Causes and Excuses for Failure of Polio Eradication in India Grassly et al have used logistic regression and found significant association between continued reporting of polio acute flaccid paralysis (AFP) and (i) population density, (ii) the prevalence of diarrhea, and (iii) low routine coverage with three doses of trivalent oral polio vaccine (tOPV)1. 'This Week in Science'2 declares that Grassly et al have shown that "high population density and poor sanitation are causing persistence … of poliovirus," as if a causal relationship has been established. Using the same logic it may be said that (i) speaking the Bhojpuri language3, (ii) living in a State through which the river Ganges flows; and (iii) the State capital having a maximum temperature of 240C on 5 December 2005.4,5 are causing persistence of polio virus. The odds of a State reporting more than 20 cases of polio AFP in 2006 if all three factors were present (Uttar Pradesh and Bihar) was >999800. Even though the associations we found were significantly stronger than that found by Grassly it cannot be suggested that a cause and effect relationship has been established. The article by Grassly and colleagues is an attempt to shift the blame for this poorly conceived program which has wasted millions of dollars and failed to deliver on its promise to eradicate polio. The program started on the false premise that repeated doses of oral polio can by itself eradicate the disease worldwide6. The failure of the magic bullet approach to solve the world's problems (repeated doses of OPV in this instance) was predictable. The study by Grassly blames poor routine immunization against polio as one of the causes even though most of the cases that have developed polio did so after having received more than 3 to 6 doses of tOPV.1 The problems of poor sanitation and overcrowding were well known before the program was started. Smokescreens must have no place in Science ‘This week in Science’ needs to issue a correction. The full article by Grassly is not available free on the internet but 'This week in Science' is accessible free online and is accessed by a much larger number of readers. The journal cannot allow this editorial error to misinform in the name of Science.

However the Editor declined publication of this letter both in the print version as alkso on the electronic version

Sona Chowdhary MD Jacob M Puliyel MD MRCP M Phil Department of Pediatrics St Stephens Hospital Tis Hazari, Delhi India 110054 Email: Puliyel@vsnl.com References 1. Grassly NC, Fraser C, Wenger J, Deshpande JM, Sutter RW, Heymann DL, Aylward RB. New strategies for the elimination of polio from India. Science. 2006;314:1150-3. 2. Editor. This week in Science. Science. 2006;314: 1045 3. http://en.wikipedia.org/wiki/Bhojpuri_languag... Accessed 5/12/06 4. http://www.wunderground.com/history/station/4... Accessed 5/12/06 5. http://www.wunderground.com/history/airport/V... Accessed 5/12/06

6. Sathyamala C, Mittal O, Dasgupta R, Priya R. Polio eradication initiative in India: deconstructing the GPEI. Int J Health Serv. 2005;35:361-83