PopPlaces: India After Polio

The extraordinary success and challenges of eradicating a disease

Published on February 21, 2014by Kathleen Bachynski

On January 13, 2011, Rushka Shah, a little girl from West Bengal, made history as having the last recorded case of polio in India. After three polio-free years confirmed by testing final samples, on February 11, 2014, the World Health Organization certified India as a polio-free nation.

This is an extraordinary public health achievement, especially because India is one of the most populous countries in the world, and was once a major epicenter of polio cases. As Indian Health Minister Ghulam Nabi Azad observed in The Times of India, “India accounted for half of all the cases of polio reported globally in 2009.”

Enormous commitments and allocations of resources at the national and international levels were necessary to eradicate this devastating disease from a nation of over one billion people. In 1995, the India government launched the Pulse Polio Immunization Program to vaccinate children aged five years and younger against the disease. This was no small undertaking. At that time, an estimated 150,000 polio cases were reported in India each year.

The effort also involved setting up special booths in regions that bordered neighboring countries, to ensure that all children under five coming into India were vaccinated. In all, every year, more than 170 million young Indian children are vaccinated, with an additional 70 million children in high-risk areas vaccinated multiple times in additional special campaigns.

Media campaigns also helped spread the word to Indian communities. For example, famous Bollywood actor Amitabh Bachchan encouraged parents to vaccinate their children in a public service announcement. The slogan “Do boond zindagi ke” [two drops of life], referring to the polio vaccine, became a very recognizable message originating from this campaign.

At the international level, in 1988 the World Health Assembly launched the Global Polio Eradication Initiative to eradicate the disease worldwide. A number of organizations contributed to GPEI’s efforts in India, including the World Health Organization, Rotary International, and the Gates Foundation, which has contributed $1.2 billion toward polio eradication since 2009. Bill Gates told the Hindustan Times, “India’s success in eradicating polio is the greatest global health achievement I have ever witnessed.”

Yet some have criticized the enormous cost of the polio eradication campaign, observing that it diverted resources from other pressing health needs. For instance, Leena Menghany of Médecins Sans Frontières told The Hindu, “Making India polio-free was indeed an achievement but the entire exercise was done at the cost of the national vaccine program.”  Indeed, rates of routine immunizations in India remain frustratingly low, reaching only about 60 percent of the population. According to the CDC, in 2011, India accounted for about one third of all the world’s incompletely vaccinated children.

Deepak Kapur, the chairman of the Rotary International’s India National PolioPlus Committee, contends that the successful campaign against polio will help India move forward to other pressing health challenges. He told the New York Times that the National Polio Surveillance Committee and World Health Organization are using the infrastructure built up from the polio campaign to improve routine immunizations.

In particular, the disease surveillance programs developed in the fight against polio may translate to other health concerns. Dr. Shruti Chhabra trained in medicine in Mumbai and worked in Maharashtra and Gujarat, which are western states of India. Most recently she was in Bihar, one of the states that previously lagged behind the rest of the country for polio eradication. She noted “Traditionally, monitoring has been very poor. If we can translate that kind of surveillance to other health issues, that could be very useful.”

Nonetheless, she cautions that one of the high costs of investing so much into addressing a single disease may be the diversion of resources away from more integrated programs. Dr. Chhabra says, “I think managerially there is a conflict here because on the one hand, we say we need to democratize decision-making, and on the other hand, we have this very central, vertical program which is not integrated with anything else, which actually functions on its own separate axis. Its success is because of that. If you want these two different approaches to overlap, I am not sure how that happens.”

Going forward, then, public health leaders should consider how to set priorities to reflect Indian communities’ needs. Ideally, this would involve addressing diseases of particular global concern while not overlooking a more comprehensive approach to health that reflects local values. As Dr. Chhabra asks, “How do you find the happy medium? The success of the polio program should put these questions center stage again.”

Edited by Dana March