India wins the war on polio; now it needs to be extra vigilant.
After successfully eradicating smallpox in 1980, India has now gone
three straight years without reporting any new case of poliomyelitis
infection (“polio”). This qualifies it to receive the World Health
Organisation’s (WHO) certification for being polio-free. Undoubtedly,
this is a victory that has been fought every inch of the way by myriad
agencies on a number of fronts and against what seemed like
insurmountable odds. The lessons learnt are precious beyond words and
the expectation is that these will be harnessed to fight other
infectious diseases that plague the country. In fact, the “how” of the
war on polio – for a war it was – is as fascinating as educative. There
is though some controversy about whether polio really has been
eradicated in India and there are warnings about a possible return.
There is also the remaining challenge of treating and rehabilitating
those who have already been crippled by the disease.
In the mid-1990s the vaccination programme that was undertaken
involved the government, United Nations bodies, charitable organisations
and private donors. While coordinating the activities of all these
agencies was a humungous task, the vaccination programme itself called
for dealing with fears and prejudices – social, religious and cultural –
and the physical logistics of reaching every nook and corner of a vast
country. The task was even more difficult in the high-risk states of
Bihar and Uttar Pradesh which also witness large-scale outmigration.
Nearly two million vaccinators not only went to slums and villages but
also provided their services at railway stations, bus terminals and
construction sites as well as at fairs and other public gatherings,
apart from making house to house visits. Religious and community leaders
were persuaded to preach and cajole where parents were afraid of
vaccination even as the media, college students, volunteers, film stars
and celebrities were roped in to popularise the campaign. The
expectation now is that this strategy and the mechanisms that have been
put in place can be used to tackle other diseases like measles which
claim thousands of under-five lives and even to push for 100%
immunisation of children against the major infectious diseases. Of
course, vaccination is not a cure-all solution for all infectious
diseases. There are other aspects of public health like provision of
sanitation and supply of potable water that need to be addressed and are
as important as, if not more so than, vaccination.
There are alarming signs, however, in reports that a suspected
increased dosage of polio drops in India has given rise to cases of
non-polio acute flaccid paralysis (NPAFP). While the cause of the NPAFP
cases is disputed, a number of doctors and health activists have pointed
out that the government’s surveillance data shows that in the past 13
months, 53,563 cases have been reported. The government attributes this
to more sensitive and vigilant surveillance and not to the increased
vaccination dosage. The fact remains that along with those who are
already the victims of polio, this huge number of NPAFP-affected need
treatment and rehabilitation.
In 1985 there were 1,50,000 reported cases of paralytic polio,
whereas in 2009 the fresh cases numbered 741 (half of the world’s
number). This came down further to 42 in 2010 and the last reported case
was in 2011. India’s achievement in eradicating polio provides hope for
other countries where the socio-economic conditions are similar. But
India’s victory is fragile for until polio is eradicated from every
region in the world, there remains a constant risk of a return. Going by
the experience of a number of countries, it is easy for polio to be
imported from neighbouring countries even after it is completely
eradicated at home. At present, Afghanistan, Pakistan and Nigeria are
the polio-endemic countries while previously polio-free countries like
Syria and Somalia saw an outbreak last year.
As the battle against a number of other health issues, notably the
fight to bring down the maternal mortality rate shows, the link between
increased public awareness and discourse and the political will to deal
with them is a strong one. For the well-being of its children, India
simply cannot afford to forget the lessons it has learnt in its battle
against polio.
