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The Episcopal Church (TEC) is the member church of the worldwide Anglican Communion based in the United States with dioceses elsewhere. It is a mainline Christian denomination divided into nine provinces. The presiding bishop of the Episcopal Church is Michael Bruce Curry, the first African-American bishop to serve in that position.
In 2017, the Episcopal Church had 1,905,349 baptized members, of whom 1,745,156 were in the United States.[1] In 2011, it was the nation's 14th largest denomination.[2] In 2015, Pew Research estimated that 1.2 percent of the adult population in the United States, or 3 million people, self-identify as mainline Episcopalians.[3]
The church was organized after the American Revolution, when it became separate from the Church of England, whose clergy are required to swear allegiance to the British monarch as Supreme Governor of the Church of England. The Episcopal Church describes itself as "Protestant, yet Catholic".[4] The Episcopal Church claims apostolic succession, tracing its bishops back to the apostles via holy orders. The Book of Common Prayer, a collection of traditional rites, blessings, liturgies, and prayers used throughout the Anglican Communion, is central to Episcopal worship.
The Episcopal Church was active in the Social Gospel movement of the late 19th and early 20th centuries.[5] Since the 1960s and 1970s, the church has pursued a decidedly more liberal course. It has opposed the death penalty and supported the civil rights movement and affirmative action. Some of its leaders and priests are known for marching with influential civil rights demonstrators such as Martin Luther King Jr. The Church calls for the full legal equality of LGBT people. In 2015, the Church's 78th triennial General Convention passed resolutions allowing the blessing of same-sex marriages and approved two official liturgies to bless such unions.[6]
The Episcopal Church ordains women and LGBT people to the priesthood, the diaconate, and the episcopate, despite opposition from a number of other member churches of the Anglican Communion. In 2003, Gene Robinson became the first openly gay person ordained as a bishop.
Names

The Protestant Episcopal Church in the United States of America (PECUSA) and "The Episcopal Church" (TEC) are both official names specified in the church's constitution.[7] The latter is much more commonly used.[8][9][10] In other languages, an equivalent is used. For example, in Spanish, the church is called La Iglesia Episcopal Protestante de los Estados Unidos de América or La Iglesia Episcopal.[11] and in French L'Église protestante épiscopale dans les États Unis d'Amérique or L'Église épiscopale.[12]
Until 1964, "The Protestant Episcopal Church in the United States of America" was the only official name in use. In the 19th century, High Church members advocated changing the name, which they felt did not acknowledge the church's Catholic heritage. They were opposed by the church's evangelical wing, which felt that the "Protestant Episcopal" label accurately reflected the Reformed character of Anglicanism. After 1877, alternative names were regularly proposed and rejected by the General Convention. One proposed alternative was "the American Catholic Church". By the 1960s, opposition to dropping the word "Protestant" had largely subsided. In a 1964 General Convention compromise, priests and lay delegates suggested adding a preamble to the church's constitution, recognizing "The Episcopal Church" as a lawful alternate designation while still retaining the earlier name.[13]
The 66th General Convention voted in 1979 to use the name "The Episcopal Church" in the Oath of Conformity of the Declaration for Ordination.[14] The evolution of the name can be seen in the church's Book of Common Prayer. In the 1928 BCP, the title page read, "According to the use of The Protestant Episcopal Church in the United States of America", whereas on the title page of the 1979 BCP it states, "'According to the use of The Episcopal Church".[15]
The Episcopal Church in the United States of America (ECUSA) has never been an official name of the church but is an alternative commonly seen in English. Since several other churches in the Anglican Communion also use the name "Episcopal", including Scotland and the Philippines, some, for example Anglicans Online, add the phrase "in the United States of America".[16]
The full legal name of the national church corporate body is the "Domestic and Foreign Missionary Society of the Protestant Episcopal Church in the United States of America",[7] which was incorporated by the legislature of New York and established in 1821. The membership of the corporation "shall be considered as comprehending all persons who are members of the Church".[7][17] This should not be confused with the name of the church itself, as it is a distinct body relating to church governance.[7]
History

Colonial era

The Episcopal Church has its origins in the Church of England in the American colonies, and it stresses continuity with the early universal Western Church and claims to maintain apostolic succession (though the Catholic and Orthodox churches do not recognize this claim).[18]
The first parish was founded in Jamestown, Virginia in 1607, under the charter of the Virginia Company of London. The tower of Jamestown Church (c.  1639–43) is one of the oldest surviving Anglican church structures in the United States. The Jamestown church building itself is a modern reconstruction.[19]
Although no American Anglican bishops existed in the colonial era, the Church of England had an official status in several colonies, which meant that local governments paid tax money to local parishes, and the parishes handled some civic functions. The Church of England was designated the established church in Virginia in 1609, in New York in 1693, in Maryland in 1702, in South Carolina in 1706, in North Carolina in 1730, and in Georgia in 1758.[20]
From 1635 the vestries and the clergy came loosely under the diocesan authority of the Bishop of London. After 1702, the Society for the Propagation of the Gospel in Foreign Parts (SPG) began missionary activity throughout the colonies. On the eve of  Revolution about 400 independent congregations were reported throughout the colonies.

Revolutionary era
Embracing the symbols of the British presence in the American colonies, such as the monarchy, the episcopate, and even the language of the Book of Common Prayer, the Church of England almost drove itself to extinction during the upheaval of the American Revolution.[21] More than any other denomination, the War of Independence internally divided both clergy and laity of the Church of England in America, and opinions covered a wide spectrum of political views: patriots, conciliators, and loyalists. While many Patriots were suspicious of Loyalism in the church, about three-quarters of the signers of the Declaration of Independence were nominally Anglican laymen, including Thomas Jefferson, William Paca, and George Wythe.[22] It was often assumed that persons considered "High Church" were Loyalists, whereas persons considered "Low Church" were Patriots: assumptions with possibly dangerous implications for the time.

Of the approximately three hundred clergy in the Church of England in America between 1776 and 1783, over 80 percent in New England, New York, and New Jersey were loyalists. This is in contrast to the less than 23 percent loyalist clergy in the four southern colonies.[22] Many Church of England clergy remained loyalists as they took their two ordination oaths very seriously. Anglican clergy were obliged to swear allegiance to the king as well as to pray for the king, the royal family, and the British Parliament.[22] In general, loyalist clergy stayed by their oaths and prayed for the king or else suspended services.[22] By the end of 1776, some Anglican churches were closing.[22] Anglican priests held services in private homes or lay readers who were not bound by the oaths held morning and evening prayer.[22] During 1775 and 1776, the Continental Congress had issued decrees ordering churches to fast and pray on behalf of the patriots.[22] Starting July 4, 1776, Congress and several states passed laws making prayers for the king and British Parliament acts of treason.[22] The patriot clergy in the South were quick to find reasons to transfer their oaths to the American cause and prayed for the success of the Revolution.[22] One precedent was the transfer of oaths during the Glorious Revolution in England.[22] Most of the patriot clergy in the South were able to keep their churches open and services continued.[22]
Early Republic era
In the wake of the Revolution, American Episcopalians faced the task of preserving a hierarchical church structure in a society infused with republican values.

When the clergy of Connecticut elected Samuel Seabury as their bishop in 1783, he sought consecration in England. The Oath of Supremacy prevented Seabury's consecration in England, so he went to Scotland; the non-juring Scottish bishops there consecrated him in Aberdeen on November 14, 1784, making him, in the words of scholar Arthur Carl Piepkorn, "the first Anglican bishop appointed to minister outside the British Isles".[23][24] On August 3, 1785, the first ordinations on American soil took place at Christ Church in Middletown, Connecticut.
By 1786, the church had succeeded in translating episcopacy to America and in revising the Book of Common Prayer to reflect American political realities. Later, through the efforts of Bishop Philander Chase (1775–1852) of Ohio, Americans successfully sought material assistance from England for the purpose of training Episcopal clergy. The development of the Protestant Episcopal Church provides an example of how Americans in the early republic maintained important cultural ties with England.[25]
In 1787, two priests – William White of Pennsylvania and Samuel Provoost of New York – were consecrated as bishops by the archbishop of Canterbury, the archbishop of York, and the bishop of Bath and Wells, the legal obstacles having been removed by the passage through Parliament of the Consecration of Bishops Abroad Act 1786. Thus there are two branches of Apostolic succession for the American bishops: through the non-juring bishops of Scotland who consecrated Samuel Seabury and through the English church who consecrated William White and Samuel Provoost. All bishops in the American Church are ordained by at least three bishops. One can trace the succession of each back to Seabury, White and Provoost. (See Succession of Bishops of the Episcopal Church.)
In 1789,  representative clergy from nine dioceses met in Philadelphia to ratify the church's initial constitution. The Episcopal Church was formally separated from the Church of England in 1789 so that clergy would not be required to accept the supremacy of the British monarch. A revised version of the Book of Common Prayer was written for the new church that same year. The fourth bishop of the Episcopal Church was James Madison, the first bishop of Virginia. Madison was consecrated in 1790 by the Archbishop of Canterbury and two other Church of England bishops. This third American bishop consecrated within the English line of succession occurred because of continuing unease within the Church of England over Seabury's nonjuring Scottish orders.[22] The Episcopal Church thus became the first Anglican Province outside the British Isles.[26]
On 17 September 1792, at the triennial general convention (synod) of the Episcopal Church at Trinity Church on Wall Street, in New York City, Thomas John Claggett was elected the first bishop of Maryland. He was the first bishop of the Episcopal Church ordained and consecrated in America and the fifth Bishop consecrated for the Episcopal Church in the United States.[27]
Nineteenth century

In 1856 the first society for African Americans in the Episcopal Church was founded by James Theodore Holly. Named The Protestant Episcopal Society for Promoting The Extension of The Church Among Colored People, the society argued that blacks should be allowed to participate in seminaries and diocesan conventions. The group lost its focus when Holly emigrated to Haiti, but other groups followed after the Civil War. The current Union of Black Episcopalians traces its history to the society.[28] Holly went on to found the Anglican Church in Haiti, where he became the first African-American bishop on November 8, 1874. As Bishop of Haiti, Holly was the first African American to attend the Lambeth Conference.[29] However, he was consecrated by the American Church Missionary Society, an Evangelical Episcopal branch of the Church.
Episcopal missions chartered by African-Americans in this era were chartered as a Colored Episcopal Mission. All other missions (white) were chartered as an Organized Episcopal Mission. Many historically Black parishes are still in existence to date.[30]

When the American Civil War began in 1861, Episcopalians in the South formed the Protestant Episcopal Church in the Confederate States of America. However, in the North the separation was never officially recognized. By May 16, 1866, the southern dioceses had rejoined the national church.[31]
By the middle of the 19th century, evangelical Episcopalians disturbed by High Church Tractarianism, while continuing to work in interdenominational agencies, formed their own voluntary societies, and eventually, in 1874, a faction objecting to the revival of ritual practices established the Reformed Episcopal Church.[32]
Samuel David Ferguson was the first black bishop consecrated by the Episcopal Church, the first to practice in the U.S. and the first black person to sit in the House of Bishops. Bishop Ferguson was consecrated on June 24, 1885, with the then-Presiding Bishop of the Episcopal Church acting as a consecrator.
During the Gilded Age, highly prominent laity such as banker J. P. Morgan, industrialist Henry Ford, and art collector Isabella Stewart Gardner played a central role in shaping a distinctive upper class Episcopalian ethos, especially with regard to preserving the arts and history. These philanthropists propelled the Episcopal Church into a quasi-national position of importance while at the same time giving the church a central role in the cultural transformation of the country.[33] Another mark of influence is the fact that more than a quarter of all presidents of the United States have been Episcopalians (see religious affiliations of Presidents of the United States). It was during this period that the Book of Common Prayer was revised, first in 1892 and later in 1928.
Era of change (1958–1970s)
At the 1958 General Convention, a coalition of liberal church members succeeded in passing a resolution recognizing "the natural dignity and value of every man, of whatever color or race, as created in the image of God". It called on Episcopalians "to work together, in charity and forbearance, towards the establishment ... of full opportunities in fields such as education, housing, employment and public accommodations". In response, the Episcopal Society for Cultural and Racial Unity (ESCRU) was founded in December 1959 in order to eliminate racial, ethnic and class barriers within the Episcopal Church. Opposition from southern church leaders prevented the Episcopal Church from taking a strong stand on civil rights prior to 1963. One prominent opponent of the movement was Charles C.J. Carpenter, the bishop of Alabama.[34] By 1963, many church leaders felt more comfortable speaking out in support of racial equality. That year, Presiding Bishop Arthur Lichtenberger wrote a pastoral letter urging Christians to work "across lines of racial separation, in a common struggle for justice", and the House of Bishops endorsed civil rights legislation.[35]
In 1967, Lichtenberger's successor, John Hines led the Episcopal Church to implement the General Convention Special Program (GCSP). The Special Program was designed to redirect nine million dollars over a three-year period (a quarter of the church's operating budget at the time) to fund special grants for community organizations and grassroots efforts facilitating black empowerment in America's urban ghettos.[36] The effectiveness of the GCSP was limited due to the reluctance of conservative bishops in southern dioceses, who objected to the awarding of grants to groups perceived as radical. The GCSP also drew opposition from the recently formed Foundation for Christian Theology, a conservative organization opposed to "involv[ing] the Church in the social, political, and economic activities of our times". The tension between liberal and conservative constituencies in the church erupted during the Special General Convention of 1969. The convention was disrupted by black militants who demanded that the Episcopal Church hear their concerns. When white deputies objected to allowing the militants a hearing, African-American deputies walked out of the convention. The Special General Convention also witnessed protests of the Vietnam War. During this time period, African-American clergy organized the Union of Black Episcopalians to achieve full inclusion of African Americans at all levels of the Episcopal Church. [37]
The liberal policies of Presiding Bishop Hines and the General Conventions of 1967 and 1969 led to a conservative reaction. Facing declining membership and a one million dollar budget cut, the Special Program became an easy target for conservatives, who succeeded in drastically reducing the financial support for the program in 1970. It was finally ended in 1973 with little protest. A year later, Hines was succeeded by John M. Allin, the bishop of Mississippi and a conservative.[38]
The first women were admitted as delegates to General Convention in 1970.[39] In 1975, Vaughan Booker, who confessed to the murder of his wife and was sentenced to life in prison, was ordained to the diaconate in Graterford State Prison's chapel in Pennsylvania, after having repented of his sins, becoming a symbol of redemption and atonement.[40][41]
Recent history
In recent decades, the Episcopal Church, like other mainline churches, has experienced a decline in membership as well as internal controversy over women's ordination and the place of homosexuals in the church. The 1976 General Convention also passed a resolution calling for an end to apartheid in South Africa and in 1985 called for "dioceses, institutions, and agencies" to create equal opportunity employment and affirmative action policies to address any potential "racial inequities" in clergy placement. Because of these and other controversial issues including abortion, individual members and clergy can and do frequently disagree with the stated position of the church's leadership.  In January 2016, the Anglican Primates Meeting at Canterbury decided that in response to the "distance" caused by what it called "unilateral action on matters of doctrine without catholic unity", "for a period of three years, The Episcopal Church [would neither] represent [the Communion] on ecumenical and interfaith bodies… [nor] take part in decision making on any issues pertaining to doctrine or polity."[42]
Revised prayer book
In 1976, the General Convention adopted a new prayer book, which was a substantial revision and modernization of the previous 1928 edition. It incorporated many principles of the Roman Catholic Church's liturgical movement, which had been discussed at Vatican II. This version was adopted as the official prayer book in 1979 after an initial three-year trial use. Several conservative parishes, however, continued to use the 1928 version.
Ordination of women
On July 29, 1974, a group of women known as the Philadelphia Eleven were irregularly ordained as priests in the Episcopal Church by bishops Daniel Corrigan, Robert L. DeWitt, and Edward R. Welles, assisted by Antonio Ramos.[43] On September 7, 1975, four more women (the "Washington Four") were irregularly ordained by retired bishop George W. Barrett.[44] In the wake of the controversy over the ordination of the Philadelphia Eleven, the General Convention permitted the ordination of women in 1976 and recognized the ordinations of the 15 forerunners. The first women were canonically ordained to the priesthood in 1977. The first woman to become a bishop, Barbara Harris, was consecrated on February 11, 1989.[45]
At the same time, there was still tolerance for those dioceses who opposed women's ordination. In 1994, the General Convention affirmed that there was value in the theological position that women should not be ordained. In 1997, however, the General Convention then determined that "the canons regarding the ordination, licensing, and deployment of women are mandatory" and required noncompliant dioceses to issue status reports on their progress towards full compliance.[46]
In 2006, the General Convention elected Katharine Jefferts Schori as Presiding Bishop. She is the first and, currently, the only woman to become a primate in the Anglican Communion. Schori's election was controversial in the wider Anglican Communion because not all of the communion recognizes the ordination of women.[47]
At the time of the formation of the Anglican Church in North America (ACNA), three U.S. dioceses did not ordain women as priests or bishops: San Joaquin, Quincy, and Fort Worth.  Following the departures of their conservative majorities, all three dioceses now ordain women. With the October 16, 2010, ordination of Margaret Lee, in the Peoria-based Diocese of Quincy, Illinois, women have been ordained as priests in all 110 dioceses of the Episcopal Church in the United States.[48]
Affirmation of LGBT people

The Episcopal Church affirmed at the 1976 General Convention that homosexuals are "children of God" who deserve acceptance and pastoral care from the church and equal protection under the law. The first openly gay person ordained as a priest was Ellen Barrett in 1977.[49] Despite such an affirmation of gay rights, the General Convention affirmed in 1991 that "physical sexual expression" is only appropriate within the monogamous lifelong "union of husband and wife".[50]
The church elected its first openly gay bishop, Gene Robinson, in June 2003.[51] News of Robinson's election caused a crisis in both the American church and the wider Anglican Communion. In October 2003, Anglican primates (the heads of the Anglican Communion's 38 member churches) convened an emergency meeting. The meeting's final communiqué included the warning that if Robinson's consecration proceeded, it would "tear the fabric of the communion at its deepest level".[52] The news of his ordination caused such an outrage that during the ceremony, at which his long-time partner was present, Robinson was forced to wear a bullet-proof vest beneath his vestments, and he also received numerous death threats following his installation as bishop of the Episcopal Diocese of New Hampshire.
In 2009, the General Convention charged the Standing Commission on Liturgy and Music to develop theological and liturgical resources for same-sex blessings and report back to the General Convention in 2012. It also gave bishops an option to provide "generous pastoral support", especially where civil authorities have legalized same-gender marriage, civil unions, or domestic partnerships.[53]
On July 14, 2009, the Episcopal Church's House of Bishops voted that "any ordained ministry" is open to gay men and lesbians. The New York Times said the move was "likely to send shockwaves through the Anglican Communion". This vote ended a moratorium on ordaining gay bishops passed in 2006 and passed in spite of Archbishop Rowan Williams's personal call at the start of the convention that, "I hope and pray that there won't be decisions in the coming days that will push us further apart."[54]
On July 10, 2012, the Episcopal Church approved an official liturgy for the blessing of same-sex relationships. This liturgy was not a marriage rite, but the blessing included an exchange of vows and the couple's agreement to enter into a lifelong committed relationship.[55]
On June 29, 2015, at the 78th General Convention of the Episcopal Church, a resolution removing the definition of marriage as being between one man and one woman was passed by the House of Bishops with 129 in favor, 26 against, and 5 abstaining.[56] The current Archbishop of Canterbury, Justin Welby, expressed "deep concern" over the ruling.[57] In 2016, Anglican leaders temporarily suspended the Episcopal Church from key positions in their global fellowship in response to the church changing its canons on marriage.[58][59]
Separations from the church

Following the ordination of Bp. Gene Robinson in 2003, some members of a number of congregations and six dioceses left the Episcopal Church.[60] For example, in Cleveland, Ohio, four parishes “with about 1,300 active members, decided to leave the U.S. church and the local diocese because of 'divergent understandings of the authority of scripture and traditional Christian teaching,’” [61] and the Pittsburgh diocese voted to leave the church because they felt the church had been “hijacked” by liberal bishops. [62]
Many of those who separated themselves joined the Continuing Anglican movement or advocated Anglican realignment, claiming alignment with overseas Anglican provinces including the Anglican Province of the Southern Cone of America and the Church of Nigeria.[63]
Differences over social issues led to the formation of the Anglican Church in North America which has over 1,000 parishes and has grown to over 134,000 members.[64] Episcopal Church leaders, particularly former Presiding Bishop Katharine Jefferts Schori, responded by taking a firm stance against the separatists, initiating litigation against departing dioceses and parishes that has cost all parties tens of millions of dollars; one estimate has the Episcopal Church spending over $42 million and separatists roughly $18 million, for a total of over $60 million in court costs.[65] Litigation has largely centered around church properties, with the Episcopal leadership asserting ownership of buildings occupied by departing congregations.[66][67]
On October 15, 2012, the Episcopal Diocese of South Carolina voted to withdraw from the Episcopal Church and become an autonomous Anglican diocese after a long period of conflict with the national leadership of the Episcopal Church. Established in 1785, the diocese was one of the nine original dioceses of the Episcopal Church. On 11 March 2017, The Diocese of South Carolina voted unanimously to affiliate with ACNA at their 226th Convention, held in Summerville. ACNA's Provincial Council voted unanimously to formally receive the Diocese of South Carolina at ACNA's Third Provincial Assembly, meeting in Wheaton, Illinois, on 27 June 2017.[68][69][70]
Church property disputes
In a letter to the House of Bishops during summer 2009, Presiding Bishop Katharine Jefferts Schori instructed local dioceses not to sell parish property to departing groups. She stated: "We do not make settlements that encourage religious bodies who seek to replace The Episcopal Church".[71]
Before Schori took this stand, prior Bishops had treated parish property disputes as internal diocesan matters that are "not subject to the review or oversight of the presiding bishop." One example was when then-Presiding Bishop Frank Griswold told the Diocese of Western Louisiana on May 11, 2006 that the national church involved itself in parish property disputes only upon invitation of the local bishop and diocesan standing committees.[72] Schori's letter stated that her firm stance was the consensus of the Council of Advice and expressed hope that "those who have departed can gain clarity about their own identity".[71]
After the South Carolina Diocese voted to withdraw, it sued the national Episcopal Church to retain control over its property, and in a court decision announced in February 2015, the local diocese kept $500 million worth of property including the historic Cathedral of St. Luke and St. Paul. Circuit Court Judge Diane Goodstein ruled that the conservative diocese and its parishes are "the owners of their real, personal and intellectual property" and that the national church has no legal interest in the properties.[73] However, this ruling was substantially overturned by the Supreme Court of South Carolina on August 2, 2017, which issued a split decision that effectively returns the property of 29 parishes and the St. Christopher Camp and Conference Center to the Episcopal Church in South Carolina,[74] while seven parishes retained their properties because they had never ratified the Episcopal Church's Dennis Canon (a church bylaw meant to impose a trust on parish property).[75] Because of a tie on the court, the Circuit Court's ruling on the name "Episcopal Diocese of South Carolina" and related intellectual property remains in place.[74]
Membership

As of 2014, the Episcopal Church reports 1,956,042 baptized members. The majority of members are in the United States, where the Church has 1,866,758 members, a decrease of 27,423 persons (-1.4 percent) from 2012. Outside of the U.S. the Church has 142,326 members, a decrease of 30,203 persons (-17.5 percent) from 2012. Total average Sunday attendance (ASA) for 2013 was 657,102 (623,691 in the U.S. and 33,411 outside the U.S.), a decrease of 3.4 percent from 2012.[76]
According to ARIS/Barna, 3.5 million Americans self–identified as Episcopalians, highlighting "a gap between those who are affiliated with the church (on membership rolls), versus those who self-identify [as Episcopalians]".[77] Church Pension Group also cited having 3.5 million adherents in 2002.[78]  More recently, in 2014, Pew Research found that approximately 1.2 percent of 245 million U.S adults, around 3 million people, self–identified as mainline Episcopalian/Anglican.[3]
According to data collected in 2000, the District of Columbia, Rhode Island, Connecticut, and Virginia have the highest rates of adherents per capita, and states along the East Coast generally have a higher number of adherents per capita than in other parts of the country.[79] New York was the state with the largest total number of adherents, over 200,000.[80] In 2013, the Episcopal Diocese of Haiti was the largest single diocese, with 84,301 baptized members, which constitute slightly over half of the church's foreign membership.[76]
According to the latest statistics U.S. membership dropped 2.7 percent from a reported 1,866,758 members in 2013 to 1,745,156 in 2016, a loss of 121,602 persons. Attendance took an even steeper hit, with the average number of Sunday worshipers dropping from 623,691 in 2013 to 570,454 in 2016, a decline of 53,237 persons in the pews, down 8.5 percent. Congregations dropped to 6,473.[81]
The Episcopal Church experienced notable growth in the first half of the 20th century, but like many mainline churches, it has had a decline in membership in more recent decades.[82] Membership grew from 1.1 million members in 1925 to a peak of over 3.4 million members in the mid-1960s.[83] Between 1970 and 1990, membership declined from about 3.2 million to about 2.4 million.[83] Once changes in how membership is counted are taken into consideration, the Episcopal Church's membership numbers were broadly flat throughout the 1990s, with a slight growth in the first years of the 21st century.[84][85][86][87][88] A loss of 115,000 members was reported for the years 2003–05.[89] Some theories about the decline in membership include a failure to sufficiently reach beyond ethnic barriers in an increasingly diverse society, and the low fertility rates prevailing among the predominant ethnic groups traditionally belonging to the church. In 1965, there were 880,000 children in Episcopal Sunday School programs. By 2001, the number had declined to 297,000.[90]
Influence
In the twentieth century, Episcopalians tended to be wealthier[91] and more educated (having more graduate and postgraduate degrees per capita) than most other religious groups in the United States,[92] and were disproportionately represented in the upper reaches of American business,[93] law, and politics.[94]
In the 1970s, a Fortune magazine study found one-in-five of the country's largest businesses and one-in-three of its largest banks was run by an Episcopalian.[91] Numbers of the most wealthy and affluent American families as the Vanderbilts, Astors, Whitneys, Morgans and Harrimans are Episcopalians.[91] The Episcopal Church also has the highest number of graduate and post-graduate degrees per capita (56%)[95] of any other Christian denomination in the United States,[96] as well as the most high-income earners.[97] According to a 2014 study by the Pew Research Center, Episcopalians ranked as the third wealthiest religious group in the United States, with 35% of Episcopalians living in households with incomes of at least $100,000.[98]
Structure
The Episcopal Church is governed according to episcopal polity with its own system of canon law. This means that the church is organized into dioceses led by bishops in consultation with representative bodies. It is a unitary body, in that the power of the General Convention is not limited by the individual dioceses. The church has, however, a highly decentralized structure and characteristics of a confederation.[99]
Parishes and dioceses

At the local level, there are 6,447 Episcopal congregations, each of which elects a vestry or bishop's committee. Subject to the approval of its diocesan bishop, the vestry of each parish elects a priest, called the rector, who has spiritual jurisdiction in the parish and selects assistant clergy, both deacons and priests. (There is a difference between vestry and clergy elections – clergy are ordained members usually selected from outside the parish, whereas any member in good standing of a parish is eligible to serve on the vestry.) The diocesan bishop, however, appoints the clergy for all missions and may choose to do so for non-self-supporting parishes.
The middle judicatory consists of a diocese headed by a bishop who is assisted by a standing committee.[100] The bishop and standing committee are elected by the diocesan convention whose members are selected by the congregations. The election of a bishop requires the consent of a majority of standing committees and diocesan bishops.[101] Conventions meet annually to consider legislation (such as revisions to the diocesan constitution and canons) and speak for the diocese. Dioceses are organized into nine provinces. Each province has a synod and a mission budget, but it has no authority over its member dioceses.
There are 110 dioceses in the United States, Colombia, the Dominican Republic, Ecuador, Haiti, Honduras, Puerto Rico, Taiwan, Venezuela and the Virgin Islands. The Convocation of Episcopal Churches in Europe and the Navajoland Area Mission are jurisdictions similar to a diocese.[8][9][10] The Presiding Bishop is one of three Anglican primates who together exercise metropolitan jurisdiction over the Episcopal Church of Cuba, which is an extraprovincial diocese in the Anglican Communion.[102]
National church
The National Cathedral is the seat of the Presiding Bishop of the Episcopal Church as well as the bishop of the Episcopal Diocese of Washington.
The highest legislative body of the Episcopal Church is the triennial General Convention, consisting of the House of Deputies and the House of Bishops. All active (whether diocesan, coadjutor, suffragan, or assistant) and retired bishops make up the over 300 members of the House of Bishops. Diocesan conventions elect over 800 representatives (each diocese elects four laity and four clergy) to the House of Deputies. The House of Deputies elects a president and vice-president to preside at meetings. General Convention enacts two types of legislation. The first type is the rules by which the church is governed as contained in the Constitution and Canons; the second type are broad guidelines on church policy called resolutions.[103] Either house may propose legislation.[104] The House of Deputies only meets as a full body once every three years; however, the House of Bishops meets regularly throughout the triennium between conventions.
The real work of General Convention is done by interim bodies, the most powerful being the Executive Council, which oversees the work of the national church during the triennium. The council has 40 members; 20 are directly elected by the General Convention, 18 are elected by the nine provinces, and the Presiding Bishop and President of the House of Deputies are ex officio members.[104] Other interim bodies include a number of standing commissions which study and draft policy proposals for consideration and report back to General Convention. Each standing commission consists of three bishops, three priests or deacons, and six laypersons. Bishops are appointed by the Presiding Bishop while the other clergy and laypersons are appointed by the president of the House of Deputies.[104]
The Presiding Bishop is elected from and by the House of Bishops and confirmed by the House of Deputies for a nine-year term.[105] The Presiding Bishop is the chief pastor and primate of the Episcopal Church and is charged with providing leadership in the development of the Church's program as well as speaking on behalf of the Church.[106] The Presiding Bishop does not possess a territorial see; since the 1970s, however, the Presiding Bishop has enjoyed extraordinary jurisdiction (metropolitical authority) and has authority to visit dioceses for sacramental and preaching ministry, for consulting bishops, and for related purposes.[107] The Presiding Bishop chairs the House of Bishops as well as the Executive Council of the General Convention. In addition, the Presiding Bishop directs the Episcopal Church Center, the national administrative headquarters of the denomination. Located at 815 Second Avenue, New York City, New York, the center is often referred to by Episcopalians simply as "815".[108]
A system of ecclesiastical courts is provided for under Title IV of the canons of General Convention. These courts are empowered to discipline and depose deacons, priests, and bishops.
Worship and liturgy

Varying styles and degrees of liturgical practice prevail within the church, including: traditional hymns and anthems, more modern religious music, Anglican chant, liturgical dance, charismatic prayer, and vested clergy. As varied as services can be, the central binding aspect is the Book of Common Prayer or supplemental liturgies. Most Episcopal services are similar in structure and liturgy to the Roman Catholic Church, as the Eucharist is the central focus of the service (sometimes called Mass in High Church and some Broad Church circles). Generally, Episcopal churches have retained features such as the altar rail, the inclusion or exclusion of which does not elicit much controversy, but usually celebrate in the versus populum orientation.
Often a congregation or a particular service will be referred to as Low Church or High Church. In theory:
High Church, especially the very high Anglo-Catholic movement, is ritually inclined towards the use of incense, formal hymns, and a higher degree of ceremony such as ad orientem in relation to the priest and altar. In addition to clergy vesting in albs, stoles, and chasubles, the lay assistants may also be vested in cassock and surplice. The sung Eucharist tends to be emphasized in High Church congregations, with Anglo-Catholic congregations and celebrants using sung services almost exclusively. Marian devotion is sometimes seen in the Anglo-Catholic and some High Church parishes.
Low Church is simpler and may incorporate other elements such as informal praise and worship music. "Low" parishes tend towards a more "traditional Protestant" outlook with its emphasis of Biblical revelation over symbolism. A few "low" parishes even subscribe to traditional Evangelical theology (see Evangelical Anglicanism). The spoken Eucharist tends to be emphasized in Low Church congregations. Altar rails may be omitted in this type.
Broad Church indicates a middle ground. These parishes are the most common within The Episcopal Church. However, unlike the Anglican Church in England, most Episcopal 'broad church' parishes make use of a catholic liturgy that includes eucharistic vestments, chant, and a high view of the sacraments, even if the liturgy is not as solemn or lacks some of the other accoutrements typical of Anglo-Catholic parishes. Unlike mainstream Catholic Churches, the altar rail has usually been retained and communion is usually served kneeling at the altar rail similar to a Tridentine Mass, because the Episcopal Church teaches, through its Book of Common Prayer, a theologically high view of the Church and its sacraments, even if not all parishes carry this out liturgically.[109]

A majority of Episcopal services could be considered to be "High Church" while still falling somewhat short of a typical Anglo-Catholic "very" high church service. In contrast, "Low Church" services are somewhat rarer. However, while some Episcopalians refer to their churches by these labels, often there is overlapping, and the basic rites do not greatly differ. There are also variations that blend elements of all three and have their own unique features, such as New England Episcopal churches, which have elements drawn from Puritan practices, combining the traditions of "high church" with the simplicity of "low church". Typical parish worship features Bible readings from the Old Testament as well as from both the Epistles and the Gospels of the New Testament. Some latitude in selecting Bible readings is allowed, but every service includes at least a passage from one of the Gospels, as well as the praying of the Lord's Prayer.
In the Eucharist or Holy Communion service, the Book of Common Prayer specifies that bread and wine are consecrated for consumption by the people. A valid communion is made in either species, so those wishing for whatever reason to avoid alcohol can decline the cup and still make a valid communion. A Eucharist can be part of a wedding to celebrate a sacramental marriage and of a funeral as a thank offering (sacrifice) to God and for the comfort of the mourners.
The veneration of saints in the Episcopal Church is a continuation of an ancient tradition from the early Church which honors important people of the Christian faith. The usage of the term "saint" is similar to Catholic and Orthodox traditions. There are explicit references in the 1976 Book of Common Prayer to invoking the aid of the prophets, patriarchs, saints, martyrs and the Virgin Mary as in an optional prayer in the committal at a funeral, p.504. In general Anglicans pray with and for the saints in the fellowship of the saints, not to them, although their intercessions may be requested. Those inclined to the Anglo-Catholic traditions may explicitly invoke saints as intercessors in prayer.
Book of Common Prayer

The Episcopal Church publishes its own Book of Common Prayer (BCP) (similar to other Anglican prayer books), containing most of the worship services (or liturgies) used in the Episcopal Church. Because of its widespread use in the church, the BCP is both a reflection and source of theology for Episcopalians.
The full name of the BCP is: The Book of Common Prayer and Administration of the Sacraments and Other Rites and Ceremonies of the Church Together with The Psalter or Psalms of David According to the use of The Episcopal Church.
Previous American BCPs were issued in 1789, 1892, and 1928. A proposed BCP was issued in 1786 but not adopted. The BCP is in the public domain; however, any new revisions of the BCP are copyrighted until they are approved by the General Convention, after which they are placed in the public domain.
The current edition dates from 1979 and is marked by language modernization and, in returning to ancient Christian tradition, a restoration of the Eucharist as the central liturgy of the church. The 1979 version reflects the theological and worship changes of the ecumenical reforms of the 1960s and 1970s. On the whole, the revision changed the theological emphasis of the church to be more Catholic in nature. In 1979, the Convention adopted the revision as the "official" BCP and required churches using the previous 1928 prayer book to also use the new revision. There was enough strife in implementing and adopting the 1979 BCP that an apology was issued at the 2000 General Convention[110] to any who were "offended or alienated during the time of liturgical transition to the 1979 Book of Common Prayer." The 2000 General Convention also authorized the occasional use of some parts of the 1928 book, under the direction of the bishop.
The 1979 edition contains a provision for the use of "traditional" (Elizabethan) language under various circumstances not directly provided for in the book, and the Anglican Service Book was produced accordingly, as "a traditional language adaptation of the 1979 Book of Common Prayer together with the Psalter or Psalms of David and Additional Devotions."
Belief and practice

The center of Episcopal teaching is the life and resurrection of Jesus Christ.[111] The Doctrine of the Episcopal Church is found in the Canon of Holy Scripture as understood in the Apostles' and Nicene Creeds and in the sacramental rites, the Ordinal and Catechism of the Book of Common Prayer.[112] Some of these teachings include:
Jesus Christ is fully human and fully God. He died and was resurrected from the dead.
Jesus provides the way of eternal life for those who believe.
God the Father, God the Son (Jesus Christ), and God the Holy Spirit, are one God, and are called the Holy Trinity ("three and yet one").
The Old and New Testaments of the Bible were written by people "under the inspiration of the Holy Spirit." The Apocrypha are additional books that are used in Christian worship, but not for the formation of doctrine.
The two great and necessary sacraments are Holy Baptism and Holy Eucharist.
Other sacramental rites are confirmation, ordination, marriage, reconciliation of a penitent, and unction.
Belief in heaven, hell, and Jesus' return in glory.
Emphasis on living out the Great Commandment to love God and neighbor fully.[113]
The full catechism is included in the Book of Common Prayer and is posted on the Episcopal website.[114] In practice, not all Episcopalians hold all of these beliefs, but ordained clergy are required to "solemnly engage to conform" to this doctrine.[115]
The Episcopal Church follows the via media or "middle way" between Protestant and Roman Catholic doctrine and practices: that is both Catholic and Reformed. Although many Episcopalians identify with this concept, those whose convictions lean toward either evangelicalism or Anglo-Catholicism may not.[116]
A broad spectrum of theological views is represented within the Episcopal Church. Some Episcopal members or theologians hold evangelical positions, affirming the authority of scripture over all. The Episcopal Church website glossary defines the sources of authority as a balance between scripture, tradition, and reason. These three are characterized as a "three-legged stool" which will topple if any one overbalances the other. It also notes[117]
The Anglican balancing of the sources of authority has been criticized as clumsy or "muddy." It has been associated with the Anglican affinity for seeking the mean between extremes and living the via media. It has also been associated with the Anglican willingness to tolerate and comprehend opposing viewpoints instead of imposing tests of orthodoxy or resorting to heresy trials.

This balance of scripture, tradition and reason is traced to the work of Richard Hooker, a 16th-century apologist. In Hooker's model, scripture is the primary means of arriving at doctrine and things stated plainly in scripture are accepted as true. Issues that are ambiguous are determined by tradition, which is checked by reason.[118] Noting the role of personal experience in Christian life, some Episcopalians have advocated following the example of the Wesleyan Quadrilateral of Methodist theology by thinking in terms of a "Fourth Leg" of "experience". This understanding is highly dependent on the work of Friedrich Schleiermacher.
A public example of this struggle between different Christian positions in the church has been the 2003 consecration of Gene Robinson, an openly gay man living with a long-term partner. The acceptance/rejection of his consecration is motivated by different views on the understanding of scripture.[119] This struggle has some members concerned that the church may not continue its relationship with the larger Anglican Church. Others, however, view this pluralism as an asset, allowing a place for both sides to balance each other.
Comedian and Episcopalian Robin Williams once described the Episcopal faith (and, in a performance in London, specifically the Church of England) as "Catholic Lite – same rituals, half the guilt".[120]
Social positions
Economic issues
In 1991, the Convention recommended parity in pay and benefits between clergy and lay employees in equivalent positions.[121]
Several times between 1979 and 2003, the Convention expressed concern over affordable housing and supported work to provide affordable housing.[122]
In 1982 and 1997, the Convention reaffirmed the Church's commitment to eradicating poverty and malnutrition, and challenged parishes to increase ministries to the poor.[123]
The Convention urged the church in 1997 and 2000 to promote living wages for all.[124][125]
In 2003, the Convention urged U.S. legislators to raise the national minimum wage, and to establish a living wage with health benefits as the national standard.[126][127]
Marriage of same-sex couples
At its 2015 triennial General Convention, the Church adopted “canonical and liturgical changes to provide marriage equality for Episcopalians.” The canonical change eliminated “language defining marriage as between a man and a woman.” The “two new marriage rites” contain language that allows “them to be used by same-sex or opposite-sex couples.”[6] The blessing of same-sex relationships is not uniform throughout the Episcopal Church. Following the 2015 General Convention, bishops were able to determine whether churches and priests within their dioceses were permitted to use the new liturgies. Bishops who did not permit their use were to connect same-sex couples to a diocese where the liturgies were allowed.[128]  However, following the 2018 General Convention, resolution B012 was amended to “make provision for all couples asking to be married in this church to have access to these liturgies.”  This effectually granted all churches and clergy, with or without the support of their bishop, the ability to perform same-sex marriages.[129] The Church also opposes any state or federal constitutional amendments designed to prohibit the marriages of same-sex couples.[130]
Ordination of LGBT-identified individuals
Openly gay, lesbian, bisexual and transgender individuals are eligible to be ordained.[131][132]
Racial equality
In 1861, a pamphlet entitled, A Scriptural, Ecclesiastical, and Historical View of Slavery, written by John Henry Hopkins, attempted to justify slavery based on the New Testament and gave a clear insight into the Episcopal Church's involvement in slavery. Bishop Hopkins' Letter on Slavery Ripped Up and his Misuse of the Sacred Scriptures Exposed, written by G.W. Hyer in 1863, opposed the points mentioned in Hopkins' pamphlet and revealed a startling divide in the Episcopal Church over the issue of slavery.[133] In 1991, the General Convention declared "the practice of racism is sin,"[134] and in 2006, a unanimous House of Bishops endorsed Resolution A123 apologizing for complicity in the institution of slavery, and silence over "Jim Crow" laws, segregation, and racial discrimination.[135] In 2018, following the white nationalist rally in Charlottesville, Presiding Bishop Michael B. Curry said that "the stain of bigotry has once again covered our land" and called on Episcopalians to choose "organized love intent on creating God's beloved community on Earth" rather than hate.[136]
Abortion
The Church does not approve of the use of abortion as a means of birth control or family planning, but considers it a woman's right to receive one. [137] The Church opposes any legislation which would prevent women from obtaining abortions or information about abortions.[138]
Euthanasia
The Episcopal Church disapproves of assisted suicide and other forms of euthanasia, but does teach that it is permissible to withdraw medical treatment, such as artificial nutrition and hydration, when the burden of such treatment outweighs its benefits to an individual.[139]
Agencies and programs
Society for the Increase of the Ministry (SIM)
 is the only organization raising funds on a national basis for Episcopal seminarian support. SIM's founding purpose in 1857 – "to find suitable persons for the Episcopal ministry and aid them in acquiring a thorough education." SIM has awarded scholarships to qualified, full-time seminary students.[140]
Episcopal Relief & Development
Episcopal Relief & Development is the international relief and development agency of the Episcopal Church of the United States. It helps to rebuild after disasters and aims to empower people by offering lasting solutions that fight poverty, hunger and disease. Episcopal Relief and Development programs focus on alleviating hunger, improving food supply, creating economic opportunities, strengthening communities, promoting health, fighting disease, responding to disasters, and rebuilding communities.[141]
Scholarships
There are about 60 trust funds administered by the Episcopal Church which offer scholarships to young people affiliated with the church. Qualifying considerations often relate to historical missionary work of the church among American Indians and African-Americans, as well as work in China and other foreign missions.[142][143] There are special programs for both American Indians[144] and African-Americans[145] interested in training for the ministry.
Ecumenical relations

Like the other churches of the Anglican Communion, the Episcopal Church has entered into full communion with the Old Catholic Churches of the Union of Utrecht, the Philippine Independent Church, and the Mar Thoma Syrian Church of Malabar. The Episcopal Church is also in a relationship of full communion with the Evangelical Lutheran Church in America[146] and the Northern and Southern Provinces of the Moravian Church in America.[147] The Episcopal Church entered into a full communion agreement with the Church of Sweden at its General Convention in Salt Lake City on June 28, 2015.
The Episcopal Church maintains ecumenical dialogs with the United Methodist Church and the Moravian Church in America, and participates in pan-Anglican dialogs with the Oriental Orthodox Churches, the World Alliance of Reformed Churches, and the Roman Catholic Church. In 2006 a relation of interim Eucharistic sharing was inaugurated with the United Methodist Church, a step that may ultimately lead to full communion.
Historically Anglican churches have had strong ecumenical ties with the Eastern Orthodox Churches, and the Episcopal Church particularly with the Russian Orthodox Church, but relations in more recent years have been strained by the ordination of women and the ordination of Gene Robinson to the episcopate. A former relation of full communion with the Polish National Catholic Church (once a part of the Union of Utrecht) was broken off by the PNCC in 1976 over the ordination of women.
The Episcopal Church was a founding member of the Consultation on Church Union and participates in its successor, Churches Uniting in Christ. The Episcopal Church is a founding member of the National Council of Churches, the World Council of Churches, and the new Christian Churches Together in the USA. Dioceses and parishes are frequently members of local ecumenical councils as well.
Historical societies
There are two historical societies of American Episcopalianism: Historical Society of the Episcopal Church or National Episcopal Historians and Archivists (NEHA).
Church Publishing
Church Publishing Incorporated (Church Publishing Inc., CPI) began as the Church Hymnal Corporation in 1918, dedicated initially to publishing a single work, The Hymnal 1918, which still remains in print. It is the official publisher for the General Convention of the Episcopal Church in the United States.
Imprints include Church Publishing, Morehouse Publishing (independently founded in 1884) and Seabury Books (the "trade" imprint).[148]
See also

Episcopal Youth Community
List of colleges and seminaries affiliated with the Episcopal Church
Historical List of bishops of the Episcopal Church in the United States of America
List of Episcopal bishops of the United States
List of the Episcopal cathedrals of the United States
List of presiding bishops of the Episcopal Church in the United States of America
Protestantism in the United States

Sources

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Further reading

Anglican & Episcopal History— (articles, church reviews, and book reviews).
Articles on leading Episcopalians, both lay (e.g., George Washington, Franklin D. Roosevelt, Frances Perkins) and ordained, in American National Biography. (1999). Edited by John A. Garraty and Mark C. Carnes. New York: Oxford Univ. Press. Also 100 biographical articles in Hein and Shattuck, The Episcopalians: see below.
A Brief History of the Episcopal Church. Holmes, David L. (1993). Harrisburg, PA: Trinity Press International.
A Dictionary for Episcopalians. Wall, John N. (2000). Boston, MA: Cowley Publications.
Documents of Witness: A History of the Episcopal Church, 1782–1985. Armentrout, Don S., & Slocum, Robert Boak. (1994). New York: Church Hymnal Corporation.
Readings from the History of the Episcopal Church. Prichard, Robert W. (Ed.). (1986). Wilton, CT: Morehouse-Barlow.
The Episcopal Clerical Directory. New York: Church Publishing.
 An Episcopal Dictionary of the Church: A User Friendly Reference for Episcopalians. Armentrout, Don S., & Slocum, Robert Boak. (Eds.). ([1999]). New York: Church Publishing Incorporated.
About the Concordat: 28 Questions about the Agreement between the Episcopal Church and the Evangelical Church of America [i.e. the Evangelical Lutheran Church in America], prepared by the Ecumenical Relations Office of the Episcopal Church. Cincinnati, Ohio: Forward Movement Publications, [1997?]. 43 p. Without ISBN
A Commentary on [the Episcopal Church/Evangelical Lutheran Church in America] Concordat of Agreement, ed. by James E. Griffes and Daniel Martensen. Minneapolis, Minn.: Augsburg-Fortress; Cincinnati, Ohio: Forward Movement Publications, 1994. 159 p. ISBN0-8066-2690-9
Concordat of Agreement [between the Episcopal Church and the Evangelical Lutheran Church in America]: Supporting Essays, ed. by Daniel F. Martensen. Minneapolis, Minn.: Augsburg-Fortress; Cincinnati, Ohio: Forward Movement Publications, 1995. 234 p. ISBN0-8066-2667-4
 An essay on Hooker and the present discontents.
The History of the Episcopal Church in America, 1607–1991: A Bibliography. Caldwell, Sandra M., & Caldwell, Ronald J. (1993). New York: Garland Publishing.

Historical Dictionary of Anglicanism by Colin Buchanan; (2nd ed. 2015)
Jamestown Commitment: the Episcopal Church [i.e. the Protestant Episcopal Church in the U.S.A.] and the American Indian, by Owanah Anderson. Cincinnati, Ohio: Forward Movement Publications (1988). 170 p. ISBN0-88028-082-4
Mullin, Robert Bruce. "Trends in the Study of the History of the Episcopal Church," Anglican and Episcopal History, June 2003, Vol. 72 Issue 2, pp 153–165, historiography

"The Forgotten Evangelicals: Virginia Episcopalians, 1790–1876". Waukechon, John Frank. Dissertation Abstracts International, 2001, Vol. 61 Issue 8, pp 3322–3322

Noble Powell and the Episcopal Establishment in the Twentieth Century. Hein, David. (2001, 2007). Urbana: University of Illinois Press; paperback reprint, Eugene, Ore.: Wipf & Stock.
. Savitri Hensman. Ekklesia. 2007.

No URL found. Please specify a URL here or add one to Wikidata.

 at the Archives of the Episcopal Church

does the Reformed Episcopal Church still stand?


Polio vaccines are vaccines used to prevent poliomyelitis (polio).[1] Two types are used: an inactivated poliovirus given by injection (IPV) and a weakened poliovirus given by mouth (OPV).[1] The World Health Organization recommends all children be fully vaccinated against polio.[1] The two vaccines have eliminated polio from most of the world,[2][3] and reduced the number of cases reported each year from an estimated 350,000 in 1988 to 22 in 2017.[4]

The inactivated polio vaccines are very safe.[1] Mild redness or pain may occur at the site of injection.[1] Oral polio vaccines cause about three cases of vaccine-associated paralytic poliomyelitis per million doses given.[1] This compares with 5,000 cases per million who are paralysed following a polio infection.[5] Both are generally safe to give during pregnancy and in those who have HIV/AIDS but are otherwise well.[1]

The first polio vaccine was the inactivated polio vaccine.[1] It was developed by Jonas Salk and came into use in 1955.[1][6] The oral polio vaccine was developed by Albert Sabin and came into commercial use in 1961.[1][7] They are on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[8] The wholesale cost in the developing world is about US$0.25 per dose for the oral form as of 2014.[9] In the United States, it costs between $25 and $50 for the inactivated form.[10]

Medical uses

Interruption of person-to-person transmission of the virus by vaccination is important in the global polio eradication,[11] since  no long-term carrier state exists for poliovirus in individuals with normal immune function, polio viruses have no nonprimate reservoir in nature,[12] and survival of the virus in the environment for an extended period of time appears to be remote.
Inactivated
When the current formulation of IPV is used, 90% or more of individuals develop protective antibodies to all three serotypes of polio virus after two doses of inactivated polio vaccine (IPV), and at least 99% are immune to polio virus following three doses. The duration of immunity induced by IPV is not known with certainty, although a complete series is thought to provide protection for many years.[13]
Attenuated
OPV proved to be superior in administration, eliminating the need for sterile syringes and making the vaccine more suitable for mass vaccination campaigns. OPV also provided longer-lasting immunity than the Salk vaccine, as it provides both humoral immunity and cell-mediated immunity.
One dose of OPV produces immunity to all three poliovirus serotypes in roughly 50% of recipients.[14] Three doses of live-attenuated OPV produce protective antibodies to all three poliovirus types in more than 95% of recipients. OPV produces excellent immunity in the intestine, the primary site of wild poliovirus entry, which helps prevent infection with wild virus in areas where the virus is endemic.[15] The live virus used in the vaccine can rarely shed in the stool and can rarely spread to others within a community. The live virus also has stringent requirements for transport and storage, which are a problem in some hot or remote areas. As with other live-virus vaccines, immunity initiated by OPV is probably lifelong.[13]
The trivalent (against wild types 1, 2, and 3) OPV has been used to nearly eradicate polio infection worldwide.[16] Led by The Global Polio Eradication Initiative, 155 countries switched to use the bivalent (against wild type 1 and 3) between 17 April and 1 May 2016.[17] The bivalent OPV is at more effective against type 1 and 3 but does not cover type 2.[18] The United States as of 2017 continues to recommend the use of a trivalent version, but a fully inactivated version.[16]
Schedule
In countries with endemic polio or where there is a high risk of imported cases, the WHO recommends OPV vaccine at birth followed by a primary series of 3 OPV and at least one IPV doses starting at 6 weeks of age, with a minimum of 4 weeks between OPV doses. In countries with >90% immunization coverage and low risk of importation, the WHO recommends one or two IPV doses starting at 2 months of age followed by at least two OPV doses, with the doses separated by 4–8 weeks depending on the risk of exposure. In countries with the highest levels of coverage and the lowest risks of importation and transmission, the WHO recommends a primary series of 3 IPV injections, with a booster dose after an interval of six months or more if the first dose was administered before 2 months of age.[19]
Side effects
The inactivated polio vaccines are very safe. Mild redness or pain may occur at the site of injection. Oral polio vaccine results in vaccine-associated paralytic poliomyelitis in about three per million doses. They are generally safe to give during pregnancy and in those who have HIV/AIDS, but are otherwise well.[1]
Vaccine-induced polio

A potential, but rare, adverse effect of the OPV is its known ability to recombine to a form that may cause neurological infection and cause paralysis.[20] Clinical disease, including paralysis, caused by vaccine-derived poliovirus (VDPV) is indistinguishable from that caused by wild polioviruses.[21] This is believed to be a rare event, but outbreaks of vaccine-associated paralytic poliomyelitis (VAPP), caused by a circulating vaccine-derived poliovirus (cVDPV),[22] have been reported, and tend to occur in areas of low coverage by OPV, presumably because the OPV is itself protective against the related outbreak strain.[23][24] With wild polio cases at record lows, 2017 was the first year where more cases of cVDPV were recorded than the wild poliovirus, a trend that is expected to continue.[25]
Contamination concerns
In 1960, the rhesus monkey kidney cells used to prepare the poliovirus vaccines were determined to be infected with the Simian Virus-40.[26] SV40 was also discovered in 1960 and is a naturally occurring virus that infects monkeys. In 1961, SV40 was found to cause tumors in rodents.[27] More recently, the virus was found in certain forms of cancer in humans, for instance brain and bone tumors, pleural and peritoneal mesothelioma, and some types of non-Hodgkin's lymphoma.[28][29] However,  SV40 has not been determined to cause these cancers.[30]
SV40 was found to be present in stocks of the injected form of the polio vaccine (IPV) in use between 1955 and 1963.[26] It is not found in the OPV form.[26] Over 98 million Americans received one or more doses of polio vaccine between 1955 and 1963 when a proportion of vaccine was contaminated with SV40; an estimated 10–30 million Americans may have received a dose of vaccine contaminated with SV40.[26] Later analysis suggested that vaccines produced by the former Soviet bloc countries until 1980, and used in the USSR, China, Japan, and several African countries, may have been contaminated, meaning hundreds of millions more may have been exposed to SV40.[31]
In 1998, the National Cancer Institute undertook a large study, using cancer case information from the institute's SEER database. The published findings from the study revealed no increased incidence of cancer in persons who may have received vaccine containing SV40.[32] Another large study in Sweden examined cancer rates of 700,000 individuals who had received potentially contaminated polio vaccine as late as 1957; the study again revealed no increased cancer incidence between persons who received polio vaccines containing SV40 and those who did not.[33] The question of whether SV40 causes cancer in humans remains controversial, however, and the development of improved assays for detection of SV40 in human tissues will be needed to resolve the controversy.[30]

During the race to develop an oral polio vaccine, several large-scale human trials were undertaken. By 1958, the National Institutes of Health had determined that OPV produced using the Sabin strains were the safest.[34] Between 1957 and 1960, however, Hilary Koprowski continued to administer his vaccine around the world. In Africa, the vaccines were administered to roughly one million people in the Belgian territories (now the Democratic Republic of the Congo, Rwanda, and Burundi).[35][36] The results of these human trials have been controversial,[37] and unfounded accusations in the 1990s arose that the vaccine had created the conditions necessary for transmission of simian immunodeficiency virus from chimpanzees to humans, causing HIV/AIDS. These hypotheses, however, have been conclusively refuted.[35] By 2004, cases of poliomyelitis in Africa had been reduced to just a small number of isolated regions in the western portion of the continent, with sporadic cases elsewhere. Recent local opposition to vaccination campaigns have evolved due to lack of adequate information,[38][39] often relating to fears that the vaccine might induce sterility.[40] The disease has since resurged in Nigeria and in several other African nations without necessary information, which epidemiologists believe is due to refusals by certain local populations to allow their children to receive the polio vaccine.[41]
Manufacture
Inactivated
The Salk vaccine, IPV, is based on three wild, virulent reference strains, Mahoney (type 1 poliovirus), MEF-1 (type 2 poliovirus), and Saukett (type 3 poliovirus), grown in a type of monkey kidney tissue culture (Vero cell line), which are then inactivated with formalin.[42] The injected Salk vaccine confers IgG-mediated immunity in the bloodstream, which prevents polio infection from progressing to viremia and protects the motor neurons, thus eliminating the risk of bulbar polio and post-polio syndrome.
In the United States, vaccine is administered along with the tetanus, diphtheria, and acellular pertussis vaccines (DTaP) and a pediatric dose of hepatitis B vaccine.[14] In the UK, IPV is combined with tetanus, diphtheria, pertussis, and Haemophilus influenzae type b vaccines.[43]
Attenuated

OPV is an attenuated vaccine, produced by the passage of the virus through nonhuman cells at a subphysiological temperature, which produces spontaneous mutations in the viral genome.[44] Oral polio vaccines were developed by several groups, one of which was led by Albert Sabin. Other groups, led by Hilary Koprowski and H.R. Cox, developed their own attenuated vaccine strains. In 1958, the National Institutes of Health created a special committee on live polio vaccines. The various vaccines were carefully evaluated for their ability to induce immunity to polio, while retaining a low incidence of neuropathogenicity in monkeys. Large-scale clinical trials performed in the Soviet Union in late 1950s to early 1960s by Mikhail Chumakov and his colleagues demonstrated safety and high efficacy of the vaccine.[45][46] Based on these results, the Sabin strains were chosen for worldwide distribution.[34] Fifty-seven nucleotide substitutions  distinguish the attenuated Sabin 1 strain from its virulent parent (the Mahoney serotype), two nucleotide substitutions attenuate the Sabin 2 strain, and 10 substitutions are involved in attenuating the Sabin 3 strain.[42] The primary attenuating factor common to all three Sabin vaccines is a mutation located in the virus's internal ribosome entry site,[47] which alters stem-loop structures and reduces the ability of poliovirus to translate its RNA template within the host cell.[48] The attenuated poliovirus in the Sabin vaccine replicates very efficiently in the gut, the primary site of infection and replication, but is unable to replicate efficiently within nervous system tissue. In 1961, type 1 and 2 monovalent oral poliovirus vaccine (MOPV) was licensed, and in 1962, type 3 MOPV was licensed. In 1963, trivalent OPV (TOPV) was licensed, and became the vaccine of choice in the United States and most other countries of the world, largely replacing the inactivated polio vaccine.[49] A second wave of mass immunizations led to a further dramatic decline in the number of polio cases. Between 1962 and 1965, about 100 million Americans (roughly 56% of the population at that time) received the Sabin vaccine. The result was a substantial reduction in the number of poliomyelitis cases, even from the much-reduced levels following the introduction of the Salk vaccine.[50]
OPV is usually provided in vials containing 10–20 doses of vaccine. A single dose of oral polio vaccine (usually two drops) contains 1,000,000 infectious units of Sabin 1 (effective against PV1), 100,000 infectious units of the Sabin 2 strain, and 600,000 infectious units of Sabin 3. The vaccine contains small traces of antibiotics—neomycin and streptomycin—but does not contain preservatives.[51]
History

In a generic sense, vaccination works by priming the immune system with an 'immunogen'. Stimulating immune response, by use of an infectious agent, is known as immunization. The development of immunity to polio efficiently blocks person-to-person transmission of wild poliovirus, thereby protecting both individual vaccine recipients and the wider community.[11]
The development of two polio vaccines led to the first modern mass inoculations. The last cases of paralytic poliomyelitis caused by endemic transmission of wild virus in the United States occurred in 1979, with an outbreak among the Amish in several Midwest states.[14]
1935
Two separate teams, led by John Kolmer and Maurice Brodie respectively, developed polio vaccines and reported their results at the annual meeting of the American Public Health Association in November 1935. Despite promising results, both were cancelled as a result of the angry reaction from other researchers, as vaccinated children had died in both studies; no researchers dared attempt a polio vaccine for another 20 years.[52]
Professor John Kolmer, MD (1886–1962), of Temple University in Philadelphia, presented his findings first. He had developed an attenuated poliovirus vaccine, which he tested in about 10,000 children across much of the United States and Canada.[52] Five of these children died of polio and 10 more were paralyzed, usually in the arm where the vaccine was injected, and frequently affecting children in towns where no polio outbreak had occurred.[52]  He had no control group, but asserted that many more children would have gotten sick.[52] The response from other researchers was uncharacteristically blunt; one of them directly called Kolmer a murderer.[52]
Maurice Brodie, MD (1903–1939), a young researcher at New York University and the New York City Health Department, presented his results afterwards, but the feelings of the researchers were already unfavorable before he started because of Kolmer's report.[52] Brodie and his team had prepared a formaldehyde-killed poliovirus vaccine, testing it first on himself and five co-workers, and eventually on 7,500 children and adults, with another 4,500 people serving as a control group.[52] In the control group, Brodie reported that one out of 900 developed polio; in the group receiving the vaccine, only one out of 7,500 developed polio, making the vaccine 88% effective during the first year. However, other researchers believed that the one case was likely caused by the vaccine, and two more possible cases were reported later.[52]
After this meeting, Brodie, whose polio vaccine was at least partially effective and reasonably safe, and who developed several ground-breaking ideas about vaccination whose validity was confirmed two decades later with the development of the Salk vaccine, was immediately fired and had trouble finding employment again. Brodie died three and a half years later.[52] Kolmer, an established researcher whose vaccine was unsafe and probably ineffective, kept his job, was given a second appointment as professor of medicine at the Temple University School of Dentistry the next year, continued to publish research papers, and received multiple awards throughout his academic career.[52][53]
1948
A breakthrough came in 1948 when a research group headed by John Enders at the Children's Hospital Boston successfully cultivated the poliovirus in human tissue in the laboratory.[54] This group had recently successfully grown mumps in cell culture. In March 1948, Thomas H. Weller was attempting to grow varicella virus in embryonic lung tissue. He had inoculated the planned number of tubes when he noticed that there were a few unused tubes. He retrieved a sample of mouse brain infected with polio virus and added it to the remaining test tubes, on the off chance that the virus might grow. The varicella cultures failed to grow, but the polio cultures were successful.
This development greatly facilitated vaccine research and ultimately allowed for the development of vaccines against polio. Enders and his colleagues, Thomas H. Weller and Frederick C. Robbins, were recognized in 1954 for their labors with a Nobel Prize in Physiology or Medicine.[55] Other important advances that led to the development of polio vaccines were: the identification of three poliovirus serotypes (Poliovirus type 1 — PV1, or Mahoney; PV2, Lansing; and PV3, Leon); the finding that prior to paralysis, the virus must be present in the blood; and the demonstration that administration of antibodies in the form of gamma globulin protects against paralytic polio.[42][56]
1950–1955
During the early 1950s, polio rates in the U.S. were above 25,000 annually; in 1952 and 1953, the U.S. experienced an outbreak of 58,000 and 35,000 polio cases, respectively, up from a typical number of some 20,000 a year, with deaths in those years numbering 3,200 and 1,400.[57] Amid this U.S. polio epidemic, millions of dollars were invested in finding and marketing a polio vaccine by commercial interests, including Lederle Laboratories in New York under the direction of H. R. Cox. Also working at Lederle was Polish-born virologist and immunologist Hilary Koprowski of the Wistar Institute in Philadelphia, who tested the first successful polio vaccine, in 1950.[36][58] His vaccine, however, being a live attenuated virus taken orally, was still in the research stage and would not be ready for use until five years after Jonas Salk's polio vaccine (a dead-virus injectable vaccine) had reached the market. Koprowski's attenuated vaccine was prepared by successive passages through the brains of Swiss albino mice. By the seventh passage, the vaccine strains could no longer infect nervous tissue or cause paralysis. After one to three further passages on rats, the vaccine was deemed safe for human use.[34][59] On 27 February 1950, Koprowski's live, attenuated vaccine was tested for the first time on an 8-year-old boy living at Letchworth Village, an institution for the physically and mentally disabled located in New York. After the child suffered no side effects, Koprowski enlarged his experiment to include 19 other children.[34][60]
Jonas Salk

The first effective polio vaccine was developed in 1952 by Jonas Salk and a team at the University of Pittsburgh that included Julius Youngner, Byron Bennett, L. James Lewis, and Lorraine Friedman, which required years of subsequent testing. Salk went on CBS radio to report a successful test on a small group of adults and children on 26 March 1953; two days later, the results were published in JAMA.[61] Beginning 23 February 1954, the vaccine was tested at Arsenal Elementary School and the Watson Home for Children in Pittsburgh, Pennsylvania.[62]
Salk's vaccine was then used in a test called the Francis Field Trial, led by Thomas Francis, the largest medical experiment in history at that time. The test began with about 4,000 children at Franklin Sherman Elementary School in McLean, Virginia,[63][64] and eventually involved 1.8 million children, in 44 states from Maine to California.[65] By the conclusion of the study, roughly 440,000 received one or more injections of the vaccine, about 210,000 children received a placebo, consisting of harmless culture media, and 1.2 million children received no vaccination and served as a control group, who would then be observed to see if any contracted polio.[34]
The results of the field trial were announced 12 April 1955 (the tenth anniversary of the death of President Franklin D. Roosevelt, whose paralytic illness was generally believed to have been caused by polio). The Salk vaccine had been 60–70% effective against PV1 (poliovirus type 1), over 90% effective against PV2 and PV3, and 94% effective against the development of bulbar polio.[66] Soon after Salk's vaccine was licensed in 1955, children's vaccination campaigns were launched. In the U.S, following a mass immunization campaign promoted by the March of Dimes, the annual number of polio cases fell from 35,000 in 1953 to 5,600 by 1957.[67] By 1961 only 161 cases were recorded in the United States.[68]
A week earlier in April 1955, Pierre Lépine at the Pasteur Institute in Paris also announced an effective polio vaccine.[69][70]
Safety incidents
In April 1955, soon after mass polio vaccination began in the US, the Surgeon General began to receive reports of patients who contracted paralytic polio about a week after being vaccinated with Salk polio vaccine from Cutter pharmaceutical company, with the paralysis limited to the limb the vaccine was injected into. In response the Surgeon General pulled all polio vaccine made by Cutter Laboratories from the market, but not before 250 cases of paralytic illness had occurred. Wyeth polio vaccine was also reported to have paralyzed and killed several children.
It was soon discovered that some lots of Salk polio vaccine made by Cutter and Wyeth had not been properly inactivated, allowing live poliovirus into more than 100,000 doses of vaccine. In May 1955, the National Institutes of Health and Public Health Services established a Technical Committee on Poliomyelitis Vaccine to test and review all polio vaccine lots and advise the Public Health Service as to which lots should be released for public use. These incidents reduced public confidence in polio vaccine leading to a drop in vaccination rates.[71]
1961

At the same time that Salk was testing his vaccine, both Albert Sabin and Hilary Koprowski continued working on developing a vaccine using live virus. During a meeting in Stockholm to discuss polio vaccines in November 1955, Sabin presented results obtained on a group of 80 volunteers, while Koprowski read a paper detailing the findings of a trial enrolling 150 people.[34] Sabin and Koprowski both eventually succeeded in developing vaccines. Because of the commitment to the Salk vaccine in America, Sabin and Koprowski both did their testing outside the United States, Sabin in Mexico[72] and then in the Soviet Union,[73] and Koprowski in the Congo and Poland.[36] In 1957, Sabin developed a trivalent vaccine, containing attenuated strains of all three types of poliovirus.[73] In 1959, ten million children in the Soviet Union received the Sabin oral vaccine. For this work, Sabin was given the medal of the Order of Friendship Among Peoples, described as the Soviets' highest civilian honor,[74] despite having become an American during the height of the cold war. Sabin's oral vaccine using live virus came into commercial use in 1961.[1]
Once Sabin’s oral vaccine became widely available, it supplanted Salk’s injected vaccine, which had been tarnished in the public's opinion by the Cutter incident, in which Salk vaccines prepared by one company resulted in several children dying or becoming paralyzed.[75]
1987
An enhanced-potency IPV was licensed in the United States in November 1987, and is currently the vaccine of choice there.[14] The first dose of polio vaccine is given shortly after birth, usually between 1 and 2 months of age, and a second dose is given at 4 months of age.[14] The timing of the third dose depends on the vaccine formulation, but should be given between 6 and 18 months of age.[43] A booster vaccination is given at 4 to 6 years of age, for a total of four doses at or before school entry.[15] In some countries, a fifth vaccination is given during adolescence.[43] Routine vaccination of adults (18 years of age and older) in developed countries is neither necessary nor recommended because most adults are already immune and have a very small risk of exposure to wild poliovirus in their home countries.[14] In 2002, a pentavalent (five-component) combination vaccine (called Pediarix) containing IPV was approved for use in the United States.
1988

A global effort to eradicate polio, led by the World Health Organization, UNICEF,[76] and the Rotary Foundation, began in 1988 and has relied largely on the oral polio vaccine developed by Albert Sabin and Mikhail Chumakov (Sabin-Chumakov vaccine).[77]
After 1990
Polio was eliminated in the Americas by 1994.[78] The disease was officially eliminated in 36 Western Pacific countries, including China and Australia, in 2000.[79][80] Europe was declared polio-free in 2002.[81] Since January 2011,  no cases of the disease have been reported in India, hence in February 2012, the country was taken off the WHO list of polio-endemic countries. In March 2014, India was declared a polio-free country.[82][83][84]
Although poliovirus transmission has been interrupted in much of the world, transmission of wild poliovirus does continue and creates an ongoing risk for the importation of wild poliovirus into previously polio-free regions. If importations of poliovirus occur, outbreaks of poliomyelitis may develop, especially in areas with low vaccination coverage and poor sanitation. As a result, high levels of vaccination coverage must be maintained.[78] In November 2013, the WHO announced a polio outbreak in Syria. In response, the Armenian government put out a notice asking Syrian Armenians under age 15 to get the polio vaccine.[85] As of 2014, polio virus has spread  to 10 countries, mainly in Africa, Asia, and the Middle East, with Pakistan, Syria, and Cameroon advising vaccinations to outbound travelers.[86]
Polio vaccination programs have received resistance from some people in Pakistan, Afghanistan, and Nigeria (the three countries as of 2017 with remaining polio cases). Some Muslim religious leaders believe that the vaccines are secretly being used for sterilization of Muslims.[41] The fact that in 2011, the CIA organized a fake vaccination program  to help find Osama Bin Laden is an additional cause of distrust.[87] In 2015, the WHO announced a deal with the Taliban to encourage them to distribute the vaccine in areas they control.[88] However, on 11 September 2016, two unidentified gunmen associated with the Pakistani Taliban, Jamaat-ul-Ahrar, shot Zakaullah Khan, a doctor who was administering polio vaccines in Pakistan. The leader of the Jamaat-ul-Ahrar claimed responsibility for the shooting and says that the group will continue to keep doing these kinds of attacks. This resistance to and skepticism of vaccinations has consequently slowed down the polio eradication process within the three remaining countries.[87]
Society and culture
Cost
The wholesale cost is about US$0.25 per dose for the oral form as of 2014.[9] The Global Alliance for Vaccines and Immunization supplies the inactivated vaccine to developing countries for as little as €0.75 (about US$0.88) per dose in 10-dose vials.[89] In the United States, the inactivated form costs between $25 and $50.[10]
Misconceptions
A widespread misconception has arisen in Pakistan that polio vaccine contained haram ingredients and could cause impotence and infertility in male children, leading some parents not to have their children vaccinated. This belief is most prevalent in the Khyber Pakhtunkhwa province and the FATA region. Attacks on polio vaccination teams have also occurred, thereby hampering international efforts to eradicate polio in Pakistan and globally, since the virus can be carried by travelers.[90][91]

 final project to eliminate polio by 2018.
 History of Vaccines, a project of the College of Physicians of Philadelphia
 — 'People and Discoveries: Salk Produces Polio Vaccine 1952', PBS
, Smithsonian Magazine, April 2005
, Dream 2047 Magazine, April 2004