Despite recent improvements, India’s public health structure is still in a shambles. But astonishingly, the same structure managed to recently score the greatest public health achievement in its history by making India polio-free. No case has been reported since January 13, 2011. Thanks to this record, the World Health Organisation (WHO) has taken the country off the polio endemic list — and if India does not report any more cases in the next two years, it will be officially ‘polio free’.
To understand the extent of this achievement, consider this: Just three years ago, India recorded 741 cases of polio, nearly half the number of global cases.
India has been one of the developing world’s largest polio-endemic countries along with Pakistan, Afghanistan and Nigeria. Before the introduction of the National Immunisation Days (NID) in 1994-95, as many as 500 children were reportedly infected with the virus every day. A noted scientist once remarked that for the world to be polio-free, India had to be polio-free; for India to be free of polio, Uttar Pradesh had to be free of the virus; and for UP to be polio-free, Moradabad district had to be polio-free.
Polio is an acute, viral, infectious disease that spreads from person to person primarily via the faecal-oral route. It managed to spread so quickly and extensively in India because of certain reasons (unfortunately, these reasons still exist): high density habitation, poor sanitation, poor access to clean water and toilets, poor breastfeeding rates, poor nutrition and high number of entric diseases among children, making it impossible for their bodies to retain polio vaccine drops.
The reasons for the success of the anti-polio campaign in India are many: a humongous immunisation programme and a strong and sustained political-bureaucratic-religious advocacy. One of the key reasons for the accomplishment was the successful coordination among the State, Rotary International and the WHO. While the government stepped up its immunisation programmes, Rotary chipped in with additional funds, advocacy efforts and manpower to supplement the State’s efforts. It was thanks to the sustained advocacy of Rotary India’s National PolioPlus Committee that the government started the NID. In India, Rotarians has contributed R744 crore to fund eradication activities.
Deepak Kapur, chairman, India National Polio Plus Committee, Rotary International, says the biggest challenge was UP and the Muslim community that was against the vaccine because of rumours that it had pig fat in it and that the immunisation programme was a device to control the Muslim population.
To get around this problem, Rotary approached the Muslim Ulema Committee in 2004. “After some discussion, they started announcing the immunisation dates after the Friday prayers and some even held camps inside the mosques,” says Kapur. “That gave a great push to the campaign.”
While this was a major victory, there were many smaller — but equally important — efforts that kept the seamless immunisation process intact. The organisation helped the state governments to meet their immunisation targets and also chipped in with vaccine carriers, marker pens, cold boxes and free general health camps in affected districts.
The scale of the challenge can perhaps be understood by the case of Dharavi in Mumbai, a mega-slum that is home to a million people in a 3 sq kms space. Here the immunisation teams followed carefully developed micro-plan maps, walked in single files in tiny, winding lanes, scrambled up rickety ladders to reach children living in corrugated iron homes stacked one on the top of other, three or four storeys high.
The success of the anti-polio drives demonstrates that it is possible to ensure equity in the availability of health services in even the poorest, most densely-populated environments. Hopefully, the success of the campaign can also help eliminate, as the health minister said recently, measles-related child deaths and neo-natal tetanus from India.