Has India’s Fight Against polio coming to an end?
A limp is all that sets Ruksha Shah, 5, apart from other girls of her age in her home in Subharara village in the Panchla block of the Howrah district of West Bengal. It’s the only remnant of the polio infection that ravaged her in 2011, which left her right leg a little shorter and weaker than the left.
Ruksha’s the last recorded case of polio — on January 13, 2011 — in India, and if the nation’s polio eradication programme stays on track, it may well be India’s last. Being declared polio-free means the virus has died in the environment and new cases, if any, would be caused by infection in another country where infection persists.
“Ruksha is cured though she feels A little pain in the affected right leg when she runs. Earlier, many of us did not take our babies to get polio drops, but now most have understood the deadliness of the infection,” said her father Abdul Shah, a zari embroidery-worker with a monthly income of Rs. 2,000.
Today marks a major global public health milestone and a huge success as India celebrates the third anniversary of its last reported case of wild polio virus and counts down to when the World Health Organization (WHO) is due to declare India as officially polio-free. But with nearly
seven million children still not receiving basic immunisation, there is still so much more to be done, and if India were to build on this success then in a few years it could have so much more to celebrate.
That’s because the benefits of eliminating polio have the potential to go well beyond just preventing paralytic poliomyelitis. The government of India now also has the opportunity to immunise millions of children against a range of other life-threatening diseases, by helping to boost the provision of routine immunisation along the way.
Back in the early 1980s an estimated 2,00,000 children in India were affected by polio every year. And as recently as 2009 nearly half of all the cases of wild polio in the world were found in India.
In light of this, and the fact that India had the largest number of unimmunised children in the world, many people believed that India would end up being the last country to banish polio, while others even questioned whether it could ever be achieved.
However, thanks to the government’s strong political commitment, a multi-stakeholder approach and the use of highly-innovative methods improving polio vaccine coverage, the naysayers have now been proved wrong. But, it didn’t happen overnight, and none of it would have been possible without an army of several hundred thousand frontline workers, often working in extremely challenging situations.
This began in earnest in 1995, when the government launched its first nationwide polio immunisation campaign, and, thereafter, continued to step up its efforts, bringing in national immunisation days and holding regular supplementary immunisation activities (SIAs), as well as other intensive immunisation and surveillance activities against polio.
Under this initiative as many as 175 million children have been vaccinated in a single day, thanks to the efforts of 2.3 million health workers. And when combined with the 3 million house calls made every month by a network of 9,125 community mobilisers, nearly one billion doses of polio vaccine are delivered in India each year.
But as crucial a role as this mass mobilisation has played in the eradication effort, India’s other secret weapon has been — innovation.
By combining meticulous microplanning, monitoring, mobilisation and data analysis, state health officials, the WHO and Unicef, have been able to create a huge and highly effective network that is able to identify priority or problem areas, and important changes or trends in an area, practically in real time.
Although also relying upon a huge workforce, the clever design and use of accountability and prioritising, has enabled India to use this to effectively cast a polio immunisation net over the entire country in a bid to reach every last child.
One remarkable example of this is the way in which teams of vaccinators board trains across the country during SIAs.
Methodically working their way through the carriages they deliver two drops of the polio vaccine into the mouth of every young child they find who doesn’t bear the indelible ink mark on his or her finger, to indicate he/she has already been vaccinated. In this way they can carry out an entire sweep of a train within a few stops, and across the entire country as many as 1,00,000 children are typically vaccinated in a 24-hour period.
That’s 1,00,000 children who might have otherwise slipped through the net.
This kind of out-of-the-box thinking is precisely what has enabled India to beat polio. And now Bihar, once regarded as a failing state, has been applying the same innovative principles to other vaccines and achieving stunning results in the process.
In less than a decade Bihar has gone from a point where just 18% of its children were receiving all three diphtheria-tetanus-pertussis (DTP) shots — a rate way too low to have a dramatic effect on public health — to a reported routine immunisation coverage today of more than 85%.
This transformation has come about partly because improvements to immunisation infrastructure, from this extended polio coverage, have helped strengthen routine immunisation.
But also because Bihar has emulated polio’s successful model and created a similar system of microplans, monitoring, mobilisation and accountability for routine immunisation. In fact, in 2009 when staff compared polio microplans with existing ones for routine immunisation, they found that the latter was missing a quarter of the population.
Then in 2012, following a further painstaking yet meticulous line-by-line comparison, they were able to identify and add more than 50,000 transitional or high risk people to the routine immunisation microplans.
And now as India begins to scale back its polio activities, reducing the number of SIAs carried out each year, encouragingly we are seeing coverage of polio continuing to rise in Bihar.
So polio has helped routine immunisation in Bihar and now routine immunisation is returning the favour.
Yet 1.4 million children under five are still dying every year from vaccine preventable disease, such as pneumonia and diarrhoea, and from malnutrition.
So coming at a time when the government is on the verge of launching the 5-in-1 pentavalent vaccine, the question now is can India replicate this success to protect its children from other deadly diseases? Doing so would give us an even bigger cause for celebration!
– See more at: http://www.hindustantimes.com/comment/analysis/standing-tall-against-polio/article1-1172136.aspx#sthash.BqYMsYmv.dpuf
Villagers in Panchla where the country’s last polio case was reported are still extremely resistant to vaccination. Many families of the mainly minorities-dominated villages in Panchla block, about 50 km away from Kolkata, still believe —wrongly — that vaccines cause infertility and do not get their children vaccinated.
“We have some pockets in Howrah, South 24 Parganas and even in Metiaburuz in Kolkata where people are highly resistant to polio immunisation,” said Dr S K Seal, deputy director health services in charge of the polio eradication programme. On each Pulse Polio Day, 97 lakh children under 5 years are given polio drops across West Bengal.
HT visited several villages including Subharara, Beldubi, Golpara and Biti Hakola around the Kulai Rural Hospital and found many families have not got their children immunised, which can result in new infection and outbreaks and threaten India’s efforts to eradicate polio.
A recent WHO report said pulse polio immunisation-awareness programmes are yet to gain momentum in Howrah and South 24 Parganas district, where about 2,000 polio booths are set up during each vaccination round to immunise children.
India will be officially declared “polio-free” on January 13 by the World Health Organisation. There hasn’t been a new case of polio in three years, but the threat of re-infection from across the border looms large.
India’s last polio case – a two-year-old girl in the Panchla block of Howrah, West Bengal – was reported on January 13, 2011. But nationwide immunisation drives continued and will go on.
“The risk of importation (of polio virus) is real and has increased since 2013 with outbreaks in the Horn of Africa and the Middle East, in addition to the continuing poliovirus transmission in Afghanistan, Pakistan and Nigeria. Since 2000, 49 countries that were polio-free suffered from one or more importations of wild poliovirus,” said Nicole Deutsch, polio chief, UNICEF India.
Of the total 372 polio cases in 2013, 85 were from Pakistan and 12 from Afghanistan. Somlia had the biggest outbreak with 183 cases — it had been polio-free since 2007. The polio strain was traced to Nigeria, which reported 51 cases. Syria, Cameroon, Ethiopia and Kenya also had outbreaks after being declared polio-free in 2012.
India has already taken precautions to avoid re-infection.
Since 2011, all children under 5 years of age crossing from Pakistan, Nepal, Bangladesh, Myanmar and Bhutan are given polio drops at 102 border-crossing posts. In two years, more than 4.2 million children have been immunised.
And beginning January 30, those entering India from Pakistan, regardless of age, will be required to carry a certificate of vaccination against polio.
The immunisation drives will go on too. “India will have two national and four sub-national polio vaccination campaigns in 2014 and 2015, down from two national and six sub-national campaigns in 2013,” said a Union health ministry official.
In each national campaign, 2.3 million vaccinators immunise nearly 172 million children. In the past, “India exported the virus to every continent except Antarctica and the virus can take the same route back to infect every corner of the country,” said Deepak Kapur, head of Rotary International’s polioplus committee. To further strengthen its defenses, India has set up a “laboratory-backed surveillance” to detect the virus, even in sewage samples, and will soon be expanded to cover five states, including Punjab, said Deutsch.
“Around 500 families are still strongly reluctant to get their babies vaccinated with pulse polio oral drops. On behalf of the government, we, along with UNICEF and NGOs, are conducting regular awareness programmes and have got a positive response from some conservative families.”
“Many, unfortunately, are still against immunisation,” Dr Prasanta Biswas, polio monitoring officer in charge of Howrah.
Religious leaders are regularly invited to raise health awareness.
“They have read out the religious texts to persuade villagers to look after their children’s health. Panchla block is the most sensitive area in the state because of the last reported case was from here, but about 5 % of the roughly 30,000 children up to five years who need to be vaccinated are yet to be immunised with polio drops,” said Dr Biswas.
FASTFACTS
What is polio?
Polio (poliomyelitis) is an infectious disease caused by a virus that invades the nervous system through the mouth (faecal-oral route). Initial symptoms are fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. One in 200 infections cause irreversible paralysis, usually in the legs. About one in 10 of those paralysed die.
Who is the most at risk?
Polio mainly affects children under 5 years.
Can polio be cured?
There is no cure for polio, but it can be prevented. Polio vaccine (drops), given multiple times till the age of 5, protect a child for life.
How many oral polio drops does a child need?
A child should get four doses of oral polio vaccine in the first year with supplementary doses till the age of five on the immunisation days.
How is a country declared polio free?
Before a country can be certified polio-free, it should have at least three years of zero polio cases. Since the launch of the 1988 Global Polio Eradication Initiative to eradicate polio, 5 million people – mainly in the developing world – who would otherwise have been paralysed, will be free of polio.
