India Loses Ground in Effort to Stop Polio

Rani Begum lost her faith somewhere in the wretched slums sandwiched between fetid sewage canals on the eastern outskirts of Calcutta.

Despite her poverty, Begum obeyed the constant reminders by local health workers to take her two little girls to the clinic for oral polio vaccine.

But her youngest, 2-year-old Simran, now sits idly on their woven bamboo mattress, her left leg limp since she contracted the crippling disease last year.

“I have no faith in these people anymore. Despite the polio drops, my child was hit with it,” Begum said.

Such feelings are worrisome for the international campaign to wipe out polio.

India saw a dramatic sixfold increase in polio cases last year, indicating a decline in children getting the vaccine. Health workers blame distrust in the government, official disgruntlement over the program’s cost and rumors among Muslims that the vaccine can cause infertility.

Health workers don’t know why Simran contracted polio, but say her mother probably didn’t follow the correct dosage or the vaccine was not potent from improper refrigeration or mishandling.

India reported 1,556 new cases last year, 84% of all cases worldwide, the World Health Organization says. That’s solid progress from the 1980s, when India had as many as 200,000 new cases a year. But this nation of 1 billion people is one of the world’s last reservoirs of the virus, and each new case increases the chance of its spreading.

“We are so close, we cannot allow all our success to go to waste,” said Dr. Anubha Ghose, a pediatrician who contracted polio as a child, before there was a vaccine. “This last push is the most difficult, but we have no option but to move forward.”

Ghose, director of health for the humanitarian group CARE India, said the government has grown weary of the effort to vaccinate all children against polio, having spent $300 million since 1996. Officials wonder if the money might be better spent on diseases that kill more children, such as malaria and cholera.

“The bureaucrats who are allocating the money, they cannot say at the end of the day that they saved so many children,” she said. “We can only say to them: It’s our responsibility to the world.”

Federal health minister Sushma Swaraj recently proclaimed that India would be free of new polio cases next year despite the upturn. She blamed the increase partly on “fictitious reporting” in previous years by field workers competing for lower figures.

Polio typically strikes before age 5. It can cripple the spinal cord, causing paralysis and, in some cases, death. It is transmitted through food or water contaminated by the fecal matter of an infected person.

Although polio has been suppressed in many parts of the world -- the last case in the Western Hemisphere was more than a decade ago -- children worldwide will be at risk until the last case is wiped out.

“If you don’t eradicate it everywhere, it can come back and then you have to start all over again,” said Dr. Jay Wenger, WHO project manager for the National Polio Surveillance Project in India.

On May 13, WHO and its partners in the global eradication campaign announced that they will cut back on immunization programs in many countries to concentrate efforts in India and 12 other nations.

Carl Tinstman of the U.N. Children’s Fund said health officials learned a lesson the last two years when they cut back efforts in India, thinking that the virus was well under control. “It was a misjudgment,” he said.

When the worldwide effort began in 1988, with a goal of wiping out polio by 2005, there were 350,000 new cases in 125 countries. Last year, 1,866 new cases were reported, and polio was considered endemic in only India, Nigeria, Niger, Egypt, Somalia, Afghanistan and Pakistan.

In India’s West Bengal province, around Calcutta, there was one new case in 2001. Then last year, 48 cases were reported and, in the first four months of this year, 22 more cases occurred.

“This should be sending off alarm bells,” Ghose said.

Such alarm doesn’t filter down to Calcutta’s slums, where hunger drowns out any calls for global responsibility.

Begum, whose husband is a rickshaw puller, says there is no way she’ll get the last of the four polio doses for her older daughter, Pinky, 4. “The more you give the drops, the greater the chance you’ll get polio,” she said.

Across the city, Mohammed Taher, 14, limps through the sprawling slums around the Park Circus railroad station, along the Ganges River. He doesn’t go to school and is on his way to his job in a shoe factory.

Mohammed, whose left leg is badly twisted, believes he contracted polio when he was inoculated for measles as a toddler. “I don’t know anything about these polio drops,” he said with a shrug. “Anyway, it’s god’s will.”

Brothers Dawood and Mustaq Hussein, 16 and 14, also believe that it was their fate to contract polio. But they believe that it’s their duty to prevent it in others. “We’ve accepted it and we could care less,” Mustaq said. “We tell the mothers that they must get the drops or their children will end up like us.”

Many of the new cases have been among Muslims like Begum, Taher and the Husseins. Some in India’s largest minority fear the vaccine is part of a government plot to limit the Muslim population in predominantly Hindu India.

“There’s some distrust of the government in general because they don’t get much from the government in general,” said WHO’s Wenger. “And what little they do get, they tend to be suspicious.”

Prabhakar Chatterjee, director of health services for West Bengal, said such tales are hard to quell. He went house to house on the last national polio immunization day, April 6, encouraging parents to give their youngsters the polio drops. One Muslim couple with five daughters and one son resisted.

“I finally convinced them to agree to the five girls,” Chatterjee said. “But not the son. They worried the family name would die out if the boy was sterile.”

More national immunization days are planned this year.

Health workers are also reaching out more to Muslim schools and mosques, looking to the clerics who wield much influence in their communities.

Ghose, the CARE official, said India will not meet the goal of eradication by 2005. WHO requires a country to go without new cases for three years before it is certified as clear.

“If we get certified by 2010, I’ll be happy. But we are nowhere near that last case,” she said.