HEALTH: Int’l Offensive against Persistent Polio in India

By Gustavo Capdevila Reprint | | Print |

Gustavo Capdevila

GENEVA, Feb 5 2003 (IPS) - The government of India and the international health community are joining forces for a massive vaccination campaign aimed at wiping out poliomyelitis in one of its last strongholds: the minority Muslim population of the northern Indian state of Uttah Pradesh.

During the flash effort, a six-day campaign beginning Feb 9, more than a million volunteers and health workers will go door-to- door and set up at community centres to inoculate some 165 million children throughout India, which alongside Nigeria, saw a rise in polio cases last year.

An international initiative to eradicate polio worldwide began in 1988, a year when 350,000 new polio cases in 125 countries were recorded. The goal of the health organisations, inter-governmental and private agencies, was to eliminate all new cases by 2002.

By last year, the spread of the disease was limited to seven countries where polio is endemic: India, Nigeria, Pakistan, Afghanistan, Egypt, Niger, Somalia, Angola, Ethiopia and Sudan (in descending order of number of new cases). A total 1,866 new cases were reported in 2002.

The figures represent significant progress, says Carl Tintsman, a polio expert with UNICEF (United Nations Children’s Fund).

But the numbers do not hide the fact that there were more new cases in 2002 than in 2001, when 983 people were infected with the disease.

Of the 1,866 new cases in 2002, 1,566 were people in India, which concentrates 85 percent of all polio cases in the world. And Uttah Pradesh state alone held 66 percent of all new infections.

Nigeria also saw a considerable rise in new cases, with 187 new infections reported last year, compared to 56 in 2001. In that region of Africa, said Tintsman, the disease is centred in northern Nigeria and in the south of neighbouring Niger.

But health officials are most concerned about Uttah Pradesh, which had new cases last year in each of the 70 districts that make up this state of 173 million inhabitants.

Uttah Pradesh had been hard hit by the epidemic the year before as well, but the focal points of infection did not reach all 70 districts, the UNICEF expert said.

In that state, "the infrastructure, the health systems, the social network, the social contract are all under stress," says Daniel Tarantola, director of vaccines and biologicals for the World Health Organisation (WHO).

"All these factors create specific vulnerability to a problem like polio, as Uttah Pradesh was very vulnerable 25 years ago to harbouring the last smallpox cases during the campaign" that eradicated that disease around the world, said Tarantola.

In explaining the continued presence of the disease in the northern Indian state, the WHO official noted the 10 supplementary immunisation campaigns, "mass campaigns that are carried out from time to time between 1999 and 2000… In the following two years, 2001 and 2002, there were only five."

"Therefore, the vulnerability of populations to poliomyelitis increased," Tarantola said.

Furthermore, he said, "10 to 15 percent of children – in spite of these campaigns – remain unprotected" from polio in Uttah Pradesh.

"That’s a failure of the system, it’s a failure of services, it signals the imperfection of the outreach systems and the quality of vaccinations that are extended to the populations."

Tarantola pointed out that all people are equal when it comes to polio, but in Uttah Pradesh the disease has a much higher incidence among the Muslim minority than among the Hindu majority.

While Muslims comprise just 17 percent of the state’s population, they represent 59 percent of polio cases.

The WHO official rejects the "easy" explanation that "Muslims don’t want to be vaccinated."

On the contrary, says Tarantola, "studies show that they do (want immunisation), but they are not necessarily consistently offered access to such services."

There are economic and cultural aspects that might hinder access, such as the community’s relative marginalization, and the fact that a male, non-Muslim health professional might not be welcomed into a Muslim home to vaccinate the children.

"But over the last year there have been tremendous efforts to mobilise communities, particularly to strengthen the capacities of Muslim communities to respond to their own needs in ways that are culturally well suited," said Tarantola.

According to UNICEF expert Tintsman, of the other countries where polio is still endemic, none face a situation as difficult as Uttah Pradesh.

In Egypt, said Tintsman, the polio eradication campaign "is going very well," with encouraging data in the last six to eight months. "We are confident that with a bit of a luck we will eradicate polio in the course of 2003."

Pakistan and Afghanistan report a similar panorama, leading him to say he is "95 percent confident that in 2003 we will finish the job in the two countries."

"In Somalia the problem has been access to Mogadishu," said Tintsman. The anarchy in the streets and 15,000 militia are "interfering with polio eradication and everything else."

But the UNICEF official said vaccination teams had successfully visited the city twice in the last few months, "so we are pretty confident we can succeed there as well."