Is India actually free of polio?(Health- Paper III)
On November 30, the day India introduced an Injectable Polio Vaccine (IPV) in its routine immunisation programme, stating that it “will be an important step in the Polio Endgame Strategy”, a case of Vaccine Derived Polio Virus (VDPV) was reported from New Delhi. This was the second such case to be reported this year.
India has not reported a single case of polio caused by the wild polio virus (WPV) since January 2012. It is important to note that it also received a polio-free certificate from the World Health Organisation (WHO) in 2014, after a nervous two-year wait to establish that the country can indeed maintain its polio-free status.
The polio virus causes paralysis — medically known as an acute flaccid paralysis (AFP) — which is characterised by sudden muscle weakness, and fever in one or more limbs. AFP can occur due to many reasons, one of which is vaccine-linked.
If this is the case, then is India still a polio-free nation if vaccine-derived polio cases are still being reported? Yes, because WHO certified ‘freeness’ only from WPV, a condition which India still meets. Other cases of the same condition are called non-polio AFP.
Hollow status
Between January 2014 and March 2015, India reported four cases from four different States, of vaccine-derived polio. This is not all. Until November this year, the country has reported 36,968 cases of non-polio AFP. For those who follow the sector, this is neither news nor surprising. There has been a surge of non-polio AFP since India eradicated polio. The number of cases reported in 2012 was 59,436, in 2013 it was 53,421, and in 2014 it was 53,383.
Three years after India reported its last case of WPV, the country has, in one form or another, been reporting around 50,000 cases of flaccid paralysis that, clinically, is exactly like polio, indicating how hollow the polio-free status is.
According to an article in the American journal Pediatrics , there is an undeniable link between the increase in incidence of NPAFP (non-polio AFP) and the number of OPV doses delivered in any region. Oral polio vaccine (OPV) contains an attenuated (weakened) vaccine-virus. The weak form of the polio virus is used to activate an immune response in the body, which then protects the child when challenged by WPV. But when a child is immunised with OPV, the weakened vaccine-virus replicates in the intestine. During this time, the vaccine-virus is also excreted. In areas of inadequate sanitation, this excreted vaccine-virus can quickly spread in the community and infect children with low immunity. This excreted vaccine undergoes genetic changes as it circulates in the community and causes VDPV.
The cases of VDPV are rare as it has to circulate for a long time in the community of under-immunised populations before it can infect and cause paralysis in someone.
Low vaccination coverage
To be clear, the problem is not with the vaccine itself, but low vaccination coverage. That VDPV is circulating in the community that is under-immunised marks the failure of the Central government — which even in best case scenarios has achieved only 70 per cent immunisation coverage, leaving a massive cohort susceptible to poliovirus, vaccine derived or otherwise.
At present, the government’s only strategy to combat the invisible kinds of polio is the addition of IPV. As per the WHO norms, the best way to cope with cases of NPAFP and VDPV is a synchronised switch from trivalent to bivalent Oral polio vaccine, which India has already done. To further prevent the risk of re-emergence, a booster dose of inactivated polio vaccine (IPV) is recommended in routine immunisation, prior to the switch.
A 2005 study in the Indian Journal of Medical Research on NPAFP found that a fifth of cases of NPAFP were reported from Uttar Pradesh. On follow-up after 60 days, researchers realised that 35.2 per cent children had residual paralysis and 8.5 per cent had died (making the total of residual paralysis or death a startling 43.7 per cent. This means that children who had NPAFP are more than twice at risk of dying than those who get infected with WPR.
We may be polio-free but we are reporting the world’s largest number of NPAFP. Realistically speaking, we need an urgent policy intervention to address NPAFP and VDPV with the same urgency and political will with which we addressed the wild polio virus cases.
For now, unfortunately, the government is still basking in the glory of one of its rare public health achievements since Independence, and is patting itself on the back for eradicating polio even while cases of flaccid paralysis have seen a serious resurgence. For a parent whose child has been diagnosed with flaccid paralysis polio or the non-polio kind, nomenclature offers little consolation.
Which begs this question, what is the value of this polio-free certification when nearly 50,000 children fall prey to polio-like flaccid paralysis every year?
vidya.krishnan@thehindu.co.in
For a parent whose child is diagnosed with flaccid paralysis, polio or the non-polio kind, nomenclature offers little consolation
Intolerance fuels radicalisation (Global Perspective Of Intolerance-Paper II)
India is awash with Islamophobia and there could not be a more dangerous time for this pernicious slant in our national politics.
Hateful vitriol was spewed upon actor Aamir Khan recently, for expressing concern over the rising anti-minority attitude, just as black ink was literally spilled on the Observer Research Foundation’s Sudheendra Kulkarni last month for organising a book release event for a former Pakistani foreign Minister.
Even more violent and disquieting were September’s mob lynching of Mohammad Akhlaq in Dadri, Uttar Pradesh, over rumours that he had stored beef in his home, and August’s murder of notable rationalist M.M. Kalburgi, who was shot dead after being threatened for his criticism of idolatry in Hinduism.
There will no doubt be more such displays of bigotry in the months ahead, as fringe elements of the Hindutva brigade, emboldened by Prime Minister Narendra Modi’s description of the Dadri lynching as “unfortunate” and “undesirable”, go on the rampage to correct what they perceive to be injuries to the sentiments of the majority.
The most compelling reasons for Mr. Modi to decisively stymie this rising tide of hatred are quite obvious: respect for India’s constitutionally protected secular credentials, and the maintenance of broader societal peace and harmony between communities.
Yet there is a third feature of the Indian political firmament that makes it urgent, nay imperative, that the country’s leadership effectively tamp down on the flames of extremism — the alarming proliferation of support for Islamic State (IS), the jihadist terror outfit that controls parts of Syria and Iraq.
The discovery of these IS-sympathisers has had a creeping quality, starting late last year with a handful of youth travelling to West Asia from Kalyan, near Mumbai, but more recently has been gathering momentum with a much larger cohort being pulled into the net by intelligence operations.
The fact that this trend has been coterminous with the surge in anti-minority violence ought to be a red flag for the Modi government, for there is a risk that the two developments may begin to feed off one another, leading to a perfect storm linking an ongoing foreign policy crisis to a community under siege on Indian soil.
Consider the speed and pattern of IS proliferation on Indian soil over the past year.
Back in January The Hindu received a response on a Freedom of Information Act request to the U.S. Department of Defence asking what information it had on Indian nationals discovered to be fighting for IS in Syria and Iraq.
Their answer was simple: none. Clearly the few Indians that had made it into the ranks of IS at that point were either relegated to menial tasks or used as cannon fodder on the frontlines as they have generally been considered “inferior” fighters.
Yet, as outlined in a series of reports in The Hindu (“The IS Files”), the last past year has witnessed a slew of intelligence operations that have flushed out a number of potential IS recruits, and they hail from across the breadth of India.
For example, Haja Fakkrudeen and Gul Mohamed Maracachi Maraicar both grew up in Cuddalore district in Tamil Nadu, and while Maraicar is now lodged in an Indian prison, Fakkrudeen, who may have been radicalised by Maraicar, is likely to be fighting alongside IS in Syria.
The case of Muhammed Abdul Ahad, a U.S.-educated computer professional from Bengaluru, reflects the diversity of backgrounds from which IS has managed to woo supporters in India. Ahad was intercepted by Turkish authorities last year on the Syrian border and deported earlier this year after authorities suspected him of seeking to enter the Syrian battlefield.
At the opposite end of the nation, in the Kashmir Valley, Kamil Wada spoke to The Hindu about how his older brother Adil had travelled to Syria, with authorities noting that he may have got radicalised by an Australian Islamic group after a visit to that country.
As Indian intelligence agencies continue to grapple with the “foreign fighter” question, an issue that has long been front and centre for the U.S., Canada and Western Europe, it behoves the government of Mr. Modi to more effectively address societal forces that make the isolation, demonisation and ultimate radicalisation of minority communities more likely.
Unless there is a concerted effort to neutralise the impunity of extremist elements that regularly engage in anti-Muslim violence, there may be little to halt the drift of a few members of an overwhelmingly moderate community into the arms of IS radicals.
In the present climate of hostility, a vicious cycle is likely, as there are groups that would happily seize upon the insidious presence of the IS in India to paint the entire Muslim community with the broad brush of negative propaganda or worse.
To have any hope of success in this context, anti-radicalisation strategies of the government must foster a sense of physical security, democratic space and cultural sensitivity towards traditions of minority communities while adopting a no-nonsense, intelligence-based crackdown on the shadowy menace of the IS.
narayan@thehindu.co.in
Unless there is a concerted effort to neutralise extremist elements that engage in anti-Muslim violence, there may be little to halt the drift of a few members of a moderate community into the arms of IS radicals
Myanmar’s best hope(International Affairs-Paper II)
Aung San Suu Kyi’s meetings with Myanmar’s President Thein Sein and military chief General Min Aung Hlaing, nearly a month after her party’s resounding election win, are highly significant, given the tumultuous civil-military relations in the Southeast Asian nation. Ms. Suu Kyi had reportedly asked for these meetings immediately after the polls. But the delay had triggered some concerns over whether the still-powerful military would accept the election result and let her National League for Democracy form the next government, which is expected to assume office on March 31. A presidential spokesperson later allayed the concerns, saying both leaders had discussed a “smooth transition and transfer of power to the newly elected government”. While the military-backed government’s reassurance that it is committed to political transition is welcome, the process of transition and building a constitutional framework for the new government could turn out to be a cumbersome process. That is mainly because the military is unlikely to be willing to cede full control to the civilian government. The military-written Constitution bars Ms. Suu Kyi from becoming the President because her children are not Burmese, and it reserves key Ministries, including defence, interior and border security, for the military. Gen. Aung Hlaing has already said there would not be any change in the Constitution to let Ms. Suu Kyi become the President. She has, on the other hand, vowed to lead the government “whether or not” she is the President.
Ms. Suu Kyi is the best hope Myanmar has at this point of time. She is a stout democrat and widely popular, and her party has a legitimate mandate to lead the country, which faces several problems from poverty to ethnic conflict. One of the reasons the military agreed to a transition to a more democratic set-up was the realisation that it could not rule the country with an iron fist forever. Despite years of suppression, the political opposition has been resolute. Besides, the internal dynamics of the Myanmar society remain fragile. The Rohingya community, Muslims castigated as illegal immigrants, have been widely discriminated against by sections of the Buddhist majority. The government’s efforts to end the civil war with ethnic groups through negotiated agreements were only partially successful as rebels in the region bordering China refused to sign ceasefire pacts in October. The country also faces a huge economic challenge. What Myanmar needs now is a leader who can unify the people and take the country to a new era of social and political democracy. A large number of people inside and outside the country believe that, under the circumstances Ms. Suu Kyi may be the best person to take up the challenge. But the question is whether the generals would let her do it. For her part, Ms. Suu Kyi needs to be more forthright in articulating an inclusive agenda, for example vis-à-vis the Rohingya, that addresses ethnic tensions, and gives democracy in Myanmar a stronger chance.
Wasn’t the world always modern?(Modernism -Paper I)
By most indices, the world we inhabit today is the very epitome of modernity, even as distinct survivals of the distant past are an integral part of our daily life. One wonders how the 19th, 20th and 21st centuries will be characterised in, say, the 22nd or the 23rd century. “Modern”? Very unlikely, for modernity would have acquired a different set of markers and perhaps meaning. And surely not Medieval or Ancient or any variation of these. It’s time perhaps to rethink the very category of “Modern” and its derivatives, Medieval and Ancient — time, in other words, to rethink the whole problematic of historical periodisation. Indeed, the discipline of history is abuzz with numerous questions on the theme springing up everywhere within the academia. Not a fragment is left of what was “out there” (in the late C.A. Bayly’s words) for everyone to see and absorb with nary a doubt in anyone’s mind just a quarter of a century ago; today it lies in a shambles.
Markers of time
The markers to distinguish the present from the past are understandably present at all times and in all civilisations. For everyone living, say, in the 10th century BC would be aware that they were living in the present as distinct from the past; some of them did employ the term “modern” to articulate the distinction; others may not have. In Balmiki’s Ramayan (on present reckoning, some six to three centuries prior to the Mauryan period) when Ram prepares to go into exile, the more impatient Lakshman argues with him to defy their father’s command. Ram then calms him by pointing out that while the present times they lived in ( adhyatan ) were in some ways different, yet in some other ways were similar to the past and parallel situations had occurred earlier too. In Islam there was the constant lament that times had changed, leaving behind the puritanical age of the Prophet and the first four “pious” Caliphs, even as three of them had fallen to assassins’ daggers. To my knowledge, no specific term was used to identify the distinction between the present and the past, even as tarikh to denote the past would necessarily imply its awareness. In Europe, “modern” was first used in the 5th-6th centuries as a descriptive term for the present with no value attached to it.
Division of history
Emphatic transformation in the significance of the “modern” occurred when post-Renaissance and post-Enlightenment Europe invested it with what it assumed was the universal value of rationality. Once this self-image of the age was defined, the “medieval”, or the “dark age” of religiosity and superstition was also bestowed an identity, not its own but as rationality’s or modernity’s “other”, thus reinforcing it. “Antiquity”, now post-Renaissance investing it with rationality that was compatible with the wide spread phenomenon of slavery, also came along as the legitimising source of modernity. These were clearly derivatives of the “modern”. By 1688, the tripartite division of historical time had been formalised by German historian Cellarius, even as its origins lay in Christian theological debates. The rise of Positivism from the 18th century gave a “scientific” edge to rationality. It came to acquire an “objective” existence immune to mutation through human intervention.
We thus get a construction of ideal types of historical temporality with clear-cut attributes, though these had only a provincial provenance, that is Europe. As Europe expanded to the rest of the world with its trade and arms and very soon its governance structures, its displacement of other regional intellectual constructs followed. The varied notions of historical time in the Indian, Chinese, Japanese, the Arab-Islamic and other civilisations gave way to the tripartite division of history which became universalised by the late 19th-early 20th century. For a pretty long time, the entirety of the long “Middle Ages” was set off by historians as the era of encompassing stagnation to highlight the rapidity of transformations brought about by reason, science and technology — that is, by “modernity”. As doubts about the notion of stagnation began to crop up, the three-fold division began to get qualified into Late Antiquity, Early Medieval, Late Medieval, Early Modern, etc in Europe for the original temporal slabs were far too large to reveal the underlying restiveness and energy for change. This too has induced revision of large temporal blocks elsewhere. But the basic structure remained — still remains — intact.
Idea of modernity
However, the global scrutiny chasing it underscores the increasing discomfort with the received idea of modernity and therefore with all its derivatives. A telling example is two observations spread over 30-odd years by the same major intellectual of our times, S.N. Eisenstadt. In 1966, he had confidently stated, “historically, modernisation is the process of change towards those types of social, economic and political systems that have developed in Western Europe and North America from the 17th century to the 19th.” By 1998, he was less confident about it and announced, “That there is only one modernity is a fallacy.”
It is getting increasingly hard to argue for modernity as a temporally and territorially limited category in origin, as the gift of Europe to humanity during the 18th to 20th centuries with industry, electoral democracy, capitalism, individualism, secularism, etc as its hallmarks. The discipline has come to recognise that this world of ours has evolved as a cumulative effect of a range of contributions by all societies and civilisations in various spheres and varying degrees throughout the past in terms of crops or crafts, trade or transport, culture or philosophy, concepts or aesthetics, you name it.
One specific feature that is attributed to modernity is the fast pace of change. It, however, ignores that the pace of change itself is the cumulative effect of the past. It also ignores that several clusters of innovations at various time periods in different societies accelerated encompassing changes with universal impact. Just two quick examples. The inventions/evolution of advanced compass, gunpowder, and printing in China in the 9th-10th centuries were soon to overwhelm the world quickly, by the standards of those times. The shift of European agriculture from two-field to three-field rotation in the first two centuries after 1000 AD gave it a 100 per cent increase in food availability, which led to rapid, comprehensive transformation of its social, economic, even political landscape with far-reaching consequences beyond its boundaries. The world was rapidly “modernised” in pronounced ways. Stories of this kind are on record in various regions and times. It is also evident in current historiography that besides commodities, techniques, ideas and concepts were travelling around vast stretches of the globe at a much faster pace over the centuries and the millennia than had been given credit, a denial predicated upon the notion of stagnation and the dark ages. Much change inheres in continuity even as much continuity is embedded in change.
Thus, as the perspectives of history are getting redefined, do we still need the old temporal straitjackets, the old labels? It must be emphasised that however “modern” and its derivatives are modified, there is no getting away from the value embedded in these which singularly locates rationality in Europe and to a certain period. What is left to other regions is to assess their proximity to the model in a sort of “me-too-ism” exercise.
How do we then escape the trap? The fact that the tripartite division is a rather recent conceptual construct which is getting constantly modified underlines its transience. In another century or two, it is most likely to be displaced by some other construct, less burdened with a baggage. Perhaps we could anticipate some of that transition by studying history in more value-neutral temporal brackets, like centuries: How societies/economies/cultures changed from, say, 5th to 10th or 14th to 18th centuries? How much more useful it would be to drop “medieval” or “early modern” from it! In the end, these terms have become more like slogans than helpful analytical categories.
(Harbans Mukhia is National Fellow, Indian Council of Historical Research.)
One specific feature that is attributed to modernity is
the fast pace of change. This, however, ignores that the pace of change itself is the cumulative effect of the past. It also ignores that several clusters of innovations at various time periods
in different societies accelerated encompassing changes
with universal impact.
It is time to rethink the very category of ‘Modern’ and its derivatives, Medieval and Ancient; time,
in fact, to rethink the whole problematic of historical periodisatio
n
