One more year of nil case and it will be ‘Goodbye, Polio’

It is two years since India has had a polio case. One more before the country can say ‘Goodbye, Polio.’ The battle against the wild polio virus is poised interestingly in the nation that, not long ago, in 2009, accounted for nearly half the world’s polio cases.

An 11-member Regional Certification Commission from the WHO’s South East Asia Region is meeting regularly to review reports submitted by India’s National Certification Committee. Three years of absence of polio cases, caused by the wild polio virus (WPV), coupled with intense surveillance, is essential before India can be declared polio-free, in 2014.

Naveen Thacker, past president, Indian Academy of Paediatrics, who has been involved for nearly two decades in the fight against polio, says: “It is probably the biggest public health success story of this century. For us, this is very encouraging; it gives us a lot of confidence. It also gives other polio-endemic countries a lot of confidence.”

Surveillance system

The team had thought the task of eradicating polio from India would be fairly easy, when the Pulse Polio programme was initiated in 1995-1996. “We had about 1,006 cases then, and we thought it was going to be really easy. And then, my God! It was like the wild polio virus was always smarter than us.”

And now, after nearly two decades, the tide has turned. There is celebration in the air, but it is muted with wide-eyed caution. “The price of freedom is eternal vigilance,” Dr. Thacker says. “We need to sustain the campaign, and immunity. We also need to keep up our surveillance system. Our capacity to respond should be in place.”

T. Jacob John, who was professor of clinical virology in the Christian Medical College, Vellore, and has served on The National Technical Advisory Group on Immunisation, says: “Last year, the question was, ‘Is this for real?’ But two years is long enough to be sure that the WPV has been conquered. There have been two high seasons (for the virus) — the second half of the year in North India, and no cases. All sewage samples have also tested negative for the WPV.”

From a position in the past when Indians travelling abroad exported the polio virus to many countries, it has come to India worrying about possible imports from countries that are still endemic to polio. These nations are Pakistan and Afghanistan, nearby, and Nigeria. Dr. John says, “But we are prepared. There are five border crossing areas with Pakistan — two in Jammu and Kashmir, two in Punjab and one in Rajasthan. Anyone coming across has to take the vaccine.” Additionally, every State has emergency action plans ready, along with good surveillance systems.

To prevent polio from re-emerging, the government has planned to keep up intensive campaigns, especially in high-risk areas. Two nationwide campaigns and four sub-national polio campaigns will take place in 2013. High-risk areas, including blocks in Uttar Pradesh and Bihar, and migrant populations, are being targeted. A mapping system has been developed to ensure that all newborns in these areas are vaccinated, and that no one slips through the net. While the success of the polio campaign is a model of focussed attention, the attention is now being turned on increasing routine immunisation coverage, according to those involved in public health administration.

A joint statement from the WHO, the CDC, the UNICEF, the End Polio Now campaign, and the Central government, indicates that the sensitivity of surveillance in India now surpasses the globally recommended standards. Over 35,000 health facilities are reporting cases of Acute Flaccid Paralysis as part of polio surveillance. Over 1,20,000 stool specimens are tested annually in the eight WHO accredited labs in India. Surveillance has also been intensified along the international border, the statement adds.

Credit is being accorded to the commitment of the Centre for pushing ahead with the programme in the face of major hurdles. However, equally important is the seamless partnership between the government, and the Rotary International, the WHO, the UNICEF and private paediatricians – for it was the scale of this alliance that managed to mobilise vast quantities of field-level workers. In the final call, this probably swung the balance in favour of humans over the wild polio virus.