India shows the way for other polio-endemic nations

After India’s unexpected feat of freeing itself from polio, the target to eradicate the debilitating disease from the world, set in 1988, seems possible

By Kundan Pandey
Published: Thursday 27 March 2014

In spite of all hurdles, India did manage to overcome the challenge and was declared polio free this year after no case was reported for three consecutive years

When the WHO South East Asia region receives the certificate for being polio free on Thursday, it would be an accomplishment that until a few years ago was considered a pipe dream—mainly because of the large number of cases that continued to be reported from India. 

As recently as 2009, India accounted for 741 out of the total 1,604 polio cases recorded across the worldr. While some experts believed that India would be the last country to be declared polio free, others said it a task that could never be accomplished.

Eradication of the disease from India appeared to be the toughest part of the global campaign against the disease. There were several reasons for it: high density of population in India, poor sanitation, high birth rate, low rate of routine immunisation, widespread diarrhoea, difficult terrain, high rate of migration and also resistance to vaccination among some groups.

In spite of these hurdles, India did manage to overcome the challenge and was declared polio free this year after no case was reported for three consecutive years. Celebrating the achievement on February 11, director-general of the World Health Organization (WHO), Margaret Chan, said that many critics believed that this day would never come, that the polio virus was too firmly entrenched in India, and that India would never be polio free.

The global threat

But the risk is not gone as yet. The polio-free status of every country is under threat as long as poliovirus is prevalent in any part of the world. According to Bill & Melinda Gates foundation, more than 20 countries have experienced outbreaks of polio, imported from endemic countries—some of them multiple times—since 2008.

After South East Asia gets the certificate on Thursday, only two regions, East Mediterranean and Africa, will be left out of list of polio-free certified regions. The remaining three WHO regions are—Americas (got certificate in 1994), European region (2002), and Western Pacific region (2000).

After India’s unexpected feat, the target to eradicate polio from the world, set in 1988, seems possible. It is believed that the other two regions are not as difficult as India was. Moreover, India is assisting countries, including Pakistan, Afghanistan (East Mediterranean region) and Nigeria (Africa). This is expected to make the task less difficult.

Lessons to learn from India’s achievement

The story of India’s victory against polio involves fight against challenges like surveillance, confusion over separate pockets, infrastructure issues, logistical limitations and dealing with marginalised groups. India’s collaboration with international agencies like WHO, Rotary international and Unicef made it possible to achieve the feat.

When India faced the problem of identifying children in need of vaccination, National Polio Surveillance Project was established in 1997. The government included community leaders to deal with local challenges. In an interview with Down To Earth, WHO regional director for South-East Asia, Poonam Khetrapal Singh, said, “Success in eradicating polio has come after intensive community involvement. Working with local, traditional and religious leaders in advocating the benefits of the vaccination helps fight false perceptions and build confidence in immunisation.” It is well-known that Bollywood star Amitabh Bachhan was also roped in for the immunisation campaign because of his influence on people.

To reach the hidden pockets, local people and health workers were engaged. This helped to trace even those children who had never been targeted by any other health programme. Tracking such groups not only helped in eradicating polio but may also help in other health campaigns in future.

For other countries which are still suffering from polio, Khetrapal said that there are many lessons to learn from experience of India. It includes ensuring accountability at every level of administration for delivering service to the community. She also suggested that it is important to focus on finding local solutions to solve local challenges. It may need some innovations, technologies and mapping to ensure vaccination of migrant communities (click here to read the full interview).

India has shown the world that there is no such thing as impossible – WHO Director-General

From 200,000 to zero: the journey to a polio-free India

Eradicating poliomyelitis: India's journey from hyperendemic to polio-free status

Fatigue and fear with shifting polio eradication strategies in India: A study of social resistance to vaccination

Social mobilization: lessons from the Core Group Polio Project in Angola, Ethiopia, and India

Operational guide for pulse polio immunization in India

Polio eradication and endgame strategic plan 2013-2018

Social mobilization: lessons from the Core Group Polio Project in Angola, Ethiopia, and India

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