Two drops of life

Nasrin Sultana Delhi

Do boond zindagi ki... (Two drops of life). Two drops that can decide whether a child will walk or limp or even die. Amitabh Bachchan calls polio a terrorist on national television. Celebrated sports and film stars plead and exhort with people through public interest advertisements on channels to administer polio vaccine to their children and prevent the virus from spreading. The high profile, high voltage media campaign seems to have marginal impact. The once near-extinct polio is on a menacing comeback trail.

The ministry of health and family welfare has been engaged in a massive polio-eradication drive since 1994. Hoardings advertising pulse polio vaccinations used to be a regular sight at traffic lights, schools and hospitals in cities and towns. People queued up at polio booths on what came to be known as polio Sundays, and nurses visited homes to take the vaccine to people with small children. Pulse polio was on the way to being wiped off. Unfortunately, the diminishing numbers are climbing back, causing concern and consternation among health officials.

Despite the initial success of massive television ad campaigns featuring popular Bollywood actors like Amitabh Bachchan and Shah Rukh Khan, the new numbers show a puzzling reversal. According to one UNICEF report, there were a total of 597 polio cases in India in 2006 as against 66 in 2005. On December 23, PTI reported 13 fresh polio cases in India out of which 12 cases are from UP and one from Delhi. This addition takes the total number of polio cases in India to 610. Delhi used to have an average of 500 annual polio cases in 1994-95, a number that dropped to two in 2004 and one in 2005, but has risen again to five in 2006. Uttar Pradesh has registered an alarming rise to 489 cases in 2006 compared to 29 in 2005.

The upward trend of polio cases in UP is being attributed to the fact that many Muslims in the state have turned hesitant, and even hostile, about allowing their children to be given the polio vaccine. Some doctors and health officials have gone so far as to say that the Muslim community’s hesitation is preventing India from becoming a polio-free nation. According to sources, the reason behind this reluctance on the part of the Muslims could be an article published in a Lucknow-based Urdu magazine, Tamir-e-Hayat, which claims that the polio vaccine which is manufactured in the US causes infertility, and that it is targeted at eradicating the Muslim community. This has apparently left the Muslim community very disturbed.

Although it is unclear as to what extent this misinformation is affecting immunisation efforts, it is true that 70 per cent of polio cases in India occur among uneducated and poor minorities, even though Muslims account for only 13 per cent of India's population

Shabina Begum, 27, mother of two children aged two and five, of Jamia Nagar, Delhi, says, "When a nurse came to our house to administer polio drops some years ago, I allowed my son to take them. Now that I have heard about the conspiracy about making our children sterile, I will never allow them to come near us again." Her husband, Yusuf Ali, 34, a rickshaw puller, fails to persuade his wife to put away her fear and suspicion.

Heena Alam, 36, of Delhi, says she has made it a point not to allow health officials to visit her family with pulse polio drops. "Once we set dogs on the two women who came to give polio drops," she says triumphantly. She is joined by other women from the community, who say, "Inshaallah, hum apne bachchno ka khud khayal rakhenge. Khuda ki marzi hui to in pe koi museebat nahin aayegi (By Allah’s grace we will take care of our own children. If Allah wants it, then there would be no danger to our children.)" Even this reporter was chased away at first by people, who thought she was visiting in connection with a pulse polio campaign.

Health officials at the Ansari Health Centre (Health Centre of Jamia Millia Islamia), however, deny that many Muslims are not aware of the repercussions of the polio virus and are unwilling to take them. Dr Quasar Raza says, "Pulse polio drops are just a different way of giving a vaccination. There is nothing to fear about it, some people are just being led astray."

A striking paradox here is that Muslims, when visiting their holy shrine at Mecca in Saudi Arabia, have to take at least one dose of the oral polio vaccine. As per the recommendations of the Global Advisory Committee on Polio Eradication published in WHO’s weekly Epidemiological Record, the Saudi Health Ministry makes it mandatory for all travellers from India, Afghanistan and Pakistan, regardless of age and prior vaccinations, to be vaccinated with at least one dose of oral polio vaccine prior to departure for Saudi Arabia.

Poliomyelitis, often called polio or infantile paralysis, is a viral paralytic disease. The causative agent, a virus called polio virus (PV), enters the body orally, infecting the intestinal wall. It may enter the blood-stream and then into the central nervous system, causing muscle weakness and often paralysis. Humans are the only reservoir of polio, also known as the Wild Virus, which is of three types. It is Type II polio that is the first to get eliminated, followed by Type III and Type I, by successive doses of the oral vaccine. The strategy for eradication is composed of a strong system of four components: strong routine immunisation, well- conducted pulse polio rounds, selective /focal mop-up rounds, and a sensitive and responsive AFP (acute flaccid paralysis) system.

Maulana Abu Baksh, of a mosque in Nizamuddin, Delhi, says, "Many people in the community in this area are not educated. Most of them are daily wage earners who are superstitious and can be easily manipulated. The only way to dispel their ignorance is by taking their community representatives into confidence."

Saba Sheikh, 26, a graduate and a housewife, dismisses such rumours, "I do not think these polio drops have any element that will make our children sterile. Nobody can be so inhuman as to do that. I have given polio drops to my six-month-old son and I am not scared at all."

The National Polio Surveillance Project, a collaborative effort between the Indian government and WHO, identifies Muzzafarpur, Saharanpur, Muradabad, Badayun, Rampur and Bijnaur districts of Uttar Pradesh as areas where polio cases have been registered on a larger scale. Assam which showed no sign of polio cases in 2004 and 2005 has reported two recent instances. Besides, the deadly virus has spread to Bangladesh, Nepal, Angola and Namibia. Bangladesh was polio free for five years. In 2006, 13 were registered.

Malati Mishra, 30, a call-centre worker says, "Being an educated mother, I know about vaccinating my child. We had taken her to the nearby mobile polio drop booth last year, but somehow this time neither my husband nor I had time to take her. We thought after all she has been given the dose once." Many educated people like the Mishras are unaware that to eradicate polio virus completely, children have to be given polio drops as many number of times till the age of five.

Says Dr. Harish Mehta, a child specialist, "Most people think once they have administered oral polio drops to their newborns, they do not have to bother again. But the fact is that till the age of five all children should be given polio drops every year. Giving polio drops once does not ensure safety."

It is necessary that before the polio virus resurfaces, the social stigma attached to preventive vaccination against it has to be rooted out. The alternative scenario is sad and frightening: children will learn to limp rather than to walk.