9 Apr (New Delhi) - India was taken off the list of polio-endemic countries by the World Health Organization (WHO) two months ago, but the polio eradication campaign will have to be continued in some format forever.
“The long promised monetary benefits from ceasing to vaccinate against poliovirus will never be achieved,” Neetu Vashisht and Jacob Puliyel of the Department of Pediatrics at St. Stephens Hospital in Delhi report in the April issue of Indian Journal of Medical Ethics.
The doctors note that it was long known to the scientific community that eradication of polio was impossible because scientists had synthesized poliovirus in a test-tube as early as in 2002.
“The sequence of its genome is known and modern biotechnology allows it to be resurrected at any time in the lab,” they report. “Man can thus never let down his guard against poliovirus.”
According to the authors it was unethical for WHO and Bill Gates to flog this programme when they knew 10 years back that it was never to succeed. “Getting poor countries to expend their scarce resources on an impossible dream over the last 10 years was unethical.”
They say that another major ethical issue raised by the campaign is the failure to thoroughly investigate the increase in the incidence of non-polio acute flaccid paralysis (NPAFP) in areas were many doses of vaccine were used. NPAFP is clinically indistinguishable from polio paralysis but twice as deadly.
The authors note that while India was polio-free in 2011, in the same year, there were 47500 cases of NPAFP. While data from India’s National Polio Surveillance Project showed NPAFP rate increased in proportion to the number of polio vaccine doses received, independent studies showed that children identified with NPAFP “were at more than twice the risk of dying than those with wild polio infection.”
According to their report, nationally, the NPAFP rate is now twelve times higher than expected. In the states of Uttar Pradesh and Bihar — which have pulse polio rounds nearly every month — the NPAFP rate is 25 and 35 fold higher than the international norms.
The authors point out that while the anti-polio campaign in India was mostly self-financed it started with a token donation of two million dollars from abroad. “The Indian government finally had to fund this hugely expensive programme, which cost the country 100 times more than the value of the initial grant.”
“This is a startling reminder of how initial funding and grants from abroad distort local priorities,” the authors note. “From India’s perspective the exercise has been an extremely costly both in terms of human suffering and in monetary terms. It is tempting to speculate what could have been achieved if the $ 2.5 billion spent on attempting to eradicate polio, were spent on water and sanitation and routine immunization.”
In conclusion they say that “the polio eradication programme epitomizes nearly everything that is wrong with donor funded ‘disease specific’ vertical projects at the cost of investments in community-oriented primary health care (horizontal programs).”
The WHO’s current policy calls for stopping oral polio vaccine (OPV) vaccination three years after the last case of poliovirus-caused poliomyelitis. Injectable polio vaccine (IPV), which is expensive, will replace OPV in countries which can afford it.
“The risks inherent in this strategy are immense,” Puliyel and Vashisht warn. “Herd immunity against poliomyelitis will rapidly decline as new children are born and not vaccinated. Thus, any outbreak of poliomyelitis will be disastrous, whether it is caused by residual samples of virus stored in laboratories, by vaccine-derived polioviruses or by poliovirus that is chemically synthesized with malignant intent.”
They argue that the huge costs of repeated rounds of OPV in terms of money and NPAFP shows that monthly administration of OPV must cease. “Our resources are perhaps better spent on controlling poliomyelitis to a locally acceptable level rather than trying to eradicate the disease.”
This press-release has been requested by and written for Jacob Puliyel MD.