Resurgent polio

Posted under:: Feature Articles

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.

But there are question marks over the claims. When the India Expert Advisory Group for polio eradication (ieag) met in May 2006, it ascribed the rising incidence of polio in western up to the large number of houses missed during vaccination rounds in the second half of 2005. Vaccinators missed more than 10 per cent of the houses according to this international group of experts that monitors India's polio eradication programme This omission, in fact, was one reason behind the recent suspension of health officials in Moradabad, including the district's immunisation officer.

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.