Chitra Subramaniam| Geneva| July 16, 2014| 9.20 am ISTThe World Health Organisation (WHO) has said that as Pakistan grapples with the outbreak of the wild polio virus, India cannot afford to let its guard down on polio eradication. “The anxiety levels for public health workers in India must be very high at this moment – they have to ensure that all their citizens are vaccinated and their surveillance systems are robust†Sona Bari, the point person on polio for the WHO told The News Minute (TNM). “The situation in Pakistan where polio is endemic is a serious cause for concern for India,†she added. Earlier this year, the WHO declared the spread of wild polio virus as an international public health emergency and signaled outbreaks in over a dozen countries including Pakistan. Polio, which principally affects children under the age of five, is endemic in Pakistan and spreading virulently in certain regions and sections of the population. Syria and Cameroon are the two other countries along with Pakistan where the WHO said the risk of further spread and exportations of the polio virus was a serious public health problem. Read the alert here.The WHO’s concern is echoed by Dr. Emmanuel Vidor of Sanofi Pasteur, one of the three major pharma companies that make polio vaccines. “The situation in Pakistan seems to have deteriorated. The political situation in the region makes vaccination extremely difficult,†Dr. Vidor told a group of reporters. “Under the circumstances, the WHO’s parget to eradicate polio by 2018 will be difficult to meet,†he added. Glaxo Smith Kline and India’s Serum Institute are the other two pharma companies that make the oral and injectable polio vaccines.In 1988 the WHO launched a global polio eradication programme setting the year 2000 as the deadline to control and roll back the disease. That deadline has now been moved to 2018 as new challenges emerge including wars and civil wars. In Pakistan, for example, health workers have either been killed or driven away from inoculating children in some areas. “The WHO has been on the brink of eradicating polio for some years now – it’s a perfect example to show the importance of communication a determinant of health,†said Dr. Franklin Apfel, Managing Director of the UK-based World Health Communications Associates. Apfel, who was earlier with the WHO said there are new insights available about why vaccines are shunned for political or other reasons and it is important to communicate the right message to communities and health workers. The outbreak in Pakistan is a spanner in the works for India, poised between its newly-acquired polio free status and a virulent outbreak in Pakistan with which the country has porous borders. Syria, which was polio free for 15 years, was re-infected with polio virus from Pakistan. This year Pakistan has reported 84 cases of polio. Pakistanis coming to India are required to produce a vaccination certificate or be vaccinated when they enter the country. However, a former resident of Kashmir now working in public health told TNM certificates are easy to come by and checks are spotty where they exist. The last case of polio in India was reported in 2011 making it eligible to be declared free of the virus after the mandatory three year period when no cases are reported. Eradicating polio from India was a monumental task. For example, on the National Immunisation Day, over 2.5 million volunteers inoculated over 170 million children under five. Since each child requires two drops, some 340 million drops of the oral polio vaccine (OPV) developed in the 1957 by the Polish-American scientist Albert Sabin were administered. It may be recalled that till recently, India was exporting the polio virus and the Indian virus was found in Angola, the Central African Republic and Tajikistan. The polio virus is food and water-borne and it multiplies in the intestines. From there it can invade the nervous system leading to paralysis in one in every 200 infections and is also capable of causing death within a few hours. There are two types of vaccines, the OPV and the injectable polio vaccine, IPV which contains a killed or inactivated polio virus and was developed by Jonas Salk in 1952.Public health workers are hoping to have greater access to the IPV which is considered a safer way to inoculate children against the disease because it does not carry the live virus. Western industrialised countries have moved to the IPV and India is recently looking at this option as WHO recommends. At 14 cents a dose for the OPV where two or three doses suffice to some 99 cents per IPV shot where two shots are required cost is a major stumbling block. “In some instances, India has used upto 14-15 doses of OPV per child – the way forward is a combined regime of both the OPV and the IPV and moving to the latter under guidelines established by the WHO,†Vidor said. The shift to the IPV regime is widely seen as the endgame of the battle and among the principle benefactors of the eradication programme are the Bill and Melinda Gates Foundation. Estimates show that 125 million infants need to be vaccinated annually. The Serum Institute entered the IPV segment of the market recently after it acquired Bilthoven Biologicals, a Dutch pharma company. Public health experts say Serum Institute’s entry into this market will push Sanofi and others to do more to help countries make that critical transit from oral to injectable vaccines. Over the past two decades, Sanofi Pasteur has supplied UNICEF with over 5 billion doses of OPV. Where the price-war meets philanthropy and where volumes drive the price down as countries move to the IPV regime will be a keenly watched conversation. In the meantime, Dr. Apfel says, it is important to communicate, credibly and continuously.TNM was part of a group of journalists invited by Sanofi Pasteur to visit its facilities in Lyon France.