Clue in the missing numbers

The children left out of the immunization drive hold the key to the recent outbreak of polio cases, writes Sonu Jain

ON a lengthy form to be filled by the pulse polio vaccination team, there is an X marked against a few names. The Xs are the families/children left out of the immunization drive. These hold the key to the recent outbreak of polio cases in India.

All through last year, the Xs kept increasing in Uttar Pradesh, especially in western UP, the epicentre of this year8217;s outbreak. The state government blamed it on defective vaccines, the faulty cold chain and the minority community8217;s refusal to cooperate.

But it all points to an administrative failure, starting from the block level medical officer and the CMO in the district to the chief secretary of the state who is supposed to hold review meetings on the Pulse Polio Programme PPP.

A compilation undertaken by the central government shows a clear pattern: the cases of polio were the highest where the largest percentage of children were not given the vital drops.

Cause for concern

IT is certainly a worrying development since 2005 was a very good year for the PPP. The number of districts infected and cases were coming down. There was realistic hope that polio could be eradicated by the end of 2006. But those familiar with the workings of the virus were not celebrating. They were aware that if not completely rooted out from every district, it can resurface. And that is exactly what happened. This year, the cases quadrupled see graphic.

Districts in western UP that had successfully fought the virus, fell again: Meerut, Saharanpur and Muzaffarnagar. Meerut had 0 cases in 2005. This year, it had 23. It was also discovered that the Indian polio strain had spread to other countries in Africa. The UP strain was found in Mumbai sewers as well. The WHO was forced to revise its high-risk zone. There is renewed concern not just in India but all over the world India is one of the four countries in the world that has failed to eradicate polio, the others being Afghanistan, Pakistan and Nigeria.

8216;8216;It is not as if it can8217;t be done. There have been districts in western UP where the virus has been eradicated at least once. It can be done again,8217;8217; says Jay Wenger, head of National Polio Surveillance Programme. 8216;8216;What is required is a uniform approach,8217;8217; he adds.

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Wenger agrees that more than a technical exercise, it8217;s a management one. In UP alone, there are 37 million children to be vaccinated. The procedure the state follows is this: It sets up vaccination booths, an exercise it widely advertises. Usually nearly 40 per cent of the state8217;s children turn up at the booths. In the second stage, a team A is formed which goes door to door, trying to reach every child. When they come across a child they put an indelible mark on her finger; if they don8217;t find her at home they mark an X for the house. They return in the evening to check again. The list of X houses is passed on to team B which follows a few days later. It is a bigger team 8211; it has doctors as well as prominent members of the community.

After their visit, a new list of X houses is given to the block level health officer the same day, then to the CMO of a district within the next few days. So, there is no way any administrator associated with the programme can feign ignorance on the status of implementation of pulse polio.

Clear Evidence

THERE is clear evidence that it8217;s areas where the children were left out of the vaccination drive that have reported polio cases. Consider this: In Budhan block, 13-14 per cent houses were left out between January and July 2005 and it has reported 7 cases. In Kairana, the missing figure was 12-13 per cent and the block threw up two cases. Kandhla reported 13-14 per cent missing houses and three polio cases. There is a whole list of blocks where this correlation has been found.

In a press conference this week. Health Minister Ambumani Ramadoss admitted that 8-15 per cent children were left out of the vaccination drive in UP last year. On the other hand, blocks where only 0-5 per cent houses were left out the drive threw up no polio cases. There is more evidence8212;WHO surveillance team collects and tests random stool samples to detect the presence of vaccine. It fell from 11 per cent in January 2005 to 4 per cent in April-June 2006 in Moradabad and JP Nagar see graphic. The polio cases started surfacing in January this year and since then the graph has only been going up.

Link with immunization

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IN the last few years there has been an attempt to link the polio exercise to routine immunization as well. UP which initially had 10 per cent coverage now has 30-40 per cent. 8216;8216;In Delhi the pulse polio teams distributes pamphlets for routine immunization dates. This is ideal,8217;8217; says Wenger.Now Ramadoss has set a new date for banishing polio: 2007. Hope India turns up for the date.