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out as the most difficult regions for polio eradication.
Indian scientists had actually warned the GPEI of such
pitfalls but global leaders from rich countries couldn’t
believe that such extreme variations could exist with wild
virus epidemiology and vaccine effectiveness. Once that
lesson was learned, the progress was rapid.
Wild polioviruses exist in 3 types, and OPV also contains
attenuated strains of the 3 types. So it is called trivalent
OPV (tOPV). Among the 3 types, type 2 is the most
efficient; that was why type 2 wild virus disappeared in
1999, within a few years of national pulse vaccinations.
But type 2 in the tOPV also interferes with the others,
making them very inefficient. From 2000, the frequency
of campaigns with tOPV was increased in U.P. and Bihar,
but to no avail. Type 2 had to be removed from tOPV to
get the best out of types 1 and 3. In 2005 and thereafter,
a new monovalent type 1 OPV (mOPV-1) was used in
U.P. and Bihar — it is three times more effective than
tOPV. This was one factor of success. But gaps in
immunity were created against type 3; consequently,
type 3 outbreaks occurred in 2007-2009. Then, a bivalent
vaccine (bOPV with 1 and 3) was developed. It was noninferior
to mOPV-1 or mOPV-3. From early 2010, bOPV
has been widely used in U.P. and Bihar during
campaigns, while tOPV is used everywhere for routine
immunisation.
While the problem of “failure of vaccine” was being
addressed, there was also the problem of “failure to
vaccinate”. Seasonally, millions of families from U.P. and
Bihar migrate for work — some to Maharashtra or Punjab,
others within their States. Their children missed both
routine and campaign doses. The tactic of vaccination
in transit — in trains/buses and in stone quarries/brick
kilns — became the norm from 2005. As all bottlenecks
were cleared, success ensued.
TRIBUTE TO THE NATION
Many global experts marvel at the ability of Indians to
work with diligence and sincerity, and at India’s tenacity
in spite of pessimistic prophecies of failure. So a tribute
is due: to the families of children and all workers, district
managers — medical and administrative — State
leadership, the National Polio Surveillance Project
personnel, the Government of India staff working
alongside the global polio partners, WHO, UNICEF,
Rotary International and the U.S. Centres for Disease
Control, and the vaccine manufacturers who up-scaled
production on demand, and filled the prescriptions for
mOPV-1 and 3 and for bOPV. All of them deserve our
applause and gratitude.
In many other programmes in India, poor implementation
is the oft-repeated reason for failures and delays. The
success of implementation depends on the design of
the programme and proper supervision of activities. The
government must learn and apply this lesson in all other
faltering health projects — against TB, malaria, child
mortality and under-nutrition.
WHAT NEXT?
For certification of eradication, two more years should
pass without any case of wild virus polio. Polio virus
The Game of Water by Sanjay Kumar
Water: from Bilateral to Strategic Issue
The core issue of water is taking a new turn in regional
geopolitics be it India, Pakistan or China. The water
availability statistics pose a dire future and consequently
it is emerging as a critical resource. China and India are
especially vulnerable, for they have to cater to the
growing demands of industrialisation and agricultural
needs. The per capita availability of water in China and
India stands at respectively, 2100 and 1700 cubic metres.
By 2025, it is estimated that water availability will decline
below the threshold level of 1700 cubic metres as
stipulated by UN standards. Amidst this global shortage
of water, is the geographical feature where nearly 270
river basins are shared by more than one country. As
water shortage increases states are bound to invest in
water infrastructure. This may be in the form of dams,
both run of the river or storage. Dams have become one
of the singularly contending issues of development
debates. While at the national and regional level,
embarking of heavy water infrastructure projects like
dams may be beneficial, it is vehemently opposed at the
local level. In the case of trans-border basins they lead
to deterioration of relations between co-basin countries.
In the case of India-China, later is the upper riparian
state in the case of trans-border Rivers, therefore it
enjoys tremendous leverage. Further, the Chinese
unilateral damming of trans-border Rivers has raised
concerns in the lower riparian countries. Chinese control
over Tibet accrues it high advantages in terms of river
sharing.
Water has become an important issue of China-India,
diplomatic discourse. India as lower riparian state is
apprehensive of Chinese attempts at diverting, storage
and general opaqueness on water issues. If water issues
between India and Pakistan are a constant irritant, then
between China and India, it raises even a deeper anxiety
and portends an ominous future. Sino-Indian relations
on water reflect as much geopolitical distrust as
difference on the issues involved per se. China’s opaque
polity is reluctant to part with information and this is
evident especially with respect to water issues. China
has not entered into a single water sharing treaty with
any country. Besides that, its deliberate policy of holding
and releasing information in instalments and that too,
when challenged by hard evidence adds to other
country’s discomfort and speculation.
problems with almost all of its co-riparian countries,
Russia, Kazakhstan, Mekong River Co-riparian’s and
Myanmar.
India has apprehensions on Chinese activities on the
river Sutlej and its tributaries and Yarlung Tsangpo
known as Brahmaputra on the Indian side of the border.
China has built small dams on Sutlej, which it has, not
notified India of. India’s larger apprehensions however
relate to upstream diversion and damming of
Brahmaputra. Near Mountain Namcha Barwa the river
takes a ‘U’ bend involving steep gradient of around 5000
mtrs. The ‘U’ bend has hydropower potential of around
50,000 MWs. This is one of the deeper anxieties of the
government. The main issue of concern is the run of the
river dam at Zangmu a 540 MW power project. What is
even more disconcerting that feasibility studies have
been carried out for five more such projects further
upstream? Water diversion projects are part of Chinese
plan to feed its starving north through these major
diversion projects. As Syed Hussein contends China
has practically redeployed its entire labour force
responsible for construction of Lhasa Gyalmo railway
line on these projects.
What is worrying India is that China never shares any
data on these projects and acknowledged there existence
only when confronted by hard evidence such as sub
metric remote sensing images. It is generally assumed
that these are run of the river project. The new projects
on the pipeline propose to generate close to 40,000 MW
of electric power and their construction entails tunnels,
reservoirs etc. The issue of concern is that run of the
river dams do not involve construction of massive
storage facilities, rather they involve channelising of
potential energy of the falling water, in this case, steep
gradient of Tibetan geographical feature. It is obvious
that something is amiss and reassurances from the
Chinese government must not be taken at face value.
It needs to be underscored that even in the case of run
of the river schemes, though net storage of water may
not be involved, but river course needs to be altered or
managed so as to make exploiting of energy potential.
Therefore, India cannot take satisfaction from mere
sharing of hydrological data or sharing of technological
feature. Further, once a cascade of engineering projects
begins to take place on a trans-border river, is reduced
to the mercy of upper riparian. The cascade of proposed
projects will affect rivers at their will. As rivers are
environmentally living resources, they are bound to
effect river dependent populations downstream. For
example, in case of upstream activities on the river,
downstream rivers carry high silt content, fish catch is
reduced and other environmental effects also multiply.
The former was noticed in case of Nathpa Jhakri Power
Project, when it was feared that Chinese activities on
upper reaches of Sutlej in Tibet, was the cause of high
silt content. Similar problems are being observed in the
case of downstream Mekong River, affecting lower
Mekong delta countries, such as Vietnam and Cambodia
which are being are facing serious droughts and leading
to tensions between these countries and China.
can remain silently in circulation for short periods; so,
complacency must not set in. We must continue working
as if we still have poliovirus lurking somewhere, only to
show up when least expected. There is also the threat of
importation of wild virus from Pakistan, Afghanistan and
Nigeria.
Vaccine viruses by themselves can rarely cause polio;
the balance is roughly one case of vaccine-associated
paralytic polio (VAPP) replacing 200 cases of wild virus
polio. Yet, in the absence of wild virus polio, VAPP is
unacceptable. Moreover, vaccine viruses may gradually
revert to wild-like properties if allowed to circulate. Such
circulating vaccine-derived polioviruses (cVDPV)
cropped up in many OPV-using countries recently,
including India since 2009. If allowed to grow, they can
capture the niche vacated by wild viruses. We have to
stop OPV to stop VAPP, but some cVDPV may already
be in silent circulation to show up in outbreaks one or
more years later. The safest solution is to introduce IPV,
reach 90 per cent or more coverage and only then stop
OPV. That will pre-empt the evolution of cVDPVs. Only
after we ensure the absence of wild and vaccine
polioviruses in the population can we claim complete
success of polio eradication. That is the challenge of
the present decade.
(The author was professor of clinical virology in the
Christian Medical College, Vellore until retirement,
and has served on several Global and National
Committees on Immunisation and Polio Eradication.)
Most importantly, it is doubtful that on the Yarlung
Tsangpo only a power project with run of the river scheme
is attempted. Under South-North Water transfer scheme
which was visualised by Mao, in Fifties, seeks
gargantuan task of shifting of water from abundant south
to parched north. Southern China has comparatively
more water resources than northern China. Of the three
routes attempted Eastern, Central and Western, later
appears to be the chosen one for attempted shift of water
from Yarlung Tsangpo as mentioned above. The prospect
of water diversion raises a number of issues. First, is the
quantum of water will be affected by Yarlung Tsangpo
diversion? According to estimates, going around thirty
per cent of the flow comes from the China; balance is
from the catchment area mostly in India. Is this enough
to generate an alarm in the Indian policy circles? Or it is
something that can be ignored to maintain peace,
harmony and good relations with China. India is not the
only riparian state affected by the diversion; Bangladesh
too is equally affected, in fact, more so — as it is
dependent upon Faraaka Barrage for water during lean
season. In addition, taking cognisance of our own run
of the river projects for generating hydropower in the
Arunachal Pradesh, Chinese activities on the river cannot
be ignored. Arunachal Pradesh government has signed
more than hundred MOUs for setting up of hydropower
projects. Further, it is against convention to draw
projects on trans-border rivers, without consulting or –
informing the lower riparian states. What should be of
concern is the fact that China is one of the largest dam
builders in the world. From the available reports, it has
begun work on South- North Water Transfer Scheme,
where it is reported that population movement has begin
to take place. The question is whether this is technically
feasible. China is known to take technologically
gargantuan projects, be it Qinghai-Tibet Railway or
Three Gorges Dam. Third, the issue is of technological
feasibility. For, example amount of energy spent on lifting
the water and transferring it means energy gain will be
minimum or there will be a loss of energy. The argument
of technological feasibility is difficult to overturn.
Keeping in mind the scarcity of water in China, which is
bound to become acute in the long term horizons, the
project may become viable.
As the project’s completion date is 2050, perhaps, this
thinking makes Chinese spokespersons to say that
‘presently’ there are no plans on Brahmaputra. It is true
that presently China is defensive
on dams, as it has many projects going on at the same
China is in control of the Tibetan plateau from which
time and is receiving strictures for many of them.
around ten major rivers flow. Added to above are
Internally, on environmental unsoundness of the project,
concerns about how climate change is affecting the snow
even the latest Three Gorges dam is no exception.
pack and glacier mass in Tibet plateau, impacting the
Further, Chinese reluctance to recognise Arunachal
most crucial hydrological systems in the region with
Pradesh as Indian Territory, may have this aspect in mind.
great impact for Indian eco-system. As Syed Iqbal
In the past opposition by Asian Development Bank
Hasnain in an editorial in Times of India argues “China
(ADB) to give loan to India may be a tactical strategy
claims sovereign rights to control one of the world’s
with larger endgame in mind. China will pre-empt Indian
largest fresh water resources which are increasingly
objection on Yarlung Tsangpo, as it does not even
vulnerable to global warming and are critical to
recognise Arunachal Pradesh as part of India. At the
sustaining South Asia’s food and water security. The
moment many hydropower projects are going on in the
question is should China remain the sole arbitrator of
state, which is at the centre of concentred hydropower
the fate of Tibetan waters? What happens to the fate of
utilisation strategy. This could become a future source
downstream nations dependent upon these waters?” It
of friction and many projects planned could become
is not in Tibet alone; China is encountering similar
cont....
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