A Deadly Virus Spreads in India, Despite Vaccines Within Reach

A woman tends to her child, who is suffering from Japanese encephalitis, at a hospital in Lucknow, India.
A woman tends to her child, who is suffering from Japanese encephalitis, at a hospital in Lucknow, India. (By AP)
By John Lancaster
Washington Post Foreign Service
Sunday, September 11, 2005

GORAKHPUR, India -- Kiran Kumari had been sick for more than a week. Now, lying on her back in a sweltering, overcrowded hospital ward, the skinny 11-year-old with the copper-streaked hair had lapsed into unconsciousness and could no longer breathe on her own. So her father was breathing for her.

Sitting on the edge of her thin mattress, his face a taut mask of exhaustion, the destitute farmworker rhythmically squeezed a football-sized plastic ventilator with his callused hands, forcing air into her lungs with every pump.

Such life-saving duties are normally left to professionals, but in this case, there were not enough to go around. Over the last two months, hospitals in the northern Indian state of Uttar Pradesh have been overwhelmed by Japanese encephalitis, a viral infection that has sickened more than 2,000 children and killed nearly 600, making it one of the deadliest outbreaks of the disease on record in India.

In this city at the heart of the epidemic, the main government hospital resembles a war zone, with desperately ill children crowded two or even three to a bed, family members camped in filthy corridors, and weary medical staff struggling to keep pace with about 30 new cases a day. Japanese encephalitis kills nearly 30 percent of its victims, mostly children younger than 15, and leaves many of the rest with permanent neurological damage.

The toll is all the more heartbreaking because the disease can be prevented by several vaccines, including one made in India and another, more effective version developed in the 1970s in China, where mass vaccinations have largely contained the virus.

In that regard, the latest outbreak shows how bureaucratic inertia, skewed priorities and what some health experts say is a nationalistic aversion to importing medicines are undercutting efforts to improve India's shaky public health system, to the detriment of its poorest citizens.

Last week in its annual human development report, the United Nations faulted India for falling behind on key public health goals, noting that its infant mortality rate is now higher than that of Bangladesh. One in 11 Indian children dies before the age of 5.

"It's a lot of politics in vaccine," complained Komal Prasad Kushwaha, a senior pediatrician at the hospital who has watched in frustration as the death toll from Japanese encephalitis in India has climbed steadily over the last two decades. "We have been crying for vaccine since very long. If vaccine is available for all children in the community, Japanese encephalitis will certainly be controlled."

Health officials in Uttar Pradesh have said they are trying to contain the epidemic by spraying against mosquitoes, which typically acquire the virus from pigs before passing it on to humans. Over the longer term, they are trying to shift pig farms, which can act as reservoirs for the disease, away from crowded villages.

The Indian health minister, Anbumani Ramadoss, has said he wants to remove barriers to the import of Japanese encephalitis vaccines in time to begin mass vaccinations in high-risk areas by April, before the disease makes its seasonal reappearance. Ramadoss and his aides did not respond to phone messages and two faxed requests for comment.

Japanese encephalitis occurs across wide areas in Asia, where about 50,000 cases -- and 15,000 deaths -- are reported annually, according to the World Health Organization, although the number of cases is thought to be vastly underreported. In India, the virus is concentrated in eastern Uttar Pradesh, the country's most populous state and one of its poorest, as well as the states of Andhra Pradesh and Assam.

In some respects, India should be well-equipped to contain the threat. Its cutting-edge pharmaceutical industry supplies life-saving medicines -- including measles vaccine and anti-retroviral drugs used to fight AIDS -- to much of the developing world; a government research institute has made a Japanese encephalitis vaccine for years.

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