[Ip-health] The politics of polio

[Sangeeta]

Date:11/06/2008 URL:
http://www.thehindu.com/2008/06/11/stories/2008061151410900.htm
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Opinion - News Analysis

The politics of polio

Pushpa M. Bhargava
Even the appropriate WHO document clearly states that there is evidence tha=
t
OPV has not worked in developing countries.

That Sabin=B9s oral polio vaccine (OPV) has not been able to eradicate poli=
o
in our country, is now well established (inter alia, Economic and Political
Weekly, 4-11-06, p. 4538-4540; and 23-12-06, p.5229-5237; Tehelka, 11-11-06=
,
p.8-9; The Hindu, Hyderabad, November 13, 2006, p.11; Down to Earth,
31-12-06, p.24-31; Conclusions Recommendations of a National Consultative
Meeting organised by Ind ian Medical Association in New Delhi on May 14,
2006; Editorial in the Indian Journal of Medical Research, (IJMR), January
2007, p. 1-4; and numerous other articles in some of the world=B9s best kno=
wn
scientific journals, such as Science.)

Not only that the cases of non=ADpolio acute flaccid paralysis (AFP) in tho=
se
vaccinated with OPV have shown a dramatic rise. It appears that in 2005, in
Uttar Pradesh alone, 4,800 had residual paralysis, or died after acquiring
non-polio AFP, in comparison to the all-India figure of 4,793 polio cases i=
n
1994; the 2006 data, after six doses of monovalent OPV, are worse. The
infructuous expenditure on the OPV programme would probably run into
thousands of crores.

The pity of it is that all this was anticipated (Bhargava, The Hindu,
December 12, 1999 ), and that we could have easily eradicated polio from ou=
r
country by now. We did not do so because our successive governments and
those who worked for them in responsible positions such as Secretaries and
Joint Secretaries in the Ministry of Health, Directors-General of Medical
and Health Services and even of the ICMR, were primarily (exclusively?)
committed to personal and certain foreign interests and not to the cause of
polio eradication. Here is the story with which I was, in the initial
stages, connected.

Two types of vaccines
There have been two types of vaccines available against polio: the
injectable Salk vaccine (IPV) and the oral Sabin vaccine (OPV) using an
attenuated live virus. Till the early 1980s, OPV was used in the developed
countries to maintain the polio-free status that had been largely achieved
through the use of IPV beginning the 1950s. By 1988, Jonas Salk (one of the
most celebrated scientists of the last century who made the first successfu=
l
polio vaccine, the IPV) had developed an enhanced potency injectable vaccin=
e
(M-IPV). In a letter dated December 1, 1988 to me, he wrote, =B3It is urgen=
t
that the incidence [of polio] be reduced as rapidly as possible. A simple
way would be to administer a single dose of the enhanced potency IPV
(M-IPV), to all those of six months of age or over who may have already
received one or more doses of OPV (some of whom we know, from experience ma=
y
not have been protected), and to those of the same age who may not have bee=
n
previously immunised against polio. A single dose of M-IPV of sufficient
potency will induce antibody and/or immunologic memory in nearly all infant=
s
of that age. For infants less than six months of age who still possess
maternal antibody, two doses, preferably, one with DTP are necessary.=B2 I =
had
forwarded this letter to everyone concerned in the country with the polio
vaccination programme at that time, but no one took any note of it.

Evidence against OPV
Even before I had received the above-mentioned letter from Jonas Salk, at a
meeting held in Delhi in March 1988, convened by Sam Pitroda, the then
Adviser to the Prime Minister for National Technology Missions, overwhelmin=
g
evidence was presented that OPV had not worked in India (Bhargava, The
Hindu, December 12, 1999 ). Virtually every one concerned with polio was
present at this meeting at which an unambiguous decision was taken to shift
to IPV.

I quote from the official minutes of this meeting:

=B3Expedite establishment of M-IPV programme. On moral grounds and consider=
ing
the involvement of the lives of our children, cost shall be no
consideration. Indigenous production of IPV before 1991 shall be aimed at.=
=B2
=B3Whenever children in large numbers are dying, getting afflicted with pol=
io,
the empty and hollow argument of their being used as guinea pigs cannot be
accepted.=B2 =B3As new M-IPV programme ramps up, the OPV will ramp down.=B2
Although IPV has always been more expensive than OPV, this is compensated b=
y
the fact that one may need to take only one or at most two doses of IPV
whereas, in the case of OPV, the number of doses could be above ten.

It was clear that, for some time, OPV will continue to be with us. In fact,
the then Secretary of the Department of Biotechnology (DBT), S.
Ramachandran, had been earlier to the Soviet Union and, with their help, a
factory (BIBCOL) to produce OPV was set up in Bulandshahr.

In keeping with the decision of the 1988 meeting =8B the only meeting of
experts and concerned people so far convened by the government in regard to
polio vaccination programme =8B another company called Indian Vaccine
Corporation Ltd (IVCOL) was set up with a capital outlay of Rs. 90 crores.
Both DBT and the Indian Petrochemicals Ltd. of Baroda had equity in it even
though the majority shares belonged to Institut Merieux, one of the world=
=B9s
largest, most reliable and respected vaccine producers that was committed t=
o
produce M-IPV which was far more heat-stable than OPV.

Obliging WHO
But we hadn=B9t reckoned with our primary commitment to the interests of th=
e
developed countries. As already mentioned, by this time the West had decide=
d
to replace OPV with M-IPV. Therefore, market had to be found for OPV. WHO
advised that developed countries use IPV, while developing countries use
OPV. For us to oblige WHO, two steps were necessary: (1) that BIBCOL
produces no OPV of its own; and (2) India reverses its decision to graduall=
y
shift to IPV. Both the steps were taken. BIBCOL has not produced a single
dose of OPV till today, and the Ministry of Health decided soon after the
March 1988 meeting, without any further consultations, to shift permanently
to OPV. Consequently IVCOL was closed down after incurring substantial
expenditure, and a number of senior officers of the above Ministry got plum
U.N. jobs with tax-free dollar salaries, after retirement.

It is particularly interesting that at a conference jointly organised by th=
e
International Comparative Virology Organisation and the WHO in New Delhi, i=
n
January 1992, experts from all over the world indicated the preference of
IPV over OPV for any plans of eradication of polio in developing countries.

Problem continues
An interesting question that one may, therefore, ask is: if we really felt
that there was a strong scientific case for using OPV (which there wasn=B9t=
),
why did we not make it ourselves. The answer is that this wouldn=B9t have
served the foreign interests to whom we had sold ourselves, ignoring the
interests of our own people and the sane advice of our own experts based on
incontrovertible evidence. It is amusing in this context that even the
appropriate WHO document clearly states that there is evidence that OPV has
not worked in developing countries.

The 64,000-rupee question now is: would the government wake up and get out
of the clutches of WHO so that it may serve our interests and not the
interest of powers that be outside India? And if it needs endorsement from =
a
foreign channel, it may read the article by V.K. Bhasin in January 2008
issue of Nature Biotechnology, Nature being perhaps the world=B9s best-know=
n
and most respected scientific periodical. The article says that, in 2006,
there were 1,600 cases of OPV=ADinduced polio plus a large number of cases =
of
AFP from which virus was not cultured.

So, the problem continues. But who cares! Polio is not a disease of
billionaires.



(Dr. P.M. Bhargava is former vice-chairman, National Knowledge Commission.)

Corrections and clarifications

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