Programmed

INITIALLY, it was said polio was not getting eradicated due to Muslims resisting vaccination. Nobody buys this anymore of 474 cases in up this year, 190 are Hindus. Regardless of religion, a majority of the victims are poor. "Many do not vaccinate because of deep frustration with the programme, and rumours that the vaccine is not safe, or simply because they want other services (health, financial) that they need, not just polio drops for their children," says Kapur.

What is evident this time is that in many cases, several rounds of vaccinations haven't been enough to prevent the disease. The variables are too many to control. One pertains to the method of administration. It is a live vaccine that can lose potecy in less than 30 minutes; it is imperative to store it at low temperatures at all times. Such conditions are often not met. This could explain why many vaccinated children contract polio.npsp was put in place in 1997 just to ensure that this kind of problems did not harm the campaign.

Operational gaps are many--such as vacant medical officer positions, poorly supervised vaccinator teams, poor booth placements and poorly selected and trained teams. In July 2006, ieag expressed concern at the large number of medical officers' posts lying vacant in the high-risk districts. In western up, such vacancies are a whopping 30 per cent.

On the other hand, people recruited to implement the vaccination drive often lack the requisite skills. According to Chandra Pal Singh Azad, president of Bharat Gyan Vigyan Samiti (an ngo working on science and literacy), Moradabad, the programme suffered when it was decided to pay the vaccinators and mobilisers. He explains the programme was initially manned by volunteers, motivated by the desire to help the people and repected by the people. It was their mobilisation that led to a sharp fall in polio in 2003 in fact just one child contracted the disease that year. But then paid volunteers were roped in for Rs 25 per day. Many of the new vaccinators were outsiders; local mobilisation was ineffective.

Guidelines say only people from government departments can be recruited for the drive, with priority on women workers. Such people cannot match the drive of social activists. "There is a need to adapt these guidelines to the area," says Said Fatma, incharge of the urban area polio program in Sambhal. She also feels a door-to-door campaign makes people suspicious of an ulterior motive.

There are other constraints. B K Dutt, a paediatrician in Moradabad, says the programme is being run against the very logic of pulse polio vaccination inoculating all children under five at one go. Operational limitations mean that one vaccination round usually extends to 12 or 13 days.

Critics also question the basis of India's anti-virus programme before the current resurgence npsp data. A huge surveillance network has been set to monitor the anti-polio programme and generate data in 2005, around 9,500 reporting units and 12,300 informer units were part of the network. These include private practitioners and even quacks or polio doctors and religious heads. Everything is done with great speed, the district immunisation officer or the surveillance medical officer initiate investigations within 24 hours.

npsp data shows that the number of cases fell down from 3,047 in 1997 to just 54 in 2005. A paper in the International Journal of Health Services (Vol 35, No 2), points out a major misrepresentation. Before 1997, all paralytic cases diagnosed as polio were on the basis of clinical diagnosis. After 1997, the diagnosis was based on microbiological tests, and only those cases for which wild poliovirus was isolated from faeces were classified as polio. This led to a fall in the number of cases. "Number of cases before and after the change in the definition cannot be compared," says C Sathyamala, one of the authors.

While the cases of polio went down, data from 2001 to 2003 showed a disturbing trend the number of non-polio cases of paralysis increased. Most of these were in up and Bihar, which saw multiple rounds of vaccinations. It is suggested that there is a direct link between an increase in the number of polio vaccinations and the increase in the number of paralysis cases.

"Vaccine manufacturers are misleading the funding agencies about the seriousness of the diseases and that it could be eradicated. The earlier the funding agencies realise the disease cannot be eradicated, more money is going to be saved," says Anant Phadke of cehat, an ngo in Mumbai. Several countries have given up the oral polio vaccine in light of the vaccine associated polio paralysis.