[dropcap]T[/dropcap]he war to eradicate polio has been one of India’s public health success stories with a relentless and orchestrated public campaign to reach to the remotest corners of the country over a decade.
An 18-month-old baby detected with polio in January 2011 in Howrah near the eastern city of Kolkata was the last reported case of the disease in the country. One more before the country can say ‘Goodbye, Polio.’ The battle against the wild polio virus is poised interestingly in the nation that, not long ago, in 2009, accounted for nearly half the world’s polio cases.Medical experts however warn against complacency as the threat of risk continues from porous borders that allow migration and spread of polio to India from Pakistan and Afghanistan. In 2013 isolated polio outbreaks reported in Syria and Horn of Africa made health experts cautious. Re-infection has been recorded of the endemic in countries like Somalia.“We cannot let this happen to our country according to Raman Bhatia, member of India National PolioPlus Committee (INPPC).
An 11-member Regional Certification Commission from the WHO’s South East Asia Region is meeting regularly to review reports submitted by India’s National Certification Committee. Three years of absence of polio cases, caused by the wild polio virus (WPV), coupled with intense surveillance, is essential before India can be declared polio-free, in 2014.
Naveen Thacker, past president, Indian Academy of Paediatrics, who has been involved for nearly two decades in the fight against polio, says: “It is probably the biggest public health success story of this century. For us, this is very encouraging; it gives us a lot of confidence. It also gives other polio-endemic countries a lot of confidence.”Surveillance system
The team had thought the task of eradicating polio from India would be fairly easy, when the Pulse Polio programme was initiated in 1995-1996. “We had about 1,006 cases then, and we thought it was going to be really easy. And then, my God! It was like the wild polio virus was always smarter than us.”
And now, after nearly two decades, the tide has turned. There is celebration in the air, but it is muted with wide-eyed caution. “The price of freedom is eternal vigilance,” Dr. Thacker says. “We need to sustain the campaign, and immunity. We also need to keep up our surveillance system. Our capacity to respond should be in place.”
T. Jacob John, who was professor of clinical virology in the Christian Medical College, Vellore, and has served on The National Technical Advisory Group on Immunisation, says: “Last year, the question was, ‘Is this for real?’ But two years is long enough to be sure that the WPV has been conquered. There have been two high seasons (for the virus) — the second half of the year in North India, and no cases. All sewage samples have also tested negative for the WPV.”
From a position in the past when Indians travelling abroad exported the polio virus to many countries, it has come to India worrying about possible imports from countries that are still endemic to polio. These nations are Pakistan and Afghanistan, nearby, and Nigeria. Dr. John says, “But we are prepared. There are five border crossing areas with Pakistan — two in Jammu and Kashmir, two in Punjab and one in Rajasthan. Anyone coming across has to take the vaccine.” Additionally, every State has emergency action plans ready, along with good surveillance systems.
To prevent polio from re-emerging, the government has planned to keep up intensive campaigns, especially in high-risk areas. Two nationwide campaigns and four sub-national polio campaigns will take place in 2013. High-risk areas, including blocks in Uttar Pradesh and Bihar, and migrant populations, are being targeted. A mapping system has been developed to ensure that all newborns in these areas are vaccinated, and that no one slips through the net. While the success of the polio campaign is a model of focussed attention, the attention is now being turned on increasing routine immunisation coverage, according to those involved in public health administration.
A joint statement from the WHO, the CDC, the UNICEF, the End Polio Now campaign, and the Central government, indicates that the sensitivity of surveillance in India now surpasses the globally recommended standards. Over 35,000 health facilities are reporting cases of Acute Flaccid Paralysis as part of polio surveillance. Over 1,20,000 stool specimens are tested annually in the eight WHO accredited labs in India. Surveillance has also been intensified along the international border, the statement adds.
Credit is being accorded to the commitment of the Centre for pushing ahead with the programme in the face of major hurdles. However, equally important is the seamless partnership between the government, and the Rotary International, the WHO, the UNICEF and private paediatricians – for it was the scale of this alliance that managed to mobilise vast quantities of field-level workers. In the final call, this probably swung the balance in favour of humans over the wild polio virus.
India is marking three years without any new recorded cases of polio – a feat that is expected to prompt the World Health Organisation (WHO) to declare the country polio-free in March.
India’s nationwide anti-polio campaign began with a vaccination programme in the mid-1990s. The federal government was supported by non-profit groups, UN agencies and prominent individuals including Bollywood stars who were roped for publicity of the campaign.
India’s PolioPlus campaign had 2,400,000 volunteers and over 150,000 community workers to carry out the immunisation programme. The free polio vaccination cost the government Rs 1000 crore ($160 million).
Reports say polio vaccinations are held 608 times annually and 2.3 million vaccinators are used to immunise more than 170 million children yearly. India’s record of going polio-free for the last three years was called “a monumental milestone” by Nicole Deutsch, head of polio operations for UN’s children’s arm UNICEF, reports say.
Probably the biggest public health success story of this century India has come in for congratulations from Germany. Germany, which has contributed 243 million euros to the Indian Polio Eradication Programme, Monday termed it a “landmark achievement”.
German Ambassador Michael Steiner here said: “I congratulate India on successfully eradicating polio. This is a landmark achievement. We are happy to have contributed to India’s Polio Eradication Programme.”
“Germany remains committed to the global initiative to eliminate polio from the few remaining pockets around the world,” he added.
Polio crippled an estimated 200,000 children in India each year before the launch of the Global Polio Eradication Initiative in 1996.
As recently as 2009, half of the cases worldwide were reported in India. It was considered one of the most difficult countries in eradicating polio. The Indian Polio Eradication Programme is part of the Global Polio Eradication Initiative.
The German government initiated its assistance for the programme in 1996, and has been extending it ever since to the Indian Ministry of Health and Family Welfare. The German financial cooperation is channelled through German Development Bank KfW, which acts as the implementing agency on behalf of the German government.
