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Source: Polio programme: let us declare victory and move on | Indian Journal of Medical Ethics (ijme.in)

Polio programme: let us declare victory and move on

NEETU VASHISHT1, JACOB PUlIYEl1


Department of Paediatrics, St Stephens Hospital, Delhi 110054 INDIA Author for correspondence: jacob Puliyel: e-mail: puliyel@gmail.com

Abstract

It was hoped that following polio eradication, immunisation could be  stopped.  However  the  synthesis  of    polio  virus  in  2002,  made eradication  impossible.  It  is  argued  that  getting  poor  countries  to expend their scarce resources on an impossible dream over the last 10 years was unethical.

Furthermore,  while  India  has  been  polio-free  for  a  year,  there  has been a huge increase in non-polio acute flaccid paralysis (NPAFP). In 2011, there were  an extra 47,500 new cases of NPAFP.  Clinically indistinguishable  from  polio  paralysis  but  twice  as  deadly,  the incidence  of  NPAFP  was  directly  proportional  to  doses  of  oral polio  received.  Though  this  data  was  collected  within  the  polio surveillance   system,   it   was   not   investigated.   The   principle   of  primum-non-nocere was violated.

The authors suggest that the huge bill of US$ 8 billion spent on the programme, is a small sum to pay if the world learns to be wary of such vertical programmes in the future

[. . .]

Conclusion

The polio eradication programme epitomises nearly everything that is wrong   with   donor   funded  ‘disease   specific’   vertical projects,  at  the  cost  of  investments  in  community-oriented primary    health    care    (horizontal    programmes)(38).    Gilliam has  described  how  vertical  programmes  undermine  broader health   services   through   duplication   of   effort   (each   single disease   control   programme   requires   its   own   bureaucracy), distort national health plans and budgets and, because salaries of  donor-funded  vertical  programmes  are  often  more  than double  those  of  equally  trained  government  workers,  lead to  a  diversion  of  skilled  local  health  personnel  from  primary healthcare,  causing  an ‘internal  brain  drain’  (39). We  have  seen how  polio,  that  was  not  a  priority  for  public  health  in india, was  made  the  target  for  attempted  eradication  with  a  token donation  of  $  0.02  billion. The  Government  of india  finally  had to  fund  this  hugely  expensive  programme,  which  cost  the country 100 times more than the value of the initial grant.

De Maeseneer and colleagues suggest that vertical programmes have unwittingly increased the incidence of other diseases  and  broken  the  first  rule  of  medicine  –  primum  non nocere  –  first  do  no  harm.  They  cite  the  example  of  HiV  and hepatitis caused by WHO-endorsed immunisation programmes against  other  diseases  (40).  With  polio  eradication  there  was a  huge  increase  in  non-polio  AFP,  in  direct  proportion  to  the number  of  doses  of  the  vaccine  used. Though  all  the  data  was collected  within  an  excellent  surveillance  system,  the  increase was  not  investigated  openly.  Another  question  ethicists  will ask,  is  why  champions  of  the  programme  continued  to  exhort poor countries to spend scarce resources on a programme they should have known, in 2002, was never going to succeed.

In  the  final  analysis,  if  the  right  lessons  have  been  learnt  and the world does not repeat these mistakes, the costs may yet be justified.


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Source of what follows: PubMed

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