Let us help push polio off the planet
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The numbers are worrying since we were well on the way to eradicating polio
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— photo: AFP
REACHING OUT: A well-designed educational campaign can help get the message across to the target population.
THERE ARE almost 200 countries in the world. All but four have got rid of the disability disease polio. The culprits are Nigeria, India, Afghanistan and Pakistan.
Indeed, up until two years ago we thought polio would have been eradicated in the world by now, or at least before this decade gets over.
Now there are grave worries. The British Medical Journal of October 21, 2006 says that as of a month ago, the number of confirmed polio cases worldwide stood at 1403 (the number was 1349 in 2005). Of these, 888 were in Nigeria (up from 489 last year), 360 in India (up from 37), 28 in Afghanistan (4 last year) and 24 in Pakistan (18 last year). Today's number in India is 490.
The numbers are worrying since we were well on the way to eradicating polio. The numbers were 350,000 in the 1980s, which came down to 1973 in the year 2005.
Then why is it staying at 1403 now, and not dropped to zero? Why is the vaccine campaign failing? The WHO, Rotary International, UNICEF and national governments are working together to find answers.
Sustained efforts
That there was a political complication in Nigeria is known. Amid rising Muslim-Western tensions, many in the Kano province of northern Nigeria seemed to have heeded unfounded allegations in 2003-2004 that the polio vaccine was a U.S. plot to spread AIDS or cause infertility by lacing the vaccine with chemicals. This led to a rise in polio cases not only there, but in several neighbouring countries as well. Sustained efforts by the Nigerian federal government and international agencies have helped to reverse this trend.
Why are we lagging?
Why are we slipping in India? After all, we as a nation have done remarkably well in ridding small pox, reducing leprosy to astonishingly low levels, fighting goitre valiantly and with major success.
Why is polio on the rise? Relevantly, Mr. Robert Scott of the Rotary International's `Polio-Plus' committee points out that polio eradication hinges on four factors: vaccine supply, community acceptance, funding, and political will. How do we in India fare in each of these?
Funding is surely not the problem. The government has allocated a budget of Rs. 1,039 crores for the anti-polio drive for the current year alone. Let us then look at the other three factors.
Many have pointed to the community acceptance issue. Yes, there have been occasional hard line Muslim clerics opposing the vaccination. On the other hand, national icons like Amitabh Bachhan and Sachin Tendulkar have come on TV persuading people for the `Two Drops.'
Others like Shabana Azmi, Mohammed Kaif and the Jamia Hamdard University have visited pockets in western Uttar Pradesh where some hesitation and opposition were faced, and convincing people in the streets and neighbourhoods of the value of polio vaccination, with salutary effect.
Generalisation of what has been happening in pockets of western U.P. into a religious or ideological issue can only be counterproductive.
Instead, look at what is happening in other parts of India where too ghettos exist. Look at Bangla Desh, where polio is not resurgent. Look at Saudi Arabia, which demands that every Haj pilgrim to the Great Mosques is vaccinated against polio.
What we need to do is identify the pockets and work on them. As The Hindu editorialised: "A well-designed educational campaign can help get the message across to the target population. Large number of motivated volunteers should be deployed for this drive. A clear focus should be on densely populated villages of western U.P. where immunisation has been obstructed because of misconceptions about the vaccine."
We see the famous Khans promoting pop drinks as safe. Will they do the same for polio vaccine — and now? That would be a greater service to society.
That leaves the other two factors — political will and polio vaccine supply. Some have argued that the state government in U.P., which is not of the same political alliance as the central government in New Delhi, has been slack.
It is unfortunate that politics and shibboleths are brought in where none seems to exist. At a time when we want all the help and effort, it is pointless — indeed dangerous — to imagine and divide. Blame games do not help. Concerted and collective action will.
On the issue of vaccines, the noted virologist of Vellore, Dr. Thekkeleara Jacob John, had the following comments. He points out that there are some areas in the world where infection by the polio virus leads to far more severe reactions and pathology than elsewhere.
Some pockets of western U.P. appear to be so. Three or even seven doses of the vaccine do not seem enough. Several children have actually contracted polio even after this. Do we give them 10 doses? And if so, when? The family might fatigue of the routine and drop out.
There is thus the case for monovalent versus trivalent vaccine, may be even vaccines against type 1 and type 3 viruses together — perhaps even the injectable vaccine rather than oral drops, where justified.
In other words, should we rethink the present `one size fits all' mode and delve deeper into possible deficiencies in the programme and in the policy?
Flexible programme
These issues need to be discussed in greater detail, and a flexible programme needs to be launched urgently.
Polio is not an unsolved problem. We understand it in great measure and can conquer it. We must do it. Not to do so is a crime against our children, from whom we have borrowed this earth.
D. BALASUBRAMANIAN
dbala@lvpei.org
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