The Global Effort To Eradicate Polio-The Crippler Disease

Shivaprasad M Khened     

E-mail: Khened@yahoo.com

Polio Vaccination Declared Effective, April 12, 1955

Polio eradication efforts in India

India officially committed itself to eradicate polio, supporting the WHO resolution to that effect in the very same year 1998.  India had more polio cases than any other country in the world.  It was estimated that the Indian health care personnel officially reported to the government over 24,000 cases of polio.  In reality though, there were probably as many as 10 times that number of cases that went unreported.  The sight of children and adults with withered arms and legs throughout the cities, towns and villages of India was routine, and some of the major risk factors for polio virus transmission – crowing, poverty and poor sanitation – were present in India to a degree not seen in most countries. 

Progress towards eradication of polio has been steady.  The government of India, along with key partners including WHO, UNICEF and Rotary International, has spearheaded a massive effort.  The initial attack on polio came with provision of universal immunization Programme (UIP), more Indian children were provided oral polio vaccine (OPV) than ever before in history.  The numbers of reported polio cases have dropped from over 24,000 in 1998-89 to less than 5,000 in 1993-94.  Although this was encouraging, the government of India soon responded to the need to intensity the polio eradication effort and developed the Pulse Polio Immunization (PPI) strategy.   The key innovation was utilization of mass immunization campaigns to supplement the routine immunization activities.  The state of Delhi was the first area to adopt a PPI component in 1994.  The first round National Immunization Day (NID) programme was held in late 1995, which was followed with a second round in early 1996.  The NIDs featured booths (fixed sites) to which children under 5 were invited to take two oral polio drops.  Over 5,00,000 booths were set up nationally during the first NID programme, and on a single day a total of 87 million children received oral polio vaccine.  The scope and intensity of mobilization utilized for this activity was unprecedented in the annals of the health initiatives in India, and possibly, the world.  To understand this remarkable achievement, it is important to comprehend the scale of the efforts made to meet this gigantic challenge.  At the same time as the NIDs were being initiated, it became clear to the government that better information on polio cases was necessary to complete the job of polio eradication.  The government of India and WHO developed a collaborative unit, the National Polio Surveillance Project (NPSP), to provide accurate and rapid surveillance information on polio cases in India.  There is now a systematic methodical tracking of cases, finding the source of infection and flooding infected area with massive doses of polio vaccines.  Beginning in 1997, NPSP is now supporting over 200 surveillance medical officers through India to coordinate polio surveillance activities.  In adition to NPSP network, a regional laboratory network of 9 highly qualified Indian research centres provides rapid and accurate analysis of samples from patients.                    

Conclusion

The poliovirus lives in the human intestine, is ejected into the environment through excreta, and spreads by contact with fecal matter.  The disease strikes mainly children, cripples the limbs, and is sometimes fatal.  Children living in unhygienic condition without access to clean drinking water are particularly vulnerable to it.   This is why a bombardment of the virus through a synchronized mass immunization of children in the zero to five age group such as the one carried out nationally on January 4, 2004 is considered the best way to ensue zero incidence.  India has done this since 1996 but a cutback in planned immunization programmes in 2002 was the main factor behind that year’s polio resurgence in Uttar Pradesh.  It pushed back the goal of a polio-free India and a polio-free world from 2005 to 2007.  This year the Government is reported to be considering holding five nationwide immunization days as against the usual two annually.  This decision, despite the costs involved in conducting such an exercise, will be timely and appropriate in reaching the goal.  The benefits of total polio eradication, which will eventually include savings on the massive national expenditure in fighting the disease, far outweigh the expenditure.   In order to be effective, national immunization days must cover as many as possible of India’s 165 million children under the age of five years.  Superstition and fallacies about the perceived side effects of the oral polio vaccine still deter many parents from getting their children vaccinated.  Large-scale public awareness campaigns through mass media, using brand ambassadors, like the ones that involve matinee idols Amitabh Bachhan and Aishwarya Rai, should be continued for the efficacy of the polio eradication efforts.  The involvement of voluntary organizations such as Rotary in a door-to-door campaign to build awareness has helped immensely, however educating people about the disease and the vaccine still remains a key challenge for the Government. 

Simultaneously, the Government must also ensure that the focus on planned immunization does not distract attention from routine immunization through which newborn children get four oral polio vaccine doses from children get four oral polio vaccine doses from zero to three months.  With 15.5 million children born every year in India, routine vaccination is the only way to prevent gaps in immunity from developing.  As Tamil Nadu has shown, much also depends on surveillance.  The early detection of the two cases reported in Tamil Nadu enabled health officials immediately to immunize all children in those two areas.  The Union Health Minister, Sushma Swaraj, wants zero incidences of polio in India in 2004, so that the country can be declared polio-free after the waiting period of three years.  The goal is within reach.  It must not be allowed to slip away this time not after so much has already been done.

The Government and other agencies involved in the programme should therefore emphasized on human cooperation and not let their guard down in waging the final assault on one of the world’s most debilitating diseases.  They should intensify the National Immunization Programme all through this year, specially targeting states like Uttar Pradesh and Bihar, which have accounted for most reported cases of polio.  They should also address the issues of the emergence of polio in Karnataka, West Bengal, and Andhra Pradesh.  As long as the wild poliovirus exists anywhere in India, the risk of it spreading to areas considered free of the disease will remain.  Since polio is completely eradicable, even one case of polio is a case too many and therefore we should not miss out on this last too many and therefore we should not miss out on this last opportunity to kill the virus before it can strike back. 

Source: Vigyan Prasar Dream, Vol No. 6, No. 7

Date: April 2004