Eradication versus control for poliomyelitis

Abstract

Two articles have highlighted the need to sustain high levels of immunisation for the eradication of wild poliovirus. However data on health systems indicators for the Indian states of Uttar Pradesh and Bihar raise questions about whether the singular focus on efficacious vaccines will be able to overcome the weaknesses in the health services in these two states. Both Uttar Pradesh and Bihar were unable to report (as of September 2005 the year before a polio outbreak) the number of primary-health centres (PHCs) without a doctor. In Uttar Pradesh 25% of auxiliary nurse-midwife positions and 72% of health-worker positions were vacant. Although only 5% of PHCs in Uttar Pradesh were reportedly without an electricity supply 75% of subcentres were without electricity 59% were without a regular water supply and 56% did not have motorable roads. In a state that is notoriously power-deficient pulse polio immunisation rounds were done in the month of April when average temperatures are around 40°C. In Uttar Pradesh and Bihar 23.8% and 18.6% of deliveries are institutional and only 20% and 31% of infants are fully immunised. Although 80% of children report having had three doses of oral polio vaccine the timeliness of the doses being given becomes questionable since only 27.8% and 45.2% of rural children in these two states complete routine immunisation with three doses of triple antigen. Cost-benefit studies that favour eradication through a concentrated vaccination effort should examine the larger picture. This should include an assessment of the consequent effects of targeted polio eradication activities on health and health systems in poor countries. (full text)