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Administrative lapses and the fears of young parents
keep a small percentage of infants outside the vaccine’s reach,
and this may be enough to keep the virus alive.

01 January 2003

A resurgence
of polio cases in northern India
has sent alarm bells ringing across a country that is one of the last
holdouts of the virus in the world.

Total polio cases in India shot up by more than six times last year to
1,509, up from 268 in 2001, according to health ministry figures. Though
the last quarter of 2002 showed some signs of decline, the comeback of the
disease, defying publicity and awareness drives, is both embarrassing and
worrying government health officials. It also sets back the eradication
campaign that is already behind schedule. India has already extended its
polio eradication target – from the initial 2000 set by the World Health
Organization (WHO) to 2005.

The rise in polio cases, most of them in Uttar
Pradesh, was serious enough to cause Health Minister Shatrughan
Sinha to announce that the Central government would undertake the polio
eradication drive “on a war footing.” Uttar Pradesh accounts for 68
percent of the global polio burden. In India
alone, it accounted for nearly 80 percent of the cases (1,197) last year.
After Uttar Pradesh, its eastern neighbor Bihar had the next highest
number of cases.

“The rise is embarrassing. But we are also worried that polio might spread
from Uttar Pradesh to adjoining densely populated areas,” Shobhan Sarkar,
head of the polio eradication programme in the government’s health
ministry, said. The fears are not unfounded. Delhi shares its eastern
border with Uttar Pradesh and reported 24 polio cases last year — mostly
in children of slum dwellers who had migrated from Uttar Pradesh. Migrants
from Uttar Pradesh increased last year after a severe drought shriveled
crops there and destroyed the livelihood of thousands of small and
marginal farmers.

The only silver lining appears to be a report in January that indicates
that after the alarming rise up to September last year, the number of
cases in Uttar Pradesh declined from September to December. The report by
Jay Wenger, WHO manager of the independent polio surveillance project,
says the monthly figures in Uttar Pradesh fell from 334 in September to 18
in December 2002. But then, maximum cases are recorded in the monsoon
months, after which there is a natural decline in transmission of the
polio virus. Winter is a lean transmission season for the virus.

Still, a health ministry official said: “Things are looking up, with fewer
cases in the last three months. We are keeping our fingers crossed and
hoping the trend continues.” India has been implementing an intensified
Pulse Polio Immunization (PPI) campaign since 1995 – under which all
children below five years would be vaccinated. India conducts two
immunization campaigns every year, in December and January with a six-week
interval between the two. In 1999, India launched additional immunization
drives in its eight endemic states, including Uttar Pradesh.

One problem has been the inability to maintain the
“cold chain” properly –
ensure that the vaccine is under refrigerated conditions until it reaches
the child.

The alarm triggered by the spiraling polio cases is such that even
academic institutions have joined the anti-polio drive in Uttar Pradesh
this year. In the Jan. 5 immunization drive, the Aligarh Muslim University
(AMU) vice chancellor led health and social workers in Aligarh and
Moradabad districts in a public awareness drive to dispel misconceptions
about vaccination. Hollywood star Amitabh Bachchan too was invited in, and
polio campaign visuals are aired on prime time on several television
channels. Rotary International has tried out novel ideas like giving out
rattles, whistles and sunshades to children coming for the polio drops.

Fears of poor families that the polio
vaccine may do some harm, were not countered properly. “We are scared to
give the anti-polio drops. We go only if we are forced to,” says Sharbati,
a domestic worker whose family migrated from Uttar Pradesh to Delhi five
years ago. She says many in her native village fear the anti-polio drops
may make children ill. In the Jan. 5 immunization round, Rotary involved
1,500 volunteers from the state specifically to dispel myths about the
vaccination process.

Press reports quoted Uttar Pradesh health minister Phagu Chauhan as
conceding that administrative slackness was partly responsible for the
rise in polio cases in the state. Another problem has been inability to
maintain the “cold chain” properly – ensure that the vaccine is under
refrigerated conditions until it reaches the site – despite additional
machinery for storage and transportation of the vaccine.

There are problems of vaccine shortage too. A health ministry report says
that in India, four to five percent of children – mostly in remote rural
areas – continue to be missed in the government anti-polio campaign.
“Even this four to five percent would still constitute a number of
unvaccinated children large enough to keep the virus alive,” a health
official pointed out.

T V Padma is a correspondent with Inter
Press Service, a global news resource faciliating south-south and
south-north dialogue on important economic, social, environmental, and
other issues. IPS is distributed by Global Information Network

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