Systematic approach to polio eradication
EFFORTS against polio have been stepped up lately and rightfully so. However, there seems to be a missing link somewhere, the absence of which has led to lacklustre results of the campaign.
While there is no doubt about the sincerity of the efforts, there does seem to be a gap somewhere at the strategic or tactical level.
Having been a part of these campaigns for the past few years, I have an observation to share. The frequency of polio campaigns has increased to a great extent lately: at some places being conducted almost weekly. Unfortunately, this has proved to be counterproductive to the cause of polio eradication at two fronts: first, due to this high frequency even the parents who were earlier willing to get their children vaccinated have now started asking questions and even refusing in many cases.
This phenomenon can be referred to as ‘frequency refusal’ as in contrast with ‘religious refusal’. Although there might be no harmful effect of administering the drops so frequently, yet the basic idea that even a good thing when in excess can prove bad makes these parents sceptic of the campaign.
Secondly, because of this high frequency, the efforts being put in by the health department and district administrations have become rather frantic. Their energies are being divided up between the ‘post – campaign’ activities of one campaign and ‘pre-campaign’ activities of the next campaign, affecting their efficiency in both pre- and post-phases.
It is recommended that either sufficient gap be placed between two successive campaigns so that the ‘post-campaign’ activities of one campaign do not overlap with the ‘pre-campaign’ activities of the next or the human resource engaged in executing the two phases should be separated to ensure dedication.
Most importantly, campaigns should be conducted in such a way that the children missed for any reason in the first three days of the campaign are noted and then followed up and vaccinated on the fourth day called the ‘catch – up day’.
The children missed even after this catch-up day are called the ‘still missed children’ and are supposed to be covered before the start of the next campaign, though, at best, only half of this number is successfully vaccinated before the next campaign starts.
This happens for various reasons, one of which is the start of preparatory activities of the next campaign. The real catch, interestingly, is that no matter how many of these children are vaccinated or left over, the new campaign starts all over again without first ensuring that the leftover children of the last campaign are covered.
The presumption is that if we keep repeating the campaign for all children, the missed children of the previous campaign would also be covered eventually.
Although this approach may as well be of value, yet it fails to deliver because right after the end of one campaign the staff involved has to do post-campaign activities of that campaign, pre-campaign activities of the upcoming campaign.
It will also try to vaccinate all the ‘still missed’ children of the just-ended campaign. All of this is not possible without compromising on the quality of either or all of these components.
A more logical approach might be to dedicate the first day or two of the campaign to vaccinating the missed children of the last campaign and then start vaccinating the other children, who had already been vaccinated successfully in the previous campaign.
If the need be, the duration of the campaign be increased by one day. This would objectively ensure that every child is vaccinated at least once within a maximum of two successive campaigns and would not leave this objective to chance.
Health experts at the federal and provincial polio-eradication forums, and those from WHO, are invited to ponder.