Resurgent polio

Eradicating polio in India is proving to be a tough ask. The disease, which seemed to have been contained a few years ago, is rearing its head again. It has returned with vengeance in the states of Uttar Pradesh and Bihar. Government's deadline for eradicating polio is 2007. But experts remain divided on the basics. One school of thought argues the disease will be eradicated if more of the oral polio vaccine is reached to the children. Another believes that the goal of eradication requires a change in the vaccine being used. A third group strikes a more radical chord the disease cannot be eradicated, and so the anti-polio campaign should be stopped. The stakes are higher. The anti-polio programme would lay down the ground for controlling other disease that have vaccines. vibha varshney ventures into an increasingly fraught territory, as another deadline for polio eradication closes in

 
Last Updated: Sunday 07 June 2015

Resurgent polio

-- (Credit: Agnimirh Basu / CSE) cripple EFFECT

Moradabad district in western Uttar Pradesh (UP) holds a dubious distinction: this year it has registered the highest number of polio cases of any district in the country. When this magazine went to press, officials there were gearing up for a special polio vaccination drive slated for December 10. They exuded confidence; quite unimaginable for officials of a district that has recorded 64 polio cases this year. “Everything is under control now,” said Moradabad’s district collector Pandhari Yadav. “More cases are now being reported from other UP districts,” he said. This year, 234,520,826 children in UP had been vaccinated by October 2006. But 471 of the total 571 polio cases in India in 2006 have come from this state (see: Polio vault). District officials in Moradabad claim they have done their best, and their counterparts in the National Polio Surveillance Project (NPSP)—a watchdog appointed by the World Health Organization (WHO)—support their assertions.

 Number of people who contracted polio in 2006

Despite the vaccine
Moradabad is not the only problem area. In neighbouring Bijnor, 27 polio cases have been detected this year. Monis of village Daulatabad is one of polio's 2006 victims. Seven doses of vaccination did not protect the two-year old from the disease. Several rounds of vaccination also failed to protect Bikash and Nikhil of Shadipur village in the same district.

When India's mass anti-polio campaign began in 1995, this failure wasn't anticipated. It was a joint effort of the Union government and the Global Polio Eradication Initiative (gpei), a programme of who, Rotary International, unicef, and a few other international organisations. who's role is a major deviation from its typical, advisory role in such matters.

It was believed that two drops of the oral vaccine, administered three times to all children below three years, would be sufficient to stem the disease. 2000 was set as the deadline for polio eradication, and it was believed that by 2005, all traces of polio would be removed. Much store was laid on the theory of herd effect vaccinating a majority of the children within one region would ensure protection of the rest.

Today, the herd effect has been forgotten all children below the age of five have to be vaccinated; that, too, every time a round of vaccination is held. The polio eradication programme has become a long-drawn affair, with 44 rounds of inoculation held since its inception.

But, the partners of the high-profile programme remain optimistic of rooting out polio in even the stubborn areas of western up. "The polio programme has shown that India is capable of eradicating polio--every single district of India has at some point been polio-free," says Jay Wenger, project manager of India's National Polio Surveillance Project (npsp). "There is no question that polio eradication is feasible. The only question is whether all children in the remaining infected areas can be reached with polio vaccine enough number of times to eradicate this disease forever. To succeed in eradicating polio in the few remaining endemic areas, we need political oversight at all levels, and also facilitate community mobilisation," says Bruce Aylward, gpei's international coordinator.

Better said than done.

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