Oral polio vaccine could cause vaccine induced polio.

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Experts call for more potent polio vaccine Pioneer News Service/ New Delhi http://www.dailypioneer.com/indexn12.asp?main_variable=NATION & file_name=nt4%2Etxt & counter_img=4 As India heads towards the finishing line for polio eradication, it is just the right time to debate and decide on the future strategy to prevent re-emergence of the disease. One section of opinion is in favour of introducing inactivated polio vaccine as oral polio vaccine is phased out. "Optimistically, wild virus transmission could be interrupted within a few months, but the road map beyond remains unclear. It will be safer, hence wiser, to use IPV to conclude polio eradication. Delay in decision may create a situation in which we may not have what we need and cannot use what we have," said Dr T Jacob John in Indian Journal of Medical Research. Last year least number of new polio cases were recorded, and the Central Government is hopeful that the transmission chain, especially in Uttar Pradesh and Bihar, have weakened. But the unavoidable fallout of oral polio vaccine (OPV) has been one associated with the vaccine itself. Dealing with vaccine associated paralytic polio (VAPP) may require a different strategy than continuing with the oral vaccine. It would be a fallacy to presume that once oral vaccination is stopped, the virus derived from the vaccine will also stop. At present, the situation is controlled by massive deployment of oral polio, over ten doses in a year. But as zero case is achieved, the thrust me be lowered. This will raise genuine fears of emergence of a vaccine-derived virus circulating among children. The situation will be disastrous, he felt. "Continuing OPV post-phase eradication of wild polio is unethical on account of VAPP. Slow withdrawal is risky," he wrote. The small but significant risk of circulating vaccine-derived polio virus is not worth taking, he felt. "If circulating

vaccine-derived polio virus were to emerge, there will be a delay of one year or more before it is discovered. By then it would have spread widely, silently, even across national borders. Should we then flood the community with OPV (monovalent or trivalent) to eradicate the VDPV, knowing that young children in surrounding communities will be naive to polio viruses, wild and vaccine? Is it ethical or scientifically acceptable to re-introduce OPV into a world with no vaccination, when the probability of transmission and circulation will be higher than now? Are we willing to risk the entire investment of eradication for the sake of the cheapest or simplest of all future options? In the un-chartered sea ahead, are we confident our Titanic is un-sinkable," he asked. "The only rational option, therefore, is to introduce inactivated polio virus in preparation of withdrawing

oral polio vaccine," he asserted. Scandinavian countries eliminated polio by directly employing inactivated polio vaccine. Germany, France, Canada, UK, New Zealand and the US employed oral vaccination in the initial stages and then switched to inactivated polio vaccine. If India does opt to introduce inactivate polio vaccine, used as injectibles, it will need to look at cost and technical expertise to manufacture these in the country. Short supply has kept the cost of injectibles high. "Technology for its manufacture can be re-established if the Government so decides. If made here, the cost will be affordable," he said. The decision must be

taken by India now rather than waiting for a World Health Organisation's decision, which may take time, Dr John felt. "Our ideal is not the spirituality that withdraws from life but the conquest of life by the power of the spirit." - Aurobindo.

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