The Trouble With The Polio Vaccine

By M H Ahssan

It's not just the proposed-pentavalent vaccine that is causing problems. India’s Pulse Polio Immunisation programme is apparently not showing the results it was expected to. The worst states for polio in India, Uttar Pradesh and Bihar are now reporting more cases of Acute Flaccid Paralysis (AFP), even from last year, even though the doses have been increased.

The AFP rate is the number of persons paralysed per 100,000 population. Ordinarily, it is expected to be one or two per 100,000. But, the official figures of the National Polio Surveillance Project (NPSP), a joint effort of the union government and the WHO, show that the number of AFP cases by the first week of June 2009 were 4,280 in Bihar. This year, the figure has gone up to 5,190, which is a 21.26 percent increase. In Uttar Pradesh, the AFP cases have gone up from 5,286 in June 2009 to 6,824 in June this year. This represents a 22.54 percent increase.

Almost all cases of AFP are seen as polio. “When we refer to AFP, we take it polio although not all AFP cases are caused by the polio virus. But a majority would be,” says Dr Sanjeev Singh, an advisor to many hospitals in Delhi. Singh says he can barely recall two cases of non-polio AFP over several years of work.

However, the NPSP says only six of the 5,190 AFP cases from Bihar are confirmed polio cases so far this year. It also says it has discarded 4,266 cases as not polio and that 918 cases are pending. Likewise, in Uttar Pradesh the NPSP is confirming only 10 cases of AFP as polio so far adding it has discarded 5,362 cases as not polio and 1,450 cases are pending.

Another reason given for the increase in polio cases even after a massive Pulse Polio Immunisation programme is that there is better surveillance now, people are more aware, and they are therefore reporting more cases now. If that were so, there is all the possibility of far more polio cases being discovered. This, in turn, raises doubts over the efficacy of the polio vaccine.

In 2007, HNN reported that a new polio vaccine was introduced without informing the public and the the AFP rate in Uttar Pradesh rose from 3,789 in 2004 to 10,055 in 2005, when six doses of oral polio vaccine were given, and to 11,538 in 2006 when a further nine doses were administered.

In 2006, the AFP rate in Uttar Pradesh was 16.87 per 100,000. Today, it is 22. In Bihar it is 32. So, is the repeated vaccination in these states, which are receiving more doses, responsible? AFP is no mild disease. About half the cases are permanently paralysed, says an analysis in the journal Indian Pediatrics. It appears that the polio vaccine is another example of the government ceding to international agencies, who are pushing for more doses.