[op-ed snap] Protecting against polio
Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources
From the UPSC perspective, the following things are important:
Prelims level: Poliovirus and its immunisation
Mains level: Need of using IPV instead of OPV to eradicate Polio in India
- With wild poliovirus strains reduced by 99.9% since 1988, the world is inching towards eradicating polio
- But unfortunately, more children today are affected by the live, weakened virus contained in the oral polio vaccine (OPV) that is meant to protect them.
- The weakened virus in the vaccine can circulate in the environment, occasionally turn neurovirulent and cause vaccine-derived poliovirus (VDPV) in unprotected children
Less awareness about VAPP
- While circulating VDPV strains are tracked, and outbreaks and cases are recorded and shared, little is known about vaccine-associated paralytic poliomyelitis (VAPP) cases, particularly in India
- VAPP occurs when the virus turns virulent within the body of a recently vaccinated child and causes polio
- With high-income countries switching to the inactivated polio vaccine (IPV) that uses the dead virus to immunise children, the VAPP burden is concentrated in low-income countries which continue to use the OPV
- In spite of the World Health Organisation asking all countries using the OPV to include a “continuous and effective system of surveillance” to monitor the frequency of VAPP in 1982, India did not comply
- Data on VAPP became available only years after active polio surveillance was initiated in 1997
- Even after 1997, India did not count VAPP cases
Use of OPV main culprit
- The decision to use only the OPV was faulty
- Vaccination (using OPV) has become the main source of polio paralysis in the world
- Despite knowing that there is a higher burden of polio caused by oral vaccines, India continued to use the OPV
- OPV fared poorly on two important counts: safety and efficacy
- The primary objective of polio vaccination is to prevent the disease, which the OPV failed to fully achieve
- The OPV was used for eradicating purposes but without fully protecting the children
- Parents were obliged to accept the OPV and face the consequences of VAPP as well as VDVP
Resoning behind the use of OPV
- India’s goal was to eradicate polio, and the OPV was crucial for that
- The IPV produces humoral immunity (involving antibodies in body fluids) so the immunised child does not get paralysis, but it can’t stop the circulation of wild polioviruses
- For instance, no polio cases were seen in Israel but wild polioviruses were detected in the environment
- The viruses will continue to circulate in the community
- It is easier to administer the OPV than the IPV and the cost per dose of OPV is also lower than that of the IPV
- Another reason given for not switching over to the IPV was that global production was too low to meet India’s demand. India is the largest cohort. It needs 48 million doses per year to immunise all children
Need for IPV
- The IPV is essential for post-wild-type poliovirus eradication, to get rid of VDPV and VAPP
- A single dose of the IPV given before the OPV prevents VAPP cases
- A single dose of the IPV primes the immune system and the antibodies against the polio virus, seen in more than 90% of immunised infants
- The globally synchronised switch from trivalent to bivalent OPV in mid-2016 was accompanied by administering a single dose of the IPV prior to administering the OPV
- The justification that VAPP cases can be ignored as they are “sporadic and pose little or no threat to others” is ethically flawed
- The stand that VAPP cases are epidemiologically irrelevant is ethically problematic
Govt targets mobile and migratory population to prevent re-emergence of polio virus
Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources.
From UPSC perspective, the following things are important:
Prelims level: Polio Virus, Mission Indradhanush
Mains level: Preventing resurgence of Polio in India
- To prevent the re-emergence of poliovirus in India, the ministry of health and family welfare is now targeting mobile and migratory population from neighbouring countries such as Nepal, Pakistan and Bangladesh.
- The government has already started the process of identifying children living with mobile and migratory families to prevent the spread of the virus.
- Health Ministry officials have prepared a database of children living near brick kilns, streets, tent houses and nomad families.
Still prevalent in the neighbourhood
- According to the World Health Organization (WHO), at least 11 cases have been registered in 2018 in Afghanistan and Pakistan.
- Since there is a possible movement of people from the countries to India, the Centre is continuing with the Pulse Polio campaign as a preventive measure despite being polio-free.
Polio incidence in India
- Polio is a highly infectious viral disease, which primarily affects young children.
- The virus is transmitted through person-to-person and spreads through the faecal-oral route or through contaminated water or food.
- It multiplies in the intestine, from where it can invade the nervous system and can cause paralysis.
- The last reported cases of wild polio in India were in West Bengal and Gujarat on 13 January 2011.
- On 27 March 2014, the WHO declared India a polio-free country, since no cases of wild polio had been reported for three consecutive years.
- Currently, two types of vaccines–oral polio vaccine and injectable polio vaccine–are being used in India to provide enhanced protection.
- The nation-wide polio campaigns are continued along with routine immunisation under initiatives such as Mission Indradhanush.
- So far, the government has been administering polio doses to children under five years through the door-to-door Pulse Polio campaign, the immunisation programme seeks to eliminate poliomyelitis (polio) in India
Off-label use of IPV vaccine to tide over shortage
- Context: India and a few other countries are stretching the supply of the vaccine to cover all children
- Reason: Shortage of Inactivated Polio Vaccine (IPV) globally
- Fractional dose: Children in Puducherry and seven States will get two fractional doses administered intradermally
- Problem: The vaccine has been licensed by the manufacturers only for intramuscular use and not for intradermal administration
- However, The Global Polio Eradication Initiative has permitted the use of the vaccine intradermally
- Why? As only one-fifth of the vaccine will be required to vaccinate a child as compared to intramuscular
- Background: The IPV vaccine was introduced into the routine immunisation programme in India from November 30, 2015
Polio vaccine switching
- Switch: tOPV (trivalent Oral Polio Vaccine) for immunisation will be completely replaced by bOPV (bivalent OPV)
- tOPV is effective against type 1, 2, 3 of polio virus while bOPV is effective against type 1 and 3 virus
- tOPV is being completely removed from the cold chain and disposed of as per national guidelines
- April 25 is the National Switch Day to make the shift of vaccine
- Part of the Global Polio Endgame Strategic Plan
Union Government launches IPV injection as part of global polio endgame strategy
The launching of IPV would enable children to get double protection from polio i.e. orally and in the form of injection.
- It was launched as part of India’s next step in Universal Immunization Programme (UIP) to fight against polio virus in country.
- UIP initially will cover six states including Uttar Pradesh , Madhya Pradesh , Bihar, Assam, Punjab and Gujarat in first phase.
- By April 2016, Union Government would switch to IPV alongside the oral polio vaccine (OPV) to eradicate polio virus.
- As part of India’s efforts to boost its polio immunization programme babies getting their third dose of OPV now would be administered an injection with IPV.
India was certified polio-free country on 27 March 2014, but the immunization programme continues since two of its neighbours Afghanistan and Pakistan still remain polio-endemic countries.
India to introduce injectable polio vaccine from November
- India is all set to introduce injectable polio vaccine (IPV) in its universal immunisation programme (UIP) in a phased manner from November.
- This will be over and above the oral vaccine.
- From April, 2016 the trivalent polio vaccine that is currently administered will be replaced by the bivalent variety to reduce incidence of vaccine-derived polio virus.
- India eliminated wild polio virus infection in January last year.
- In the first phase of IPV introduction, 17 high-risk states and four Union Territories will be covered.
Indian firm to produce injectible polio vaccine
- WHO expected to transfer manufacturing technology of Inactivated Polio Vaccine (IPV) to Indian Immunologicals.
- The OPV (Oral Polio Vaccine), which is cheap and easily administered, uses live but weakened forms of the poliovirus.
- However, live vaccine viruses can occasionally revert to virulence.
- With IPV, however, there are no such risks because the virus is deactivated.