A vaccine that costs Rs 43 could have saved Nand Kishore Sharma's 7-year-old daughter from a painful death last month.

When he's told this, he simply shrugs. He and his neighbors in a remote village in Uttar Pradesh are used to being overlooked in a place crippled by poverty.

The Sharmas are just one family hit by the area's worst Japanese encephalitis outbreak in recent memory. The dreaded disease has claimed 17 more lives, mostly children, in eastern Uttar Pradesh, pushing the death count to 741.

Gorakhpur district remains the worst-affected where 158 deaths occurred due to the disease since its outbreak two months back, followed by 151 in Kushinagar and 128 in Maharajganj. Another 271 have died across the border in Nepal.

The central government promised to immunize every child in the worst-affected areas but it is too late to save any lives this year.

Government hospitals have been overwhelmed by a deluge of sick children who sometimes lie two to a bed, and critics blame the situation on an underfunded medical system in Uttar Pradesh, which has a health budget of Rs 1.06 billion (US$24.2 million) for 180 million people.

"Saving children's lives is not the government's priority," said Dr TN 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 taken preventive steps and had inoculated the children."

Every year, Japanese encephalitis breaks out in eastern Uttar Pradesh. It is the region's main rice-growing area, with a bowl-shaped geography that traps water, providing perfect breeding grounds for mosquitoes that spread the incurable disease from pigs to humans. With this year being exceptionally rainy, pools of water are everywhere to be found.

State Health Minister Jaiveer Singh said the government was working to obtain money for vaccines and was 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 are asking why.

Critics point to millions spent on building parks and statues of Italian marble, noting the state recently gave former US President Bill Clinton [Images] a welcome costing Rs 10 million ($228,000).

Last week's groundbreaking for a multimillion dollar runway in the home village of the state's top leader, Mulayam Singh Yadav, fueled more resentment.

"How can you justify the government's decision to spend Rs 500 million ($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?" asked Dr Radha Mohan Agarwal, an opposition lawmaker and a pediatrician in Gorakhpur, where most sick children are sent for treatment.

Singh defended the money spent on parks, saying they are built to send messages to voters that the government was working for them. A Rs 700-million ($16 million) park was recently constructed in Lucknow.

"It does not mean we are not sensitive to what is happening," Singh said, adding, "our government has ordered free medical help to all Japanese encephalitis children."

Money is not the only obstacle. The country produces about 4,00,000 doses annually of the brain fever vaccine used in the US and some other countries.

It is labor intensive and requires 3 injections to be effective, costing about Rs 150 ($3) per child.

A one-shot vaccine used routinely in China is 3 times cheaper, but cannot be licensed in India until undergoing clinical trials to ensure its safety and effectiveness.

The World Health Organization says it cannot help because it can only procure approved vaccines. The WHO has not endorsed any brain fever vaccine, though officials stress that does not mean the vaccines in use are bad or should not be imported.

Union Health Minister Anbumani Ramadoss said the central government has asked its Asian embassies to buy as much of the three-dose vaccine as possible and added that the government has also pushing a domestic laboratory to increase production.

Squabbling between cantral and state authorities can also sometimes get in the way of effective action.

Meanwhile, the Congress paty alleged the Samajwadi Party-led state government, had intentionally grounded a helicopter sent last week by the central government to spray for mosquitos because of political differences.

State officials insist spraying is not feasible because the affected villages are too spread out. However, despite obstacles, some are optimistic.

Mapping of the hardest-hit districts has already begun to determine where the vaccine should be given first, but it's unknown how long the momentum will last.

"The government is seriously planning," said Rajshankar Ghosh, Japanese encephalitis senior project manager for the US non-profit organisation PATH.

"I'm not able to predict, but I'm very, very hopeful," he said.

Brain fever 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 up to 75 per cent of survivors are left with some type of disability.

In Rakshwapar village, just outside of Gorakhpur, brain fever affected two children, killing one. Kamlesh Kumar, uncle of a three-and-a-half year old boy who nearly died, said villagers had sought unsuccessfully to get inoculations for their children.

"People want that vaccine, but they cannot get it," he said.

With PTI inputs