India has just been taken off the World Health Organisation (WHO) list of polio-endemic countries. And if the success of not having a single new case over the past year is sustained for another two years, India will finally emerge as a polio-free country. The nation's public health administrators and international agencies deserve praise for this achievement.
This is also perhaps just the right moment to recall the hands-on leadership role of Rajiv Gandhi in kickstarting the anti-polio campaign in right earnest. A quarter of a century ago he crafted and launched the Technology Mission on Immunisation. It was one of five such landmark initiatives, each of which have had their own impacts — the others being on drinking water, oilseeds, literacy and telecom. Sam Pitroda was entrusted with the overall responsibility of getting these missions going and monitoring their implementation. The then prime minister's instructions on the immunisation mission were clear — while it was to cover the six vaccine-preventable childhood diseases (diphtheria, pertusis, tetanus, tuberculosis, polio and measles), special emphasis should be placed on polio and putting in place a system that would rid the country of this scourge at the earliest. Gandhi's instructions also stressed a focus on the four Bimaru (Bihar, Madhya Pradesh, Rajasthan and UP), states, a term which he had just about then picked up from the noted demographer Ashish Bose.
The initial months were spent on addressing some basic issues. For instance, it was discovered that polio vaccines were almost entirely imported. Thus, plans were prepared to establish manufacturing facilities within the country and upgrade the existing ones at the Pasteur Institute at Coonoor and Haffkine Institute at Mumbai. Rajiv Gandhi spearheaded the creation of the Bharat Immunologicals and Biologicals Corporation Limited (BIBCOL) in Bulandshahr district of UP in 1989, a company that supplies 60% of polio vaccines used in India. It also emerged that epidemiological facilities were not as extensive as they should be and, therefore, a nation-wide network was put in place. Experts like Dr. Jacob John of the Christian Medical College, Vellore called into question the efficacy of the oral polio vaccine (OPV) strategy arguing for the use of the injectable killed polio vaccine (KPV). This debate helped improve the OPV strategy and also led to investments in the KPV area, although these investments were to prove infructuous later.
It was at Gandhi's suggestion that Pitroda also opened a close dialogue with a number of NGOs and organisations like Rotary International. The latter has played an important role in the pulse polio campaign in the country. Gandhi himself appeared on Doordarshan to administer OPV drops to an infant, images of which began to be used across the country to create awareness and heighten public consciousness for the need to administer the polio vaccine according to the prescribed schedule.
Between September 1987 and November 1989, the prime minister would, from time to time, call in his advisor on technology missions and inquire about their progress. In these reviews he would take a special interest in the polio immunisation programme. In one of these interactions he lamented the fact that with two-third of all cases in the world, India had the highest incidence of polio and remarked that if we could eradicate smallpox why can't we do the same in the case of polio? It is this personal commitment of his to this noble cause that motivated all those who worked in the mission during that exciting period.
However, while we celebrate the most recent accomplishment on the polio front, let us not get lulled into complacency. Immunisation coverage overall remains pathetically low in large parts of the country. We remain vulnerable on this score. And many of India's public health concerns can be addressed meaningfully only when we give increased importance to public investments in drinking water supply (particularly quality) and sanitation, something we recognise in theory but have yet to make an operational reality on any significant scale.
Jairam Ramesh is Union rural development minister and was associated with the technology missions during 1987-89.The views expressed by the author are personal.