Towards a Polio-Free World

The World Health Organization (WHO) officially certified India polio-free this year. The jubilation was even doubled when the entire South-East Asia Region, home to a quarter of the world’s population, was certified polio-free by an independent commission under the WHO certification process. India’s polio-free certification came along with that of 10 other countries in the South-East Asia region — Bangladesh, Bhutan, Democratic People’s Republic of Korea, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. This is the fourth of six WHO Regions to be certified, marking an important step towards global polio eradication. With this step, 80 per cent of the world’s population now lives in certified polio-free regions. Several conditions must be satisfied before a region can be certified polio-free: at least three years of zero confirmed cases due to indigenous wild poliovirus; excellent laboratory-based surveillance for poliovirus; demonstrated capacity to detect, report, and respond to imported cases of poliomyelitis; and assurance of safe containment of polioviruses in laboratories.

Certification of the Region comes as countries prepare for the introduction of inactivated polio vaccine (IPV) in routine immunization as part of the eventual phasing out of oral polio vaccines (OPV). More than 120 countries currently use only OPV. These countries will introduce a dose of IPV by the end of 2015 as part of their commitment to the global polio endgame plan which aims to ensure a polio-free world by 2018. IPV consists of inactivated (killed) poliovirus strains of all three poliovirus types. IPV is given by intramuscular injection and needs to be administered by a trained health worker. 

Advantages of IPV:

  • As IPV is not a ‘live’ vaccine, it carries no risk of vaccine-associated polio paralysis.
  • IPV triggers an excellent protective immune response in most people.

Disadvantages of IPV:

  • IPV induces very low levels of immunity in the intestine. As a result, when a person immunized with IPV is infected with wild poliovirus, the virus can still multiply inside the intestines and be shed in the faeces, risking continued circulation.
  • IPV is over five times more expensive than oral polio vaccine.
  • Administering the vaccine requires trained health workers and sterile injection equipment and procedures.

IPV is not recommended for routine use in polio-endemic countries or in developing countries at risk of poliovirus importations. In these countries, oral polio vaccines either trivalent, bivalent or monovalent, depending on local epidemiology are used. Once polio has been eradicated, use of the oral polio vaccine will need to be stopped to prevent re-establishment of transmission due to vaccine-derived polioviruses. Switching to IPV is one option for this post-OPV era.

Millenium star Amitabh Bachchan was felicitated by UNICEF India for lending his domineering baritone to the successful campaign. His unique style of being angry in the advertisements towards people who don’t immunize their children against polio did the trick. 

A few years ago nobody thought that India could do it, but India did it. This victory against the ghastly disease demonstrates what a united society or nation can achieve if it commits itself towards a cause with determination and fortitude. India embarked on the programme to eradicate the nation of polio 19 years ago in 1995, when the disease used to cripple more than 50,000 children in the country every year. The country reported more than half of the global polio cases until the year 2009. India was considered one of the most technically difficult places to eradicate the disease, because of sanitation challenges and high-density population. The achievement has been made possible with resolute will at the highest levels, technological innovations like the indigenous bivalent polio vaccine, adequate domestic financial resources and close monitoring of the polio programme, with which immunization levels soared to 99 per cent coverage and India achieved polio eradication. A 2.3-million strong team of polio volunteers and 150,000 supervisors worked day and night to reach every child.

Ideally speaking the millions of health workers who have worked with governments, non-governmental organisations, civil society and international partners to eradicate polio from the Region deserve the highest form of honour and salute by the nation for what they have helped us achieve. India launched a massive effort involving a surveillance network and 2.3 million vaccine administrators, who identified communities falling through the cracks.To counter rumors and misgivings about the vaccine, social mobilizers, religious leaders and parents were included to increase understanding about immunizations.They also bolstered communication and outreach efforts that often included Bollywood celebrities and cricket players. The efforts combined government, various U.N. agencies as well as philanthropic organizations. The highly infectious viral disease primarily affects young children and could lead to paralysis and death. It can be prevented through immunization, but there is no cure. India overcame huge challenges, with a strong commitment that matched $ 2 billion allocation over the years to stop polio. Implementing innovative strategies, the programme reaches an incredible 99 per cent coverage in polio campaigns, ensuring every child, even in the remotest corner of the country is protected against polio. 

The next step for us Indians will be to get motivated from this great achievement, learn from it and quickly replicate it across all the states of the country for controlling the other persistent diseases plaguing the country like TB (tuberculosis), malaria, dengue and cancer.

Diseases like these don’t adhere to borders. These are mutual enemies of all the nations of the world for which all countries will have to cooperate and work together hand in hand to obliterate from the face of the earth. There is simply no other solution. Although India has become polio-free, there is risk of the disease entering the country again from across the borders. Pakistan and Nepal are two vulnerable neighbouring countries from where there is a threat of the disease entering India again. Few years back, polio had entered China from neighbouring countries after China was declared polio-free by WHO. Similar risk haunts the minds of our policy-makers. The World Health Organisation has confirmed this year that polio virus from Pakistan has spread to Israel, West Bank and Gaza, and Iraq. According to WHO, Pakistan’s situation is particularly problematic. Its polio control programme is years behind that in the other endemic countries. As currently constituted, the structure of the Prime Minister’s Polio Monitoring Cell does not allow effective action against polio. A much stronger form of management and co-ordination is required. Targeted killing of polio vaccinators in Pakistan, entering of polio virus in Waziristan, a part of Pakistan in which polio vaccination had been and remains banned by Taliban commanders is proving to be a hindrance towards global polio eradication. We need to remain alert as 94 of the 123 cases last reported in the world are from neighbouring Pakistan. The incidence of the disease has dropped by more than 99% since 1988. It remains endemic in three countries — Pakistan, Nigeria and Afghanistan — down from more than 125 countries in 1988. All the polio-free nations of the world must help and assist these polio-endemic countries to achieve a truly global goal and yet another terrific win by humanity against jading odds.

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Fighting this disease is also a big painful drain on any nation’s wealth. The saved health expenditure for fighting against polio can be utilized in other meaningful infrastructure developments or in the education and skills sector.

I end in the hope that the various countries will resolve their differences and consociate to eliminate this epidemic from the world. Jai Hind.

-Ribhu V.

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