The ethical principles involved in any public health programme are Respect to individual rights, Beneficence (doing no harm), and Justice (fair treatment to all). The case of Polio eradication in India clearly demonstrates violating all these basic principles. This article examines various facets of unrighteous atrocities committed on the innocent children in India.
“Who is the evil? Virus or Vaccine”
The National Polio Surveillance Project in India is the brain of polio eradication efforts in India. Due to advocacy of NPSP, Government started introduction of monovalent Oral Polio vaccine against type 1 (mOPV1) polio virus in the year 2006. Before the introduction of mOPV1, there were no studies done in real life settings to examine the safety and efficacy of this vaccine. The unprecedented speed with which this vaccine was cleared and licensed to use in India is phenomenal compared to decades of research required to introduce a new vaccine in any developed country. According to studies done by NPSP, the protective efficacy of mOPV1 was estimated to be 30% per dose against type 1 paralytic disease, compared with 11% for the trivalent oral vaccine. Despite the use of mOPV1, India still had 80 cases of type 1 Polio during the year 2007. However the bigger crime is that a new set of 781 children were paralyzed with type 3 polio viruses in 2007. These 781 children are paralyzed only because they were given mOPV1 which protected only against type 1 and made prone to paralysis by other two types instead of trivalent OPV (tOPV). On the other hand, tOPV was the vaccine of choice to eradicate polio virtually in all parts of the world. Worse still, we do not know the incidence of VAPP caused by mOPV1.
The policies of the Government are led by malfeasant agencies who have never informed the public regarding number of paralysis cases due to oral intake of Polio vaccine. This is called Vaccine associated paralytic poliomyelitis (VAPP). In the current scenario, it can be postulated that the number of VAPP cases in India are more than the actual number of paralysis caused by wild polio virus. In the modern informed world, it is highly negligible on part of any responsible Government not to take cognizance of such crime being committed due to rampant, frequent use of oral polio vaccine in the country.
According to the website of Indian Academy of Pediatrics (IAP), (http://www.iapindia.org/afp.cfm), discussion of VAPP should be restricted to only academic circles. However many private pediatricians inform the educated parents not to immunize their children with repeated oral doses due to fear of VAPP. The irony is that in the same website, IAP documents that there is a felt need to plan a new strategy to minimize occurrence of VAPP. If there is so high case load of VAPP, then why the public are not informed regarding this? The ethical stand would be inform the Public and give them options to protect their children against polio in terms of Inactivated Polio Vaccine (IPV). Due to the inherent nature of this dilemma faced by IAP
There is also another type of paralysis from vaccine called as Vaccine-Derived Paralytic Poliomyelitis (VDPP). According to studies done, the replication of OPV in humans is frequently accompanied by genetic change of the vaccine virus, including reversion of key attenuating mutations, introduction of other mutations throughout the genome, and intertype recombination among OPV strains. This results in the vaccine virus mutating into viruses that can paralyze the nerves in humans. The Indian public is not made aware regarding the numbers too.
Even if India stops transmission of Polio, immunization with OPV will continue almost forever. Clearly, the greatest advantage of restricted wild poliovirus transmission in India is not to India itself but to the benefit of developed countries who are supporting the global initiative. In countries which have been certified as Polio free, any importation of wild polio virus would lead to crisis like situation with inconceivable financial and human resource management. The initial implementation of polio eradication efforts were generously funded by developed countries for the same reason. However, with thousands of crores of Indian taxpayer’s money being given to Polio eradication, these developed countries are happy for many reasons. But the ethical question to be asked here is “Can India prioritizes preventing high infant and maternal mortality instead of funding a programme that is responsible for making hundreds of innocent children crippled for life?”
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