The World Health Organization is intensifying efforts to eliminate polio from four countries - India, Nigeria, Pakistan and Egypt. The efforts are most intense in India, which accounted for the majority of new cases last year. From New Delhi, Anjana Pasricha reports on how India's polio eradication program was set back, partly because tens-of-thousands of parents refused to get their children immunized.
In a television ad, popular Indian cricket players appeal to people in Uttar Pradesh state to give their children the oral polio vaccine. It is part of a huge publicity drive to convince tens of thousands of reluctant parents to get their children immunized against the crippling disease, which usually strikes children under the age of five.
Over the past decade, mass immunization programs across India reached more than 100 million children, bringing down the incidence of the disease dramatically in most areas, and raising hopes that the country would soon be polio free. The Indian campaign is part of a global drive launched in 1988 to eradicate the disease.
But an unexpected outbreak of 1,600 new cases in Uttar Pradesh last year caught health authorities by surprise. It raised fears that the disease could spill into regions where polio has been stamped out.
Worried health officials say the disease resurfaced because millions of children in Uttar Pradesh apparently had never been immunized.
Many households had simply been missed due to poor implementation of the program in Uttar Pradesh. It is India's most populous state and its public health infrastructure is inadequate.
But in scores of villages, campaigners met unexpected resistance, as fears, rumors and misconceptions about the vaccine circulated, prompting many people to refuse the polio drops.
U.N. Childrens Fund spokesman Savita Naqvi says many parents, particularly in the minority Muslim community, thought the vaccine could make their children infertile.
"There had been cases when people thought that the vaccine would not do any good to the children, or would harm the children," said Ms. Naqvi. "Infertility or impotency was one of the issues, and these are delicate issues, which people do not often discuss. But they would just hide the children, or close the doors, and say the children have gone out, or are not there."
Health workers say that in many villages, Muslims thought the vaccine was part of a conspiracy by the Hindu-dominated government to limit the birth rate of Muslims, the country's largest minority group.
A senior official in the federal government's Child Health Division, Shoban Sarkar, said the rumor took hold even in non-Muslim homes, especially in areas where literacy rates are low.
"This has been among the Muslim community, but we are also seeing some rippling effect in other communities," said Mr. Sarkar.
It has been painstaking work to reverse the damage. During the past year, the government mounted what it calls a social mobilization campaign to reassure people that the vaccine saves lives and does no harm. Religious leaders, influential Muslim thinkers, popular Indian film stars and cricket heroes are all pitching in.
The World Health Organization's polio project manager in India, Jay Wenger, says tens of thousands of parents have been convinced by the campaign. "That has included increased interaction with local populations and communication activities, so that people understand what the vaccine is about, and that it is safe and effective and does not cause problems," he said.
There are similar obstacles elsewhere to overcome. In Assam state, for example, vaccines are regarded with suspicion, after many people heard rumors that 16 children died and hundreds fell ill after being given doses of Vitamin A during an anti-blindness drive. The rumors were not true, but the stigma against vaccines has stuck.
Indian health workers think they are breaking through the barriers. The number of polio cases in Uttar Pradesh has come down substantially in recent weeks, indicating immunization drives have been more successful. The campaigns are also being repeated in the rest of the country.
The WHO's earlier deadline of 2000 for eradicating polio has been missed and another deadline of 2005 is also likely to be pushed back. But health workers hope that they are now in the end game in their fight against the disease and a successful campaign in India may make it possible to eventually eliminate polio.
This report is part of VOA's series on world health