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| July 03, 2000 | ||
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| POLIO The Polio pipe dream A controversy over the choice of vaccines threatens to derail India's polio eradication programme By Farah Baria
The controversy erupted when the US decided not to use the oral polio vaccine (OPV) which is the backbone of the anti-polio programme in India. Reason: ever since the disease was eradicated from the western world in 1975, the dozen-odd new cases every year are caused by the vaccine itself. After a spate of lawsuits, in January this year the US Centre for Disease Control and Prevention "strongly objected" to OPV use and advised doctors to switch to the older, more stable injectible polio vaccine (IPV) At present, OPV costs about Rs 3 per dose; the prescribed five doses add up to Rs 15 per child. On the other hand, a single shot of IPV costs $10 (Rs 450); the standard three shots work out to Rs 1,350 per child. Thus, if India opts for the IPV, it will cost the exchequer thousands of crores of rupees more. Not incidentally, the medical community in India is completely divided on this issue. Which is unfortunate because according to a who study, India figures in the top 10 of 20 nations where the virus is still active. What is the difference between IPV and OPV? Both create antibodies that help the immune system build resistance to the disease. But while IPV, developed in the 1950s by Jonas Salk uses a dead or inactivated polio virus, the OPV, discovered by microbiologist Albert Sabin in 1960 uses a live weakened virus. Both have their pros and cons. And both have defenders and detractors.
However, since the OPV is now unofficially banned in the US, India, with 60 per cent of the world's polio cases, has reason to worry. Dr Indira Nath of the All India Institute Of Medical Sciences says that she has seen a rise in the number of "immunised" polio victims in recent years. How can OPV backfire? "When weakened organisms are injected into the body, the immune system is instantly alerted to fight the invader," explains Shankar War, head of the Bacterial Vaccine Department at Mumbai's Haffkine's Institute. But sometimes, the weak virus may mutate and become neuro-virulent, causing what is called vaccine associated paralytic polio (VAPP). Such instances are relatively rare, but extremely disturbing. In other cases, the OPV is simply ineffective.This is because, being a live virus, the OPV must be stored between minus 2 and minus 8 degrees Celsius. Any break in these "cold-chain conditions" due to improper administration or cold-storage facilities could affect the vaccine's efficiency, making even vaccinated children prey to the dreaded disease. The solution? Dr P.M. Bhargava, founder-director of the Hyderabad-based Centre for Cellular and Molecular Biology, says it's time India reverted to the IPV. Surprisingly, this was decided way back in 1988 when Rajiv Gandhi assigned Sam Pitroda to oversee India's immunisation programme. A Rs-70 crore IPV manufacturing unit at Gurgaon near Delhi, to be jointly funded by the Government and global giant Pasteur-Merieux, was sanctioned. Two years later, in an unexpected volte face, the unit was wound up in favour of imported OPV from America, France and Russia. The Health Ministry said the who had recommended the switch. Bhargava and others like virologist Dr T. Jacob John from CMC, Vellore, say the move was mala fide, especially since who had recommended IPV for developed nations. "After the West started discarding OPV in 1995, the who -- through UNICEF -- has been trying to find new markets in poorer countries," says Bhargava. "Since retired Indian health officials seek jobs with these organisations, they are only too happy to comply." But many believe that OPV is India's answer to polio eradication. Swati Bhave, president of the Indian Academy of Paediatrics, explains that it is cheaper, easier to administer and has a "herd immunisation effect", protecting not only the child but also the community at large. "We are in the last and most crucial phase of polio eradication," she says. She also adds a warning: "If people stop taking OPV now, the backlash will be an epidemic." In addition OPV makes strong economic sense. Also, as Dr Stephen Atwood, chief of the health section at UNICEF, India, explains: "In a country where health facilities are basic, the very idea of inoculating 200 million children with properly sterilised needles is unthinkable." Although OPV carries an acceptable risk factor, only one in two million immunised get VAPP, a "statistically insignificant" figure. But what if that one sacrificial lamb happens to be your own baby? Most paediatricians do not have an answer to this moral dilemma. "Educated parents who want to make an informed choice about vaccination could get the safer IPV," advises Dr R.K. Anand, a Mumbai-based child specialist. But he adds that India should switch to IPV only after polio is completely eradicated in the country. Yet the larger questions remain. Can an expensive, injectible vaccine be logistically administered to millions of children in over one lakh villages? On the other hand , given India's frequent power cuts, poor cold-storage facilities and inadequate medical infrastructure is OPV really efficacious? Only time will tell. Until then, those images of disfigured men and women haunting India's lanes and bylanes will never go away. |
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 © Living Media India Ltd |
It's
a crippling situation. Just months before India is to be declared a
polio-free country after spending Rs 2,000 crore on the aggressive Pulse
Polio Campaign to eradicate the disease, there's evidence that our
policymakers may have grasped the wrong end of the stick.