A few years ago, health officials proudly heralded the end of polio in India. Following the government's programme to completely eradicate polio by 1997, as many as 33 Indian states and union territories had eradicated the virus. But in 2006, there is bad news; Uttar Pradesh, home to over 170 million people, has registered 474 cases during the year, raising fears of a resurgence of the virus. Elsewhere in India, there were a few hundred more cases reported, but it is in UP that the risk of contracting polio is greatest; nearly ninety per cent of the new polio cases in India are from this state. The deadline for polio eradication has now been pushed back to 2010. To be declared polio-free, India should show no new cases for three years.


India 		571
Bangladesh	15
Indonesia	2
Nepal		2
Cambodia 	1
China 		0


Uttar Pradesh	474
Bihar		46
Haryana		14
Uttaranchal	13
Punjab		5
Delhi		5
Maharashtra	4
Gujarat		3
Madhya Pradesh	3
Assam		1
West Bengal	1

 •  Resurgence worries officials
 •  The unfinished war

Of the 1,763 global polio cases this year, as many as 571 are from India. In 2005, there were only 66 polio cases; the figures for 2006 are thus ten-fold higher. There is plenty of money available to fight polio - the National Pulse Polio Programme had an outlay of Rs.925 crores in 2004-05 and Rs.877 crores in 2005-06. But the political and bureaucratic will have been found lacking.

Global fear

The outbreak is sending shivers not only in India, but all over the world. The crippling disease is endemic in four countries: India, Afghanistan, Pakistan and Nigeria and is a potential danger for 190 other countries who have today become polio free. United Nations Secretary General Kofi Annan minced no words when he wrote to Prime Minister Dr. Manmohan Singh, noting that the outbreak in India could result in the disease being re-introduced to many countries that have completely eradicated the disease. These fears are real. Indian states that were complacent that the spread of the disease had been controlled are now awakening to new instances being reported. Annan said that the outbreak in Uttar Pradesh had resulted in the virus spreading to polio-free parts of India, and to Nepal and Bangladesh.

For centuries, poliomyelitis crippled and killed thousands of children ever year. With a vaccine invented by Jonas Salk in the 1950s, it was eradicated from the Western world. But it continues to plague some of the poorest pockets in the world, including India. The virus is now circulating in only seven countries around the world, reduced from over 125 when the Global Polio Eradication Initiative was launched in 1988. The seven countries with indigenous wild poliovirus strains are India, Nigeria, Egypt, Pakistan, Afghanistan, Niger and Somalia. The World Health Organization, Rotary International, the US Centers for Disease Control and Prevention and UNICEF together spearhead the Global Polio Eradication Initiative. In 1988, when the world launched its drive to eradicate polio, there were 350,000 new cases in 125 countries. These organisations aggressively helped make most of the world polio free by 2005.

The polio virus strain from Uttar Pradesh is now reported to have spread outside the country's boundaries to neighbouring Nepal and Bangladesh. The strain was also found in Mumbai, which sees a lot of migrant labourers arrive in search of work. The world is waking up to the threat. Saudi Arabia, for instance, says that travelers under the age of 15 from polio affected countries like India will have to show valid proof of polio vaccination to enter.

Poor management

What went wrong in Uttar Pradesh? Government officials point out that slackness in immunisation programmes could be one reason. Poverty, dense population, poor hygiene, poor sanitation, pathetic health services, dirty surroundings in the small towns and rural areas makes the state a fertile ground for the polio virus to flourish. 63 per cent of the people in the state have no access to sanitation. In addition, says the journal Science, malnutrition is a contributing factor. If the immune system is weak, it is ideal for polio to strike. As many as 52 per cent of UP children suffer from malnutrition, according to the Nutrition Foundation of India. In Moradabad district famed for its brasswork, reported 64 cases this year. And in neighbouring Bijnor, 27 cases were found.

UNICEF's State of the World's Children 2007 report reveals that only 58 per cent of the newly born got polio drops after birth this year. 250,000 babies are born in the state each month, and a very high number are therefore left unvaccinated.

- Immunize every child aged one year with at least three doses of oral poliovirus vaccine (OPV). Paralytic polio can be caused by any of three closely related strains of poliovirus. Infants should receive three routine OPV doses at ages 6, 10 and 14 weeks.

- Step up investigation of all cases of detected Acute Flaccid Paralysis (AFP) to identify all reservoirs of polio transmission.

- Have immunization days every month that should be heavily publicized.

- Organize aggressive media campaigns that can be sponsored in public interest, and get celebrities to endorse them.

- Get religious leaders to talk about the need to allow polio drops to be administered.

 •  Resurgence worries officials
 •  The unfinished war

The Union Health Minister, Anbumani Ramadoss told Parliament that the failure in Uttar Pradesh was possibly due to the poor quality of immunisation, where many children were missed. He said the state's crowded and unsanitary towns interfered with the efficacy of oral polio drops. The polio outbreak is an opportunity for the state government to order a clean up, just as was in the case of Surat which was affected by plague many years ago; Surat today is one of the cleanest cities in India.

Mistrust of the vaccine

But there is another anachronism looming large in the state. Around 70 per cent of the new polio cases have been found among the Muslim community though their form just about 13 per cent of the Indian population. Health officials were aghast when they found that Muslims were refusing to allow their children to get the polio vaccine administered through drops, as they felt that it was a clever ruse to limit their population, and the drops would make their children impotent. Banners and posters were put up in the state's villagers telling Muslims that health workers should not be welcomed as they were carrying a potion that the West had invented to limit their population. In some rural areas, Muslim clerics were found to have told their followers to shun the vaccine, calling it 'evil' and part of a conspiracy by the Hindu-dominated government.

To complicate this further, poor Muslims also do not usually get the attention of the state health services, and the new-found interest among officials to immunize every Muslim child is therefore viewed with sceptism.

With 70 per cent of the global cases of the virus reported here, the war against polio must be won in Uttar Pradesh, or health officials elsewhere too will not be able to breathe easy. The assembly elections are around the corner in the state, but so far no one, not even the opposition, is talking of polio eradication. Central minister Ramadoss says that the government will now start a special programme to enlighten the Muslims to dispel their fears about the polio vaccine. He said he would take the help of clerics to do this. The government is now persuading Muslims clerics to talk during prayer meetings about the importance of containing polio, and helping people understand why the drops have to be administered to every child.