India’s health minister Ghulam Nabi Azad in an official release issued by the health ministry said not a single case of wild polio has been reported from any part of the country since the past three years.
“It is a matter of great pride for all of us. This monumental milestone was made possible due to unwavering political will at the highest levels, commitment of adequate financial resources, technological innovations like the bivalent vaccine and tireless efforts of millions of workers, including more than 2.3 million vaccinators and volunteers, and more than 150,000 supervisors,” Azad said.
India last recorded a polio case on 13 January 2011, that of a two-year-old girl from West Bengal state. The poliovirus spreads through contaminated water and food, multiplies in the intestines and attacks the nervous system, to cause permanent paralysis.
“This (polio elimination from India) is the biggest public health success story of the century. Everybody is learning from India,” Naveen Thacker, president-elect of the Asia-Pacific Paediatric Association and former member of India’s expert advisory group on polio, tells SciDev.Net.
Thacker says the ‘the last mile’ in India’s polio elimination campaign proved longer than anticipated. India’s health ministry began an intensified national campaign to eliminate polio in from 2000 to 2005; but found to its dismay that the infection could not be entirely wiped out.
In 2005, India changed its polio vaccination strategy to substitute the routine ‘trivalent’ vaccine that works against three polio virus strains, to a ‘monovalent’ strain specifically tailored to act against the single strain circulating in the northern states of Bihar and Uttar Pradesh.
It also zeroed in on children of migrants who may have missed repeat immunisation drives because their parents were on the move.
But even as India mounted its attack on strain 1, experts faced a sudden outbreak of strain 3 from 2007 to 2009. In 2009, India recorded 741 polio cases, almost half of 1604 global cases, says UNICEF. Experts then adjusted their vaccination strategy, switching to a ‘bivalent’ vaccine against the two strains in 2010.
India also upgraded its polio monitoring facilities; devised house-based micro plans to map children and vaccinators; set up immunisation camps in key migration hubs such as railway stations, bus stands and sate borders and involved Muslim clerics and religious leaders to address resistance to immunisation programmes.
Nigeria’s polio campaign in 2012 introduced house-based micro plans; while Afghanistan is revising its monitoring procedures using Indian models, says Thacker.
Beginning late January, India will make polio vaccination compulsory for travellers from the three remaining polio-endemic countries of Afghanistan, Nigeria and Pakistan, to prevent disease resurgence.
Other measures to avoid risk for re-emergence include continuing focus on multiple vaccination campaigns and a robust surveillance system, says Thacker.