Organized by Polio Eradication Committee of IAP
Hosted by - IAP Muradabad Branch
Venue-IMA Hall
Sponsored by UNICEF India

April 28th was the day when in this world famous city of brass, IAP Moradabad wrapped itself in ignominious glory. Many bigwigs of IAP, UNICEF, WHO, Rotary and other eminent people involved with polio eradication collected to work out new strategies and review the current ones so that Polio can be given a final push from this subcontinent.

After inauguration of the workshop by the Chief Medical Officer, Muradabad, Dr Paul Francis, from NPSP India, opened the discussion with a presentation on the 'Current scenario of Polio in India'. He graphically presented the facts and figures, which reminded everybody of how far really we have come on this arduous road to polio eradication and how little is the distance to be covered. It showed how Polio is confined to scattered areas of UP and Bihar. He informed that at first the Pulse Polio Program cut the Polio cases number drastically, then in the Intensive phase with the door-to-door administration of Polio drops by health workers on days following specified booth days, excellent results were achieved. Now with the Mop up round in the 'hot zones' the P2 virus has disappeared and only P1& P3 are left scattered in limited areas.

Dr Nitin Shah the Hon Secretary General of National IAP elaborated on the role of IAP in Polio eradication. He said that in 1989 the IAP recommended the concept of Pulse immunization and explained how intricately it had been involved in this campaign by sending letters and posters to its members. This role is now more organized with the formation of the National, State, Zonal, and district Coordinators who are given the responsibility to collaborate with governmental and non-governmental agencies to instigate its members to play a key role. He said that all controversial issues like IPV/OPV, vaccine induced paralysis, vaccine failure etc, should be discussed in private forums and that in public all issues should be presented with clarity without any scope of confusion.

Dr K Suresh from the UNICEF India called upon the need of social mobilization on this issue. He highlighted how appropriate measures should be taken to neutralize the resistance in minority communities. He called for the need to win the confidence of the people by organizing Health Camps. He assured that there is no technical flaw per se in Pulse Polio Program and that only its correct implementation, which would help eradicate PPP. He said if anything was lacking it is the commitment. He called for a need to weed out the 'black sheep' who are present at every level.

Dr Naveen Thacker, National Convener of IAP Polio Eradication Committee made a fervent appeal to fellow Pediatricians to be unflinching in their commitment to Polio eradication He called for the need to first convince ourselves for the need for so many extra doses of OPV. He explained why 6-7 doses of OPV are required to eliminate the chances of Polio. He said that Pediatricians often do not bother to re-emphasize the need of this point to their patients. He urged that it is the moral responsibility of everyone to motivate patients and make them aware of the importance of Pulse Polio doses. He suggested that such workshops ought to be held in not only State & District levels but also at the Block Level. He called for the need of involvement of General Practitioner and even quacks in the villages! He also called for the need to form a Task force by Local IAP BranchES, which could coordinate between governmental and non-governmental agencies and serve as a guiding force to them. He suggested that doctors should go to the houses of their influence in hot zones.

Dr Swati Bhave, Immediate past President IAP elaborated how IAP has been actively involved in Pulse Polio Program during her tenure.

Dr Rajiv Tandon Executive Director Polio-Plus India Rotary International, Delhi informed of the diligent involvement of Rotarians in the Polio eradication program. He assured full cooperation from Rotary to IAP in this program.

A lively Open House Discussion followed these individual presentations. Dr BK Dutt, Senior pediatrician of Moradabad, who has reported about 200 cases of AFP in last 3-4 years and has been at the forefront of Moradabad IAP Surveillance role, opened the debate with brutally frank comments. He said that Government health agencies were not only guilty of making a mess of routine immunization but also of reporting it to be 100 percent when it was not more than 15-20 percent. He said Polio could not be eradicated until this false reporting is discontinued. He called for strengthening routine immunization program, which lies in tatters, particularly after the start of Pulse Polio Program. He called for a system in which Health personnel reporting correct figures be encouraged and used as a corrective tool rather than being made a scapegoat.

Reacting to Dr BK Dutt's remarks Dr Nanak Chandra, District Immunization Officer, Moradabad gave an account of the trying circumstances under which Health workers work. He said workers are stacked against heavy odds of rumors, cynicism and confusion in people's mind regarding the Pulse Polio Program. However he was candid enough to admit that the level of routine Immunization was really very poor. He reasoned that this would go on till immunization is removed from the 20-point program of the Govt. of India - a key reason for bureaucratic pressure in tampering with data.

Dr Mahesh Goyal from Saharanpur stressed the need to reach out to remote areas and to change the present approach towards people in order to increase the acceptance of the program. He suggested infusing new ideas and incentives like Health camps, distribution of medicines etc.

Dr Atul Agarwal the Secretary of UPIAP called upon Pediatricians to be more conscious of their social responsibilities. He said that they were not just destined to treat children but also to play a key role in this noble program by keenly participating in all activities of PPP. He called upon the media to highlight the positive aspects and not the negative ones. He said that media representatives should think of the impact of their reporting. He rightly appealed to media to play a pivotal role in Polio Eradication and that it should work in tandem with IAP and other agencies.

Dr Vineet Saxena from Meerut and Dr Arvind Garg from Meerut presented the state of Polio eradication in their respective districts.

Release of a manual "Polio Eradication: Waiting For A Final Push" published by IAP Polio Eradication Committee and edited by Dr.Vipin M Vashishtha, by Honorary Secretary General, Dr. Nitin K Shah. Around 1,000 copies of the bulletin, which was published in three languages, English, Hindi and Urdu were distributed amongst IAP members, GPs, RMPs, NGOs residing in a polio endemic areas. The polio eradication committee is also going to published an eight-page pullout in Hindi (in a form of Q&A) for distribution amongst the GPs, RMPs and influential community workers of the region where a stiff resistance to polio drops and the compaign was reported and documented.

In conclusion, Dr K Suresh appealed for sincerity and dedication by all IAP members and took a pledge to this, from all of those present in the workshop. His untiring attitude was just the tonic needed to overcome the fatigue seeping into those involved in PPP. It was decided to pass a resolution, which would be referred to as the "Muradabad Declaration" of IAP.

Highlights of Moradabad Declaration

There is no flaw in Pulse Polio Program. By taking corrective measures in its implementation, we can surely overcome the last hurdle.
IAP members will be more conscious of their role in motivating people for PPI. They will not only provide correct and appropriate information to parents coming at their clinics but also go to remote areas to disseminate these.
IAP members will give their services in health camps organized by UNICEF.
IAP members will help UNICEFs social mobilization coordinators in overcoming resistance in families for taking polio doses.
IAP members will help in disseminating scientific reasoning that why additional doses are needed, why polio occurred in a vaccinated child etc.
IAP will establish field coordination with Rotary in achieving polio eradication.
IAP members now onwards will screen their admitted patients' for number of OPV doses received (Surveillance for OPV doses).
Action should take place where the problem lies. IAP has moved from national level to state and now to the district level. Next we should move to small towns, village and block levels in hot zones. IAP has decided to hold such workshops at districts and block levels.
At all public forums, there should be complete consensus amongst the experts as any discordance will send confusing signals to the media and society. All controversies should be settled on academic platforms.
IAP advises the government to strengthen the routine immunization, as very poor coverage will continue to be a stumbling block in Polio eradication. There should be complete honesty in reporting immunization coverage.
Media should be primed of its pivotal role. If duly utilized, the media can be a potent weapon to fight misconceptions and in motivating and informing people.
Some new ideas and approach should be infused along with door-to-door campaigns not only to lend more credibility but also to overcome irritation among the people because of repetition. This can be in form of distributing medicines, and holding health camps in problematic areas.
Local IAP branch will coordinate between governmental and non-governmental agencies and serve as a guiding and motivating force. They will form a task force to serve this purpose.
Polio is on truly on the verge of eradication and requires just a 'final push' and thus it is most important that we should have belief in this. This will help overcome the sense of fatigue and boredom.
Sincerity, dedication and honesty in approach are that is all required.