Polio programme: let us declare victory and move on.

Area of Science:

• Global health
• Infectious disease epidemiology
• Public health policy

Background:

• The global initiative aimed to eradicate poliomyelitis, with the expectation of discontinuing immunisation post-eradication.
• The synthesis of poliovirus in 2002 rendered complete eradication unachievable, raising ethical questions about resource allocation in developing nations.

Purpose of the Study:

• To evaluate the ethical implications of pursuing polio eradication despite the impossibility of achieving it.
• To investigate the observed increase in non-polio acute flaccid paralysis (NPAFP) in India following a year of being polio-free.

Main Methods:

• Analysis of data collected through the established polio surveillance system.
• Correlation of non-polio acute flaccid paralysis (NPAFP) incidence with the number of oral polio vaccine doses administered.

Main Results:

• A significant increase in non-polio acute flaccid paralysis (NPAFP) cases was observed, with 47,500 additional cases in 2011.
• The incidence of NPAFP was found to be directly proportional to the number of oral polio vaccine doses received.
• This critical data, collected via polio surveillance, was not investigated, potentially violating the principle of 'primum-non-nocere'.

Conclusions:

• The pursuit of polio eradication, given the circumstances, may have been unethical due to resource misallocation.
• The rise in non-polio acute flaccid paralysis (NPAFP) necessitates further investigation into the safety and efficacy of oral polio vaccines.
• The substantial financial investment in the polio program offers a lesson on the potential pitfalls of vertical health programs.