This week, the world applauded a wonder double-strain polio vaccine that emerged as a potent weapon in the battle to wipe out the crippling virus forever.
The vaccine drastically cut down infection wherever it as used, including in India, which recorded the lowest number of polio cases ever: 39 till October 22, compared to 498 up to this time last year. The lowest polio cases were 66 in 2005.
The new vaccine was introduced in India in January this year, the month when the country emerged as the top of the world’s polio charts for 2009. India had 741 cases last year, up from 559 in 2008. This means almost half — 46 per cent — of the global total of 1,604 infections were in India. Nigeria had 798 cases in 2008, highest in the world, but it succeeded in halving them to 388 in 2009.
As much as the new vaccine, what worked for India was the people behind the scenes, who biked, swam, hiked to give drops to children in flooded villages, inside running trains, at bus stands, market areas, brick kilns, construction sites.
In Bihar, for example, where its over dozen tributaries make the Kosi basin one of the largest in the world, annual flooding forces families to live marooned for months. Children in these hamlets have to be reached 10 times a year using bicycles and boats — and, at times by swimming with the waterproof vaccine box strapped to the body.
"A combination of risk factors for polio such as overcrowding, large number of new births, poor sanitation and hygiene allows polio virus to thrive in pockets in Uttar Pradesh (UP) and Bihar, challenging strategies that had worked successfully elsewhere," says Dr Hamid Jafari, project manager, World Health Organisation’s National Polio Surveillance Project, which is tracking India’s polio programme.
About 172 million children get polio drops on each national immunisation day, with 70 million of them getting them 10 times a year in UP, Bihar and high-risk cities such as Delhi and the NCR, and Mumbai, Thane and surrounding areas, which get a large migrant population.
The hard work of the vaccinators is getting global attention. The musahar-inhabited (rat-eater) Guleria village in northern Bihar had a celebrity visitor in April this year. Microsoft-founder Bill Gates, 54, took public transport — in this case a village boat — across the Kosi and the Siswa rivers to meet healthworkers at the primary health centre to congratulate them on a job well done: they had taken polio drops to areas where no modern medicine has reached before.
"The newborn tracking information used for polio has even boosted routine immunisation in UP and Bihar, with coverage in Bihar going up from 32% in 2006 to 55% in 2008," says Dr Jafari.
The new double-strain vaccine was introduced in January 2010 in Bihar and since February 2010, in UP and other polio high-risk areas such as Delhi and Mumbai, Thane and surrounding areas.
The results will only get better, with a study published in The Lancet on Tuesday confirming that the new bivalent vaccine worked better than the triple and single vaccines being used so far to stamp out the virus that has evaded global eradication efforts for more than two decades. Unlike the earlier vaccines, the double-strain vaccine targets oral polio virus types 1 and 3, which persist in Afghanistan, Pakistan, India, and Nigeria.
"Trials in India with bivalent oral vaccine show the vaccine is superior to the traditionally used trivalent oral vaccine and is as good as the type specific monovalent oral polio vaccines against both type 1 and type 3 polio virus concurrently. The new vaccine allows children to be immunised against the two remaining types simultaneously," says Dr Jafari.