India's anti-polio campaign 'a model for other countries to follow'

Eradicating polio through immunisation in a country as vast and populated as India was once considered an impossible feat. The campaign is now on the verge of being celebrated as a model for other countries. Suryatapa Bhattacharya reports

Deepak Kapur, the chair of India's national PolioPlus committee with Rotary International, said rumours and misinformation about the polio vaccine were spread by local villages "for their own gains".

NEW DELHI // The day India's health minister announced the country had been polio free for more than a year was one of the most memorable moments of Lokesh Gupta's life.

Eradicating polio through immunisation in a country as vast and populated as India was once considered an impossible feat. The campaign is now on the verge of being celebrated as a model for other countries to follow.

For Mr Gupta, the manager of PolioPlus India, part of Rotary International's polio eradication programme, the big moment came in an auditorium in New Delhi on February 25 last year when India's health minister announced that the World Health Organisation no longer considered India a source of the disease.

"I just sat there and started to think about of how long it took us to get to get here," said Mr Gupta, who, with PolioPlus India, has spent the better part of three decades working with politicians, health-care workers, activists and volunteers to help eliminate the crippling disease.

Rotary launched PolioPlus in 1985 and in India, approximately 170 million children under the age of 5 have since been vaccinated with drops each year in India on national immunisation day.

The PolioPlus programme has, over the years, received two grants totalling US$355 million (Dh1.3 billion) from the Bill & Melinda Gates Foundation.

Polio officers go door-to-door, street artists trained by Rotary members blow whistles to attract children and sing about the benefits of the vaccine.

In 2009, India reported 741 polio cases, more than any other country in the world. In January, 2011, the country's last case, an 18-month-old girl named Rukhsar, was reported in West Bengal. If no new cases turn up this year, India will meet the three-year benchmark to be declared "polio free" in 2014.

The likes of Mr Gupta faced unique challenges as they tried to eradicate the disease in India.

Its large transient population made it difficult for health workers to ensure vaccinations were delivered to all children. Many other children were malnourished and their weak immune systems struggled to create the disease-fighting antibodies that the vaccine was supposed to stimulate.

As polio is usually transmitted through faeces, the disease ran rampant as 68 per cent of the population defecates outdoors.

The final hurdles were religious and cultural.

For example, among the Muslim community in the state of Uttar Pradesh (UP), rumours were spread by unqualified imams, who said that the polio vaccine would cause infertility or had ingredients that were considered "haram".

Deepak Kapur, the chair of India's national PolioPlus committee with Rotary International said "there seemed to have been roots in rumours and misinformation being spread by local villages for their own gains".

"In UP, it became such a major issue that it threatened to derail the entire eradication drive," Mr Kapur said.

At the heart of the fight was the city of Moradabad in UP, where the polio virus was thought to be six times more prevalent than anywhere else in the world.

Members of the Rotary International, including Mr Kapur, approached Muslim religious leaders and formed the Muslim Ulema Committee, where the religious leaders were convinced of the long-term effects of eradicating polio.

"It worked wonders," Mr Kapur said. "From the Friday call to prayer to their teachings based on ethics and religion, they helped because people there listen to them more than anyone else."

Naveen Thacker is a paediatrician and has been part of the Indian government's advisory group on polio for the past ten years. He said India cannot grow lax, even if it is declared free of polio, as it can be reintroduced from neighbouring countries.

African countries, such as Chad, Angola and the Democratic Republic of Congo were previously declared polio-free, but have since reported outbreaks.

India borders Pakistan, which is one of only three countries in the world where polio is still endemic. Recently, there has been a series of deadly attacks by gunmen on polio workers in northwestern Pakistan.

"We have to maintain the immunity of the population, and we must continue eternal vigilance so we that we don't import the virus from other countries. We have to invest in routine immunisation and that will continue in some states in India, the ones most vulnerable," Dr Thacker said. He added that states such as UP and Bihar have continued their polio immunisation drives, with the support of the government of India.

Sri Lanka, Bangladesh, Thailand, Indonesia and Myanmar have been polio-free for at least a decade, and India is eager to join their ranks with a certificate awarded by World Health Organissation.

"Everyone is waiting for that day," Dr Thacker said. "The rest of South-east Asia is waiting for India to join them."

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