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Encephalitis overwhelms India

KUSHINAGAR, India -- When Nand Kishore Sharma learned that his 7-year-old daughter might have been saved from her painful death by a $1 vaccine, he shrugged. People in this impoverished northern corner of India are used to being overlooked.

The Sharmas are victims of the worst Japanese encephalitis outbreak in memory. More than 1,100 people, most of them children, have died in India's Uttar Pradesh state and in Nepal.

India's government has promised to immunize every child in the worst-affected areas, but it is too late to save lives this year.

Hospitals have been overwhelmed by a deluge of sick children who sometimes lie two to a bed. Critics attribute this to an underfunded medical system and wasteful projects. Uttar Pradesh, where the disease has killed 850 people in the last few months, has a health care budget of $24.2 million for 180 million people -- about 13 cents per person.

''Saving children's lives is not the government's priority," said Dr. T. N. Dhole, head of the microbiology department at the Sanjay Gandhi Post-Graduate Institute in the state capital, Lucknow. ''Deaths could have been prevented if the government had . . . inoculated the children."

Japanese encephalitis breaks out every year in eastern Uttar Pradesh, the region's main rice-growing area. It has a bowl-shaped geography that traps water, providing the perfect breeding grounds for mosquitoes that spread the incurable disease from pigs to humans. This year has been exceptionally rainy, leaving pools of water everywhere.

The state's health minister, Jaiveer Singh, said the government is working to obtain money for vaccines and is prepared to tap a discretionary fund to ensure children are immunized before the next rainy season.

But as images emerge of hundreds of children dying in filthy, understaffed and ill-equipped hospitals, some people are asking why.

Critics point to millions spent on building parks and statues of Italian marble, noting that the state recently gave former President Clinton a welcome costing $228,000. A recent groundbreaking for a multimillion-dollar runway in the home village of the state's top leader, Mulayam Singh Yadav, led to more resentment.

''How can you justify the government's decision to spend $11 million in construction of an airstrip in a remote village where no airplane is expected to land while thousands of children are dying without medicine?" said Dr. Radha Mohan Agarwal, an opposition lawmaker and a pediatrician in the eastern Uttar Pradesh city of Gorakhpur, where most sick children are sent for treatment.

Singh, the state health minister, defended the money spent on parks, one of which was built in Lucknow at a cost of $16 million.

''It doesn't mean we are not sensitive to what is happening," Singh said. ''Our government has ordered free medical help to all Japanese encephalitis children."

Money isn't the only obstacle. India produces about 400,000 doses annually of a Japanese encephalitis vaccine used in the United States and some other countries. It requires three injections, and costs $3 per child.

A vaccine used routinely in China is a third of the price but cannot be licensed without trials. The World Health Organization says it cannot help because it can procure only approved vaccines. The WHO has not endorsed any Japanese encephalitis vaccine, though officials stress that does not mean the vaccines are bad.

Mapping of the hardest-hit districts has begun to determine where the three-dose vaccine should be given first.

''The government is seriously planning," said Rajshankar Ghosh, Japanese encephalitis senior project manager for the US-based nonprofit group PATH.

Japanese encephalitis is found only in Asia, where the WHO says up to 50,000 cases, and an average of 15,000 deaths, are reported each year. Many cases go unreported, and as many 75 percent of survivors are left with a disability.

In Rakshwapar village, just outside Gorakhpur, Japanese encephalitis sickened two children, killing one. Kamlesh Kumar, uncle of a 3-year-old who nearly died, said villagers had sought unsuccessfully to get inoculations for their children: ''People want that vaccine, but they can't get it."

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