World Polio Day: How India managed to eradicate polio
In 2009, India had reported 741 polio cases, the highest in the world. In January 2011, India reported its last polio case. How did the turnaround come about? Here’s a brief account.
The fact that polio drops could be given orally and not as an injection was an advantage, as local health workers could administer them even without special training. (Express Photo for representation: Pavan Khengre)
October 24 is observed as World Polio Day. The Day was established by Rotary International to commemorate the birth of Jonas Salk, who led the first team to develop the vaccine against the disease in the 1950s.
India has managed to eradicate polio, a highly infectious viral disease that causes paralysis and even death, mainly affecting children. There is no cure for polio, it can only be prevented through a vaccine.
In 2009, India had reported 741 polio cases, the highest in the world, according to the Global Polio Eradication Initiative. In January 2011, India reported its last polio case, in West Bengal’s Howrah. The turnaround, in the face of huge challenges, was a major success story of India’s healthcare system, and learnings from the process were utilised during the Covid-19 vaccination drive recently.
India beat polio through coordination between various levels of government and international aid agencies, successful messaging, overcoming cultural barriers, and ensuring last-mile coverage. Here’s a brief account of how the story unfolded.
First, the challenges
India had a huge population, with millions living in crowded settlements with inadequate hygiene arrangements. Challenges in different parts of the country were entirely different. Many parts of the country were geographically difficult to access. On top of this were fears of the vaccine, born out of religious beliefs and a mistrust of the government machinery.
Narrowing down on the problem
Vaccination against polio began in 1972, and expanded in 1985 as the country-wide Universal Immunisation Programme (UIP). For polio, one immunisation day would be fixed for the whole country and awareness created about it. The fact that polio drops could be given orally and not as an injection was an advantage, as local health workers could administer them even without special training.
Vaccination drives would be held on festivals, at railway stations, and any place where a large number of people gathered.
Special awareness camps were held for mothers, where they were addressed by women of their community and social class, speaking their language.
Celebrities like Amitabh Bachchan were roped in to create awareness. According to a UNICEF report, “Building on the huge reach of soap operas, polio and other health messages were woven into storylines and episodes.”
The polio vaccination tagline — do boond zindagi ki (two drops of life) — still has recall value.
Polio often spreads through the feces of the infected person, which others can come in contact with from contaminated food and water, poor hygiene, etc. Thus, along with vaccination, the importance of washing hands, boiling drinking water, giving only breastmilk to babies below six months of age, etc. was also communicated to people.
The efforts were led by the Centre and state governments, supported by the World Health Organisation (WHO), UNICEF, US Center for Disease Control
and Prevention (CDC), Rotary International, and donors like the Bill and Melinda Gates Foundation.
By 2008, cases had begun to decline in many parts of the country. According to a UNICEF report, “In 2009, the polio partners found that more than 80 per cent of polio cases were persistently occurring in just 107 blocks of Uttar Pradesh and Bihar.”
Efforts were scaled up to target these regions.
Monitoring
A cornerstone of the strategy was effective surveillance and monitoring of high-risk groups. According to a research paper by Toronto-based Reach Alliance, “Availing itself of the expertise of the World Health Organization (WHO), India developed a robust surveillance system… Without this multilayered surveillance system, cases of polio among the hardest-to-reach groups were being missed, leading to continued transmission.”
This involved monitoring the occurrence of acute flaccid paralysis in children, which is often caused by the polio virus, and then immunising those around the affected child. For this, a network of ‘informers’ was built, including community health workers, local residents, doctors, faith healers etc.
