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Polio Vaccination Efforts in India Focus on Convincing Parents of Safety - 2004-05-26


Polio is on the ropes. A $3 billion global campaign has driven the crippling and sometimes-fatal disease to just six source countries. Experts say the campaign has the potential to win the war this year. Polio would then join only smallpox in the very short book of eradication success stories.

But achieving final victory will not be easy. Wiping polio out of the last few strongholds will be the hardest.

The click-clacking of weavers' looms rattles through the village of Sarva in Uttar Pradesh. Weavers from India's Muslim minority are making silk saris for the women of the Hindu majority. This northern Indian state is one of polio's last strongholds.

That's in part because when the campaign to vaccinate children against the disease comes knocking, many people here don't answer.

"This is a typical case. They are not even opening the door," says Subodh Kumar, polio eradication campaign official, who says in some villages, vaccinators find that parents go to great lengths to hide their children.

"They went to one of the houses where [the parents] said, 'There is no child. [The] child has gone to school.' But [the vaccinators] said, 'The child is not of that age to go to school. Where is the child?' They went in and they found the child was under the blanket," he recalled.

Some parents hide their children because of rumors that the vaccine will make children infertile, or harm their health some other way. Officials know that unless they can convince parents in these last few pockets of resistance that the polio vaccine is safe, the eradication effort will fail. In Nigeria, misinformation about the vaccine has shut down vaccination programs, causing an outbreak that has spread the disease to polio-free countries.

So Indian health officials are pulling out all the stops. In Sarva and a few other villages where resistance is strongest, 10-person teams have been assembled, including local doctors, religious leaders, and other community members. Their mission is to go house by house, convincing, cajoling, and if necessary browbeating parents into vaccinating their children.

The team meets this man outside his home in Sarva. He's heard the false rumors that the vaccine is dangerous.

"I had 12 children," he said, "and I'm left with just two. The rest of them died. I just don't have the courage to let the doctor give my child the vaccine."

It's not an unusual story. Child mortality rates in Uttar Pradesh are among the highest in the world. The team tries to reassure him that the vaccine won't do any harm. They say look at all the other neighborhood children who have taken the vaccine with no ill effects. At the same time, they urge the father to think of what can happen if his children don't get vaccinated. Team member and local doctor Awadhesh Kumar Singh notes that polio victims are a common sight in India.

"You've seen children who have had polio," he said. "It's very difficult for them to walk. Think of your neighbor's child, how difficult it is for him to walk."

But still the father is not convinced. He stands frowning, arms crossed and silent as the team tries different approaches. But it's no use. After 15 minutes, he storms off without agreeing. So the team heads across town, past the rattling looms, to see his father.

The children's grandfather sells betelnut packets, a mildly narcotic treat that's popular in India. The team finds him sitting in the wooden box on stilts that serves as his roadside stall. Dr. Singh asks for permission to vaccinate his grandchildren.

"Is it necessary?" the grandfather asked.

"Yes," Dr. Singh answered. "And if all the children in your family don't get vaccinated, polio will spread to other children. If one child is left unvaccinated, the vaccine won't work," he said.

That's because it can take up to 10 doses of vaccine to provide complete protection. One child with polio can infect others who haven't completed the course of vaccination. And, he says, it's essential to give the vaccine before the child gets sick.

"If a dog bites," Dr. Singh said, "the victim can go get a vaccine against rabies. But if polio strikes, it's too late. There is no cure, only prevention. Only the polio vaccine can prevent children from getting the disease." But the grandfather is not convinced.

"I leave everything in God's hands," he said.

The team members keep talking, but the grandfather won't budge. Dr. Singh gets annoyed, and he threatens to put him in his report to the government about the day's activities. Refusing the vaccine is not illegal. But Dr. Singh suggests it soon will be.

"If people like you don't do it," he said, "there will be a rule. Whoever has the disease will spend six months in jail and pay a 5,000 rupee fine. Then you'll understand. Then you'll run to get this."

But there's no response. They offer him one last chance. Still no response. But just as they're about to give up,

The grandfather relents. But the saga doesn't end there. When two team members go back to the house to vaccinate the children, they find the father has hidden them. The vaccinators have to bring the grandfather back to the house before the father brings them out.

The team started the day with a list of 22 such families. At the day's end, they had convinced 16 of them to change their minds.

But Sarva is just one small village. Experts say a similar effort will be necessary in every last pocket of resistance. The final battle to eradicate polio must be fought house to house.