India is Polio Free

A child receiving the polio vaccine | Image courtesy of the CDC Public Health Image Library

Two weeks into 2014, and we have already received one of the best public health stories of the year: India is polio free.  For a country that accounted for over half of the world’s polio cases until 2009 (1), this achievement is remarkable. The last recorded case occurred three years ago, on 13^th January 2011, when an 18 month old girl was diagnosed with polio in Howrah, West Bengal (2).  Since then, no other cases have been recorded over a three year period and India is set to be declared officially polio-free after samples are tested by the World Health Organization next month (3).

Polio is a crippling, life-threatening disease caused by the poliomyelitis virus.  Polio is transmitted through contaminated food and water, and mostly affects children under age five.  Common symptoms include headache, lethargy, and gastrointestinal upset, but paralysis and permanent disability occur in some cases (4).  Polio was a huge public health problem worldwide, until a vaccine was developed in 1957 by Jonas Salk.  For more info on Salk, check out our history of epidemiology series.  In 1988, the forty-first World Health Assembly adopted a resolution for the global eradication of polio (4).  Since then, polio has decreased by 99% worldwide (4).  However, polio lingered in India.  India’s high population density, slum pockets, and poor sanitation, combined with poor health infrastructure and a diverse population with varying attitudes toward the vaccine made for a ‘perfect storm’ for polio to spread (5, 6).

The Oral Polio Vaccine (OPV) | Image courtesy Wikimedia Commons

How has India overcome these hurdles to polio eradication? India’s government and health system collaborated with international organisations including the World Health Organization, Rotary International, and UNICEF in a fine logistical feat to immunise the nation’s children.  Young children under age five are the target for vaccination to eradicate the disease, as they are the most vulnerable.  An initial key piece of the puzzle was generating data: who needed vaccination, and where.  In 1997, the National Polio Surveillance Project was established by the World Health Organization and the Indian government.  Data from this surveillance system informed the country’s medical surveillance officers, government officials, and thousands of volunteer vaccinators of where the areas of highest risk where, and in turn where to distribute the vaccine (6, 7).

A major victory in the eradication was the targeting of marginalised and mobile communities within India.  For example, families in Uttar Pradesh were refusing the vaccine for their children, doubting its effectiveness and some suspecting rumours that the vaccine caused impotence (6).  UNICEF set up social mobilisation networks to specifically target these social groups and dispel myths about the vaccine (6, 7).  Other public awareness methods, such as the famous Indian film star Amitabh Bachchan lending his image to the polio eradication efforts as a UNICEF Goodwill Ambassador certainly helped (8).  Over time, the concerted effort of international health organisations, the Indian government, the millions of dollars and vaccine doses donated to the effort, and uncountable numbers of volunteers have led to the zero cases of polio in India today.

Polio eradication in India may be one of the top public health stories of the century, and will be surpassed once global eradication is achieved.  Polio remains in endemic in Nigeria, Afghanistan, and Pakistan.  Populations in these countries can be difficult to reach due to war, geographic instability of their people, and poor health infrastructure.  Fortunately, the World Health Organization has recently announced that over 23 million children in the Middle East will be vaccinated against polio, in the largest-ever vaccination campaign (9).  Because of its proximity to countries such as Pakistan, India runs the risk of re-infection in the population and is running polio campaigns in 2014-15, where 2.3 million vaccinators will immunise 172 million children (6).  With these further efforts, India is a lesson in exquisite public health planning and cooperation across organisations with the daily efforts of individual people working for a common goal.

References

1. Al Jazeera. India marks three years without polio. Al Jazeera. 13 January 2014. http://www.aljazeera.com/news/2014/01/india-wins-battle-against-polio-201411355459437799.html (accessed 15 January 2014).
2. Subhendu Maiti. Close to victory: India will officially be declared polio-free from today. Hindustan Times. 13 January 2014. http://www.hindustantimes.com/india-news/close-to-victory-india-will-officially-be-declared-polio-free-from-today/article1-1171899.aspx (accessed 15 January 2014).
3. BBC News India. India hails polio-free ‘milestone’. BBC. 13 January 2014. http://www.bbc.co.uk/news/world-asia-india-25708715 (accessed 15 January 2014).
4. World Health Organization. Poliomyelitis: Fact Sheet No. 114, April 2013. http://www.who.int/mediacentre/factsheets/fs114/en/index.html (accessed 15 January 2014).
5. Michael Sheldrick. 1.2 billion reasons to celebrate: India set to be polio-free. The Guardian. 13 January 2014. http://www.theguardian.com/global-development-professionals-network/2014/jan/13/lessons-india-polio-free-landmark (accessed 15 January 2014).
6. Patralekha Chatterjee. How India managed to defeat polio. BBC. 13 January 2014. http://www.bbc.co.uk/news/world-asia-india-25709362 (accessed 15 January 2014).
7. UNICEF. From 200,000 to 0: the journey to a polio-free India. http://www.unicef.org/india/Polio_Booklet-final_(22-02-2012)V3.pdf (accessed 16 January 2014).
8. UNICEF. Amitabh Bachchan launches new Polio Communication Campaign. http://www.unicef.org/india/media_7464.htm (accessed 16 January 2014).
9. World Health Organization. Over 23 million children to be vaccinated in mass polio immunization campaign across Middle East. 9 December 2013. http://www.who.int/mediacentre/news/releases/2013/polio-vaccination-20131209/en/ (accessed 16 January 2014).

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