If India is polio-free, why are children still getting paralysed?
If India is polio-free, why are children still getting paralysed by the polio virus?
The oral vaccination used to eradicate polio actually caused the disease in rare cases. Now, 20 years after the vaccination programme started, the government is finally revising it.
The dangers of the Oral Polio Vaccine have never been unknown. It was adopted in the 1990s, in an ethically controversial decision, over the relatively safer injectable Inactivated Polio Vaccine. While the oral vaccine used a weakened virus, the injectable one used an inactivated one. The injectable vaccine was however more than five times costlier than the oral version.
Ignoring the warnings
In the 1990s, many experts had opposed the use of oral vaccine because it is not 100% safe.
“As chairman of the India Expert Advisory Group [which monitors and accesses the progress of the programme], I had always been telling everyone that we should have IPV instead of OPV,” said Dr TJ John, former Professor of Christian Medical College, Vellore, and an expert in virology. “We could have saved some funds by using IPV from the beginning. Ethics demands IPV and in fact the whole world uses it. But OPV had its role as without it we would not have ventured to eradicate polio.”
In fact, in 1988, scientist Pushpa Bhargava, founder director of the Centre for Cellular and Molecular Biology who was recently in news for returning his Padma Bhushan, had argued against the use of OPV.
In an opinion piece in The Hindu, he wrote that he was part of a meeting where it was decided to use injectable polio vaccine in India because of the poor efficacy of the oral polio vaccine. A factory to manufacture injectable vaccine was set up in Gurgaon, in Haryana, but was abandoned on the advice of the WHO in 1992. Bhargava claimed that he wrote to various authorities seeking to know what evidence prompted the government to shift to OPV.
Clearly, the government did not share Bhargava’s concerns then. Even today, very often in India, the parents of a child afflicted with vaccine-derived poliovirus are not informed of the source. And nearly always, nobody takes responsibility here, unlike in other nations.
At least 19 counties in the world have a vaccine compensation programme. Germany was the first to enact a compensation programme for vaccine-derived poliovirus in 1961. It was followed by France, then Austria, Denmark, Japan, New Zealand, Sweden and the UK. A similar programme has been set up in the US, Quebec, Italy, Norway, the Republic of Korea, Hungary, Iceland and Slovenia. In UK, the vaccine damage payment is a tax-free one-off payment of 120,000 pounds.
Some studies say there’s a link between non-polio AFP and the increasing doses of Oral Polio Vaccine.
Last year, there were 42,804 cases of non-polio AFP, a majority of them in Uttar Pradesh and Bihar. The number of such cases was 59,436 in 2012, and 53,421 and 53,383 in 2013 and 2014, respectively.
Non-polio AFP is indistinguishable from polio paralysis cases, but is twice as fatal, as studies show. A delegation from the Public Report on Health from Council for Social Welfare in Delhi found that most of the non-polio AFP cases were not followed up. According to information obtained through the Right to Information Act by Dr Jacob Puliyel, who heads the paediatrics department at St Stephens Hospital in Delhi, of the 10,055 cases of non-polio AFP, only 2,553 were investigated. Of these 2,553 cases, 898 had residual paralysis and 217 children died.
“In the regular polio cases only 1/10th of children suffer from paralysis or death, whereas in non-polio AFP, more than half the children suffer from paralysis or death,” said Dr Puliyel. “This is not a mild disease.”
A study published last year in the American journal Pediatrics said that there is a link between non-polio AFP and the number of OPV doses administered. Another study in the Indian Journal of Medical Ethics in 2012 said that after the polio vaccination programme intensified in 2005, the non-polio AFP cases increased exponentially.
The rise was marked in Uttar Pradesh and Bihar, states where the pulse polio drives would take place almost every month. Only in areas where fewer than six doses were given in a year was the incidence of non-polio AFP low. The number of non-polio AFP cases began reducing in UP and Bihar in 2012, a year after the last polio case was reported in West Bengal and as the two states cut down the oral vaccine doses delivered. The Pediatrics study maintained that the case studies of Bengal of UP are evidence of a causative association between OPV doses and the non-polio AFP rate.