PULSE POLIO PROGRAMME AND OPV---- The Government Stand

When Albert Sabin discovered Oral Polio Vaccine (OPV) he made a point to the WHO that the vaccines contain live polio virus. Though cheaper than IPV, it carries a risk of pathogenic reversion in the vaccinated individual. He reminded the countries using OPV to immunize children that it is not the ultimate, but the immediate solution to control polio, and that they should switch back to IPV or a clinically balanced combination of OPV and IPV. The issue that we have come across in recent years in our country is that over 4,000 immunized children with OPV have shown polio like symptoms and there are numbers above it who have died. The question arises when majority of countries e.g. USA has recourse to use IPV since 2000, how India justifies the continued use of OPV even today? And the most serious question that prevails –Can India, ever become Polio free?

Modern polio vaccines are based on viruses grown in bulk in tissue cultures derived from monkey kidney cells. Live attenuated vaccines such as OPV generally elicit a stronger and long-lasting immune response than is provoked by ‘killed’ viral antigen preparations like IPV. The strong IgA response elicited by OPV in the gut also gives a high level protection against infection with wild-type, I repeat, ‘wild-type’. The ease with which an oral vaccine can be given and its low cost has made it very popular. Hence OPV has replaced IPV in many countries.

However we cannot ignore the danger associated with the OPV. As I have mentioned before, OPV contains live virus, so there is always a possibility of pathogen reversion in the vaccinated individuals. Genetic changes that occur in the attenuated strain are reversed, or new mutations are acquired, to provide a virus with similar properties to the wild-type strain. The closer the similarity between the wild-type strain and the attenuated strain, the greater the chances of pathogenic reversion occurring. In the past three years, over 4,000 children have been tested positive with vaccine-associated paralytic polio (VAPP). By contrast with OPV, IPV has been responsible for only one instance of VAPP in its 50 years history. For this reason countries like Netherlands, USA and many more have increasingly switched back to using IPV, or a combination of IPV followed by OPV to maximize the safety and effectiveness of each vaccine.
Trusting that the children can be saved from Polio, we are vaccinating them with OPV. But simultaneously, we are also throwing them in the clutches of VAPP. Injections are costly but less risky. In comparison, drops are 25 times cheap, and easy to administer, the least responsibility our government is ready to carry. In recent times the government has declared that some children whose stool did not yield wild-type polio virus, still yielded vaccine virus. Many doctors, who expected such instance of vaccine associated paralysis to be around 180, were alarmed that in the last three years alone they totaled to about 4,400. Doctors are raising ethical concerns about such issues and started addressing the press that Pulse Polio Programme has failed in India, and that it has many associated problems. A recent example of such concern was published in The Hindu, Delhi Edition.

During these 12 years that the Pulse Polio Programme continued, people, both lay and medical practitioners alike, were misled by the Government’s propaganda: that “polio drops are completely safe”, “Get your children vaccinated again and again”. Media, filmdom, and even the Honorable President of India were made use of in spreading this untruth. The Government of India knew well though -like the WHO did too- that VAPP cases would surely emerge in the process. Had the Government taken people into confidence, explained the risks involved in this programme truthfully, gone on with it with their consent, examined any VAPP cases that emerged, and paid pre-arranged compensations to such victims honestly, it would have been OK. Instead, by keeping the information on VAPP secret, by spreading untruth, by declaring the numbers of only “confirmed wild polio cases” and putting all other Acute flaccid paralysis cases (AFPs) into “discarded” category- in an apparent effort to cover up the exact numbers of VAPP victims, by not taking into account the deaths following vaccination, and by employing many such devious methods, the Government of India complicated the issue.
A very simple answer to this behavior of the Government of India was drawn in a seminar that occurred at AIMS. The panel of doctors participated derived the result that India continue to hide from its responsibility because it do not want the huge funds that it receives from the WHO to stop. India every year receives millions of dollars from WHO for Polio eradication. There exists corruption at the top ministry involving the constructive deploy of these funds. Had India sincerely taken steps to eradicate Polio, Polio would have been a history. But yet even the Pulse Polio Programme, the trusted and famous endeavour of the Government of India, has failed to reach the remote part of Bihar, Jharkhand, UP, Uttrakhand, MP and many eastern states of India, where this PPP is not sincerely monitored.
After pondering over the issue for a long time, I concluded that all I can do is to create awareness among the people. People should understand the threats associated with the use of OPV. And now, it’s their own responsibility to protect their children from Polio and VAPP. The Government of India, like always, has failed to carry its responsibility in this matter also. One thing our government never fails in is- “Failing again and again!”