From 200, 000 to Zero - The journey to a polio-free India
On 11 February 2014, Indian completed three full years without reporting any case of polio and celebrated a landmark achievement in public health – the victory over polio. The last case of polio to be reported in India was on 13 January 2011 when a two-year old girl got polio paralysis in Howrah district of West Bengal. Before the launch of the Global Polio Eradication Initiative, polio crippled an estimated 200,000 children in India each year. Many health experts predicted India would be the last country to eradicate polio.
Putting all such forecasts to rest, in March 2014, India completed three years without a case of wild poliovirus and the WHO South East Asia Region, of which India is a part, was certified polio-free. This is quite incredible, and certainly unprecedented progress for a country, which till as recent as 2009, accounted for 741 out of the 1604 cases worldwide.
The journey from 200,000 to zero has been long, hard and arduous. The country overcame huge challenges, with a strong commitment that matched $2 billion allocation over the years to stop polio. Implementing innovative strategies, the programme reaches an incredible 99 per cent coverage in polio campaigns, ensuring every child, even in the remotest corner of the country is protected against polio.
India’s progress is credited to the strong commitment and seamless partnership between the Government of India, WHO, Rotary International and UNICEF - the key polio implementing partners - as well as the US Centers for Disease Control and Prevention, CORE, the Bill & Melinda Gates Foundation, the US and Japanese government aid agencies, among others.
The achievement today is of the entire country, the tireless hard work of millions of frontline workers – the vaccinators, social mobilizers and community and health workers – religious leaders, influencers, parents, and all those who supported the programme selflessly.
It is also the result of rigorous management and well planned vaccination campaigns that have provided a model for ending polio. The progress is also a credit to the raft of innovations that have been introduced in India to tackle polio – many of which are now being followed in other countries. To reach every child, frontline workers mapped every village, town and city, every brick kiln and nomadic settlement via ground-level microplanning, by focussing on the one child missed with equal passion as the 99 who were vaccinated.
The Road to Polio Free India
The country introduced the oral polio vaccine in 1985 in the Universal Immunisation Programme in the backdrop of over 200,000 cases of polio annually (as per estimates of the Indian Academy of Pediatrics).
In 1995, the first national polio immunization campaign was held; since then two national and multiple sub-national campaigns are rolled out every year for children up to 5 years of age. In each national polio campaign, 2.3 million lakh vaccinators, led by 155,000 supervisors, visit 209 million households to immunize 170 million children up to the age of 5 years.
Pregnant mothers and newborns were tracked and ‘due lists’ for vaccination shared with local health workers. Mobile vaccination teams cast a tight net for children at major intersections, at bus stations, on railway platforms and even on moving trains.
Strong Focus on Migrant Population
Nomadic groups and sites were tracked, religious festivals followed, and human resources allocated to focus on the very highest-risk groups and areas. Nearly 10 million children are immunized by the transit teams in each polio campaign, of them 100,000 on trains at border posts with Nepal, Pakistan and Bangladesh.
The programme continues to cover 70,000 brick kilns and 38,000 construction sites. Nearly 4.5 million children are immunized in the high-risk migrant settlements in each polio campaign.
A Booth Day, key pillar of the campaign, festively kicked off each round with polio booths set up in popular locations such as schools, markets and religious institutions. In a celebratory atmosphere, children received not only oral polio vaccine but also incentives such as nutritional supplements, a ball, mask, cap or whistle. The delivery of Vitamin A, bed nets and health camps regularly piggybacked on polio campaigns.
Local innovations such as children’s calling groups, or ‘Bulawa Toli’, ran through the laneways of their communities calling children to the booths. To reach missed children, innovative re-visit strategies were introduced - every afternoon of the campaign, and again after the campaign - with missed children the focus of nightly accountability meetings between partners at the local, district, state and national levels.
To find and reach children in Bihar’s flooded plains, hundreds of overnight stay huts were built, allowing surveillance medical officers, social mobilizers and vaccinators to stay in the Kosi River basin, to more rapidly map the population and ensure the programme was reaching every possible child.
UNICEF In Action
Breaking The Final Frontier
To tackle religious misconceptions and community refusals, dedicated social mobilization networks were established to spread a range of public health messages. An underserved strategy initiated by UNICEF and the other partners, was adopted and religious leaders mobilized to garner support of the community for polio vaccination. One by one, thousands of imams and community influencers were engaged to promote polio immunization.
Social mobilizers visited homes and schools, and held mothers’ and influencers’ meetings in their own communities to create acceptance and demand for the vaccine.
UNICEF Goodwill Ambassador, Amitabh Bachchan along with other celebrities berated India’s parents for failing to protect their children, and in following years, when asked why they vaccinated their children, parents would say: “Because Amitabh Bachchan told me to.”
His face adorned hundreds of thousands of posters and banners trumpeting the dates of the campaigns, turning Uttar Pradesh and Bihar pink and yellow in the days before each round. To tackle the virus in its last bastions, the ‘107 Block Plan’ was introduced in the 107very highest-risk blocks.
This plan included a convergence of public health initiatives and messaging promoting routine immunization to raise immunity, hand washing to break faecal oral transmission and other related health initiatives.
Innovative new vaccines were introduced, first the monovalent vaccines and then the ground breaking bivalent oral polio vaccine, which concurrently tackled both remaining serotypes of wild poliovirus, effectively doubling the impact of each vaccination.
Since the start of the polio campaigns in 1995, as many as 131 polio campaigns have been held in India till date, in which 12.1 billion doses of polio vaccines have been administered.
Most importantly, millions of frontline workers never wavered and for every round for a decade, hundreds of thousands of vaccinators and social mobilizers walked well-worn trails to doors with the scribbled chalk traces of years of previous polio campaigns, continuously improving the quality of those campaigns, reaching 85%, then 90%, then 95%, then 98% of children, and never failing to believe that eradication was possible.
Many of India’s parents and caregivers allowed their infant children to be vaccinated 10, 20, even 30 times and they too deserve the world’s acknowledgement.