Indian Express: Pulse of the Polio Programme.

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Pulse of the polio programmeThursday October 18 2007 09:12 IST Farah Baria http://newindpress.com/NewsItems.asp?ID=IE220071017225054 & Title=Second+Article & rLink=0 Not long ago, a gentleman turned up at our door with a large box. “Madam,” he said gravely, “according to our records your children have not availed of the government’s Pulse Polio Programme yesterday. Please ensure that this is done now.”Two days later, my daughter complained of a pain in the leg. “Could

be vaccine-associated paralytic polio,” warned my doctor. Eventually that turned out to be a false alarm. But it left me with a vague sense of dread.The disquiet returned when a fouryear- old Mumbai girl died of the virus recently. Alarmingly, the child’s records show she had received several doses of the vaccine this year. More alarmingly, the Pulse Polio Programme prescribes one dose every month, way in excess of the internationally prescribed standard of seven doses over a lifetime.Government officials believe this unprecedented blitzkrieg will check the resurgence of our Ninja bug — 676 fresh cases in 2006, another 223 this year — and plug “coverage lapses” in the implementation of its aggressive Rs 2,000 crore Polio Eradication Initiative (PEI). The strategy: propaganda and door-todoor implementation.At one level, this meticulous planning is impressive in a country where public health initiatives die early of official neglect.

Meticulous it may be but it is not exactly democratic. Even if I am a layperson, as a parent I have some questions to ask. Is this battery of “supplementary” vaccinations safe for our children? Does the government have the authority to prescribe it in the absence of any long-term studies? And what about our right to be informed about the possible side-effects?Incidentally, question three remains a moot point. Reason: medical literature maintains that the Oral Polio Vaccine (OPV) occasionally backfires because it contains a live virus which can mutate and become neuro-virulent, causing Vaccine Associated Paralytic Polio, also known as Acute Flaccid Paralysis (AFP). Despite the “negligible” risk, in 1997, there were 3,047 cases of AFP; in 2005, 26,000. Also, to be effective, the OPV must be continuously stored in temperatures below minus two degrees centigrade. In a land of power cuts, this is virtually impossible.Interestingly, many western

countries have reverted to an older, more stable, Injectable Polio Vaccine (IPV) which uses a dead virus that does not require cold storage, and carries no known risk. Recently, an article in Lancet warned that the OPV is giving rise to a new strain called Vaccine Derived Polio Virus, and recommended the use of IPV.This is controversial, especially since the OPV seems tailor-made for India. It is about six times cheaper than IPV, easier to administer, and has a “herd immunisation” effect, protecting both child and community.But the government needs to weigh the merits and demerits of both through democratic debate, not high-handed policy. Surely as parents we have the right to make an informed choice on matters that concern our children’s health. And we would like to know why we are using the OPV for our children after the West spurned it?And how we square these questions with the WHO declaring last year that India is “actively

exporting polio” to other countries. It even threatened to issue a travel advisory requiring Indians travelling overseas to provide proof of vaccination.Subsequently, the Union health minister called polio a “national shame” and vowed to atone. Again, while it is understandable to maintain that such advisories are avoidable, the government must act when warnings are based on demonstrable facts.Disease prevention must remain essentially, indeed wholly, a medical exercise, informed by the best medical evidence and choices. Which is to say, the Polio Eradication Initiative cannot and must not become an exercise in diplomacy.Let’s aim for some perspective. Polio is a dreadful bug which must be eradicated. But we should ask ourselves if we are going about it the right way — and for the right reasons. We may even perhaps need to pause, revaluate, and rethink Do You

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