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India struggles to meet polio deadline

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7258.403/a (Published 12 August 2000) Cite this as: BMJ 2000;321:403
  1. Rohit Sharma
  1. Mumbai

    Several Indian states have “unacceptably low” rates of immun-isation of children against poliomyelitis, and the country's goal of eradicating the disease by the end of the year is still proving elusive. Although many areas have made substantial progress in reducing prevalence, poor performance in Uttar Pradesh, Bihar, West Bengal, and Delhi means that India has around 40% of the world's polio cases.

    “There are pockets where almost 86% of children have been missed in the last year for immunisation and may not be protected against polio,” said Dr Stephen Atwood, chief of health at Unicef, India. The Indian Academy of Pediatrics recently held a workshop in New Delhi to highlight the problem. According to Unicef, the greatest challenge is to maintain an effective “cold chain” for storage of oral polio vaccine.

    Several cases have been reported of children contracting polio even after receiving up to a dozen doses of the vaccine. Although health ministry sources deny any problems with the cold chain system, Unicef officials believe that recurrent electricity failures—lasting days sometimes—are undermining the immunisation effort. “We know there are lapses in the cold chain,” said Dr Atwood. Experts attending the New Delhi workshop also cited in-adequate staffing, lack of coordination between different working units, and low public awareness of the importance of immunisation as additional adverse factors.

    The overall prevalence of polio in India, however, is declining rapidly. In 1999, 7086 cases were reported worldwide, of which 2814 were in India. Up to June 2000, 394 global cases have been reported, of which 70 were in India. The government plans an intensive drive in the autumn to increase the vaccination rate in the underperforming areas. “We are hopeful that at least 28 Indian states—possibly all—would have interrupted transmission by the end of 2000,” said Dr Atwood.


    Embedded Image

    Indian schoolchildren holding placards and banners in Delhi last year in support of the country's drive to eradicate polio

    (Credit: JOHN MACDOUGALL/AFP)

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