This all reminds me of something I read about how Muslims are avoiding vaccinations because they think it is a conspiracy to sterilize their children and wipe out the religion. Very sad...
Distrust Reopens the Door for Polio in India’From the NY Times
January 19, 2003
By AMY WALDMAN RAMPUR, India - The little girl sat somberly, eyes large and sad, mouth an unmoving bow, legs as lifeless as a marionette's. Her face contorted in pain and frustration. Tears streamed down her cheeks.
She clutched at her mother, who berated herself for her child's agony. In trying to do what she thought was right for her daughter, Tehazib Jahan had done something irrevocably wrong.
Last year, Mrs. Jahan had heard the story circulating through her Muslim neighborhood that the polio vaccine would make her child sterile. She believed it. So even though her daughter, Uzma, still needed two doses of the vaccine, Mrs. Jahan would not take her to the immunization booth. When the vaccinators came to her house, she demurred.
Three months ago, Uzma came down with a fever. Then the paralysis, polio's calling card, set in. Today the once playful 4-year-old cannot stand without help.
"We are illiterate, not very intelligent," Mrs. Jahan said. "We were influenced."
Borne along by rumor and fear as much as any biological route of transmission, the polio virus - almost vanquished worldwide thanks to a cheap and widely available vaccine - has made a defiant comeback in India.
In 2001, after years of aggressive mass immunizations, there were 239 new cases in the country - down from about 200,000 in the early 1980's. Officials were confident that India could eliminate the disease, as so many countries have, by the end of 2002. Instead, India had 1,509 newly diagnosed cases last year - a vast majority, 1,197, in Uttar Pradesh, the country's most populous state, and one of its poorest. Uttar Pradesh accounted for 68 percent of the polio cases worldwide.
The reason, according to government officials and community leaders, seems to be largely a rumor that the oral vaccine, given as drops, was part of a government population control scheme. No one knows how it started, but its effects are now clear.
On a recent day, another mother, Shamina, 30, initially refused doses for her three children, ages 1, 3 and 5, when the vaccinators came to her door. Her husband had told her to do so, she said. "We have heard some things about these medicines," she said as chickens pecked at her feet. "That when these children become adults - they will be useless."
The resurgence of polio here has alarmed international health experts, who had aimed for the global eradication of polio by last year. Last year, polio was found in seven countries and increased only in two: Nigeria and India.
"There's a real risk of people thinking if we fail we're going to have 1,000 cases a year," said Dr. Bruce Aylward, coordinator of the World Health Organization's global polio eradication initiative. "We're not. We're going to have hundreds of thousands of cases of kids being paralyzed by a disease that was an inch away from disappearing forever."
Dr. Sobhan Sarkar, the Indian government's deputy commissioner of child health and coordinator of the national antipolio campaign, said what worried him was the spread of polio to areas where it was not previously found. The virus is spilling from Uttar Pradesh into other states.
The polio outbreak has also exposed a religious, or communal, health divide. Only 17 percent of Uttar Pradesh's population is Muslim, but 59 percent of its polio cases last year were among Muslims, like Uzma. Although the rumor was repeated in Hindu communities too, health officials say it gained greatest currency among Muslims, who in Uttar Pradesh tend to be landless laborers with lower literacy rates and a greater mistrust of the Hindu-dominated government.
Many Indians have feared forced sterilization since it was carried out during the authoritarian period of the late Prime Minister Indira Gandhi's state of emergency in 1975. Since then, government health initiatives have often been viewed warily.
That has been especially true among Muslims, not least because most government health workers are Hindu.
Some health officials said they had known for years that they were having a harder time reaching Muslim households. But Naseem Ahmad, vice chancellor of the Aligarh Muslim University in Uttar Pradesh, said the divide between Muslims and Hindus widened when the Hindu nationalist Bharatiya Janata Party rose to power in the state five years ago. It is now part of a coalition government.
"Because of the political setup at the moment, with the B.J.P. in power," he said, "the impression from the illiterate and semiliterate is that anything from the present government would be to their detriment."
This is not the first fear to foil a health campaign in India. Last year, rumors that vitamin A - dispensed to reduced the incidence of diarrhea and measles and to help prevent blindness - had caused the death of dozens of children halted a public health drive in the state of Assam.
Mrs. Jahan, who is 26, is totally unschooled. She was married at 16 or 17. Her husband rolls cigarettes for a living, and the family earns about 2,400 rupees, or $50, a month. She lives under the purdah system and so she rarely leaves the house. When she does, it is in a burka, the head-to-toe, face-covering veil. She said she did not know how the rumor got started. "We are women, confined to the household," she said. "We work and we eat."
Uzma is unusual, in that most of the polio cases here have been diagnosed among children under 2. But almost all of them have come in places where significant percentages of children — 6 percent or more — did not complete the full course of the vaccine, which involves at least four doses.
Health officials say they hope that in the wake of the current epidemic the number of new cases will taper off this year, at least in Uttar Pradesh, with many children who are not immunized by the government developing natural immunity through mild exposure.
Dr. Aylward agreed that that could happen, but warned against a false sense of security. "It's going to plummet, and buy you a bit of time," he said, "then it's going to come roaring back." Mass immunization, he said, remains necessary, and that effort is under way.
The government and the World Health Organization, in partnership with Unicef and Rotary International, which has given more than $500 million to fight polio, started a drive this month to immunize 150 million Indian children, many of them in Uttar Pradesh.
Where possible, the government has tried to add health workers of the same religion and social caste as the people where the vaccinations are scheduled. But officials say they have struggled to find enough Muslim women with some education and without purdah strictures to join them. Nongovernment organizations have helped fill the gaps.
With 166 million people, Uttar Pradesh is more populous than all but five of the world's countries. It has long been troubled by poor governance. Federal health officials say the repeated transfers of state bureaucrats have made it difficult to mount sustained campaigns.
Health workers and those with aid organizations said that in a state where so little seemed to work, the very efficiency of the eradication drive added to people's suspicions.
"People say, `We do not have food, we do not have jobs, we do not have electricity. Why are you only after these drops? Why again and again these drops?' " said Nikhat Parvin, a Muslim volunteer with the nonprofit Adventist Development and Relief Agency. On this morning, she accompanied a vaccination team through the lanes of Ger Hassanha, a Muslim neighborhood in this bedraggled city of 300,000 people.
Rampur district had 36 polio cases last year. Of those, 29 were among Muslims, although the district's two million residents are about equally split between Hindus and Muslims. All the cases, the district's chief medical officer, Dr. Vijay Singh said, were among the poor, those with inadequate food, unclean water and poor sanitation. In many localities, he said, human waste was simply dumped in the open, making fecaloral transmission of the virus "very, very easy."
The team went house to house, checking to see whether the drops had been administered, giving them if they had not, and then chalking the status upon wooden doors.
By 11 a.m., two mothers, both Muslims, had refused. One of them was Shamina, who said she was illiterate. But she allowed the three women with the team into her courtyard to make their pitch.
"Your children are not only your children, they are like my children," said Byant Kaur, 55, a state health worker since 1969, and a Hindu. "Why would I hurt my children?"
Hamida Khan, a Unicef community mobilizer who is Muslim, joined in. "If the population decreases, who will the government rule?" she asked, as Ms. Parvin nodded.
Ms. Kaur continued, "If anything happens, you can get hold of my neck." The mother relented, and Ms. Kaur quickly dropped in the oral vaccine.
But across the narrow lane, her neighbor, who the team knew had a 3-year-old, refused even to open the door.
Instead, she shouted through it. "You are dishonest! I don't have time! I have so many other things to do!"
Then she added: "My children are already grown!"
Dr. Singh said many parents, knowing they might face pressure from the government — or even the police — if they refused the drops, were now simply lying about whether they had children younger than 5.
From behind the door came the last word: "I will not give the medicine to my child!"
To counter the creeping rumors, the government has begun a proimmunization media campaign featuring India's most popular actor, Amitabh Bachchan.
But as Mrs. Jahan herself observed, there may be no more effetive advertisement than her little Uzma. Now that people can see from her daughter's crippled limbs that polio is real, "they do not believe the rumor," Mrs. Jahan said, almost proudly. "They see the logic in getting the drops."
