India Resolutely Guards Its Polio-Free Status
May 23, 2014
As the World Health Organization (WHO) ramps up concern about polio as a global public health emergency, India is taking nothing for granted. WHO officially certified the country as polio free in March this year, but the achievement was hard fought and health officials remain vigilant.
“We have invested so much in [the] polio eradication program, so many years, so much effort, so much energy, so much money,” said Anuradha Gupta, additional secretary in the Ministry of Health and Family Welfare and director of India’s National Health Mission. Polio elimination in India was considered by some to be impossible given the country’s vast population and health services challenges. The program’s success provided a huge morale boost for the global eradication effort. “If India gets re-infected, the whole world will be dismayed. It is not just India’s loss, it is the world’s loss,” Gupta said.
While the number of polio vaccination campaigns in India has been reduced since the country saw its last case of the disease in January 2011, the intensity and attention to detail persist. Vaccinators assiduously follow micro plans that spell out how campaigns should be conducted in each neighborhood and continue follow up meetings with local health officials to discuss why some children were missed and what needs to be done to reach them. Nonetheless, the conditions remain in high risk areas that made polio so difficult to tackle there: poor sanitation, high population density, and a constant flux of migrant workers whose immunization status is difficult to track.
As an extra layer of protection against virus importation, India instituted in March this year strict polio vaccination requirements for people traveling there from polio-affected countries. All resident nationals from Afghanistan, Nigeria, Pakistan, Ethiopia, Kenya, Somalia, and Syria are required to receive a dose of oral polio vaccine at least four weeks prior to travel. Health official could amend the list of countries periodically based on virus circulation. A certificate of vaccination should be included with documents submitted for an Indian visa and Indians traveling to polio-affected countries must also be vaccinated. In addition, India has set up polio vaccination booths at border crossings where all children under five will receive polio vaccination drops.
The requirements mirror emergency recommendations issued by WHO May 5. The organization’s Director-General Margaret Chan recommended that states currently exporting wild poliovirus, Pakistan, Cameroon, and Syria, should ensure that residents and long-term visitors receive one of two available polio vaccines between 4 weeks and one year prior to international travel. Those undertaking urgent travel should be vaccinated before they leave. Travelers should be provided with proof of vaccination. WHO encourages countries infected with the virus but not currently exporting it (Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia, and Nigeria) to take similar steps. While vaccination campaigns generally focus on children under 5, there is evidence that in some recent exportations, adults carried the virus to other countries.
The practical effect of the recommendations on the number cases may be minimal. In Pakistan, considered to be the biggest exporter of the virus, the national government has little control in areas where vaccinators have been killed and where the virus is most heavily concentrated. The situation in Syria is even more chaotic. Some are concerned that focusing on vaccinating travelers could pull polio resources away from where they are needed most. Nonetheless, generating global attention to the surge in cases will put additional pressure on countries to redouble their efforts.
As long as the virus continues to percolate, particularly in its immediate neighborhood, India will press to maintain its polio free status. Among those efforts is the establishment of an emergency preparedness and response plan to react to polio outbreaks, a mechanism Gupta says government officials “hope and fervently pray” they won’t have to use. Nonetheless, they are realistic and remain on alert. “If other countries continue to be polio endemic then clearly there is a danger posed to India also,” Gupta noted.