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HEALTH: New Haj Rules to Push Polio Vaccination in India

Ranjita Biswas and Ranjit Devraj

KOLKATA, Aug 25 2005 (IPS) - New polio vaccination rules for Haj (the annual pilgrimage to holy Mecca) announced by the Saudi Arabian government are expected to have a salutary effect on Muslim communities in India, who are otherwise reluctant to get their children immunised, say followers of the faith.

Under the rules, announced this month and to be enforced from January 2006, all children below the age of 15 arriving in Saudi Arabia for the Haj must carry polio immunisation certificates.

”This will send across the right signals to the community,” Salamat Ullah, a senior banking official and former chairman of the official Haj Committee of India, said in an IPS interview in New Delhi. Of the two million pilgrims who made it to Mecca from around the world in January, at least 130,000 were from India.

A major hurdle in making India polio-free and thereby boost the global effort to eradicate polio has been resistance from pockets of conservative Muslim communities in northern Uttar Pradesh and adjoining Bihar – states which together have a population of 260 million people.

Uttar Pradesh, which borders the India capital, accounts for more than half of the country’s polio burden, and has been seriously hampering an eradication programme that India has been running through mass immunisation since 1995.

Union health ministry officials have blamed the continuing high prevalence, despite mass immunisation efforts, to resistance from Muslim communities in the western Uttar Pradesh districts of Ghaziababd, Badayun, Bulandshahr, Etawah and Moradabad.


”Muslim families in these districts resist immunisation in the mistaken belief that our teams are trying to sterilise young children,” said a health official who asked not to be named. ”Now that Saudi Arabia, the custodian of Mecca, advocates and even enforces polio immunisation, Muslims here might be better convinced that we are trying to help rather than harm them.”

Ullah said many members of the community have responded well to the Saudi regulations in spite of the extra inconvenience of getting immunisation certificates and that there is now greater confidence in the national programme. ”This is a positive move on the part of Saudi Arabia and I appreciate it,” he said.

Apart from routine immunisation, India also conducts ”pulse” immunisation campaigns twice a year that are designed to reach all vulnerable infants on a single day and replace the wild virus (which thrives only in the internal organs of young children) with the weakened one used in the vaccines.

Polio cripples because the virus, which is transmitted through water or food contaminated with faecal matter, attacks the central nervous system, resulting in paralysis or death.

On ”polio days” some 200 million doses of oral vaccine are administered on a single day by teams that fan out across India during the drives to reach all children in the country under the age of five.

According to Union Health Minister Anbumani Ramadoss, India could save some 250 million U.S. dollars on annual health expenditure if the two major north Indian states alone were to become polio-free.

So far this year, a total of 26 polio cases have been reported from across the country, but of these, 12 were from Uttar Pradesh and ten from Bihar. There was one each reported from Delhi, Jharkhand and Uttaranchal states.

”So many new cases in Bihar and Uttar Pradesh represent a setback for the polio programme,” admitted Ramadoss, who worked as a medical doctor before he took to politics.

India, Pakistan and Nigeria head the list of countries with most polio cases and are where resistance from Muslim communities to immunisation have been reported. Egypt, Afghanistan, Niger and Somalia are the other countries where the wild polio virus continues to thrive and cripple children.

When India began its Pulse Polio Programme in 1995 it was projected as one of the biggest public health programmes in the world, and the target year for eradication was ambitiously set at 2000.

But subsequent spurts of fresh cases pushed the target year forward by another five years.

The number of polio cases rose from 268 in 2001 to 1,600 in 2002. In February 2003, India launched the largest ever mass immunisation campaign against polio, targeting 165 million children. But even in that year there were 225 cases, though in 2004 there was a significant drop to 136 cases.

There have, however, been signs that India is gradually overcoming the disease and that it would be possible to halt transmission of the virus by the end of the year.

West Bengal, which borders Bihar, and also has a significant Muslim population in districts like Malda and Murshidababad, reported no new cases this past year.

”The immunisation campaign has recorded more than 98 percent success in the state. The immunity gap has now come down to four percent,” Prabhakar Chatterjee, health service director, told IPS.

Considering that in 2003, West Bengal figured on the ”polio menace list” of the World Health Organisation (WHO), and by 2004 there was only one case reported, there has obviously been rapid progress, officials said.

The encouraging results in West Bengal have been attributed to a policy of involving local influential people, including clerics in the Muslim-dominated areas.

Officials from both the state government officials and United Nations Children’s Fund (UNICEF) approached the Muslim clerics and madrasas (traditional schools for Muslim students) to help in a determined awareness campaign.

Under UNICEF’s guidance, the Board of Madrasa Education organised camps for about 1,000 madrasa teachers in nine districts so that they could directly intervene with the families.

”The important thing now is not to miss out on the surveillance. Constant monitoring has to be done so that any new case is immediately reported,” said Pankaj Mehta, UNICEF project officer for health and nutrition.

Similar campaigns have been mounted by UNICEF and WHO with support from Rotary International in Uttar Pradesh through such influential institutions as the Aligarh Muslim University (AMU), located in the town of Aligarh.

Europe, the Americas and China have achieved eradication but cannot dispense with vaccination as long the wild virus continues to exist in India and the other six countries.

The Saudi Arabian restriction on Haj pilgrims followed the discovery of two cases, one of them in the port of Jeddah, where a Sudanese girl became paralysed soon after arrival for the annual pilgrimage in January.

In the other case, a Nigerian boy fell ill in December 2004 after his family, which lives near Mecca, took in visitors from the native country where vaccinations were suspended in Muslim-dominated areas in 2003-2004 because of rumours that the vaccine made young girls sterile.

Saudi Arabia, which has been polio-free since 1995, and did not see fit to require pilgrims to be vaccinated, will now enforce the new visa rules from the next Haj in January.

 
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