The excellent and honest assessment of polio eradication in our
country(1) and acceptance of failure of polio experts and advisors
"who misread the science", need introspection by all pediatricians,
because Academy has been a party to the government as advisors. We can
not be absolved of the responsibility by just blaming the government
for "failure to assert its autonomy", and brush away our conviction
and approach towards increasing NIDs for polio eradication.
The case for switching over to IPV is convincing,
but "the government has been urged to develop a clear policy and plan
of action in terms of IPV"(1) need consideration of the logistic and
economic burden of providing minimum 2 doses of IPV to 25 million
births per year(2), which would further stretch a flail economy of the
country.
The observation of low coverage of UIP vaccines to
the tune of 15-25% in UP and Bihar, is no exception. Surprisingly, a
survey conducted in December 2002 in children <3 years of age at
Udaipur, showed that only 66.04% had received 3 doses of OPV/DPT and
0.92% of these never received any dose of polio vaccine in spite of
passing through repeated NIDs.
The efforts of government agencies to project
"achievement of targets" in terms of polio vaccine, is of serious
concern for polio strategy planners. The table of proposed milestones
is a wishful dream because in presence of 81 cases till 24, May 2003,
and still higher number of cases expected in next 3-4 months, the
eradication target to be achieved till end of 2003 is unimaginable.
All efforts would fail in view of lack of consumer
participation, overbearing cost of repeated pulse polio immunization
days, decreasing routine immunization rates, and overburdened
staff-and campaign fatigue(3) because of frequent NID-which has caused
a great loss of initiative and enthusiasm amongst them, leading to low
coverage and defeating the purpose of NID.
In view of reports of number of countries
eradicating polio with 2 NID-conducted efficiently with good
coverage(3) we need to review the scientific facts of eradication in
light of behavioral barriers of population/providers of polio services
of UP and Bihar, to plan revised methodology for IAP polio eradication
move.
A.P. Gupta,
Associate Professor,
Department of Pediatrics,
RNT Medical College,
Udaipur, Rajasthan, India.
