PHA-Exchange> Polio and OPV in India : a dead end street?

[Claudio]

From: Gopal Dabade 

http://timesofindia.indiatimes.com/articleshow/2122225.cms 


9th October 2006 TIMES OF INDIA, Editorial.    Anant Phadke

(Note: I crore= 10 million; 1 lakh=100,000)

The health secretary's glorification of the polio eradication programme takes no cognisance of some basic facts. Polio is not such a priority issue as to spend hundreds of crores every year. 

Yet the government's 2006-07 Budget has the following provisions Rs 1,004 crore for pulse polio, Rs 327 crore for routine immunisation, and Rs 184 crore for tuberculosis control. 

And, the context: 1.5 crore TB cases and four lakh annual TB deaths compared with an estimated 20,000 polio cases and less than 500 deaths annually when the polio eradication drive was launched. 

This lopsided priority is justified on the grounds that once polio is eradicated, like small pox, polio vaccination would be stopped; this would save thousands of crores in future. However, worldwide eradication of polio is not our priority, but that of the developed countries. 

Though polio has disappeared in those countries many years back, they must continue polio vaccination till polio is eradicated worldwide. Polio eradication would mean an annual saving on vaccination of $333 million and $230 million for European Union countries and the US, respectively. 

Blinded by a narrow biomedical approach, the temptation of eradicating polio, and perhaps guided by the interests of oral polio vaccine (OPV) manufacturers in the US, our experts believe that polio can be eradicated with OPV even in absence of improvements in nutrition, public sanitation and social backwardness. 

This OPV-based eradication strategy has three fundamental problems. First, it is virtually impossible to vaccinate every child in each developing country, given that there are various forms of social backwardness and social conflict. 

Second, it is impossible to ensure that in developing countries all children who receive OPV would develop immunity against polio. During last few years, 30-60 per cent of polio cases have received more than three doses of OPV. The wild virus would continue to circulate among this pool of vaccinated but unprotected population. 

Unlike in the case of smallpox, for every clinical case, there are a thousand subclinical polio infections, which are the source of wild virus for this unprotected population. That is why polio reappeared in more than 10 countries after bringing down the incidence to zero. 



Tamed, attenuated but live viruses in the OPV tend to revert to virulent viruses, which cause Vaccine Associated Paralytic Polio (VAPP). VAPP is now becoming more frequent than polio attributable to wild polio virus infection. 

Though OPV reduces the incidence of natural polio, it also generates vaccine-derived virulent polio viruses. Hence, vaccination cannot be stopped even if the incidence of wild virus polio is reduced to zero. The claim of 97 per cent reduction in polio cases in India is partly due to terminological jugglery. 

In sum, polio eradication has predictably failed, is not our priority and Indians have been forced to pay for the financial and health consequences of this eradication drive. Due to the workload of repeated rounds of pulse polio, the emaciated public health service has faltered. 

Vaccination coverage for other programmes has declined. The following needs to be done: Shift back to polio control strategy; stop additional rounds of national, state immunisation days; and adequately compensate VAPP cases for being made to sacrifice their limbs for the (mistaken) goal of polio eradication. 

To avoid VAPP, the option of shifting to injectable polio vaccine should be considered again by manufacturing IPV in the public sector. The budget for public sanitation should be increased many times over to control polio and other food and water-borne diseases. 

In the West, polio declined appreciably long before polio vaccines became available during the late 1950s. An independent commission should be set up to investigate the launching of the eradication programme with OPV. 

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