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Children die needlessly
As India dallies, an encephalitis outbreak kills the young and poor.

Sept. 20, 2005

By Mike McPhate
For The Inquirer

GORAKHPUR, India - About 60 children infected with encephalitis lie writhing and moaning on metal cots in pediatric Ward 6. Their eyes stare and roll back. Their chests jerk as they struggle for air.

A quarter will die, doctors say.

Dina Nath, 37, comforts his son Mahendra Nath, 10, at Gorakhpur medical college hospital, the heart of a Japanese encephalitis outbreak.

Among these damp lowlands spanning northern India and southern Nepal, an outbreak of the viral disease Japanese encephalitis (JE) has stretched for 11 weeks and taken more than 1,100 lives, the great majority children, officials say. The unfolding tragedy, expected to last until the monsoon heat wears off in November, could easily have been prevented, say several health experts.

Dozens of infected children arrive daily at the short-staffed public hospital in Gorakhpur, a railroad-junction town at the heart of the plague. Crowds of parents camp on squares of cloth along the reeking, red-spit-stained hallways that lead to the children's ward.

At sunrise on a recent day, a peasant woman in a corner cot cradled her 7-year-old son, Sagar, reduced by the disease to a listless 13 pounds.

"He used to play, used to study," whispered the woman, Kusum Lata Srivastava.

Gorakhpur provides yet another example of how the world's poor continue to die from ailments surmounted long ago by the wealthy.

Three million Asians have died in the last three decades from JE, caused by a mosquito-borne virus - closely related to the West Nile strand - ferried among pigs, birds and humans. The disease swells the brain, killing 30 percent of its victims and leaving many of its survivors brain-damaged or paralyzed.

Although vaccination programs in other parts of Asia have largely contained the problem, India has failed to take similar measures. With its surging middle class, India is often heralded as a star of globalization, but public-health experts here say the billion-plus country continues to neglect its most vulnerable citizens.

"The government has been grossly apathetic," said T.N. Dhole, microbiology professor at the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow. Authorities have been warned repeatedly to take three key preventive measures: Move pig farms away from villages, spray for mosquitoes, and vaccinate children.

"They didn't do any," said Dhole.

In its annual human-development report, the United Nations this month criticized India for "decades of underinvestment in human development." The government allots 0.9 percent of its gross domestic product to public health, ranking it among the world's stingiest health spenders. One of every 11 Indian children dies before the age of 5.

The state at the center of the encephalitis outbreak - Uttar Pradesh, cradle of the holy river Ganges, birthplace of Hindu lord Ram and deathbed of the Buddha - is as destitute as it is symbolic. More than 30 percent of the state's residents live below the poverty line. Less than half of women can read.

Parents at Gorakhpur hospital say they cannot even afford $2 mosquito nets to protect their families.

"We are poor," said Dina Nath, 37, wiping his 10-year-old son's forehead. Suspected of JE infection, the boy suffers an uncontrollable twitching of the eyes. "Some of us have [nets], some don't," he said.

P.L. Joshi, who heads the government's Vector Borne Disease Control Program, said last week that the administration has assumed a "war footing" for the catastrophe. More than 400,000 mosquito nets are being distributed, and mosquito poison has been sprayed over wide swaths of the state, he said.

"We see the size of the epidemic," he added. "It is horrible."

Joshi denied accusations of government inaction leading up to the crisis, and blamed the region's muggy climate and stubborn pig farmers - who resist demands to move their industries away from villages - for making containment "very, very difficult."

"You can't control anything," he said.

Though JE has plagued the state with a quietly building death toll since 1978, vaccines have long been within reach. China began manufacturing mass quantities of a vaccine known as SA 14-14-2 in 1988. More than 50 million people in several Asian countries are immunized with the vaccine yearly.

Indian authorities say the Chinese vaccine has not been properly tested for domestic use. They have instead relied on an Indian-made vaccine that is much more expensive, in short supply, and requires multiple doses. As a result, only 200,000 out of seven million children in high-risk areas of Uttar Pradesh were immunized with the drug this year.

Several heath experts here say the crisis boils down to a lack of political will.

"It should not be that difficult," said P.C. Bhatnagar, a doctor with the Voluntary Health Association. "It's more of an apathy thing. People who suffer are mostly from the poor strata of society."

Amid heavy local media attention to the crisis, Health Minister Anbumani Ramdoss told reporters recently that production of vaccines would be ramped up to between five and six million doses in time for next year's encephalitis season.

The promise comes as little solace to families at the Gorakhpur hospital, where each day between six and 10 children succumb to the disease.

Professor Dhole predicts a similar scene next year.

"They say, 'We'll start [vaccinating] in December, January,' but by then they will say, 'Everything is over,' " he said. "Then they will forget."