OPV for fattening babu's purses, not for eradicating polio.

[Guest guest]

Times Of India Editorial. Drop that paralysesAnant Phadkehttp://timesofindia.indiatimes.com/articleshow/2122225.cms --- 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. --- RSS Feeds| SMS NEWS to 8888 for latest updates Union health secretary Prasanna Hota's glorification of the polio eradication programme (TOI, October 6) takes no cognisance of some basic facts. Polio is not such a priority issue as to spend hundreds of crores every year. Yet the Union 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. Hota is silent on the reversion pheno-menon. Tamed, attenuated but

live viruses in the OPV tend to revert to virulent viruses, which cause Vaccine Associated Paralytic Polio (VAPP). Leading Indian expert on polio Dr Jacob John tells us: "VAPP is now becoming more frequent than polio attributable to wild polio virus infection". Thanks to the repeated rounds of pulse polio, VAPP cases went up. During 1998-2001, out of 5,495 polio cases, 1,770 were VAPP cases. In 2005, out of 26,070 paediatric para-lysis cases, 66 had natural polio, but 1,645 showed vaccine virus in their stool culture. 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.

Up to 1996 all reported cases of acute limb paralysis were labelled as polio. From 1997 onwards, such cases are labelled as polio only after thorough investigations. As a result, in 1999, only 29 per cent of such cases were labelled as polio, whereas earlier all such cases were labelled as polio. 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 consi-dered 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. The writer is with Medico Friend Circle. "Our ideal is not the spirituality that withdraws from life but the conquest of life by the power of the spirit." - Aurobindo.

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