To prevent polio
disease caused by polio viruses, two types of vaccines are available. 1.
Injectable inactivated polio vaccine (IPV), develpoed in year 1952 by Dr Jonas
Salk, and, 2. Oral polio vaccine (OPV) developed in year 1956 by Dr Albert
Sabin.
Like every medicine, every vaccine has some side effects, contraindications, and ineffectiveness, which is called failure-specially vaccine failure.
In 1988 the
World Health Assembly, during its 41st meeting passed resolution 28,
declaring that ‘World health Organization (WHO) takes its initiative for global
eradication of polio exclusively by OPV”. This resolution is known as
WHA-41.28.
Was WHO aware
that OPV can cause VAPP?
An enqiury instituted by WHO (1), having 35 international experts including Dr Albert Sabin concluded in year 1976 that OPV can cause paralytic polio disease.
An acute flaccid paralytic (AFP) case that fulfills all the clinical criteria to be labelled as a case of poliomyelitis where no wild poliovirus is detected in two adequate samples of fecal matter, but poilio virus is detected should be considered a case of vaccine associated paralytic poliomyelitis (VAPP). Simply put, it is a case of poilio disease caused by OPV.
There is no scientific evidence that 1999 onwards gross genetic changes occurred in people living in India which stopped occurrence of VAPP. Thus it can be said that this step taken by WHO was not only unscientific but also unethical.
In June 1999 issue of Academy Today, a quarterly bulletin of IAP on page 15 under the title’VACCINE ASSOCIATED PARALYTIC POLIO (VAPP) SILENCE IS GOLDEN BUT NOT ALWAYS’, I had raised some issues including high risk of VAPP in immunocompromised children. I had raised this issue earlier in March 1999 issue of Indian Pediatrics (2). The then President of Indian Academy of Pediatrics and Chairman, Committeeon Immunization had stated” For one thing, poliomyelitis can be eradicated by using OPV exclusively---- Even those who believe that it would have been much simpler to eradicate polio using 3 or 4 doses of enhanced potency inactivated polio vaccine (IPV) in combined form with DPT, than with targeting virtually 100% of children to take 13 to 15 doses of OPV, should hold their horses and fully endorse and support the efforts to get rid of wild polioviruses as soon as possible---- However, I will not suggest that the public be alarmed by the very small risk of vaccine associated polio, a price we have accepted to pay for the control and eradication of wild polioviruses” (3).
Man made Polio
cases: Last case of polio by Wild Polio Virus type 2 was reported in 1999.
Monovalent OPV vaccines were available, but WHO continued with Trivalent OPV
causing VAPP cases by OPV type 2 vaccine till year 2015. Bivalent OPV became
available in year 2010, but it replaced Trivalent OPV in year 2016.
According to the WHO report in year 2022, since 2017 there have been 396 cases of polio caused by wild polioviruses versus more than 2600 linked to OPV (4).
In August 2024 a
two years old girl from Meghalaya’s West Garo Hills district developed VAPP.
This was reported by many Indian newspapers. It was also reported that the
child was not immunocompromised. In WHO’s report on Global polio cases by wild
poliovirus and VAPP cases from June 4 2024 to December 3 2024, Meghalaya case
which occurred in August 2024 is not mentioned.
Two mysteries:
1. Science
behind not consideringVAPP cases as polio cases in India.
2. Silence
observed by IAP leadership and the Indian Council of Medical Research (ICMR) on
unscientific policy of WHO.
References:
1. WHO
consultation. The relation between acute persisting spinal paralysis and
poliomyelitis vaccine (oral). Result of a WHO enquiry. Bull WHO 1976; 54: 319-331.
2. Paul Y.
Contraindications of OPV. Indian Pediatrics 1999; 36:318-319.
3. John TJ.
Reply. Indian Pediatrics 1999;36:319-320.
4. WON (2022): ‘Polio in the US, the UK and Israel Reveals an uncommon Danger of Oral Vaccine”, Viewed on August 2023. https://www.WIONews.com/world/polio in the US-UK and Israel reveals -an uncommon danger of oral vaccine 508-559.
This Question has been Answered By
Dr
Yash Paul, A Senior Most Pediatrician from Jaipur, Rajasthan