THE CONTEXT: India’s journey from being a polio-endemic nation with 200,000 cases annually in 1988 to achieving polio-free status in 2014 is a remarkable public health achievement globally. It was achieved by a comprehensive strategy involving coordinated efforts of government agencies, international partners like WHO, UNICEF, and Rotary International, along with innovative approaches such as the Social Mobilization Network (SMNet) that deployed over 7,300 community mobilizers and 55,000 influencers to reach the most vulnerable populations.
THE CHALLENGES:
- Massive population: With over 1 billion people, India had to vaccinate approximately 172 million children under 5 years old annually. As of 2011, India’s population density was 382 persons per square kilometre, with some urban areas exceeding 20,000 persons per square kilometre. This high density facilitated the rapid spread of the poliovirus.
- Poor sanitation: According to a 2011 census, only 46.9% of households in India had access to toilet facilities. Poor sanitation and lack of clean water sources contributed to the persistence of the poliovirus in the environment.
- Geographic diversity: Remote areas and difficult terrain posed logistical challenges for vaccine delivery. States bordering Pakistan and Nepal required special attention due to cross-border movement and the risk of virus importation. In states like Chhattisgarh and Jharkhand, reaching tribal communities in forested areas required culturally sensitive approaches and overcoming language barriers.
- Terrain challenges: Many remote villages in mountainous regions, deserts, and flood-prone areas were difficult to access. For instance, in the Sundarbans region of West Bengal, health workers had to navigate through dense mangrove forests and tidal rivers to reach isolated communities.
- Nomadic populations: Reaching nomadic and migratory communities, such as the Van Gujjars in Uttarakhand or the Bakarwals in Jammu and Kashmir, required specialized strategies and constant vigilance.
- Vaccine hesitancy: Religious and cultural beliefs, as well as mistrust of government initiatives, led to resistance in some communities. In some Muslim communities, rumours circulated that the polio vaccine was a plot to sterilize Muslim children. A study in the Indian Journal of Medical Ethics reported that in Uttar Pradesh, nearly 15% of Muslim households refused polio vaccination in the early 2000s.
KEY STRATEGIES IMPLEMENTED:
- Vaccination Campaigns: The UIP aimed to vaccinate approximately 172 million children under 5 years old annually. National Immunization Days (NIDs) were conducted twice a year, reaching millions of children in a short period. Oral polio vaccine (OPV) administration by local health workers increased reach in remote areas. Vaccination drives at festivals, railway stations, and public gatherings ensured wide coverage.
- Awareness and Communication: The communication strategy evolved from merely informing people about polio to addressing specific concerns and misconceptions. Special camps for mothers, addressed by women from their community, built trust. Amitabh Bachchan’s involvement significantly boosted awareness. His catchphrase “Do boond zindagi ki” (Two drops of life) became iconic.
- Holistic Approach: Emphasis on handwashing and safe drinking water practices. Promotion of exclusive breastfeeding for infants under six months to boost immunity. Efforts to improve overall sanitation in high-risk areas.
- Collaborative Efforts: Central and State governments provided political will and resources. WHO, UNICEF, US CDC, and Rotary International offered technical expertise and funding. The Bill and Melinda Gates Foundation contributed significantly to the effort.
- Targeted Interventions: In 2009, efforts were intensified in 107 high-risk blocks in Uttar Pradesh and Bihar, which accounted for 80% of polio cases. Detailed house-to-house mapping ensured no child was missed.
- Surveillance and Monitoring: Acute Flaccid Paralysis (AFP) surveillance to identify potential polio cases rapidly. Environmental surveillance for Testing sewage samples for poliovirus.
- Strategies for Mobile Populations: Immunization posts at railway stations, bus stops, and border crossings. Vaccination camps organized to accommodate daily wage workers’ schedules.
- Overcoming Cultural Barriers: Imams and maulanas were involved in promoting vaccination. Aligarh Muslim University and Jamia Millia Islamia supported awareness efforts.
OUTCOMES AND SIGNIFICANCE:
- Certification: On March 27, 2014, India was officially certified as polio-free by the World Health Organization (WHO) after three years without a reported case of wild poliovirus.
- Historical Context: In 1988, India had an estimated 200,000 polio cases annually. By 2009, it accounted for over 60% of global cases. The last reported case was in January 2011, showcasing a dramatic turnaround.
MODEL FOR OTHER PUBLIC HEALTH INITIATIVES:
- COVID-19 Vaccination: The infrastructure and strategies developed during the polio campaign were leveraged for the COVID-19 vaccination drive. This included robust surveillance systems and community engagement techniques.
- Routine Immunization: The strategies used in polio eradication have been applied to improve routine immunization coverage across India, addressing other vaccine-preventable diseases.
- Government and International Collaboration: The success was due to the strong commitment of the Indian government at all levels, supported by international partners such as WHO, UNICEF, Rotary International, and the Bill & Melinda Gates Foundation.
- Community Involvement: Local NGOs and community leaders played crucial roles in overcoming vaccine hesitancy and ensuring widespread participation in vaccination drives.
LESSONS AND GLOBAL IMPACT:
- Holistic Health Approach: Addressing broader health issues like sanitation and nutrition alongside vaccination efforts proved essential. This holistic approach ensured higher uptake among hard-to-reach populations.
- Adaptability and Innovation: The use of micro plans for targeted interventions and the involvement of non-state actors were key innovations that can be applied to other health challenges.
- Sustained Vigilance: Despite being polio-free, India continues to conduct National Immunization Days to maintain immunity and prevent re-importation from neighbouring countries where polio is still endemic.
THE CONCLUSION:
India’s eradication of polio is not just a national triumph, but a global exemplar of how collaborative efforts can overcome even the most daunting public health challenges. The lessons learned continue to inform strategies for eliminating other infectious diseases worldwide.
UPSC PAST YEAR QUESTIONS:
Q.1 Appropriate local community-level healthcare intervention is a prerequisite to achieve ‘Health for All ‘in India. Explain. 2018
Q.2 To ensure effective implementation of policies addressing water, sanitation and hygiene needs, the identification of beneficiary segments is to be synchronized with the anticipated outcomes’ Examine the statement in the context of the WASH scheme. 2017
MAINS PRACTICE QUESTION:
Q.1 Discuss the key strategies that led to the successful eradication of polio in India by 2014. Critically analyze the challenges faced during the polio eradication campaign and the lessons learned for future public health efforts.
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