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HindustanTimes Sun,23 Nov 2014
Standing tall against polio
Seth Berkley, Hindustan Times
January 12, 2014
First Published: 21:20 IST(12/1/2014)
Last Updated: 16:46 IST(13/1/2014)

Today marks a major global public health milestone and a huge success as India celebrates the third anniversary of its last reported case of wild polio virus and counts down to when the World Health Organization (WHO) is due to declare India as officially polio-free.

But with nearly seven million children still not receiving basic immunisation, there is still so much more to be done, and if India were to build on this success then in a few years it could have so much more to celebrate.

That’s because the benefits of eliminating polio have the potential to go well beyond just preventing paralytic poliomyelitis. The government of India now also has the opportunity to immunise millions of children against a range of other life-threatening diseases, by helping to boost the provision of routine immunisation along the way.

Back in the early 1980s an estimated 2,00,000 children in India were affected by polio every year. And as recently as 2009 nearly half of all the cases of wild polio in the world were found in India.

In light of this, and the fact that India had the largest number of unimmunised children in the world, many people believed that India would end up being the last country to banish polio, while others even questioned whether it could ever be achieved.

Read: India will officially be declared polio-free

However, thanks to the government’s strong political commitment, a multi-stakeholder approach and the use of highly-innovative methods improving polio vaccine coverage, the naysayers have now been proved wrong. But, it didn’t happen overnight, and none of it would have been possible without an army of several hundred thousand frontline workers, often working in extremely challenging situations.

This began in earnest in 1995, when the government launched its first nationwide polio immunisation campaign, and, thereafter, continued to step up its efforts, bringing in national immunisation days and holding regular supplementary immunisation activities (SIAs), as well as other intensive immunisation and surveillance activities against polio.

Under this initiative as many as 175 million children have been vaccinated in a single day, thanks to the efforts of 2.3 million health workers. And when combined with the 3 million house calls made every month by a network of 9,125 community mobilisers, nearly one billion doses of polio vaccine are delivered in India each year.

But as crucial a role as this mass mobilisation has played in the eradication effort, India’s other secret weapon has been — innovation.

By combining meticulous microplanning, monitoring, mobilisation and data analysis, state health officials, the WHO and Unicef, have been able to create a huge and highly effective network that is able to identify priority or problem areas, and important changes or trends in an area, practically in real time.

Although also relying upon a huge workforce, the clever design and use of accountability and prioritising, has enabled India to use this to effectively cast a polio immunisation net over the entire country in a bid to reach every last child.

One remarkable example of this is the way in which teams of vaccinators board trains across the country during SIAs.

Methodically working their way through the carriages they deliver two drops of the polio vaccine into the mouth of every young child they find who doesn’t bear the indelible ink mark on his or her finger, to indicate he/she has already been vaccinated. In this way they can carry out an entire sweep of a train within a few stops, and across the entire country as many as 1,00,000 children are typically vaccinated in a 24-hour period.

That’s 1,00,000 children who might have otherwise slipped through the net.

This kind of out-of-the-box thinking is precisely what has enabled India to beat polio. And now Bihar, once regarded as a failing state, has been applying the same innovative principles to other vaccines and achieving stunning results in the process.

Read: Fighting polio was toughest in Bihar, UP

In less than a decade Bihar has gone from a point where just 18% of its children were receiving all three diphtheria-tetanus-pertussis (DTP) shots — a rate way too low to have a dramatic effect on public health — to a reported routine immunisation coverage today of more than 85%.

This transformation has come about partly because improvements to immunisation infrastructure, from this extended polio coverage, have helped strengthen routine immunisation.

But also because Bihar has emulated polio’s successful model and created a similar system of microplans, monitoring, mobilisation and accountability for routine immunisation. In fact, in 2009 when staff compared polio microplans with existing ones for routine immunisation, they found that the latter was missing a quarter of the population.

Then in 2012, following a further painstaking yet meticulous line-by-line comparison, they were able to identify and add more than 50,000 transitional or high risk people to the routine immunisation microplans.

And now as India begins to scale back its polio activities, reducing the number of SIAs carried out each year, encouragingly we are seeing coverage of polio continuing to rise in Bihar.

So polio has helped routine immunisation in Bihar and now routine immunisation is returning the favour.

Yet 1.4 million children under five are still dying every year from vaccine preventable disease, such as pneumonia and diarrhoea, and from malnutrition.

So coming at a time when the government is on the verge of launching the 5-in-1 pentavalent vaccine, the question now is can India replicate this success to protect its children from other deadly diseases? Doing so would give us an even bigger cause for celebration!


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