A resurgence of polio cases in northern India has sent alarm bells ringing across a country that is one of the last holdouts of the virus in the world. Total polio cases in India shot up by more than six times last year to 1,509, up from 268 in 2001, according to health ministry figures. Though the last quarter of 2002 showed some signs of decline, the comeback of the disease, defying publicity and awareness drives, is both embarrassing and worrying government health officials. It also sets back the eradication campaign that is already behind schedule. India has already extended its polio eradication target - from the initial 2000 set by the World Health Organization (WHO) to 2005.

The rise in polio cases, most of them in Uttar Pradesh, was serious enough to cause Health Minister Shatrughan Sinha to announce that the Central government would undertake the polio eradication drive "on a war footing." Uttar Pradesh accounts for 68 percent of the global polio burden. In India alone, it accounted for nearly 80 percent of the cases (1,197) last year. After Uttar Pradesh, its eastern neighbor Bihar had the next highest number of cases. "The rise is embarrassing. But we are also worried that polio might spread from Uttar Pradesh to adjoining densely populated areas," Shobhan Sarkar, head of the polio eradication programme in the government's health ministry, said. The fears are not unfounded. Delhi shares its eastern border with Uttar Pradesh and reported 24 polio cases last year -- mostly in children of slum dwellers who had migrated from Uttar Pradesh. Migrants from Uttar Pradesh increased last year after a severe drought shriveled crops there and destroyed the livelihood of thousands of small and marginal farmers.

The only silver lining appears to be a report in January that indicates that after the alarming rise up to September last year, the number of cases in Uttar Pradesh declined from September to December. The report by Jay Wenger, WHO manager of the independent polio surveillance project, says the monthly figures in Uttar Pradesh fell from 334 in September to 18 in December 2002. But then, maximum cases are recorded in the monsoon months, after which there is a natural decline in transmission of the polio virus. Winter is a lean transmission season for the virus.

Still, a health ministry official said: "Things are looking up, with fewer cases in the last three months. We are keeping our fingers crossed and hoping the trend continues." India has been implementing an intensified Pulse Polio Immunization (PPI) campaign since 1995 - under which all children below five years would be vaccinated. India conducts two immunization campaigns every year, in December and January with a six-week interval between the two. In 1999, India launched additional immunization drives in its eight endemic states, including Uttar Pradesh.

One problem has been the inability to maintain the "cold chain" properly - ensure that the vaccine is under refrigerated conditions until it reaches the child.
The alarm triggered by the spiraling polio cases is such that even academic institutions have joined the anti-polio drive in Uttar Pradesh this year. In the Jan. 5 immunization drive, the Aligarh Muslim University (AMU) vice chancellor led health and social workers in Aligarh and Moradabad districts in a public awareness drive to dispel misconceptions about vaccination. Hollywood star Amitabh Bachchan too was invited in, and polio campaign visuals are aired on prime time on several television channels. Rotary International has tried out novel ideas like giving out rattles, whistles and sunshades to children coming for the polio drops.

Fears of poor families that the polio vaccine may do some harm, were not countered properly. "We are scared to give the anti-polio drops. We go only if we are forced to," says Sharbati, a domestic worker whose family migrated from Uttar Pradesh to Delhi five years ago. She says many in her native village fear the anti-polio drops may make children ill. In the Jan. 5 immunization round, Rotary involved 1,500 volunteers from the state specifically to dispel myths about the vaccination process.

Press reports quoted Uttar Pradesh health minister Phagu Chauhan as conceding that administrative slackness was partly responsible for the rise in polio cases in the state. Another problem has been inability to maintain the "cold chain" properly - ensure that the vaccine is under refrigerated conditions until it reaches the site - despite additional machinery for storage and transportation of the vaccine. There are problems of vaccine shortage too. A health ministry report says that in India, four to five percent of children - mostly in remote rural areas - continue to be missed in the government anti-polio campaign. "Even this four to five percent would still constitute a number of unvaccinated children large enough to keep the virus alive," a health official pointed out.