Polio botch-up blame at Delhi door

New Delhi, Sept. 23: India’s health bureaucracy ignored scientific advice about flaws in the polio immunisation programme for nearly 20 years and suppressed research that might have led to faster eradication, doctors have said.

The doctors have challenged assertions by health officials that the surge in polio in western Uttar Pradesh this year — and the resulting setback in eradication efforts — was only due to poor immunisation there last year.

In scientific papers and interviews to The Telegraph, they said India’s failure to eradicate polio also stems from wrong decisions on dosage and choice of vaccine.

“It’s a shame. We’ve lost time,” said Renu Patel, who was a senior paediatrician in a Mumbai medical college and was reprimanded after she tried to alert health officials about problems in vaccine strategy.

The number of polio cases in India has surged this year to 297 after a steady decline for years and a record low of 66 last year.

Health officials said the eradication strategies were adopted after national and international consultations. They cited India’s plummeting polio numbers — from an estimated 200,000 cases in 1988 to 66 last year — as evidence of success.

“The UP outbreak is entirely due to state health workers failing to immunise children last year,” an official said.

Doctors who have questioned the strategies concede the programme dramatically reduced polio cases, but say that India missed the eradication deadline twice — in 2000 and 2005, and is unlikely to be certified polio-free before 2010.

They said health officials ignored evidence that had accumulated through the 1970s and 1980s that three doses of the oral polio vaccine (OPV) would not prevent polio paralysis in a large number of children.

“Policy-makers adopted three doses despite abundant data that a five-dose plan would protect more children,” said Dr T. Jacob John, former head of virology at the Christian Medical College in Vellore and a member of the India Expert Advisory Group for Polio Eradication.

The three-dose schedule lasted until the mid-1990s, when the government launched pulse polio campaigns to give all children under five years extra doses of OPV on designated days during the year.

Five doses would have also revealed multiple-dose failure with OPV and stimulated rethinking about eradication strategies, John said.

Children who got as many as 10 doses have still got polio in Uttar Pradesh this year.

John believes policy-makers displayed “an unscientific bias” towards OPV over the inactivated injectible polio vaccine (IPV) that has been shown through studies as superior in many ways.

In a paper three years ago in the Proceedings of the Indian National Science Academy, John suggested there might have been an effort to suppress findings about IPV’s advantages. His own studies comparing IPV with OPV in Tamil Nadu were approved by the Centre on the condition that he would not publish the results.

Under a government-approved project, Patel had introduced IPV in three districts of Mumbai between 1988 and 1990. “With the three-dose OPV schedule, we’d see six-seven children get polio every year. With IPV, each district became polio-free within a year,” Patel told The Telegraph.

But when she presented her findings at a scientific conference in 1992, she was reprimanded by health officials. Weeks later, she was transferred to a tribal area.

Meenakshi Mehta, another Mumbai paediatrician, was forced to apologise in writing because she pointed out that children were getting polio even after three OPV doses. “We had to suffer humiliation because our observations didn’t suit health officials,” Mehta said.

Another pediatrician in a government medical college in New Delhi told The Telegraph that he was discouraged from studying IPV.

However, many still believe OPV was the right choice. “Most countries, and all states in India except UP and Bihar eliminated polio with OPV,” said Santosh Mittal, former head of paediatrics, Maulana Azad Medical College, New Delhi.

Although the government had planned to produce IPV in the public sector in 1988, the project was abandoned. Experts argue that had local production been initiated then, the cost of the vaccine might have reduced over the years.

Mittal said IPV will have a role in the fag end of the eradication effort — in a phased manner beginning in states that have not reported polio for many years, and expanding into new areas.

While polio programme managers say IPV is expensive, scientists point out it can be given with three doses of the routine DPT vaccine — same vial and same syringe.