Submitted to the World Health Organization, UNICEF, and the Government of India, on 7 April 2004, The World Health Day.
We are a group of public health professionals from India who wish to register our concern at the manner in which the entire polio eradication ‘initiative’ has been thrust on our country by the World Health Organization (WHO), the UNICEF, the American Centers for Disease Control and Prevention, Atlanta, and the Rotary International. The Polio Eradication Initiative in India launched in 1995, as part of the Global Polio Eradication Initiative (GPEI), promised eradication by the year 2000 and the ‘certification’ of eradication by 2005. The target is now postponed to 2004-07. It is time to take stock and see what has been the achievement of GPEI in our country in the nine years of intense effort beginning from 1995. It is our contention that the goal of GPEI was flawed from the time of its conception and is unlikely to achieve its stated objectives this year or in the coming years.
The scientific organizations spearheading the initiative are aware of the flaws but are misleading our government and the world that the strategy adopted is scientifically sound and all that would be required to achieve it is ‘political will’. Instead of admitting to the programme’s failure, on January 15 this year, a ‘clarion’ call, “2004 –Now More than Ever: End Polio Forever”, was issued from the WHO Head Quarters at Geneva. On the same day, a ‘Declaration’ was signed on behalf of the Health Ministers representing the Government of Afghanistan, Egypt, India, Niger, Nigeria, and Pakistan, allegedly “…the six countries of highest priority for stopping the transmission of poliovirus globally”. These governments, were made to note “…with grave concern that the poliovirus is being exported from endemic countries and is infecting children in previously polio-free areas” thereby implicating themselves in an international ‘crime’ which they are being accused of.
It is our contention that:
- The WHO inflated the numbers of paralytic polio cases for the pre-programme period to justify GPEI;
- Repeated changes in ‘case definition’ have led to claims of a far greater impact of the programme than what it is in reality;
- An ‘Elimination’ strategy is being passed off as an ‘Eradication’ strategy when it is clear that poliovirus cannot be eradicated in India by relying on vaccination alone;
- Significant proportion of the polio cases in the country, including the epidemic in 2002 in UP, is iatrogenic;
- Significant proportion of the children with confirmed wild polio paralysis in the post GPEI are immunized children; and
- A number of children have developed vaccine-associated paralytic poliomyelitis (VAPP) in the last nine years of GPEI.
The polio eradication campaign has failed to achieve its goal. In fact, in 2002, there was a serious upsurge in the number of paralytic polio cases and the cases were spread in 16 states. Not just that, in 2003, four states (Karnataka, Assam, Andhra Pradesh and Tamil Nadu) which had been previously polio free also had cases of polio. The states of Andaman & Nicobar, Arunachal Pradesh, Lakshadeep, Manipur, Mizoram, and Sikkim are the only six states that have not reported polio cases since 1997.
We note with concern:
- The excessive dosing of our children with OPV, at times exceeding more than 25 doses in the first five years of age which is unheard of in the history of polio eradication in the West;
- The potential for future outbreaks due both to wild and vaccine-derived virus as a consequence of the impact on the natural history of polio.
- The arbitrary decision to do away with all universally held contraindications of OPV for our children;
- The resurgence of other vaccine-preventable diseases, due to the adverse impact of pulse polio on routine immunization programme;
- That a disease of lower public health importance in the country has been justified on the grounds of some small savings for the developed nations;
- The over-loading of an already weak health care system of our country by the meaningless and expensive pulse polio initiative;
- That an impossible and unnecessary case is being made for the eradication of wild poliovirus as the objective, thereby trapping the country in the unrealizable success criteria imposed by WHO;
- That the stage is now being set for an exorbitantly expensive IPV for routine immunisation in the coming years;
- That more than Rs 2500 crores have already been spent on this misadventure and that more than Rs 400 crores/year has been allocated in the Tenth plan;
- That the promises made by the international fraternity that the country will not have to borrow, has been belied by the government quietly borrowing US $ 180 million from the World Bank for the pulse polio programme thereby adding to our debt;
- That UNICEF has changed its role from being only a technical advisor to also a procurer of vaccines for the Government of India leading to conflict of interests;
- That three recent events — the discovery of revertant strain of vaccine to ‘wild’ virus, the discovery of long-term carriers of vaccine virus and conflict situations in several parts of the world, make worldwide cessation of polio vaccinations in future an empty claim.
- An independent inquiry be held on the polio eradication ‘initiative’ in India with due consideration to the relevant epidemiology as well as health-care priorities in the country. A white paper on why this ‘initiative’ was advised when the ‘experts’ knew that even after a successful campaign of full coverage was achieved, polio vaccination cannot be discontinued; a full database on the entire programme; the vaccine procurement policy; and the consequences of GPEI for public health including that for polio, be released. The independent enquiry committee should also charter the way forward.
- The right of compensation and rehabilitation for children affected by both wild polio and vaccine induced paralytic polio since 1995; and
- The right of rehabilitation of those suffering from non-polio AFP since 1995.
The GPEI is yet another negative exercise in mismanaging the health priorities and programs in developing countries in the time of globalization. We recognize the efforts of thousands of well-meaning health personnel in reaching out to lakhs of children under difficult circumstances. However, it is unfortunate that the enormous energy and goodwill that the programme generated was misguided and wasted. The failure of the eradication campaign is not because of lack of proper implementation but because of a basic flaw in the strategy itself. Instead of placing the blame where it rightfully belongs, the parents are being blamed with continuous bombardment of the propaganda machinery. We view the UN institutions, their corporate philanthropic partners and the gullible health bureaucracies, technocracies and political leaderships of the developing countries, as equal partners in this questionable venture. The WHO and UNICEF were set up with a mandate of providing scientifically sound technical advice to their member States. We are disappointed at their abdication of this responsibility. We write this memorandum with the hope that it will initiate a national level debate and allow the Government of India to take corrective measures.
This statement is endorsed by:
Dr. D. Banerji, Professor Emeritus, Centre of Social Medicine & Community Health (CSMCH), JNU, New Delhi.
Dr. N.S. Deodhar, Former Director, All India Institute of Health & Public Hygiene, Kolkata and presently Consultant in Health Sciences, Services, Management and Research.
Dr. I. Qadeer, Professor, CSMCH, JNU, New Delhi.
Dr. C. Sathyamala, Visiting Professor, CSMCH, JNU, New Delhi.
Dr. Onkar Mittal, Secretary, Society for Action in Community Health, New Delhi.
Dr. Ritu Priya, Associate Professor, CSMCH, JNU, New Delhi.
Dr. Rajib Dasgupta, Assistant Professor, CSMCH, JNU, New Delhi.
Dr. Anant Phadke, CEHAT, Pune.
Mr. S. Srinivasan, Managing Trustee, Low Cost Standard Therapeutics, Baroda.
Dr. K.R.Nayar, Professor, CSMCH, JNU, New Delhi.
Dr. Mohan Rao, Associate Professor, CSMCH, JNU, New Delhi.
Dr. Kamla Ganesh, Retd. Professor, Obs. & Gynae., Maulana Azad Medical College, New Delhi.
Dr. Alpana Sagar, Assistant Professor, CSMCH, JNU, New Delhi.
Dr. Rama Baru, Associate Professor, CSMCH, JNU, New Delhi.
Dr. Sanghamitra Acharya, Associate Professor, CSMCH, JNU, New Delhi.
Mr. K.B.Saxena, Former Health Secretary and member of the Planning Commission, Government of India.
 “Geneva Declaration for the Eradication of Poliomyelitis” dated 15 January, 2004, Geneva, Switzerland.
 Provocative paralysis due to intramuscular injection, ineffectiveness of cold chain and reduction of circulating wild poliovirus due to partial and incomplete vaccination which paradoxically increases probability of paralytic poliomyelitis. We note with concern that none of the IEC material issued in the pulse polio programme in India indicts intramuscular injections as a key risk factor for paralysis with poliovirus.
 Personal communication from the WHO dated 5.3.2004 in response to a letter written jointly by Drs Onkar Mittal and C Sathyamala dated Jan 31, 2004, addressed to Dr Brent Burkholder, Regional Advisor, Immunization and Vaccine Development, WHO/SEARO, New Delhi.
 For instance, a child born in Jan 1999 in some of the “high risk” states and districts would have received more than 25 doses of OPV during the many NIDs, SNIDs, and “Mop-up” operations by Jan 2004.
 The risk of VAPP (Vaccine Associated Paralytic Poliomyelitis) among immunodeficient infants is 3,200-fold to 6,800-fold higher than among immunocompetent infants (Sutter RW, Prevots DR, Vaccine-associated paralytic poliomyelitis among immunodeficient persons. Infect Med 1994;11:426,429-30,435-8, as quoted in Centers for Disease Control and Prevention. Poliomyelitis Prevention in the United States: updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2000;49(No. RR-5):7. The Operational Guide 2003-04 on Pulse Polio Immunization in India (GOI, June 2003) does not mention even a single contraindication for OPV.
 Paralytic polio is only a small fraction of all childhood paralysis and a polio eradication strategy will impact only marginally on childhood paralysis.
WHO (1997). Polio: The Beginning of the End. p84.
 That even if one case is reported from a population of one billion, the entire programme would be treated as a failure.
Planning Commission, (undated) Tenth Five Year Plan (2002-2007) Volume II: Sectoral Policies and Programmes Family Welfare, GOI, New Delhi p196.
 Planning Commission, (undated) Tenth Five Year Plan (2002-2007) Volume II: Sectoral Policies and Programmes Family Welfare, GOI, New Delhi, p213.
 World Bank (2000) Project Appraisal Document on a proposed IDA credit in the Amount of SDR 106.5 million (US$ 142.6 million equivalent) to India for an Immunization strengthening project, March 30,2000, Health, Nutrition and Population Sector Unit, South Asia Region, p32. World Bank (2003) Supplemental Credit Document, International Development Association, Proposed Supplemental credit of SDR 59.5 Million (US$83.4 Million equivalent) to India for the Immunization Strengthening Project, Nov 18, 2003, Human Development Unit, South Asia Region.
 One of the conditionalities of the World Bank loan is that the GOI will purchase polio vaccines only through the UNICEF.