India on verge of eradicating polio

From the Los Angeles Times:

Reporting from Moradabad, India — Scientists, health workers and community outreach officials in India believe they're finally on the cusp of a major milestone, the defeat of polio throughout the country.

The polio virus, which attacks the nervous system, has been largely eliminated in most other countries through immunizations. But it has remained a frustratingly significant threat in India, as well as in Nigeria, Afghanistan and Pakistan, largely because of unsanitary conditions. It wasn't too long ago that polio killed or crippled 100,000 children in India each year.

In a nation that sees itself as a future superpower, the disease's continued widespread existence puts the spotlight on the side of India where most of its 1 billion population lives, far from the widely promoted "Incredible India" advertisement campaigns, expensive BMWs and glitzy shopping malls.

Moradabad, in western Uttar Pradesh state, has for some time been among the worst-affected polio districts worldwide, because of poverty, dense living conditions, poor sanitation, entrenched superstition and transient population. The disease spreads when virus-infected fecal matter enters a person's digestive system, usually through contaminated food, water or hand-to-mouth contact.

But now, as a result of a more effective vaccine, billions of dollars spent over many years and other factors, there are signs of success.

The number of reported wild polio cases in India, the kind that most often causes paralysis, has dropped dramatically from hundreds just two years ago to only one in 2011, and none in Uttar Pradesh. Also promising are record-level numbers of immunizations and virus-free water samples in places such as the slums of New Delhi and Mumbai.

"It's a little premature to take out the champagne," said Lieven Desomer, UNICEF's chief polio manager. "But we're extremely encouraged."

About 100 million Indian children younger than 5 in lower-risk areas receive the oral polio vaccine two or three times annually, and about 70 million children in high risk areas such as Uttar Pradesh receive it 10 times a year.

Donor organizations such as the Bill and Melinda Gates Foundation, UNICEF, the World Health Organization, Rotary International and foreign governments have set an ambitious goal: to eliminate polio worldwide by 2013.

Some people in India remain wary. There have been near-victories before. And polio is a wily opponent. The real test will come after the July-September monsoon season, when water-borne transmission is greatest.

Furthermore, nations are considered polio-free only after going three years without an outbreak, something that requires constant vigilance. New epidemics can flare quickly.

Critics say the efforts to beat polio have commanded a disproportionate share of resources and that money could be better spent on deadlier diseases. Dr. Yash Paul, a pediatrician based in Jaipur, also argues that reporting is skewed by Indian officials inflating progress to protect their jobs.

Deepak Kapur, a New Delhi-based printer and head of Rotary International's Indian polio program, said one of the biggest problems, particularly in impoverished Muslim communities, is a suspicion that vaccines are actually chemicals designed to sterilize their children.

Muslim cleric Mohammad Omar, 37, is a key ally in fighting such misconceptions. From the Moradabad mosque's loudspeaker, usually reserved for calls to prayer, he belts out his message across the neighborhood. "I recommend you get polio drops for your young children today."

He says people trust him. "And it's not just for them," he said, dressed in a light blue traditional shalwar kameez and green scarf. "If someone gets polio and I could've prevented it, I must answer on judgment day."

Neighborhoods using the vaccination as leverage for obtaining government services present another challenge. Such services in India are often poor and corruption is entrenched. Late former Prime Minister Rajiv Gandhi once said that often less than 15% of government spending reaches its intended recipients. So when polio vaccinators show up, they're sometimes a lightning rod for pent-up frustration, prompting some residents to resist unless they get other benefits.

"Some say, 'If you give us a road, we'll let our children be vaccinated,'" Kapur said. "Their kids become a bargaining chip."

Health workers respond by trying to explain that the residents are only hurting themselves.

Another challenge comes when children contract polio despite repeated inoculation, which parents cite as "proof" the vaccines don't work. However, filth, limited clean drinking water and lack of breastfeeding result in chronic diarrhea, leaving children unable to hold the vaccine in their bodies for long, said UNICEF specialist Rod Curtis.

Haddi Mill, a community along Moradabad's rail tracks filled with impoverished migrants from West Bengal, is of particular concern to scientists because the only significant case of wild polio this year came from West Bengal. Medical experts say everyone traveling home is a potential conduit for re-infection.

"It's very alarming," said Dr. Hamid Jafari, the World Health Organization's polio project manager in India. "We don't want any virus getting a foothold."

Aiding in the fight are local women put in charge of getting neighborhoods inoculated. Handouts distributed at the vaccination booths to attract more parents include wheat supplements, whistles and visors. And teams of children known as bulawa tolis, or calling groups, go house to house on inoculation days browbeating parents.

"If parents refuse, I keep at it," 12-year-old Aggarwal said. "I enjoy helping."