A National Consultative Meeting on the Polio Eradication Initiative (and Hepatitis-B) was held on 14th May 2006 by the Indian Medical Association (IMA). While the complete report of this meeting is available on the IMA website (www.imanational.com), we reproduce here the Recommendations on Polio.
Polio Eradication: Current Status
Gains Achieved by the programme
- Confirmed wild polio cases down significantly.
- Number of `infected states’ has decreased.
- Very focal transmission now.
- P3 almost absent.
- Less genetic bio-diversity now.
- Coverage during pulse polio rounds is `improving’.
- “Excellent” surveillance system in place.
- Large scale social mobilization operation in India that cuts across several barriers (during pulse polio rounds).
- More than Rs 5000 crores have already been spent.
- Higher priority health problems have receded to the background.
- Even routine immunization has suffered, as evidenced by higher number of cases of traditional VPDs.
- No mention of VAPP at all in the grand reports of covering 170 million per NID and 67 million per SNID.
- Fatigue at all levels.
- Confidence of public and professionals shaken.
- A close look shows that with the current strategy “polio cannot be eradicated”.
- No definite plan available for post eradication scenario or if there is a failure to achieve zero WPV status.
Conclusion 1: Continuing circulation of the wild polio virus in a few states, despite intensified pulse polio activities, with multiple changes in strategies and interventions, is a matter of serious concern. At the same time a large number of states which have been free of WPV for last several years are being unnecessarily being exposed to hazards of VAPP due to OPV.
Recommendation: Strategies need to be reviewed by setting up a National Expert Group. Possible use of IPV (alone or in combination with OPV) needs to be considered strongly. (See also Conclusion/Recommendation 4).
Conclusion 2: There is an alarming increase in number of clinical AFP cases, particularly in the states of UP and Bihar. Such high incidence on non-polio AFP has not been reported from anywhere else in the world.
Recommendation: These reported cases need thorough evaluation, including clinical follow-up, to assess the possible causes and sequelae thereof. There is also an urgent need of establishing an independent agency (separate from NPSP) for carrying out surveillance activities and their review.
Conclusion 3: Administration of multiple doses of mOPV1 in a pulse manner to a very large number of children in different states of the country is unprecedented. It is alarming that the same is being done as phase IV clinical trial without following the established national guidelines for such trials.
Recommendation: There is a need to immediately evaluate the impact and side effects, if any, of the use of multiple doses of mOPV1.
Conclusion 4: At present there does not appear to be a coherent policy for the future keeping in mind the possibilities of: (a) pockets of continuing circulation of WPV; or (b) ultimate cessation of circulation of WPV.
Recommendation: There is a need for an independent National Expert Group to consider future strategies, which would be best, suited to our country within the overall objectives of the Global Polio Eradication Initiative. The feasibility and desirability of introducing IPV and the suitable timing for the same also needs to be examined by this expert group. There is urgency for deciding on these issues with a view to establish and achieve self-sufficiency in manufacturing of IPV in the country, if it is considered desirable to introduce IPV in the immunization programme.
Conclusion 5: The number of cases of VAPP is not available in the public domain. It is not known whether any effort is even being made to delineate cases of VAPP.
Recommendation: District wise and state wise data on VAPP should be made available on a regular basis. Efforts must also be made to assess VAPP among contacts of Vaccinnees. It is also important that the state initiates a comprehensive programme of rehabilitation and possibly compensation for the victims of VAPP.