Stamping Out Polio

AFTER THE POLIO outbreak of 2002, the sharp drop in the number of cases reported in 2003 all over India is a commendable public health achievement. India is among the last seven remaining nations in the world where polio is still endemic. The majority of polio cases reported worldwide are from India. A reduction from 1,600 reported cases of polio in 2002 to just 190 till November 2003 shows the Government responded swiftly to contain what could have turned into a large-scale crisis through an intensified national immunisation programme. But there can be no letting down of the guard yet. While Uttar Pradesh and Bihar account for most reported cases, the emergence of Karnataka and Andhra Pradesh as the two new “hot zones” for the disease and the detection of two cases over the last month in Tamil Nadu, also a polio-free State since 2000, are worrying developments. As long as the wild polio virus exists anywhere in India, the risk of it spreading to areas considered free of the disease will remain. Since polio is completely eradicable, even one case of polio is a case too many.

The hardy polio virus lives in the human intestine, is ejected into the environment through excreta, and spreads by contact with fecal matter. The disease strikes mainly children, cripples the limbs, and is sometimes fatal. Children living in crowded and insanitary conditions without access to clean drinking water are particularly vulnerable to it. This is why a bombardment of the virus through a synchronised mass immunisation of children in the zero to five age group — such as the one carried out nationally on January 4 — with the oral polio vaccine is considered the best way to ensure zero incidence. India has done this since 1996 but a cutback in planned immunisation in 2002 was the main factor behind that year’s polio resurgence in Uttar Pradesh. It pushed back the goal of a polio-free India and a polio-free world from 2005 to 2007. This year the Government is reported to be considering holding five nationwide immunisation days as against the usual two annually. Such a decision, despite the costs involved in conducting such an exercise, will be timely. The benefits of total eradication, which will eventually include savings on the massive national expenditure in fighting the disease, far outweigh the expenditure. In order to be effective, national immunisation days must cover as many as possible of India’s 165 million children under the age of five years. Superstition and fallacies about the effects of the oral polio vaccine still stop many parents from getting their children vaccinated. The involvement of voluntary organisations such as Rotary in a door-to-door campaign to build awareness has helped immensely but educating people about the disease and the vaccine remains a key challenge for the Government.

Simultaneously, the Government must ensure that the focus on planned immunisation does not distract attention from routine immunisation through which new-born children get four oral polio vaccine doses from zero to three months. With 15.5 million children born every year in India, routine vaccination is the only way to prevent gaps in immunity from developing. As Tamil Nadu has shown, much also depends on surveillance. The early detection of the two cases reported in the State enabled health officials immediately to immunise all children in those two areas. The Union Health Minister, Sushma Swaraj, wants zero incidence in India in 2004 so that the country can be declared polio-free after the waiting period of three years. The goal is within reach. It must not be allowed to slip away this time.

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