Polio vaccine | Photo courtesy: Special arrangement

"I don't remember if I was administered the polio vaccine as a child or not," reflects Sanjay Sah, a 40-year-old mason hailing from Samastipur in Bihar. His life took a tragic turn this February when he claims he was struck by a polio attack. Describing the experience, he shares, "I suddenly felt my muscles lose their function, and I could not move my hands and legs. I was immediately taken to the doctor, but initially, no one knew what it was. The doctors were confused, and it was only later that it was diagnosed as polio. The left side of my body got paralysed."

Sanjay is currently undergoing treatment for polio, and during this period, he emphasises that he has encountered numerous individuals, both young and old, who are grappling with this debilitating disease. 

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Is it possible for a 40-year-old man to experience a polio attack? Dr T Jacob John, former head of the Indian Council for Medical Research’s Centre for Advanced Research in Virology, firmly asserts that this is indeed a possibility. But before we delve into the details, let's look at the context of the story and the role of the polio vaccine.

October 24 marked World Polio Day, a day dedicated to shedding light on the ongoing global endeavours to eliminate poliomyelitis. Polio, a life-threatening disease caused by the poliovirus, became a target for eradication when the World Health Assembly made a commitment to this mission back in 1988.

If the claims of the government of India is to be believed then on January 13 this year, India celebrated a milestone as it completed 12 consecutive years without a single polio case, with the last reported case dating back to 2011. However, the question that lingers is whether India can truly claim to be free from polio, having eradicated it completely. The reality behind the scenes warrants a closer examination and for this we must look at what role the polio vaccine plays in the eradication of the disease.

Returning to Sanjay Shah's case, Dr John underscores, "It is indeed possible to contract polio at any age. The crucial factor lies in whether his condition was diagnosed by a medical professional with sufficient clinical rationale. If so, it's imperative that such cases be reported to the government, and the World Health Organization (WHO) needs to be alerted. However, a more significant concern surfaces when we examine the WHO's practices. What they are engaging in raises ethical questions. Natural polio results from the presence of Wild Poliovirus (WPV) in nature. When children receive the Oral Poliovirus Vaccine (OPV), there are instances where the vaccine itself can cause polio in some children. Shockingly, these cases are neither counted nor acknowledged in any of the WHO reports."

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Dr John further elaborates, stating, "The issue with vaccine-derived poliovirus lies in the fact that the polio vaccine virus can, on rare occasions, undergo genetic changes, much like what we have witnessed with coronavirus variants. In such cases, it can transform into a genetic variant capable of causing polio. This variant can spread like the Wild Poliovirus, potentially triggering a polio outbreak if there are sufficient susceptible individuals in the vicinity. What's particularly concerning is that the number of vaccine-derived polio cases, created inadvertently, surpasses the count of natural polio cases numerically. This is a situation that has been brought about by the practices of the WHO in assessing the disease and its solution."

Critics of the WHO’s polio eradication initiative cast doubt on the fundamental principles underlying the program's objectives. Dr John adds: "The World Health Assembly set a clear goal in 1988 that polio must be eradicated by 2000. However, as long as Oral Poliovirus Vaccines are being administered, we cannot claim that polio has been truly eradicated. Consequently, beyond the year 2000, there was no justification for the continuation of a polio vaccine that could potentially induce polio. While natural polio cases are indeed unfortunate, instances of man-made polio are not only unfortunate but also unethical.”

The opinions of Dr John and Dhanya Dharmapalan on the subject were published in The Lancet this July. The article reads: “Before 1988, Sweden, Iceland, Finland, and Norway had eliminated polio using the Inactivated Poliovirus Vaccine (IPV), with three doses during infancy and one or more boosters later. Denmark achieved polio elimination using a sequential schedule of IPV followed by the oral poliovirus vaccine (OPV). These experiences provided proof of principle and a one-stage, rapid, polio elimination model. For achieving zero incidence of polio by 2000, the Global Polio Eradication Initiative (GPEI) should have transitioned to the IPV in Low Income and Middle Income countries (LMICs) and phased out the OPV, since it causes Vaccine Associated Paralytic Polio (VAPP) in an occasional vaccinated child or unvaccinated contact. Indeed, OPV use is incompatible with polio eradication.”

The article then highlights that France made the decision to discontinue OPV in 1988, followed by Germany in 1989, and the USA in 2000. Remarkably, all three countries achieved polio elimination within a mere year after transitioning to IPV. The key strategy identified for successfully eradicating polio involved the introduction of IPV and the gradual phase-out of OPV, country by country. The crucial threshold was reaching an 80% coverage rate for three doses of IPV. This strategic shift required a policy overhaul during the early 1990s to facilitate the scaling up of IPV production.

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Nonetheless, the persistent use of OPV beyond the year 1999, without ensuring polio protection through IPV, has resulted in a series of alarming consequences. The authors note that between 8,800 and 17,600 children suffer from paralysis due to Vaccine-Associated Paralytic Polio. Additionally, sporadic polio cases, caused by vaccine-derived polioviruses types 1, 2, or 3, as well as polio outbreaks stemming from the circulation of these viruses, have left nearly 5,000 children paralysed. The numbers could just be the tip of the iceberg.

The path to global polio eradication hinges on the transition to IPV. The pressing question is why has there been no discernable policy shift in this direction and why hasn’t the WHO made an official announcement regarding this crucial shift? Countries like India have been at the forefront of delivering OPVs. OPV has been used exclusively in India since 1978. IPV was only recently added to India’s national immunisation program.

Dr Anant Phadke, a prominent public health activist who has worked in the Centre for Enquiry into Health and Allied Themes (CEHAT) asserts that the poliovirus has not disappeared, and the pharmaceutical industry has continued to promote OPVs. “Many countries, including India, have chosen not to discontinue OPVs, for reasons known best to their respective governments. When you examine stool samples in various cities and conduct tests for the poliovirus, it becomes evident that it still persists. In the realm of public health, we must not overlook the fundamentals. Multiple researches and studies have highlighted the link between OPVs and polio vaccine derived virus cases. A significant number of OPV administrations have inadvertently resulted in polio cases. Although OPVs are cost-effective, India should make a complete shift towards IPVs. The reasons behind the reluctance to make this transition is anybody’s guess."

Dr Phadke underscores the gravity of the situation, stating, "Thousands of children suffer paralysis every year, and some of these cases are attributed to the poliovirus. However, a crucial issue arises—none of these cases are being accurately recorded or counted as polio cases. This stems from a fundamentally flawed government policy, where unnecessary polio vaccines are being administered to children. Astonishingly, children who experience paralysis, and who would otherwise fit the textbook definition of polio cases, are no longer registered as such due to a change in the government's methodology."

Polio, once believed to be on the verge of global eradication, continues to afflict communities and children worldwide. The very principles of vaccination, designed to protect and heal, are now under scrutiny, as vaccine-derived polio cases not only persist but also go unrecorded.

Why has the crucial transition to IPV not been embraced as a global strategy, and why does the WHO maintain silence on this pivotal shift? India, a nation that has made significant progress in polio vaccination, must confront the uncomfortable reality that the poliovirus endures. The urgency of reevaluating polio vaccination and recording strategies for polio vaccine induced virus cases cannot be overstated.

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