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<DIV><B>From:</B> <A title=drdabade@gmail.com
href="mailto:drdabade@gmail.com">Gopal Dabade</A> </DIV>
<DIV style="FONT: 10pt arial"><BR><SPAN style="FONT-FAMILY: Arial"><A
href="http://timesofindia.indiatimes.com/articleshow/2122225.cms "
target=_blank>http://timesofindia.indiatimes.com/articleshow/2122225.cms
</A></SPAN></DIV>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><SPAN
style="FONT-FAMILY: Arial"></SPAN> </P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><SPAN
style="FONT-FAMILY: Arial">9th October 2006 </SPAN><SPAN
style="FONT-FAMILY: Arial">TIMES OF </SPAN><SPAN
style="FONT-FAMILY: Arial">INDIA</SPAN><SPAN style="FONT-FAMILY: Arial">,
Editorial. </SPAN><SPAN style="FONT-FAMILY: Arial">Anant
Phadke</SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><SPAN
style="FONT-FAMILY: Arial"><FONT size=1>(Note: I crore= 10 million; 1
lakh=100,000)</FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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. </SPAN><SPAN style="FONT-FAMILY: Arial"><BR><BR></SPAN><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.
</SPAN><SPAN style="FONT-FAMILY: Arial"><BR><BR></SPAN><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.
</SPAN><SPAN style="FONT-FAMILY: Arial"><BR><BR></SPAN><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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. </SPAN><SPAN style="FONT-FAMILY: Arial"><BR><BR></SPAN><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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 </SPAN><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">US</SPAN><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">, respectively. </SPAN><SPAN
style="FONT-FAMILY: Arial"><BR><BR></SPAN><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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. <SPAN></SPAN></SPAN><SPAN
style="FONT-FAMILY: Arial"><BR><BR></SPAN><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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. </SPAN><SPAN
style="FONT-FAMILY: Arial"><BR><BR></SPAN><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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. </SPAN><SPAN
style="FONT-FAMILY: Arial"><BR><BR></SPAN><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.
</SPAN><SPAN style="FONT-FAMILY: Arial"></SPAN></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT face=Arial
size=2></FONT> </P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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. </SPAN><SPAN
style="FONT-FAMILY: Arial"><BR><BR></SPAN><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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
</SPAN><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">India</SPAN><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial"> is partly due to terminological
jugglery. </SPAN><SPAN style="FONT-FAMILY: Arial"><BR><BR></SPAN><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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. </SPAN><SPAN style="FONT-FAMILY: Arial"><BR><BR></SPAN><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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. <SPAN></SPAN></SPAN><SPAN
style="FONT-FAMILY: Arial"><BR><BR></SPAN><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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.
</SPAN><SPAN style="FONT-FAMILY: Arial"><BR><BR></SPAN><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">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. </SPAN><SPAN
style="FONT-FAMILY: Arial"><BR></SPAN></P></BODY></HTML>