Policy Wise

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A recently held global conference debated a vital question; Is it time to give up the dream of eradicating polio? By all measures, the polio eradication campaign, first launched in 1970’s, has been a huge success; the incident rate has dropped by more than 99% and less than 2000 new cases of polio were reported in 2006. However, in the last five year, despite the strenuous efforts of the World Health Organization and the governments concerned–there has been very little progress. This isn’t really surprising since polio remains endemic in countries like India and Afghanistan where public health facilities are still poor.

The case for ending the polio eradication program and concentrating on a control strategy is four fold. First, resources; In a world where public health dollars are at a premium, it is questionable if billions more should be spend on polio eradication. This year the World Health Organization will be spending close to 500 million$ on polio eradication. Even among the affected states, polio is consuming huge resources–India has budgeted 1200 crores ( 300 million$) for polio eradication in the year 2007-08. Second, it’s taking the attention away from far bigger public health challenges–Tuberculosis still kills close to 300,000 Indians every year and A.I.D.S is an ever-increasing problem. Third, the only way to eradicate polio is to hold multiple campaigns where every child below the age of 5 needs to be immunized simultenously.This is not only tiring for the public health officials but leads to development of resistance among people–how many times can you convince an individual that polio drops are good for her kids? Fourth, polio campaigns are a logistical nightmare especially in a country like India where the cold chain is not always maintained, any morbidity due to the vaccine can lead to a backlash against the entire program and a general distrust of such public health efforts.

Despite such considerations, perhaps, it still makes sense to attempt to eradicate polio. For one, huge amount of resources have already been invested and it is questionable if the same commitment can be expected again. For another, giving up now would be hugely discouraging to health professionals and even governments. Also, due to its very nature, polio can stage a comeback.

However, it needs to be clearly established that the program cannot continue indefinitely and hence a goal-oriented strategy needs to be drawn up.In my view, two things are important.

First, while following a broad global strategy, local factors must be taken into account. In India, for example, polio is largely restricted to metropolitan town with large floating populations and few districts of U.P and Bihar. They require slightly different approaches. In larger cities like Delhi and Mumbai, a renewed focus on slums is imperative–this would also require keeping track of the floating population and even, administrating the drops in their home towns. On the other hand, in U.P, the problem is largely restricted to Muslim dominated areas. The government needs to involve the local clerics and other community leaders to win the trust of the people. Also, in most such households, women are the primary decision makers as men are migrant labors. Hence, it would be useful to concentrate on them and win their trust.

Second, the most important (and sadly the most neglected) element in the fight again Polio is the local community worker. No one knows the community, its needs and demands as well as they do. Since most of them live among the community, they enjoy its trust. However, they are grossly overworked and underpaid–typically 25 rs for a full day of door to door vaccination. It is essential that they are properly trained and adequately paid for their work. Also, their inputs and suggestions should be taken into account.

Finally, Polio eradication campaigns need to be coupled with larger public health programs which may be more directly relevant to the community. This would ensure community support and the much needed political impetus to the polio eradication program.

Polio can still be eradicated but the time is now. Without a renewed focus and a re-worked strategy, we might never see the end of polio

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