The fact that Oral Polio Vaccine can create polio in otherwise healthy children is still kept out of public discussion even as GOI went ahead with the programme 11years ago in 1995. Both IMA and the NPSP now acknowledge that Vaccine Associated Paralytic Poliomyelitis (VAPP) is a problem. The complex classification system that NPSP chose to adopt resulted in masking all instances of childhood paralytic diseases in India including VAPP related deaths, cVDPV and non- polio paralysis cases, in favor of confirmed polio cases that never formed more than 3% of the AFP cases chosen by NPSP. In addition it resulted in a large and unknown number of paralyzed children all across the country that were never tested. The paper argues that the GOI should apologize to the nation for hiding truth from public, that all children who developed polio in the post 1995 era are paid compensation, and that the scope of NPSP be expanded to include all children with any paralytic disease including VAPP. While criticizing NPSPs approach to club individual types of instances into monolithic categories, it argues that all children with AFP should be diagnosed fully. It exhorts GOI to make use of the infrastructure created by NPSP to further our national interests, and hopes that alternative medical systems find a genuine solution to the problem of childhood paralysis in India, so as to short-circuit the complications caused by such vaccination drives.
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Tuesday, February 20, 2007
Medico-Legal Scenario of Polio Eradication
Dr. Yash Paul's presentation in Medico-legal workship PEDICON-2007, Mumbai.
Monday, February 19, 2007
Polio vaccine in need of Public debate
Vaccine Victims need to be compensated
Trusting that children can be “saved” from the clutches of Polio if they are given polio drops, all of us have been vaccinating our children again and again for the last 12 years. As the Polio drops continued, so did the adverse reaction to it, called Vaccine Associated Paralytic Poliomyelitis-VAPP. According to Official estimates, over 4000 children in our country developed “polio like paralysis” in the last 3 years, as a consequence of consuming Oral polio vaccine. Over and above these are the children who died following vaccination. Let us all demand that the Government declare the names of these victims! Let us demand that whoever developed polio-like paralysis after consuming polio drops is paid suitable compensation!! Let us remind the Government of its responsibility to such children, who died following vaccination!!!
Poliomyelitis- Background
Paralysis of limbs during childhood is not uncommon in India. In the year 1988 alone, we had over 24,000 children developing paralysis in our country. The paralytic disease, characterized by fever and rapid progression was then called ‘Polio’ on clinical grounds. It was said that 3 types of polioviruses caused the disease, that Polio had only prevention and no cure. And the prevention was to be only through vaccination.
Polio vaccines were of two types: a. Injections, and b. Drops. Injections were costly, but less risky. These were difficult to administer, though. In comparison, the drops were 25 times as cheap, but they carried some risk. And they were easy to administer too. Both these vaccines contained in them, polioviruses. While the virus in the injections was already dead, the one used in drops was live, but was weakened sufficiently. The risk therein was that sometimes the live, attenuated virus in polio drops could back-mutate, become neuro-toxic and could cause polio-like paralysis in the recipients. Still, it was decided that India use polio drops.
Behind this decision was the pressure from international agencies. India was compelled into this quagmire by WHO with the allegation that “many countries in the world had become “polio free”, but India was still a source of wild polio”. Once begun the programme in 1995, we were assured that the polio drops were effectively reducing Polio. A new, virological testing facility was setup in India by 1998. Children who developed sudden paralysis of limbs associated with fever were now given a new title: Acute flaccid paralysis cases (AFP). Stool samples collected from these children with AFP were since tested virologically. In these AFPs, the instances of wild polio infections were shown to be going down. In the 27,000 odd children with AFP that were tested in year 2005, only 66 children were shown to have wild poliovirus infection. The remaining 26,000 odd paralytic children were simply- “discarded”. Hoping to reach the “Polio free” status soon, Government of India also enthusiastically increased the number of Pulse Polio Rounds in its endemic ‘endemic’ areas of UP and Bihar. There was hope that year 2006 would witness “zero incidence” of wild polio cases in India. But to the dismay of everyone concerned, year 2006 produced 624 wild polio cases in India, a-four-year-high. This led to widespread discouragement, and a dispute- the International agencies accusing the health staff of inefficiency and insufficient vaccine coverage, and the Governments’ pointing out to “vaccine failures”.
Vaccine Virus:
Vaccine Victims need to be compensated
Trusting that children can be “saved” from the clutches of Polio if they are given polio drops, all of us have been vaccinating our children again and again for the last 12 years. As the Polio drops continued, so did the adverse reaction to it, called Vaccine Associated Paralytic Poliomyelitis-VAPP. According to Official estimates, over 4000 children in our country developed “polio like paralysis” in the last 3 years, as a consequence of consuming Oral polio vaccine. Over and above these are the children who died following vaccination. Let us all demand that the Government declare the names of these victims! Let us demand that whoever developed polio-like paralysis after consuming polio drops is paid suitable compensation!! Let us remind the Government of its responsibility to such children, who died following vaccination!!!
Poliomyelitis- Background
Paralysis of limbs during childhood is not uncommon in India. In the year 1988 alone, we had over 24,000 children developing paralysis in our country. The paralytic disease, characterized by fever and rapid progression was then called ‘Polio’ on clinical grounds. It was said that 3 types of polioviruses caused the disease, that Polio had only prevention and no cure. And the prevention was to be only through vaccination.
Polio vaccines were of two types: a. Injections, and b. Drops. Injections were costly, but less risky. These were difficult to administer, though. In comparison, the drops were 25 times as cheap, but they carried some risk. And they were easy to administer too. Both these vaccines contained in them, polioviruses. While the virus in the injections was already dead, the one used in drops was live, but was weakened sufficiently. The risk therein was that sometimes the live, attenuated virus in polio drops could back-mutate, become neuro-toxic and could cause polio-like paralysis in the recipients. Still, it was decided that India use polio drops.
Behind this decision was the pressure from international agencies. India was compelled into this quagmire by WHO with the allegation that “many countries in the world had become “polio free”, but India was still a source of wild polio”. Once begun the programme in 1995, we were assured that the polio drops were effectively reducing Polio. A new, virological testing facility was setup in India by 1998. Children who developed sudden paralysis of limbs associated with fever were now given a new title: Acute flaccid paralysis cases (AFP). Stool samples collected from these children with AFP were since tested virologically. In these AFPs, the instances of wild polio infections were shown to be going down. In the 27,000 odd children with AFP that were tested in year 2005, only 66 children were shown to have wild poliovirus infection. The remaining 26,000 odd paralytic children were simply- “discarded”. Hoping to reach the “Polio free” status soon, Government of India also enthusiastically increased the number of Pulse Polio Rounds in its endemic ‘endemic’ areas of UP and Bihar. There was hope that year 2006 would witness “zero incidence” of wild polio cases in India. But to the dismay of everyone concerned, year 2006 produced 624 wild polio cases in India, a-four-year-high. This led to widespread discouragement, and a dispute- the International agencies accusing the health staff of inefficiency and insufficient vaccine coverage, and the Governments’ pointing out to “vaccine failures”.
Vaccine Virus:
In this situation, various problems associated with the vaccine came to light. The Government had to declare that some children whose stools did not yield wild poliovirus, still yielded vaccine virus. Many doctors, who expected such instances of vaccine associated paralysis to be around 180, were alarmed to find that in the last three years alone they totaled to about 4400. Those who expected them to be “too small numbers to be of any consequence” were startled with this information. Also the doctors, who were earlier raising ethical concerns about such issues being limited to academic circles, now became more vocal. Eventually they started writing in popular press, claiming that the Pulse Polio Programme has failed in India, and that it has many associated problems.
During these 12 years that the Pulse Polio programme continued, people, both lay and medical practitioners alike, were misled by the Government’s propaganda: that “polio drops are completely safe”, “Get your children vaccinated again and again”. Media, filmdom, and even the Honorable President of India were made use of in spreading this untruth. The Government of India knew well though -like the WHO did too- that some VAPP cases would surely emerge in the process. Had the Government taken people into confidence, explained the risks involved in this programme truthfully, gone on with it with their consent, examined any VAPP cases that emerged, and paid pre-arranged compensations to such victims honestly, it would have been OK. Instead, by keeping the information on VAPP secret, by spreading untruth, by declaring the numbers of only “confirmed wild polio cases” and putting all other AFPs into “discarded” category- in an apparent effort to cover up the exact numbers of VAPP victims, by not taking into account the deaths following vaccination, and by employing many such devious methods, the Government of India complicated the issue.
During the 80s, every case of sudden childhood paralysis associated with fever was declared polio on clinical grounds, projecting the disease as a “Big menace”. So it is not enough now, to test equal number of children with paralysis and declare only one in a hundred of them “polio’ and simply ‘discard’ others: Causes for paralysis in the remaining 99% children must also be determined and made public. Not only that, the programme has created paralysis in thousands of otherwise healthy children- the Government has to take complete responsibility for this and pay suitable compensations to all such victims.
Let us demand:
1. Polio drops contain live polioviruses. A large number of people may benefit from them; but some children will develop polio like paralysis because of the drops. The State has to own responsibility for them.
2. Tests can be conducted, within 60 days from the onset of paralysis, to determine the type of poliovirus. Yet those tests were (and are) not available to many. So the list of VAPP victims with the Government is definitely incomplete, and also unscientific. Yet their names must be made public, and their present status be verified by independent agencies.
3. Taking all aspects into account, including the governments’ contribution to chaos, all children that developed polio-like paralysis after 1995 be considered for compensations.
4. A High power commission, comprising of experts with known pro-people stance should carefully work out the details of identification of victims and compensation aspects of the programme.
5. Government has to own responsibility for investigating and diagnosing not just polio, but all paralyses of childhood.
6. Children who died after consuming polio drops must be identified and their parents compensated. Government has to publicly apologize to them, to VAPP victims, and to the Nation.
7. Vaccination programmes should exhibit truthful, transparent, and healthy attitude towards people. These programmes should evolve into democratic processes deriving the informed consent of all parties.
*********
-Dr.Samatha and Narayana
e-mail: samanarayan@.....
During these 12 years that the Pulse Polio programme continued, people, both lay and medical practitioners alike, were misled by the Government’s propaganda: that “polio drops are completely safe”, “Get your children vaccinated again and again”. Media, filmdom, and even the Honorable President of India were made use of in spreading this untruth. The Government of India knew well though -like the WHO did too- that some VAPP cases would surely emerge in the process. Had the Government taken people into confidence, explained the risks involved in this programme truthfully, gone on with it with their consent, examined any VAPP cases that emerged, and paid pre-arranged compensations to such victims honestly, it would have been OK. Instead, by keeping the information on VAPP secret, by spreading untruth, by declaring the numbers of only “confirmed wild polio cases” and putting all other AFPs into “discarded” category- in an apparent effort to cover up the exact numbers of VAPP victims, by not taking into account the deaths following vaccination, and by employing many such devious methods, the Government of India complicated the issue.
During the 80s, every case of sudden childhood paralysis associated with fever was declared polio on clinical grounds, projecting the disease as a “Big menace”. So it is not enough now, to test equal number of children with paralysis and declare only one in a hundred of them “polio’ and simply ‘discard’ others: Causes for paralysis in the remaining 99% children must also be determined and made public. Not only that, the programme has created paralysis in thousands of otherwise healthy children- the Government has to take complete responsibility for this and pay suitable compensations to all such victims.
Let us demand:
1. Polio drops contain live polioviruses. A large number of people may benefit from them; but some children will develop polio like paralysis because of the drops. The State has to own responsibility for them.
2. Tests can be conducted, within 60 days from the onset of paralysis, to determine the type of poliovirus. Yet those tests were (and are) not available to many. So the list of VAPP victims with the Government is definitely incomplete, and also unscientific. Yet their names must be made public, and their present status be verified by independent agencies.
3. Taking all aspects into account, including the governments’ contribution to chaos, all children that developed polio-like paralysis after 1995 be considered for compensations.
4. A High power commission, comprising of experts with known pro-people stance should carefully work out the details of identification of victims and compensation aspects of the programme.
5. Government has to own responsibility for investigating and diagnosing not just polio, but all paralyses of childhood.
6. Children who died after consuming polio drops must be identified and their parents compensated. Government has to publicly apologize to them, to VAPP victims, and to the Nation.
7. Vaccination programmes should exhibit truthful, transparent, and healthy attitude towards people. These programmes should evolve into democratic processes deriving the informed consent of all parties.
*********
-Dr.Samatha and Narayana
e-mail: samanarayan@.....
********
Saturday, February 17, 2007
Pulse polio programme and Aesops Fables-II
This is better than my earlier post.
The Woman and the Fat Hen
A woman owned a hen that laid an egg every morning. Since the hen's eggs were of excellent quality, they sold for a good price. So, at one point of time the woman thought to herself, "If I double my hen's allownce of barley, she'll lay twice a day." Therefore, she put her plan to work, and the hen became so fat and contented that it stopped laying altogether.
"Relying on statistics does not always produce results"
The Oral Polio vaccine lured India into something similar, and later it became so fat that it stopped working in UP and Bihar!
The Woman and the Fat Hen
A woman owned a hen that laid an egg every morning. Since the hen's eggs were of excellent quality, they sold for a good price. So, at one point of time the woman thought to herself, "If I double my hen's allownce of barley, she'll lay twice a day." Therefore, she put her plan to work, and the hen became so fat and contented that it stopped laying altogether.
"Relying on statistics does not always produce results"
The Oral Polio vaccine lured India into something similar, and later it became so fat that it stopped working in UP and Bihar!
Pulse polio programme and Aesops Fables-I
The Hawk and the Pigeon:
Some Pigeons had long lived in fear of a hawk, but isnce they had always kept on the alert and stayed near their dovecote, they had consistently managed to escape their enemy's attacks. Finding his sallies unsuccessful, the hawk now sought to use cunning to tirck the pigeons.
"Why", he once asked, "do you prefer this life of constant anxiety when I could keep you safe from any conceivable attack by the kites and falcons? all you hve to do is to make me your kind, and I wont bother you anymore".
Trusting his claims, the pigeons elected him to their throne, but no sooner was he installed than he began exercising his royal prerpgative by devouring a pogeon a day.
"It serves us right" said one poor pigeon whose turn was yet to come.
"Some remedies are worse than the disease itself"
The fable reminds me strongly of the story of Oral Polio Vaccine initiative in India.
Indeed, "Some remedies are worse than the disease itself"
Some Pigeons had long lived in fear of a hawk, but isnce they had always kept on the alert and stayed near their dovecote, they had consistently managed to escape their enemy's attacks. Finding his sallies unsuccessful, the hawk now sought to use cunning to tirck the pigeons.
"Why", he once asked, "do you prefer this life of constant anxiety when I could keep you safe from any conceivable attack by the kites and falcons? all you hve to do is to make me your kind, and I wont bother you anymore".
Trusting his claims, the pigeons elected him to their throne, but no sooner was he installed than he began exercising his royal prerpgative by devouring a pogeon a day.
"It serves us right" said one poor pigeon whose turn was yet to come.
"Some remedies are worse than the disease itself"
The fable reminds me strongly of the story of Oral Polio Vaccine initiative in India.
Indeed, "Some remedies are worse than the disease itself"
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