E-DRUG: India: Pulse polio under scrutiny
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From
Dr GOPAL DABADE
57, Tejaswinagar,
DHARWAD 580 002,
INDIA
drdabade@gmail.com
Tel 0836 2461722
http://www.deccanherald.com/deccanherald/sep282006/editpage1620422006927.asp
DECCAN HERALD 28th September 2006
IN PERSPECTIVE: Pulse polio needs a closer scrutiny
By Dr Gopal Dabade
The gains of the pulse polio programme have reached a point of saturation.
Polio is a crippling disease and efforts are on to eradicate it not only in India but globally. The much advertised and popular "Pulse Polio" programme is a decade old and was designed to eradicate polio by 2000, postponed to 2005. Just recently the Union health minister announced in Parliament that the goal of eradicating polio is no where to be visualised, even at the end of 2006.
This was the largest health programme ever to be carried out in the world and had the support of World Health Organisation, UNICEF, Centre for Disease Control of US and Rotary International. As the goal of eradication has failed, it is time to take stock of the situation and start analysing the reasons for failures. Unfortunately, this is not happening.
But what is interesting to note is that the Indian Medical Association (IMA), a rather conservative nevertheless the largest professional body of allopathic doctors in India, has come out with an independent report on the drawbacks and reasons for failure of pulse polio. One of the fears expressed by this August medical body is with regard to the number of cases of paralyses that have been happening in spite of children having been vaccinated several times. Thus by increasing the number of polio vaccines for every child "does not seem to be stopping the transmission of polio and needs to be reviewed", points out the IMA report.
One of the programme's biggest gains has been the number of infected cases has drastically decreased. Again this has been the largest mobilisation of people for public health reasons. But the gains of the pulse polio have reached a saturation and further efforts to increase the number of doses is just like flogging a dead horse as the gains far outweigh the losses.
More than Rs 5,000 crore has already been spent. But, the pressure for pulse polio is so much that high "priority health problems have receded to the background", notes the IMA report. For example if child has snake bite and needs immediate attention, there are no personal to attend, as the entire medical team is busy with pulse polio programme.
A major set back to the pulse polio programme has been from the increased cases of Acute Flaccid Paralysis (AFP). In fact India has recorded highest number of such paralyses. The global average incidence of AFP is one in 1,00,000, but in India the incidence has risen to 12-13 per 1,00,000 with the implementation of the pulse polio programme. Incidence of AFP increased from 3,047 cases in 1997, when polio eradication had just begun, to 27,000 cases in 2005. It is highly suspected that there exists a connection between vaccinations and rise in AFP. There can also be no denying that AFP has hit children who have been vaccinated.
But what is interesting to note is that the Indian Medical Association (IMA), a rather conservative nevertheless the largest professional body of allopathic doctors in India, has come out with an independent report on the drawbacks and reasons for failure of pulse polio. One of the fears expressed by this August medical body is with regard to the number of cases of paralyses that have been happening in spite of children having been vaccinated several times. Thus by increasing the number of polio vaccines for every child "does not seem to be stopping the transmission of polio and needs to be reviewed", points out the IMA report.
Injectable vaccine
While some experts continue to advocate that the injectable form of polio vaccine should be administered to overcome the AFP, the cost is prohibitive. When imported the injectable vaccine is 25 times more costly than oral vaccine. The injectable form has an advantage over oral in that it is less sensitive to temperature fluctuations and is less likely to be inactivated by breaks in cold chain. However, injectable form affords little herd immunity and so literally every child will need to be injected with the vaccine before we can eliminate polio. But in India it has not been possible to achieve 100 per cent immunisation with an easy-to-administer oral vaccine the coverage will be much worse if we approach these children with a syringe and needle.
So until India starts manufacturing its own injectable form of vaccine, incorporating oral polio vaccine should continue, along with other vaccines, like Diphtheria, Pertussis or whooping cough and Tetanus (popular as DTP) as done earlier.
And in its conclusion remarks IMA rightly recommends that "the year 2006 should be the year of the phased withdrawal and ultimate closure of the National Pulse Polio Programme". One hopes that Government stops its ostrich like attitude and take a fresh look at the problem.
(The writer is the president of Drug Action Forum Karnataka)
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Dr Gopal Dabade,
57, Tejaswinagar,
Dharwad 580 002
Tel 0836-2461722\n
Cell (0)9448862270
www.jagruti.org