Epidemic year

If only paucity of funds was the only problem. But it is not. Amar Singh, Moradabad’s immunisation officer, has a simple explanation for the recent spurt: “This is the epidemic year.” He might be right; the disease has been seen to follow a cyclic pattern. Every fourth year sees a rise in the number of cases. Down To Earth asked Singh why the district did not take special steps when it was known that 2006 was going to be an epidemic year. He declined to comment, stating merely that the disease is now under control.

This assertion notwithstanding, the failure in UP’S polio eradication programme is apparent. The administration has decided to change the strategy this year. Instead of using the trivalent vaccine, which targeted all the three strains of the poliovirus, the programme has been administering the monovalent oral polio vaccine (mOPV1), which is effective only against the P1 virus. After finding incidence of the P3 viral strain, December 2006 saw a special round of mOPV3.

It is now believed that that three strains of the poliovirus in the trivalent vaccine compete with each other, reducing the vaccine’s overall efficacy. Children under five in Moradabad, Badaun, Bareilly, Ramnagar and JP Nagar were slated to receive MOVP3 on December 10.

Earlier this year, mOPV1 targeted the most common of the three poliovirus strains. But many areas in Moradabad continue to be ravaged by polio virus’s two common strains. For example, in village Naherther in the Sambhal block, two-year old Mohammad Kaif is afflicted by the P3 virus, while threeyear old Akansha is struck by the P1 variety. This year, 52 cases of P1 and 12 cases of P3 have been reported from Moradabad.

Viral preferences

The poor have borne the brunt of the failure to eradicate polio. Bikash and Nikhil’s father, Subhash, for example, is a daily-wage labourer, who has not been able to work since his children contracted the disease. His wife and he have been camping since November in Meerut, where the children are being treated by a local vaidya. They have spent Rs 25,000 on treatment. Subhash’s mother Rajo says that they have heard that treatment can cost as much as Rs 1 lakh per child, but the family does not have any long-term plans.

Monis's parents are also getting him treated by a private doctor. The government doctors at the Kotwali block dispensary have told them there is no treatment for the disease. One of the teams that came after the child fell sick promised them Rs 10,000 for treatment. But they heard nothing further about it.

Besides being a cause of personal tragedy for families of victims like Mehreen and Nikhil, the disease also affects the country productivity. According to the Union ministry of health and family welfare’s multiyear strategic plan, annual losses to India’s GDP due to polio-related disability is around Rs 2,700 crore. This is a conservative estimate. It excludes the cost incurred on treatment of polio cases. The document also points out that, at the current rate, operational costs are around Rs 4 per round per child. The cost of oral polio vaccine per round per child is around Rs 5.

Polio in monetary terms

A lot of money has been spent to eradicate polio in India. In 1996, Rs 400 crore came from international agencies including the Rotary International. But the government also had to take loans from agencies like the World Bank. The Union government spent Rs 1,000 crore of its own money on the programme in 2006 so far—expenditure on all other essential immunisation (diphtheria, whooping cough, tetanus, measles, tuberculosis and polio) is Rs 300 crore in 2006. The costs do not include expenditure on the government machinery used. All this hasn’t done much to end the suffering of victims such as Monis.

One walk through the locality where he lives makes the reasons for his afflictions apparent. The cobbled path is flanked by open drains; dredged out sludge lies spattered at several places. A recent paper in the journal Science says unsanitary conditions and high levels of malnutrition are main reasons for UP’S failure to eradicate polio. And, according to a document by the Nutrition Foundation of India, 52 per cent of the children in UP are malnutrioned.

This not all. Unsanitary conditions fester in Moradabad’s most affected block: Sambhal. The block has reported 14 cases of the disease, eight of them in urban areas. Sneha of Manglapura is an urban victim of the virus. She developed high fever in June, and though medicines were given to her, she got paralysed below her shoulder. Her father Sharafat has other worries, too. His elder daughter Sumaila had contracted polio five years ago, and he is yet to get a report from the government certifying that she has the disease. Sneha’s samples have also been taken, but her test report has not been delivered also. Sharafat has decided against getting his children vaccinated anymore till he gets the reports. So, he has nothing to prove that his children have polio. If he gets them, he wants to question the basis of the polio eradication campaign.

Money doesn't kill a disease 

The vaccinators have even promised to give Sharafat money for constructing a latrine. But he is adamant. Sharafat represent that 63 per cent of UP’s population that, in the statistics of the Planning Commission, lacks access to sanitation. The chances of contracting polio are obviously rife under such conditions.

The situation is worse in villages. Of the total 474 cases of polio in UP in 2006, 347 cases are from rural areas. The UP government does have the Total Sanitation Campaign for rural areas under which money is given to families below poverty line. Even if the money was offered, it is too little to construct a latrine, says Mittal. The government gives about Rs 1,200, though a toilet actually costs about Rs 4,000-5,000.

Anatomy of financial burden 

Now the government has decided that if people in villagers do not make toilets, it would take the draconian measure of lodging a police complaint against them.