Dr Pushpa Bhargava's Take on Polio Politics


The politics of polio

Pushpa M. Bhargava
Even the appropriate WHO document clearly states that there is evidence that OPV has not worked in developing countries.
That Sabin’s oral polio vaccine (OPV) has not been able to eradicate polio in our country, is now well established (inter alia, Economic and Political Weekly, 4-11-06, p. 4538-4540; and 23-12-06, p.5229-5237; Tehelka, 11-11-06, p.8-9; The Hindu, Hyderabad, November 13, 2006, p.11; Down to Earth, 31-12-06, p.24-31; Conclusions Recommendations of a National Consultative Meeting organised by Indian Medical Association in New Delhi on May 14, 2006; Editorial in the Indian Journal of Medical Research, (IJMR), January 2007, p. 1-4; and numerous other articles in some of the world’s best known scientific journals, such as Science.)
Not only that the cases of non–polio acute flaccid paralysis (AFP) in those vaccinated with OPV have shown a dramatic rise. It appears that in 2005, in Uttar Pradesh alone, 4,800 had residual paralysis, or died after acquiring non-polio AFP, in comparison to the all-India figure of 4,793 polio cases in 1994; the 2006 data, after six doses of monovalent OPV, are worse. The infructuous expenditure on the OPV programme would probably run into thousands of crores.
The pity of it is that all this was anticipated (Bhargava, The Hindu, December 12, 1999 ), and that we could have easily eradicated polio from our country by now. We did not do so because our successive governments and those who worked for them in responsible positions such as Secretaries and Joint Secretaries in the Ministry of Health, Directors-General of Medical and Health Services and even of the ICMR, were primarily (exclusively?) committed to personal and certain foreign interests and not to the cause of polio eradication. Here is the story with which I was, in the initial stages, connected.
Two types of vaccines
There have been two types of vaccines available against polio: the injectable Salk vaccine (IPV) and the oral Sabin vaccine (OPV) using an attenuated live virus. Till the early 1980s, OPV was used in the developed countries to maintain the polio-free status that had been largely achieved through the use of IPV beginning the 1950s. By 1988, Jonas Salk (one of the most celebrated scientists of the last century who made the first successful polio vaccine, the IPV) had developed an enhanced potency injectable vaccine (M-IPV). In a letter dated December 1, 1988 to me, he wrote, “It is urgent that the incidence [of polio] be reduced as rapidly as possible. A simple way would be to administer a single dose of the enhanced potency IPV (M-IPV), to all those of six months of age or over who may have already received one or more doses of OPV (some of whom we know, from experience may not have been protected), and to those of the same age who may not have been previously immunised against polio. A single dose of M-IPV of sufficient potency will induce antibody and/or immunologic memory in nearly all infants of that age. For infants less than six months of age who still possess maternal antibody, two doses, preferably, one with DTP are necessary.” I had forwarded this letter to everyone concerned in the country with the polio vaccination programme at that time, but no one took any note of it.
Evidence against OPV
Even before I had received the above-mentioned letter from Jonas Salk, at a meeting held in Delhi in March 1988, convened by Sam Pitroda, the then Adviser to the Prime Minister for National Technology Missions, overwhelming evidence was presented that OPV had not worked in India (Bhargava, The Hindu, December 12, 1999 ). Virtually every one concerned with polio was present at this meeting at which an unambiguous decision was taken to shift to IPV.
I quote from the official minutes of this meeting:
“Expedite establishment of M-IPV programme. On moral grounds and considering the involvement of the lives of our children, cost shall be no consideration. Indigenous production of IPV before 1991 shall be aimed at.” “Whenever children in large numbers are dying, getting afflicted with polio, the empty and hollow argument of their being used as guinea pigs cannot be accepted.” “As new M-IPV programme ramps up, the OPV will ramp down.” Although IPV has always been more expensive than OPV, this is compensated by the fact that one may need to take only one or at most two doses of IPV whereas, in the case of OPV, the number of doses could be above ten.
It was clear that, for some time, OPV will continue to be with us. In fact, the then Secretary of the Department of Biotechnology (DBT), S. Ramachandran, had been earlier to the Soviet Union and, with their help, a factory (BIBCOL) to produce OPV was set up in Bulandshahr.
In keeping with the decision of the 1988 meeting — the only meeting of experts and concerned people so far convened by the government in regard to polio vaccination programme — another company called Indian Vaccine Corporation Ltd (IVCOL) was set up with a capital outlay of Rs. 90 crores. Both DBT and the Indian Petrochemicals Ltd. of Baroda had equity in it even though the majority shares belonged to Institut Merieux, one of the world’s largest, most reliable and respected vaccine producers that was committed to produce M-IPV which was far more heat-stable than OPV.
Obliging WHO
But we hadn’t reckoned with our primary commitment to the interests of the developed countries. As already mentioned, by this time the West had decided to replace OPV with M-IPV. Therefore, market had to be found for OPV. WHO advised that developed countries use IPV, while developing countries use OPV. For us to oblige WHO, two steps were necessary: (1) that BIBCOL produces no OPV of its own; and (2) India reverses its decision to gradually shift to IPV. Both the steps were taken. BIBCOL has not produced a single dose of OPV till today, and the Ministry of Health decided soon after the March 1988 meeting, without any further consultations, to shift permanently to OPV. Consequently IVCOL was closed down after incurring substantial expenditure, and a number of senior officers of the above Ministry got plum U.N. jobs with tax-free dollar salaries, after retirement.
It is particularly interesting that at a conference jointly organised by the International Comparative Virology Organisation and the WHO in New Delhi, in January 1992, experts from all over the world indicated the preference of IPV over OPV for any plans of eradication of polio in developing countries.
Problem continues
An interesting question that one may, therefore, ask is: if we really felt that there was a strong scientific case for using OPV (which there wasn’t), why did we not make it ourselves. The answer is that this wouldn’t have served the foreign interests to whom we had sold ourselves, ignoring the interests of our own people and the sane advice of our own experts based on incontrovertible evidence. It is amusing in this context that even the appropriate WHO document clearly states that there is evidence that OPV has not worked in developing countries.
The 64,000-rupee question now is: would the government wake up and get out of the clutches of WHO so that it may serve our interests and not the interest of powers that be outside India? And if it needs endorsement from a foreign channel, it may read the article by V.K. Bhasin in January 2008 issue of Nature Biotechnology, Nature being perhaps the world’s best-known and most respected scientific periodical. The article says that, in 2006, there were 1,600 cases of OPV–induced polio plus a large number of cases of AFP from which virus was not cultured.
So, the problem continues. But who cares! Polio is not a disease of billionaires.