How Did India Become Polio Free: Lessons For The Future
For a country to be declared polio free it should have at least three years of zero polio cases and it means that the virus has died in the environment and new cases, if any, would be caused by infection in another country where infection persists.
Since the launch of UN Global Polio Eradication Program in 1988, the cases of polio in India have dropped from 150,000 to 0. It has taken close to 25 years to reach this far and it has not been easy. India is a vast country and awareness and education are dismal in rural areas. There have been many naysayers who couldn't see a solution to the situation considering all the limitations that surround. "This was the one that everyone said could never be done," said Dr. Bruce Aylward, the World Health Organization's top person for polio eradication.
But India has proven everyone wrong. "India's success is arguably its greatest public health achievement and has provided a global opportunity to push for the end of polio," WHO Director-General Margaret Chan stated in a news release. "Stopping polio in India required creativity, perseverance and professionalism - many of the innovations in polio eradication were sparked by the challenges in India. The lessons from India must now be adapted and implemented through emergency actions to finish polio everywhere," she said.
Understanding what went behind this huge feat - how a developing country with limited means but unlimited challenges of population, sanitation and poverty managed to eradicate the deadly polio virus offers immense learning for the other nations fighting the battle as well as for India's own healthcare system.
The oral polio vaccine was introduced in India in 1978 and in 1985 Rotary International launched its global effort to end polio. India was a signatory to the 1988 WHO treaty committing participating nations to be part of that effort. In 1995, the government started organizing annual national immunization days and in 1997, India established the National Polio Surveillance Project. In 1999, it set up an expert advisory group that monitored the program and provided continuous evaluation of how the disease was behaving around the country.
All these efforts showed results. By 2009, 741 cases of polio were reported in India. By 2010 that number dropped to 42, and by 2011 only one case — as of today, India's last — was reported in the entire country.
Because of its exceptional success, the National Polio Surveillance Project has become India's most extensive public-health surveillance system. There are about 27,000 reporting units across the country, being operated through a combination of funding from the government, WHO, UNICEF, the Bill & Melinda Gates Foundation and the CDC, along with other groups. India is also now one of the world's biggest donors to global polio eradication, pouring billions of dollars into curbing the disease in the home land and also lending its well- achieved expertise to Pakistan, Afghanistan and Nigeria, where the virus is still yet to be conquered.
In every National Pulse Polio Immunization round, 24 lakh vaccinators under 1.5 lakh supervisors visit over 20 crore households to ensure that nearly 17.2 crore children of less than five years of age are immunized with Oral Polio Vaccine. Mobile and transit vaccination teams immunize children at railway stations, bus stands, market areas, construction sites etc.
India has till today easily spent over Rs 12000 crores on the Pulse Polio Programme. The program has been in the forefront of adopting technological innovations. The more successful monovalent oral polio vaccines were introduced in the Pulse Polio campaigns in 2005 which helped inhibit the most dangerous type 1 polio strains to record low levels by 2009.
In 2010 the bivalent oral polio vaccine was introduced which helped curtail both Type 1 and Type 3 polioviruses simultaneously and as efficiently as the monovalent oral vaccines. India took a lead in introducing bivalent polio vaccine in January 2010. Despite global shortage of both bOPV and trivalent Polio vaccine, India readied the domestic supply machinery for timely delivery of vaccine to ensure pulse polio rounds without interruptions.
There have been strategies and quick program responses that have been followed in the past few years which have contributed a lot in the final polio eradication efforts. As per the Advisory Group on Polio Eradication, every case, anywhere in the country is being responded to as a public health emergency. The only case of polio in 2011 in Howrah is an example of rapid response - with the first immunization round being held within seven days and three rounds in seven weeks of it being reported. In contrast, a case the same time in 2010 in Murshidabad, saw the first immunization response in five weeks and three rounds spread over 17 weeks. The rapid and intense response in Howrah helped stop polio transmission and no other case was reported. This has shown that an immediate reaction to the problem is crucial.
Besides aiding the struggling nations with funding and strategic help to bring them the same public health success, the wisdom that the country has gained during the long years of hard work will help design the future health programs. Infectious diseases like tuberculosis will benefit hugely from the kind of political will and national coordination that the government has shown in fighting polio. The infrastructure of the national surveillance project is already being used to deliver other health services to people living in hard-to-reach parts of the country.
Disha Bathija is a fashion marketing professional and writes on design and lifestyle.
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