HEALTH-INDIA: Big Hurdles to Anti-Polio Drive, Say Authorities

By Ranjit Devraj Reprint | | Print |

Ranjit Devraj

NEW DELHI, Sep 25 2000 (IPS) - Five years after India began its ambitious polio eradication drive, which is vital for the global elimination of the crippling disease, its managers admit that there are serious hurdles.

Bad road links to remote villages in this mainly rural nation, social barriers and religious taboos are hobbling the country’s biggest public health campaign, they say.

The World Health Organisation (WHO) had targeted a polio-free world by the end of this year. This depended on the success of the pulse polio drive in India, which accounted for more than 70 percent of the 5,000 polio cases reported worldwide last year.

India aimed to complete the job in just three years. But there are still large uncovered pockets in the thickly populated northern states.

More than a thousand polio cases were confirmed, by laboratory tests, to have been caused by the wild polio virus in the most populous state of Uttar Pradesh.

“Increasing coverage in these areas is a critical challenge if India is to interrupt transmission of the virus,” says Stephen Atwood, chief of the health section at the U.N. Children’s Fund (UNICEF) office in India.

Shobhan Sarkar of India’s Ministry of Health and Family Welfare, warns of ‘volunteer fatigue’ if the drive is prolonged. “If we cannot achieve eradication soon, we could lose the network of volunteers, expertise and commitment, and never be able to revive it again,” he says.

According to WHO’s Gary Hlady, the countries of the world could save more than 150 billion U.S. dollars annually in public health costs if the wild polio virus was declared completely eliminated.

The United States alone spends more than 100 million dollars annually on polio vaccines, despite having eradicated polio from the country years ago. It is estimated that each of the two annual immunisation days in India, costs 100 million dollars

“In the remote parts of India, there are physical barriers such as rivers with no bridges, or villages, which are miles away from any road that make it difficult for volunteers to reach children on immunisation day,” says UNICEF programme manager K. Suresh.

The world children’s body is one of the managers of the campaign, besides the WHO and Rotary International.

India’s complex caste system and religious values are also interfering with the smooth delivery of the oral polio vaccine. This is specially true in the two most populous and backward states of Uttar Pradesh and Bihar in the north, which are home to more than 250 million people.

“An upper caste worker may refuse to go into a village of low caste people or a low caste volunteer could be denied entry into an upper caste village. Similarly, (health) workers have no access to women in ‘purdah’ (Islamic veil for women) and their children,” says Suresh.

India’s battle against polio is publicly backed by the world’s most famous people. U.S. President Bill Clinton personally administered polio drops to children during his visit to India in March.

The world’s richest man, Bill Gates, too fed polio drops to children in a squalid, low-income squatter colony in the Indian capital earlier this month. The Bill and Melinda Gates Foundation, along with R.E. Turners’ United Foundation, has given 50 million dollars to the Indian programme.

However, in several Indian villages, polio campaign workers are viewed with suspicion. Here any government health scheme is associated with attempts at forcible birth control. “There is little confidence in government programmes in many villages,” says Suresh.

Another problem is India’s huge floating population of migrant workers, he adds. Every day, tens of thousands of people from the villages move into the big cities in search of a livelihood and it is difficult for anti-polio campaigners to keep track of them.

“Each additional year will cost upto 30 million more dollars until eradication is finally effected,” says O.P. Vaish, who leads Rotary International’s ‘Polioplus Programme’, which provides, funds, volunteers and vehicles for the campaign.

Public health researcher Lester Coutinho accuses public health authorities of inflating polio eradication figures. Programme managers are under pressure from their bosses to report success and fudge the figures, he says.

“No health worker dares to report a polio case,” says Coutinho.

Critics also doubt the efficacy of the polio vaccine used by the programme. There are several instances of those vaccinated, getting afflicted with polio.

This could be because of spoilage of the vaccine due to breakages in the cold’-chain’, say some experts. It was only recently that WHO thought of using temperature-sensitive colour codes on vaccine vials.

According to health ministry officials, the next anti-polio drive will use some 630 million doses. These are kept under refrigeration and will be distributed through a ‘cold-chain’ using special containers and some 2.5 million workers and volunteers.

However, other experts say that the polio vaccine being used is not suitable for Indian conditions where children suffer from severe diarrhoea.

Children with diarrhoea do not retain the oral vaccine long enough in their bodies to acquire immunity, says Pushpa Bhargava, former head of the Centre for Cellular and Molecular Biology in the the southern city of Hyderabad.

“Continued virus transmission is maintained through poorly immunised children,” says Narendra Arora of the country’s top medical research centre, the New Delhi-based All India Institute of Medical Sciences (AIIMS). Arora led an AIIMS evaluation of the polio drive last year.

The high-profile, polio drives, with their huge funds, are also accused of diverting attention from other pressing public health problems.

“It is as if other diseases like diphtheria, measles and hepatitis which need vaccination support have simply vanished,” says Coutinho.

The anti-polio campaign is funded by the governments of the United States, Denmark and Britain. It is also backed by the U.S.-based Centre for Disease Control and Prevention, the European Commission and Japan’s International Cooperation Agency.