joe Bowman, who has been with the Pleasure Ridge Park Fire Department since 1977, said that it was definitely PRP that helped move Ashley, but he didn't know the names of any of the firefighters in the photos.

They took him two-tenths of a mile to the school to vote. Then they took him home. 

And Billy Ashley would never vote again. 

On March 17, 1972, the Kentucky General Assembly passed a law that allowed the elderly and people who were infirm to vote by absentee ballot. 

Two weeks later, Ashley died. It was six months and seven days before Nixon would face re-election against Democrat George McGovern.

Hostetter said Billy and Dorothea Ashley passed onto their two children and ultimately their grandchildren the belief that voting is important. According to voter registration information, she's voted in every election since at least 2011. 

"I frequently tell people, 'You have no excuse not to vote,'" she said. 

The granddaughter of Billy Dare Ashley should know. 

Firefighters watch over a generator used to power Bill Ashley's iron lung before taking him to vote in the 1968 election. Ashley and his wife Dorthea can be seen in the background. By Charles Fentress Jr., The Courier-Journal. Nov. 5, 1968
By Charles Fentress Jr., The Courier-Journal


Joseph Gerth's opinion column runs on most Sundays and at various times throughout the week. He can be reached at 502-582-4702 or by email at Support strong local journalism by subscribing today:

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Simulated poliovirus containment breach helps countries increase biorisk safety and security | WHO Regional Office for Europe.


Sweden National Authority for Containment.
Biosafety includes secure handling of all potentially infectious equipment and materials.

Preparing for biosafety accidents helps to prevent them and limit their impact should they occur. In the WHO European Region, 12 countries plan to keep polioviruses for vaccine manufacturing or critical research purposes after the virus is no longer circulating anywhere in the wild; to do so, they must apply for certification of a poliovirus essential facility (PEF), where the materials can be safely stored and contained. Any breach of poliovirus containment is of serious international concern as it could lead to infection of any exposed individuals and possible transmission to others. Poliovirus circulation following global eradication would threaten not only the health of susceptible individuals but decades of historic progress in ridding the world of a devastating and preventable disease.

Mind the gaps.

To help prepare for PEF certification, representatives from the countries with planned PEFs (Belarus, Belgium, Denmark, France, Hungary, Italy, Netherlands, Romania, Russian Federation, Serbia, Sweden and United Kingdom) participated in a 2-day polio outbreak simulation exercise (POSE) organized by WHO/Europe and the European Centre for Disease Prevention and Control (ECDC) in October 2018. The scenario of the simulation exercise was based on a real event, namely the accidental spill and exposure of 2 laboratory workers to poliovirus type 2 in a vaccine manufacturing plant in the Netherlands in 2017.

“The trend of training through simulation exercises is great. The scenario we used was real – it did happen. The simulation made us think of possible gaps and what could be improved in our own country,” said Franceso Vairo, representing the Lazzaro Spallanzani National Institute for Infectious Diseases, Italy, at the meeting.

Sharing experiences to improve efficiency and effectiveness.

By simulating the occurrence of a containment breach in their own countries, participants could critically review and update their respective national plans for responding to such an event in a PEF. They could also identify potential deficiencies in their countries’ overall emergency response and contingency planning systems, including aspects related to legislation, communication, coordination and collaboration at international and national levels.

Dr Eugene Gavrilin, coordinator of WHO/Europe’s support to countries for GAPIII implementation encouraged participants to “use poliovirus containment as a powerful vehicle through which to improve your country’s overall system of biorisk safety and security”.

Global consensus to minimize risk.

Destruction or safe storage in PEFs of all potentially infectious poliovirus materials are among the requirements agreed to by all countries in the “WHO global action plan to minimize poliovirus facility-associated risk after type-specific eradication of wild polioviruses and sequential cessation of oral polio vaccine use (GAPIII)”.

WHO/Europe provides technical assistance for GAPIII implementation through training, workshops, country visits and translation and dissemination of guidelines.

Since all countries planning to apply for a PEF have begun preparations for certification as part of their emergency preparedness systems, this table-top exercise brought together representatives of the:

  • national authorities on containment, in accordance with the poliovirus Containment Certification Scheme;
  • national focal points for International Health Regulations;
  • national health risk communication experts;
  • PEFs;
  • WHO;
  • ECDC;
  • international technical partners.

Lessons learned.

At the end of the 2-day exercise, each participating country made a gap-analysis of their preparedness and response plans, including a concrete proposal for national improvements. In reflecting on lessons learned through the simulation exercise, participants noted that:

  • legislative frameworks must be reviewed and if necessary revised to enable a rapid response to a potential containment breach;
  • all biorisk requirements in GAP III need to be translated into national guidelines for practical use in the event of an actual breach.

A lack of harmonized, detailed regulations and procedures covering all aspects of such an event, including isolation and quarantining of infected individuals, can reduce the timeliness and effectiveness of a response.

“Just because there is little risk of a possible poliovirus outbreak does not mean that you don't have to be prepared for it,” said Franceso Vairo.

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Spatial Analyses of Oral Polio Vaccine Transmission in an Community Vaccinated With Inactivated Polio Vaccine | Clinical Infectious Diseases.

[Open Access] [Published: 30 October 2018]



Understanding the spatial dynamics of oral polio vaccine (OPV) transmission will improve resource targeting. Mexico provides a natural laboratory, as it uses inactivated polio vaccine routinely as well as OPV bi-annually.


Using geospatial maps, we measured the distance and density of OPV vaccinees’ shedding in the areas nearest to unvaccinated households in 3 Mexican villages. Comparison of transmission to unvaccinated households utilized a mixed effects logistic regression with random effects for household and time, adjusted for age, gender, area, and running water.


The median distance from an unvaccinated household to its nearest OPV-shedding household was 85 meters (interquartile range, 46–145) and the median number of vaccinees shedding OPV within 200 m was 3 (2–6). Transmission to unvaccinated households occurred by day 1. There was no association (odds ratio [OR] 1.04; 95% credible interval [CrI] 0.92–1.16) between the distance from OPV shedding and the odds of transmission. The number of OPV vaccinees shedding within 200 m came close to a significant association with unvaccinated transmission (OR 0.93; CrI 0.84–1.01), but this was not the case for households 100 or 500 m apart. Results were consistent across the 3 villages.


Geospatial analysis did not predict community transmission from vaccinated to unvaccinated households, because OPV use resulted in rapid, low transmission levels. This finding supports the global cessation of OPV.

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Papua New Guinea: Polio campaign vaccinates 3.1m children | Post Courier.

[November 2, 2018]

Grace Auka Salmang writes:

AS of Oct 31, 2018, in all 22 provinces, 3,112,035 children under 15-years-old have been vaccinated against polio and this had been made possible through the hard work and dedication of workers on the ground.

Health Secretary Pascoe Kase made this known yesterday, saying this is the biggest polio vaccination campaign to be implemented in PNG, mobilising more than 9,000 health workers and volunteers.

“I commend the leadership of the provincial health agencies and emergency operations coordinators for effectively launching and managing a very challenging response operations,” Mr Kase said.

He said series of polio vaccination campaigns are being conducted in PNG following the declaration of the Public Health Emergency on Jun 28, 2018, when it was confirmed that polio virus is circulating in the country.

Three provinces Morobe, Madang and Eastern Highlands were covered in the polio campaign in July while nine provinces Morobe, Madang, Eastern Highlands, Enga, Chimbu, Southern Highlands, Western Highlands, Jiwaka and Hela were covered in the polio campaign in Sept. He said based on the data submitted to date, most of the provinces have reached more than 80 per cent coverage rates while a number of them had even gone beyond 100 per cent.

“This just shows that PNG can improve our vaccine coverage and protect our children if we commit to do so. I urge all the provinces to continue the good work they are doing and to ensure all children are fully immunised against polio,” Mr Kase said.

WHO country representative Dr Luo Dapeng said launching a nationwide campaign with short preparation was very resource and labour intensive, but knowing that we immunised more than three million children against polio, makes it all worth it.

“I commend the leadership of the Government, the Health Department, the provincial health agencies and the polio workers in every village and health facility for rising up to the challenge and delivering results.

“But the work is not yet done, we have more campaigns coming up and we need to keep going.
“It is critical that we sustain this momentum and vaccinate every last child against polio,” he said.

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Infographic: Pakistan polio update – September 2018 | GPEI.


Update on polio eradication efforts in Pakistan for August 2018.

In August:

  • There was one new case of wild poliovirus (WPV1) reported.
  • 39.3 million children were vaccinated during September National Immunization Day (NID) campaign.
  • 1.7 million children were vaccinated in September 2018 at 382 Permanent Transit Points (PTPs) set up across the country and its borders.”

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Environmental Surveillance Reveals Complex Enterovirus Circulation Patterns in Human Populations | Open Forum Infectious Diseases.

[Open Access] [Received: 02 August 2018; Accepted: 28 September 2018; Published: 01 October 2018]



Enteroviruses are common human pathogens occasionally associated with severe disease, notoriously paralytic poliomyelitis caused by poliovirus. Other enterovirus serotypes such as enterovirus A71 and D68 have been linked to severe neurological syndromes. New enterovirus serotypes continue to emerge, some believed to be derived from nonhuman primates. However, little is known about the circulation patterns of many enterovirus serotypes and, in particular, the detailed enterovirus composition of sewage samples.


We used a next-generation sequencing approach analyzing reverse transcriptase polymerase chain reaction products synthesized directly from sewage concentrates.


We determined whole-capsid genome sequences of multiple enterovirus strains from all 4 A to D species present in environmental samples from the United Kingdom, Senegal, and Pakistan.


Our results indicate complex enterovirus circulation patterns in human populations with differences in serotype composition between samples and evidence of sustained and widespread circulation of many enterovirus serotypes. Our analyses revealed known and divergent enterovirus strains, some of public health relevance and genetically linked to clinical isolates. Enteroviruses identified in sewage included vaccine-derived poliovirus and enterovirus D-68 stains, new enterovirus A71 and coxsackievirus A16 genogroups indigenous to Pakistan, and many strains from rarely reported serotypes. We show how this approach can be used for the early detection of emerging pathogens and to improve our understanding of enterovirus circulation in humans.

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