The resurgence of poliomyelitis in India, from a mere 66 cases in 2005 to an alarming 583 by the end of 2006, has dealt another blow to the already crumbling public health infrastructure and delivery. While most countries have wiped out polio by 2005, detection of one-third of the load in India out of 1,763 polio cases worldwide have made the Government think-tanks deliberate on the debacle and re-think strategies.
To control the menace from spreading its tentacles any further, we need to adopt a need-based approach and more scientific methods. The focus should be on Uttar Pradesh (UP), which tops the list with 481 cases and is home to more than 90 per cent new cases and Bihar with 48 cases. The bulk of the cases in UP is the result of a single outbreak that has spread from Moradabad and JP Nagar in Western part of the state. According to the World Health Organisation, the virus has wriggled its way outside UP, as the same strain was witnessed in Nepal, Bangladesh, Angola and Namibia.
To begin with, shatter superstition engulfing the drive. Around 70 per cent of the new polio cases in UP have been found in a minority community, which resisted the vaccination fearing it would induce impotency in children. Dispelling superstition should be accomplished by roping in local health workers to convince clerics who propagate against the vaccination drive. Consistent ad campaigns and skits in the high-risk villages would also help. Second, the frequency of National Immunisation Days (NIDs) should be stepped up in high-risk areas depending on the epidemiology.
We need to use monovalent oral polio vaccine (mOPV) than the conventional trivalent oral polio vaccine (tOPV) in the high-risk districts. Scientific evidence suggests the efficacy of mOPV over tOPV in inducing immunity against WPV1.
Re-consider the policy of using only live attenuated Oral Polio Vaccine, which is less effective than injectible polio vaccine (IPV). According to Thekakkara Jacob John, an emeritus professor at the Christian Medical College (CMC), Vellore, in the Indian Journal of Medical Research, the efficacy of OPV depends on geographic settings. While a child in America has a 99 per cent probability of being fully immunised with three doses of OPV, a trial at CMC showed only 75 per cent and another study in Delhi found it to be even lower. The lack of 'prime boost effect', which means the subsequent doses after the first one induce lesser immunity, is another deterrent for OPV.
We cannot afford to be complacent towards the polio-free states. To reduce the risk of importation in polio-free areas, supplementary immunisation activities (SIAs) should be carried out as usual as per the Global Advisory Committee on Polio Eradication. Lastly, the role of GPs and paediatricians and various NGOs in this mega exercise has to be re-enforced.
Before the debilitating virus kills and maims more children, let us re-work our strategies!