The success of the polio eradication programme in India is a victory for the efforts over the plaguing, age-old polio. In spite of poor health care systems and facilities in remote areas, vast population to cover and range of socio-cultural barriers, the polio eradication programme witnessed the victory.
India before 1978 had enormous cases of polio. During that time, 500 cases of polio were being added daily. Looking at such a wide number of cases, programmes to eradicate polio were started but the mass polio vaccination campaign launched in 1995 was the most intensive of all. Continuous efforts brought a drop in the number of polio cases to 2,000 per year. In 2010, only 42 cases of polio were reported, while the last case came forward on 13 January 2011 in Howrah district of West Bengal.
On 25th February, 2012, India’s name was struck off from the list of polio endemic countries by the WHO because of no case of polio in one year. On 13th January, 2014 India completed two years without any case of polio. But it is really a commendable achievement, because in 2009 50% of the total polio cases in the world were from India. In 2009, 741 cases of polio in India were detected while there were 6,028 cases in 1991 and 150,000 cases of polio in 1985. The official website of UNICEF now mentions – India is no longer a polio-endemic country.
India and the South-East Asia region of the WHO (consisting of 11 countries including India) has come very close to getting the polio-free certification. The final decision will be taken after reviewing the documents of these 11 nations in the South-East Asia Regional Certification Commission for Polio Eradication (RCCPE), which is going to be held in the last week of March 2014 in New Delhi. Getting this certification will make it the fourth WHO region in the world to be certified as polio free. Declaring a country polio free means that polio virus has been eradicated from its environment and any new case is the result of the infection coming from other country. Pakistan, Nigeria and Afghanistan are the three remaining endemic polio countries in the world.
How India achieved success in polio programme?
Eradicating polio from India is a collaborative effort of the Government of India, the state governments, and the polio partners—WHO, UNICEF and Rotary International. At the same time, the role of the dedicated workers, volunteers, donors, and support of the society cannot be undermined.
During each polio immunization campaign, about 170 million children in more than 240 million households by 2.3 million vaccinators are vaccinated. Apart from this 70 million children from the most vulnerable areas are also vaccinated during each campaign.
Ongoing research and innovations played their own role in eradicating polio from India. The population immunity and the best suited medicine are reviewed regularly in various studies. Then the introduction of the most effective monovalent oral polio vaccine (mOPV) in 2005 gave a new direction to the programme. The last chain of polio virus was broken down by the bivalent OPV in 2010.
In addition to this, the polio eradication programme in India got success chiefly because of strong, consistent and speedy surveillance for the polio virus. It even performed better than the standards and global indicators of sensitivity indicated by the WHO. Both human and environmental surveillance has been carried out. Sewage samples have also been taken from the regions experiencing greater migration viz. Punjab, New Delhi, Mumbai, Kolkata and Patna. This was done to find out any polio viruses in the environment. Immunization activities and future strategies were then based on the outcome of these findings. Involvement and dedication of this kind led to the complete eradication of polio from India and not even a single case has been detected since January 2011.
Effective monitoring system further adds to make the programme a success. Monitoring lessened and even eliminated the gap between vigilance and implementation of the polio vaccine programme. Real-time information helped in making changes according to the need of the region. This real-time information was provided by more than 3,000 independent monitors. Apart from this, regular reviews and suggestions from the India Expert Advisory Group played a crucial role. Their timely suggestions helped in the eradication of polio.
Bordering areas of Pakistan, Nepal, Myanmar, Bangladesh and Bhutan have been provided with 102 vaccination posts. This is another polio lessening strategy to make sure that children under the age of five years crossing these borders must be vaccinated. At the same time, travellers coming from the polio-endemic and recently infected countries to India must be vaccinated.
‘Do Boond Zindagi Ke’ Pulse Polio Immunisation Campaign helped in spreading the required awareness. So everything was in place and contributed to the success of polio eradication programme that can be regarded as a “model of excellence” for other such programmes in the healthcare sector of the country. But a full stop cannot be put on the polio eradication programme in India even after getting the certificate. We must continue putting the efforts till polio is not eradicated globally. Maybe India could chip in by sharing this model with other countries too.