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A reluctant battle against polio

Print edition : May 09, 2003 T+T-

Uttar Pradesh accounts for 64 per cent of the polio cases reported worldwide, but its Chief Minister, Mayawati, is honoured with the Rotary International award for her "outstanding personal contribution" towards eradicating the disease from the State.

THE World Health Organisation (WHO) has described Uttar Pradesh as the "epicentre of polio epidemic" in the world. As per WHO estimates, the State accounts for 64 per cent of all polio cases reported worldwide. In comparison with 2001, the State registered a sixfold increase in the incidence of polio in 2002. According to the WHO, the sharp increase was because of a decrease in the number of polio eradication campaigns that year. Besides, the campaigns that were conducted failed to reach nearly 15 per cent of the targeted population.

Launching the third phase of the national pulse polio campaign on April 7, WHO Director-General Dr. Gro Harlem Brundtland said: "Eighty-three per cent of all new polio cases are now found in India. Uttar Pradesh, in particular, should be the number one priority in order to stop the transmission of the polio virus around the world."

According to WHO estimates, India's record in polio eradication is worse than that of countries such as Bangladesh. (Bangladesh has been declared `polio free'.) India tops the list of seven countries, where polio is still widespread. India and Nigeria are the only countries that have registered increases in the number of polio cases. The other countries where polio is prevalent are Egypt, Pakistan, Afghanistan, Niger and Somalia.

According to the WHO, in 2002, the epidemic spread across northern India and to hitherto polio-free States such as Maharashtra, Gujarat and West Bengal. In January 2003, a child was paralysed by polio in Lebonan for the first time in nearly 10 years. Genetic sequencing of the virus confirmed that it originated from Uttar Pradesh, WHO sources said. According to Rotary International, even in Bulgaria, which was declared polio free, cases were reported in 2002, and genetic analysis of the virus revealed it was from Moradabad in Uttar Padesh.

Given the State's poor record in dealing with the polio epidemic, it was rather surprising that Rotary International conferred the Paul Harris Fellow award on Chief Minister Mayawati for her "outstanding contribution" towards eradicating polio. The award, which includes a certificate, a gold medal and a Rotary pin, was presented to her by representatives of Rotary International and the United Nations Children's Fund (UNICEF), at her official residence on January 20. Mayawati, who became Chief Minister only in May 2002, said that eradicating polio would continue to be her government's priority. However, government officials seem to be at a loss for words when asked to elaborate on Mayawati's `personal contribution' to eradicating polio. Even Rotary functionaries are unable to explain why the State had registered a sixfold increase in polio cases in 2002, despite the Chief Minister's "outstanding contribution".

A senior Rotary functionary, who has been associated with the pulse polio campaign, said the award had been conferred on the Chief Minister to "motivate" her to take more interest in the polio eradication campaign. A Rotary member said: "The increase has not been due to mismanagement at the government level. There are other factors responsible for it. One is the people's apathy to such campaigns, which lack credibility. Besides, misinformation about the polio vaccine being administered is also greatly responsible for the increase." According to him, an alarming factor was the resistance of people belonging to the minority community, especially those from the lower income groups, to vaccinate their children. "Apparently, there is a belief that the polio vaccine causes impotency," he said. Religious leaders and prominent members of the community could help remove that, he said.

Other factors responsible for the resurgence of the epidemic in Uttar Pradesh are the high density of population and the lack of awareness about the pulse polio campaign. Extensive publicity campaigns, involving film and cricket personalities, have mitigated the opposition to a great extent, the Rotary official said. Although the exact numbers of those vaccinated would be known only after a few days, the third phase of the campaign had been successful when compared to the previous two, he said.

In association with the Rotary International, the UNICEF, the State and Central governments and non-governmental organisations, the WHO has planned six pulse polio campaigns in Uttar Pradesh for the entire year. According to WHO estimates, in the first two phases of the campaign, over 66 million children were immunised. Campaigns have been scheduled for June, September and November, and similar high-quality campaigns will be required in 2004 if the virus is to be eradicated.

According to the WHO, as of April 1, 2003, 1,925 polio cases were reported from across the world. Eighty-five per cent of the cases are in India, nearly 75 per cent of them in Uttar Pradesh. As per WHO estimates, in India, 1,934 cases were detected in 1998; followed by 1,186 in 1999; 265 in 2000; and 211 in 2001. However, there was a stupendous increase last year, when 1,556 cases were reported in India, most of them in Uttar Pradesh.

In October 2002, Rotary International reinforced its polio eradication activities in India and brought in a grant of almost $5 million, taking its total contribution to more than $46 million. The grant helped meet the costs of hiring volunteers, including women, who would do a house-to-house vaccination campaign. In the current phase, over 80 million children across six States are expected to be vaccinated.

The resurgence of polio, especially its spread outside India has alarmed the world medical fraternity. "The support of the international community has never been more crucial than it is today," said Dr. Brundtland. "We need donors to fill the $275-million funding gap that we face globally, so that all activities can go ahead as planned. The generosity of the international community and the successful partnership that has been formed with polio-infected countries are crucial to ensure the success of this initiative," she said.

"We have 15 years of experience in polio eradication... . We have the tools and we have the strategies to finish this job. Today there is simply no moral or economic justification for any child anywhere in the world to be crippled by polio," Dr. Brundtland said.

The Central government is allocating more funds for the pulse polio programme. Against last year's allocation of Rs.4 billion, Rs.4.5 billion has been earmarked for this year. Dr. Daniel Tarantola, Director of Vaccines and Biologicals at the WHO, said: "This is an extraordinary epidemic. It requires an extraordinary effort by a whole range of national and international partners. After 15 years of progress, we are very focussed on India, where stopping transmission will be a monumental task."

Maria Calivis, Country Representative of UNICEF in India, said: "We're facing an enormous job. We have to stop polio in India. We all have to work together to reach every Indian child with polio vaccine and make sure that the vast numbers of children in Uttar Pradesh receive vaccine throughout 2003 and 2004. Beyond this programme, a huge effort is needed to ensure routine immunisation and quality primary health services. Today, most of India is polio-free and none of us wants to see a reversal of the gains made in the past several years."

Worldwide, the polio eradication campaign is facing a shortfall of $275 million in funds; India alone needs $100 million. To counter this shortfall, Rotary International is intensifying its fund-raising efforts. It plans to raise $80 million by June 2003, in addition to the $500 million that Rotary has committed since 1985. "We will do everything in our power to ensure that nothing derails the dream of a polio-free world," said Bill Sergeant of Rotary International. "The international community must also step up efforts so that all children are protected from this tragic disease," he said. Sixty-five Rotary volunteers from around the world will travel to Uttar Pradesh and Delhi to administer the polio vaccine to children.

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