This past week, India marked three years since its last reported polio case. As the country gets ready to be declared 'polio-free', the author looks back at a well-deserved victory
January 13, was a milestone in the medical history of India. It marked three years since the last polio case was detected in the country - that of Rukhshar Khatoon of West Bengal.
The pride over this achievement will likely be doubled in the last week of March, when representatives of the South-East Asia Regional Certification Commission for Polio Eradication meet in Delhi. If the commission is convinced that there is no wild polio virus in the region and the surveillance quality is good enough to pick up any, it will certify the region as 'polio-free'.
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While poliomyelitis has existed as long as human society, it became a major public health issue only in late Victorian times, with major epidemics in Europe and the United States. The 20th century saw larger epidemics across the world, including in developed nations. In 1988, the World Health Assembly adopted a resolution to eradicate the disease completely by 2000.
By 2012, only four countries - Nigeria, Afghanistan, Pakistan and India - remained 'polio-endemic'. India now is no longer a member of that dubious club.
Nata Menabde, World Health Organisation representative to India, recalls the harder times. "Prior to the introduction of the oral polio vaccine in 1978 in India, over 150,000 children were being paralysed due to polio each year," she says.
So how did the battle to eradicate polio in India start? "Mass polio vaccination campaigns were launched in 1995. This reduced the number of cases to less than 2,000 annually," says Menabde. In 2009, India accounted for more than half of the global cases when it reported 741 cases. Only 42 cases were reported in 2010 followed by the last case in January 2011.
The results were due to a united effort by the government, the Rotary Club, which made Pulse Polio its special agenda, and international agencies like WHO and UNICEF. Each played its own part in the story.
"The government's main role was to lead from the front. We funded the initiative. Since 1995, we have pumped Rs 15,000 crore into it. Funding, strategising, overseeing and supervising - we did it all," says Anuradha Gupta, additional secretary, Union health ministry.
The Rotary Club has played an important part in the campaign. "Our role was four-fold - advocacy, funding, social mobilisation and aiding the government with groundwork during vaccination campaigns," says Deepak Kapoor, head, Rotary International (India) Polio Committee.
The polio eradication teams faced multiple challenges. "India's size and population density, insanitary conditions, malnutrition and gastro-intestinal ailments among children which could render the oral polio vaccine futile - all these challenges stared us in the face during the fight against polio," elaborates Kapoor.
There was also the problem of religious sentiments. "There was strong opposition to the oral vaccine from many Muslims because of rumours that it contained substances banned under Islamic dietary laws. Another insidious rumour was that the vaccine would make children sterile," recalls Kapoor.
So what did they do? "We went to the Ulema (clergy) and convinced them that Islam allowed immunisation and the well-being of one's children. They, in turn exhorted their congregations to get their children vaccinated," says Kapoor.
But while the authorities eventually conquered all these challenges, the greatest one may be the one yet to come. "The risk of polio persists in India in view of the continuing polio virus transmission in Afghanistan, Pakistan and Nigeria and the outbreaks in 2013 in previously polio-free countries such as Syria, Somalia and others. There is a risk of the virus returning to India through the same route that it used to travel out of the country in the past to re-infect countries such as Tajikistan, Nepal, Bangladesh and Angola," warns Menabde.
But with their spirits high, the authorities feel they are up to such a challenge. "The greatest lesson in it for us as a nation is that we can do it. Everything is possible. A lot of global experts had thought that India would never be able to defeat polio. Now that we have, we can tackle any other challenge. Only, we shouldn't be complacent," says Gupta.
