The Hindu : Magazine / Issues : Lessons from the polio campaign (2022)

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The Hindu : Magazine / Issues : Lessons from the polio campaign (1)The Hindu : Magazine / Issues : Lessons from the polio campaign (2)

ISSUES

Lessons from thepolio campaign

DR. JACOB M. PULIYEL

TheNational Polio Eradication Programme is not working according to plan.What went wrong and what can be done?

(Video) [CONFERENCE-CRASH] The polio eradication campaign put to test - Claire Magone


The Hindu : Magazine / Issues : Lessons from the polio campaign (3)
Controversial choice: The oral polio vaccine. Photo: H. Vibhu

IT is now being acknowledged that the NationalPolio Eradication Programme did not work according to plan. The failureof this magic bullet approach (repeated doses of oral polio vaccine) tosolve what is essentially a water and sanitation problem waspredictable. Yet, that did not mitigate the sadness its failure causedamong many of us who have worked tirelessly to make it succeed. TheIndian Medical Association (IMA) Sub-Committee on Immunisation debatedon whether to go public with its findings about the failure of thisinitiative. In August 2006, it concluded that it was its duty to do so.

The need to publicise dissent

Dr. Pushpa Bhargava, who is presently theVice-Chairperson of the National Knowledge Commission, had written anarticle, "Fighting the polio virus", published on December 12, 1999 in The Hindu.In 1988, he had attended a meeting where it was decided to useinjectable polio vaccine (IPV) in India because of the poor efficacy ofthe alternate vaccine, oral polio vaccine (OPV). A factory tomanufacture IPV was set up in Gurgaon. Four years later, in 1992, onadvice from the WHO, these plans were shelved and it was decided to useOPV. Dr. Bhargava wrote letters to the then Prime Minister (Mr.Narasimha Rao), the Health Minister and to the Health Secretary atdifferent stages. Having been party to the earlier meeting thatsuggested the OPV was unsuitable for India, he asked for the evidenceon which the government decided to switch in favour of OPV. He alsodemanded to know how the Rs. 50 crores spent by Indian VaccineCorporation Ltd. to produce IPV would be justified. His letters werenot answered. In the end he wrote this article to the press. Heconcluded the article saying, "No one will be more delighted andsatisfied than me if it can be shown indisputably that OPV has workedin this country. Unfortunately all the evidence available today goesagainst that view. It is therefore not unlikely that polio will meetthe same fate as BCG with valuable time and money lost." Events haveproved the prophetic nature of that statement.

Pubic accountability

Thanks to this publication, we now have someform of a paper trail. There is a need for public accountability andthis applies to faceless mandarins in the WHO as also to officials ofthe Government of India who have been named in the article. Decisionsbased on judgment can go wrong but unless this is acknowledged, we arebound to repeat these mistakes over and over again.

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The IMA Sub-Committee was also placed in asomewhat similar predicament as Dr. Bhargava. It was alarmed by thenumber of vaccine induced polio cases (1,600 last year) that repeateddoses of OPV were producing. More alarming were the 27,000 cases ofpolio-like paralysis in children in whom the polio virus was notcultured in the stools. The government was not willing to even enquirehow many were left with residual paralysis in this group. There wasalso clear evidence that many who were already vaccinated, were gettingpolio paralysis, suggesting the vaccine was not efficacious. In theface of a bureaucracy that would not even acknowledge the problem, theIMA Sub-Committee was left with the unpleasant task of exposing thisfarce.

It is to the credit of the maturity of thisGovernment that they have not set out to castigate the messenger anddiscredit the IMA. Unfortunately the knee-jerk reaction of thegovernment has been to start another programme which will aggravaterather than remedy this situation. This essay will conclude withsuggesting a mechanism to avoid these innumerable cycles of folly.

Before we go into the bigger issues, readersneed to understand the disease which started all this fuss. Polio is avirus that can cause paralysis. The virus multiplies in the gut and isspread by contaminated water. Improvements in water and sanitation cancontrol the disease. Routine immunisation would help hasten theeradication of polio. The polio control programme was working well withroutine immunisation before the stepped up polio eradication programmewas started. The incidence of polio fell from 24,000 in 1988 to 4,800in 1994, well before pulse-polio started.

However in 1998, the WHO and otherinternational bodies started this grand plan to eliminate the diseaseworldwide through repeated use of vaccines. Initial funding, to thetune of Rs. 400 crores a year, came from international agencies(including Rotary International). Inevitably, a couple of years afterthe programme started, these agencies claimed donor fatigue andwithdrew funding. The Government of India spent Rs. 1,000 crores onthis programme last year. Expenditure on all other immunisation (fivediseases) was Rs. 300 crores.

A pattern with external funding — countries are lured into a debt trap.

(Video) Global Polio Eradication Initiative History Project - Jay Wenger

With international funding initiatives thegovernment is made to look foolish, refusing to accept a donation madefor the benefit of its people. Once the programme is introduced on thebasis of the external funding, overseas support is withdrawn. Poorcountries fall for this ploy and vaccines are introduced without themandatory cost-effectiveness study.

We have no way of knowing what influence theoffer of overseas funding had on this decision, but the fact is that,in the end, the GOI was landed with unprecedented bills for a programmethat was destined to fail .

No lessons learnt

But unfortunately we haven't learnt from ourmistakes. In the aftermath of the failure of OPV polio eradicationprogramme, the government has accepted an overseas offer of "free"injectable polio vaccine (IPV) to be given in the high endemic areas.

The imported injectable vaccine is 25 timesmore costly than the oral vaccine. One lot of near-expiry injectablevaccines is being provided free, but we cannot base a nationalimmunisation programme on this. Furthermore, the costs of delivery ofthis injectable vaccine from door to door will be staggering. If thismoney were spent on improving water and sanitation in these areas, wewill have a permanent solution to the problem. Injectable vaccine mustbe given to every child, and if we have not succeeded in getting OPV to100 per cent of the population, the uptake will be much less with theinjectable vaccine. So failure is guaranteed once again!

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The IMA Sub-Committee had in fact suggestedthat that the government cool down this entire campaign and get back tostrengthening routine immunisation along with concerted efforts toimprove the water and sanitation in affected areas. We need a permanentmechanism to make such intricate decisions related to introduction ofvaccines. A solution could be the setting up of an independent bodysimilar to the "National Institute of Clinical Excellence" (NICE) inthe U.K., to decide these matters. A professional body of healthprofessionals, technical experts, health economists and publicrepresentatives should be formed. The government must publicise thevaccine under consideration. All stake holders, such as patient groups,health professionals, academic institutions, industry producing thevaccine, trade unions and international organisations like the WHO andGAVI must register their interest.

The body should assess the clinical evidenceand the economic data of benefits. They should put up draft guidelines,to be assessed by the registered stakeholders, and a citizen's council(which provide the social values that underpin the work of group).Based on their input, the panel should then revise the guidelines.Finally an independent panel should review the guidelines, to decide ifall stakeholder comments have been taken into account. The finalguidelines should then be issued so that the government has clear andunbiased advice on which to base decisions.

The writer is Vice Chairman, the IMA Sub-Committee on Immunisation. The opinions expressed here are his own. Email: puliyel@vsnl.com

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(Video) Archives at NCBS Public Lecture Series:Wiping polio off spaceship earth

FAQs

When was the last polio case in India? ›

The last case of polio in India was reported in Howrah, West Bengal on 13 January 2011. Since then, India has been free of the disease, officially receiving polio-free certification from the World Health Organization on 27 March 2014.

What are the objectives of pulse polio campaign? ›

The Pulse Polio Initiative was started with an objective of achieving hundred per cent coverage under Oral Polio Vaccine. It aimed to immunize children through improved social mobilization, plan mop-up operations in areas where poliovirus has almost disappeared and maintain high level of morale among the public.

What is the conclusion of polio? ›

Conclusion. It is apparent that the patient developing paralytic poliomyelitis is exposed to many hazards, of which wasting and paralysis are by no means the only ones. With active immunisation on an unprecedented scale, it is not unlikely that this scourge of mankind may become a relic of the past.

What was the impact of polio on society? ›

What is the global impact of polio? Since 1988, more than 18 million people can walk today who would otherwise have been paralyzed, and 1.5 million childhood deaths have been averted thanks to the polio vaccine.

Can polio come back? ›

But polio is making a comeback. There have been recent outbreaks around the world. Symptoms of polio can range from a mild, flu-like illness to serious muscle paralysis. Many people who survive polio are later at risk for PPS.

Which country is free from polio? ›

Until polio is completely eradicated, all countries remain at risk of imported WPV, as has happened in a number of countries.
...
Country – Year.
AfghanistanChina
DominicaIsrael
19801988
Libyan Arab JamahiriyaParaguay
19911985
53 more columns

What is the main motto of pulse polio programme? ›

'Polio free world' is our motto. All India Institute Of Medical Sciences, New Delhi. 12. All Stakeholders who agreed to share their perceptions and views about Pulse Polio Immunization Program.

What is the difference between polio and pulse polio? ›

Pulse Polio is an immunisation campaign established by the government of India to eliminate poliomyelitis (polio) in India by vaccinating all children under the age of five years against the polio virus. The project fights polio through a large-scale, pulse vaccination programme and monitoring for poliomyelitis cases.

How many times polio drops should be given in India? ›

For best protection, children should get four doses of polio vaccine.

What are the 3 types of polio? ›

There are three wild types of poliovirus (WPV) – type 1, type 2, and type 3. People need to be protected against all three types of the virus in order to prevent polio disease and the polio vaccination is the best protection.

Can you get polio after being vaccinated? ›

People with certain immune problems can catch the disease from a child who has recently been vaccinated with oral polio vaccine.

What could be done to make the polio free society? ›

One potential way for polio to return is through migrant populations. For the past few years, the polio vaccination campaign has targeted train stations where people travel from polio-infected areas.

Do people still get polio? ›

Do people still get polio in the United States? No, thanks to a successful vaccination program, the United States has been polio-free for more than 30 years, but the disease still occurs in other parts of the world.

Can a baby be born with polio? ›

In spite of this the incidence of polio virus infections causing disease in the fetus or in the new- born child is small [l]. A number of cases reported, however, have been strongly sug- gestive of an intra-uterine infection with polio virus.

Can polio affect you later in life? ›

Post-polio syndrome is rarely life-threatening, but severe muscle weakness can lead to complications: Falls. Weakness in your leg muscles makes it easier for you to lose your balance and fall. You then might break a bone, such as a hip, leading to other complications.

What animal did polio come from? ›

The discovery by Karl Landsteiner and Erwin Popper in 1908 that polio was caused by a virus, a discovery made by inoculating macaque monkeys with an extract of nervous tissue from polio victims that was shown to be free of other infectious agents.

Why did polio not affect adults? ›

In the U.S., adults aren't routinely vaccinated against polio because most are already immune, and the chances of contracting polio are minimal.

What polio does to legs? ›

Numbness, a feeling of pins and needles or tingling in the legs or arms. Paralysis in the legs, arms or torso. Trouble breathing because of muscle paralysis in the lungs. Death when the muscles you use to breathe become paralyzed.

What country has the most polio? ›

Pakistan is considered as the exporter of Wild Polio Virus (WPV) with highest number of polio outbreaks among endemic countries.

Is polio still around in 2022? ›

No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. The number of cases in 2022 remains 30. There were 415 cases reported in 2021.

Who is most likely to get polio? ›

Polio (poliomyelitis) mainly affects children under 5 years of age. One in 200 infections leads to irreversible paralysis. Among those paralysed, 5–10% die when their breathing muscles become immobilized.

Why it is called pulse polio? ›

The Government of India launched the pulse polio immunization (PPI) programme on a country wide basis in 1995. The term “pulse” describes the simultaneous, mass administration of oral polio vaccine (OPV) on a single day to all children aged below 5 years.

Who invented polio vaccine in India? ›

In 1961, Dr Albert Sabin developed a "live" oral polio vaccine (OPV) which rapidly became the vaccine of choice for most national immunization programmes globally. Following the success of smallpox eradication in 1977, Rotary International launched its ambitious dream to eradicate polio in 1985.

WHO declared India polio free? ›

Within two decades, India received 'Polio-free certification' from World Health Organization on the 27 March 2014, with the last polio case being reported in Howrah in West Bengal on 13 January 2011.

Which part of the body does polio affect? ›

Polio is a viral disease which may affect the spinal cord causing muscle weakness and paralysis. The polio virus enters the body through the mouth, usually from hands contaminated with the stool of an infected person. Polio is more common in infants and young children and occurs under conditions of poor hygiene.

Was the polio vaccine FDA approved? ›

The vaccine was not approved for use in the United States, but was used successfully elsewhere. The success of an inactivated (killed) polio vaccine, developed by Jonas Salk, was announced in 1955.

What was the survival rate of polio? ›

The mortality rate for acute paralytic polio ranges from 5–15%. The paralysis can progress for up to one week. Permanent weakness is observed in two-thirds of patients with paralytic poliomyelitis.

What happens if you miss polio drops? ›

There are no side effects to OPV, and it is not harmful to take it multiple times. What if I miss the polio drops or the routine immunization cycle? Key Response: You must resume immunization as soon as possible. Polio immunization is a cost free service available at the Government health facilities.

Who invented polio vaccine? ›

The discovery that the various antigenic strains of PVs could be grouped into three distinct viral types and the propagation of the PV in vitro led to the development of the vaccines against poliomyelitis: the formalin-inactivated vaccine (IPV) by Jonas Salk (1953) and the live-attenuated vaccines (OPV) by Albert Sabin ...

What if polio drops given twice? ›

A:Pulse Polio drops should be given as and when the cyclical polio campaign comes around. If a second dose of pulse polio vaccine was repeated accidentally, the child should come to no harm.

What is polio called now? ›

Note that “poliomyelitis” (or “polio” for short) is defined as the paralytic disease. So only people with the paralytic infection are considered to have the disease.

Is polio a DNA virus? ›

Poliovirus is composed of an RNA genome and a protein capsid. The genome is a single-stranded positive-sense RNA (+ssRNA) genome that is about 7500 nucleotides long.
...
Poliovirus
Family:Picornaviridae
Genus:Enterovirus
Species:Enterovirus C
Virus:Poliovirus
13 more rows

Is polio a virus or bacteria? ›

Polio is a serious and life-threatening disease. A virus that can affect the nervous system and cause muscle weakness, some polio cases can result in paralysis or death. There is no cure for polio, but it is preventable through safe and effective vaccination.

What vaccination left a round scar? ›

Before the smallpox virus was destroyed in the early 1980s, many people received the smallpox vaccine. As a result, if you're in your 40s or older, you likely have a permanent scar from an older version of the smallpox vaccine on your upper left arm.

When was the last time someone had polio? ›

Since 1979, no cases of polio caused by wild poliovirus have originated in the U.S. However, the wild virus has been brought into the country by travelers with polio. The last time this happened for wild poliovirus was in 1993.

Can polio spread through air? ›

Sometimes poliovirus is spread through saliva from an infected person or droplets expelled when an infected person sneezes or coughs. People become infected when they inhale airborne droplets or touch something contaminated with the infected saliva or droplets. The infection usually begins in the intestine.

Which disease is completely eradicated from India by vaccination? ›

Smallpox is an acute contagious disease caused by the variola virus, a member of the Orthopoxvirus family. It is completely eradicated from India in 1977 when A WHO International Commission comprising experts in epidemiology and infectious diseases from 16 countries carefully reviewed the data.

Did the polio vaccine eradicate polio? ›

Elimination in the U.S.

Polio has been eliminated from the United States thanks to widespread polio vaccination in this country. This means that there is no year-round transmission of poliovirus in the United States. Since 1979, no cases of polio have originated in the United States.

Which disease is totally eradicated from India? ›

India has achieved breakthrough public health milestones in the past by eradication of smallpox and guinea worm disease. There has been a concerted effort to target other diseases in the country which are amenable to eradication/elimination.

What famous person had polio? ›

Franklin D. Roosevelt was the 32nd President of the United States. Not only did he serve an unprecedented four terms in office, but he was also the first president with a significant physical disability. FDR was diagnosed with infantile paralysis, better known as polio, in 1921, at the age of 39.

Why did polio vaccine leave a scar? ›

Why did scarring occur? Scars like the smallpox vaccine scar form due to the body's natural healing process. When the skin is injured (like it is with the smallpox vaccine), the body rapidly responds to repair the tissue.

How was polio treated before vaccine? ›

Before the polio vaccine was developed, doctors tried to treat patients with ultraviolet light, which was known to inactivate the virus in the lab.

Does polio still exist in India? ›

Within two decades, India received 'Polio-free certification' from World Health Organization on the 27 March 2014, with the last polio case being reported in Howrah in West Bengal on 13 January 2011.

When did polio virus came in India? ›

In 1995, following the Global Polio Eradication Initiative of the World Health Organization (1988), India launched Pulse Polio immunization program with Universal Immunization Program which aimed at 100% coverage. The last reported cases of wild polio in India were in West Bengal and Gujarat on 13 January 2011.

Is polio active in India? ›

South-East Asia Region of WHO including India has been certified polio free by “The Regional Certification Commission (RCC)” on 27th March 2014. 2. India reported its last polio case from district Howrah, West Bengal on 13th January, 2011.

How many cases of polio are there in India? ›

India, along with 10 other countries in the World Health Organization (WHO) South East Asia Region, was declared polio free in 2014. No new case of polio has been reported in India since January 2011. There is no evidence of VDPVs circulating in the community.

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