Poverty is not an excuse

Polio is still widespread in India, and better education is needed if it is to be eradicated through immunisation, says Sanjit Bagchi

One day in January this year, I was visiting a slum in north Bengal, and I saw a beggar boy, who was almost crippled, being bitten terribly by a man. On asking neighbours, I found out that the man was the boys father, and he was biting his son as the disabled boy had earnt nothing while begging for the past three days.

The father was a drunk, and much like other residents of the slum, the boy and his mother (a maidservant in a family) were the breadwinners of the family. I gave some money to the boy and tried to become friendly with him. I found out some of his life story, much of which seemed quite sad to me.

“Im Niru. I cant move because my legs are not like yours. I cant write, as my hands are too weak to do any work. Im now 18,” he explained. “But, I wasnt born with all these disabilities. My mother says that I was like other healthy children ‘til two years old, but after that I suddenly got an attack of a very dangerous disease, which gradually made me crippled.

“A doctor once visited our slum. He said that I had polio and that I was suffering from it as my parents couldnt have given me ‘tika for that disease in my childhood.” The word “tika” means “vaccine,” in eastern India.

Stories like Nirus are common in the Indian subcontinent. Harrisons Principles of Internal Medicine says, “In 1988, the World Health Organization adopted a resolution to eradicate poliomyelitis by the year 2000. From 1988 to 1997, the number of cases worldwide decreased by 89%, with about 6227 cases reported from 46 countries in 1998. More than 80% of the worlds cases of confirmed polio in 1998 were in India, Pakistan, Bangladesh, and Nigeria.” According to another study, up to the end of 1999, more than 38% of polio cases the world over were from India.

Blaming poverty for the problem might not be wise. It is a feature of all developing countries, and, anyway, polio vaccination is completely free of charge. The Indian government has been working to eradicate the disease.

A national immunisation programme to prevent polio started in 1978. But it did not do much to wipe out the disease. In 1995 the Indian government started mass immunisation, calling it the Pulse Polio Immunization (PPI) programme. Under this project, millions of children below the age of 5 years were administered oral polio vaccines to immunise them to the disease. And regular PPI programmes have taken place since 1995. But the programmes are unable to cover 100% of the at risk population.

Why? There are many reasons, but I think the most important is the lack of education among parents. Many parents are uncooperative with the vaccination programme in India. Lots of them forget the date of vaccination, and some avoid vaccination fearing the adverse effects caused by vaccine itself on the childs health.

“No. No, doctor. my child is quite healthy ... we wont allow you to cause any harm to him unnecessarily,” a father said to me when we visited a home at Kolkata (an Indian city) for the door to door pulse polio eradication programme. I talked with the father, ultimately convincing him to let us give his baby the vaccine, but it did take more than an hour.

In developed countries, like the United Kingdom and the United States, polio is no longer a disease of concern. Harrisons book says, “After a peak of 57 879 cases of poliomyelitis in the United States in 1952, the introduction of inactivated vaccine in 1955 and of oral vaccine in 1961 ultimately eradicated disease due to wild-type poliovirus in the western hemisphere.”

I do not think it is monetary wealth, but sound health education which should be given the credit for the eradication of polio in developed countries. People in the Indian subcontinent are commonly still lacking basic health education. In order to eradicate polio from this region, the quality of health education among parents must be improved. Effective prevention of polio is impossible without this.

There should be mass public awareness campaigns before immunisation programmes. Polio has no cure and vaccination will do no harm to the children. These two facts should be made clear to everybody. A perfect coordination between the health administration, social and political organisations, and the population at large is desperately needed. Not much can be achieved unless everybody pitches in to help in the eradication programme.