We thank Dr Puliyel for showing keen interest in the recommendation of
Polio Eradication Committee of IAP(1, 2).
The word "now" does not necessarily imply
"immediately". It only means that as of "now"("presently"), we have to
start thinking of and developing the process of stockpiling the vaccine in
India. This process would be as per the norms and practices followed
internationally, including consideration of shelf life of the vaccine.
Furthermore, this is in concurrence of the guideline issued by WHO to
individual countries for the ‘endgame’ and for ‘post-eradication phase’ of
polio eradication(3).
The committee has concluded that poor RI rates in key
states like UP and Bihar is one of the main reasons why PE initiative has
failed to succeed in these areas. Bolstering of poor RI, particularly in
endemic areas must be done urgently to avoid re-introduction of the wild
virus from outside, hence the recommendation of aiming to achieve the
target at the earliest possible deadline i.e. by the end of the current
year. This recommendation reflects how much significance PEC attaches to
improved RI rates in context of achieving and maintaining polio
eradication goal. The 38% fully immunized rate was reported for the year
2001, the more recent estimate based on NFHS-3 is 43.5%(2).
We agree with Dr Puliyel that original objective of
GPEI, i.e. "absence of need to immunize children perpetually after
achieving global polio eradication" can not be met. This is mainly due to
certain unforeseen events like phenomenon of cVDPV, iVDPV, etc that
encountered during the implementation of GPEI strategy that leads WHO to
redraft their objective and goals (3). Regarding the issue of blaming GOI,
Dr Puliyel must know that technically it is the GOI which is officially in
charge of entire program run by international agencie, even though the
agencies are running and calling the shots. NPSP is officially looking
after the ‘surveillance’ part of the entire exercise; it is the GOI who is
in charge of entire proceedings. Hence, it is quite appropriate to direct
all our recommendations to GOI and not to any other organization.
It is therefore clear that the inference drawn by Dr
Puliyel "It is unfortunate that the IAP should participate in this game
plan to lay blame on the GOI" and also the heading given to his letter
"Setting the scene to blame the GOI for failure of Polio Eradication" are
based on Dr. Puliyel’s misreading/misinterpretation of the
recommendations. In this regard, we would only reiterate what was written
in an earlier issue of Indian Pediatrics(4) that the IAP believes in
lending a supporting hand to the Government and all agencies engaged in
PE, in spite of differences which it expresses through its publications,
meetings, conferences etc. It believes in adopting an attitude of
persuasion, not cynicism and acrimony. Thus, imputing the motive that IAP
is into the game plan of shifting the scene to blame the GOI is, in
itself, unfortunate.
References
1. Shah NK, John TJ, Thacker N, Vashistha VM, Kalra A,
Ugra D. Polio eradication strategies in India: Recommendation under IAP
action plan 2006. Indian Pediatr 2006; 43: 1057-1059.
2.
Polio Eradication
Committee;
Indian Academy of
Pediatrics,
Vashishtha VM,
Kalra A,
John TJ,
Thacker N,
Agarwal RK.
Recommendations of 2nd National Consultative Meeting of Indian Academy of
Pediatrics (IAP) on polio eradication and improvement of routine
immunization.
Indian Pediatr
2008; 45: 367-378.
3. World Health Organization. Global Polio Eradication
Initiative, Strategic Plan 2004-2008. Weekly Epidemiol Rec 2004; 79:
55-57.
4. John TJ, Shah NK, Thacker N. Polio eradication and
the Indian Academy of Pediatrics (Reply). Indian Pediatr 2006, 43:
1097-1101.