India’s polio triumph is a rare milestone in its uninspiring public health record.The story so far only strengthens the case for a vastly augmented routineimmunisation programme to combat disease.

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ndia has been celebrating its near-victory over polio for the past two years, but it often hogs the headlines for unacceptably high mortality and morbidity due to other communicable diseases such as malaria, tuberculosis, dengue and filaria.

The government now proposes to set up a common flexi-pool of funds to tackle communicable diseases. The modalities are being worked out.

The country’s record in tackling polio is described as unprecedented progress given that it accounted for nearly half of the world’s cases till 2009. Being taken off the World Health Organisation’s polio-endemic countries list is a major milestone indeed.

India has not reported any case after a two-year-old girl was paralysed in West Bengal’s Howrah district on January 13, 2011, though there were 741 confirmed cases nationwide in 2010, of which 8 were in West Bengal.

“We are happy we did not falter. We had a false alarm on one occasion but it helped us test our preparedness. We were, in any case, planning a simulation exercise to test our preparedness when the case came to light,” said Anuradha Gupta, Additional Secretary, Ministry of Health and Family Welfare.

Eight cases from West Bengal indicated that it was the only State where polio-virus transmission continued for 12 months despite multiple campaigns. This was because 8-15 per cent children remained unvaccinated in each of the polio campaigns conducted during 2010, following which the authorities redoubled their efforts at waging a war against polio.

India also went a step forward in procuring bivalent polio-vaccine from domestic pharmaceutical companies and raised its own resources instead of waiting for World Bank funding and procuring from WHO-pre-qualified manufacturers who were short of supplies when the vaccine was most needed. The move paid rich dividends.

While all this was going on, people continued to die from other communicable diseases such as tuberculosis, malaria, kala azar, Japanese encephalitis and leprosy. Diseases such as dengue and chikungunya continue to cripple many. Lack of funds, low human resource availability and poor coordination continue to be the traditional hurdles. “The Integrated Disease Surveillance Programme (IDSP) needs immediate direction and focus… ,” says the Sixth Common Review Mission’s report. The human resource strategy for recruiting, training and retaining the microbiologists, epidemiologists and others requires to be worked out. It suggests that the IDSP system — an important link to track and monitor disease outbreak — needs overhauling. There are also operational difficulties in remote areas in sending timely reports.

Invisible epidemics

“Making India polio-free was indeed an achievement but the entire exercise was done at the cost of the national vaccine programme,” says Leena Menghaney of Médecins Sans Frontières.

According to her, the focus should have been on the basic vaccine programme and not just on polio. “What the government did was to run a parallel programme within the vaccine programme. It was also a huge waste of human resource, as a healthcare worker would go house to house enquiring whether children had taken polio oral drops without bothering to ask whether the same children had been vaccinated against BCG or measles. We may have protected the child from polio but he or she continues to be vulnerable to other diseases.”

The latest data from the Ministry of Health and Family Welfare say there has been a 29.67 per cent reduction in malaria cases, from 18.17 lakh in 2005, in 2011.

However, several districts still have unacceptably high incidence of malaria. Kala azar and filariasis have also seen significant improvements, but dengue has spread to more geographical areas and control of encephalitis remains difficult in certain areas.

As for leprosy, three States have prevalence above the 1 per 10,000 target. “We are working towards bringing down the disease burden to a level where it ceases to be a threat to public health. Our target it to eliminate kala azar and filaria by 2015,” says Anshu Prakash, Joint Secretary, Ministry of Health and Family Welfare.