NEW DELHI (Thomson Reuters Foundation) - India on Monday marked three years since its last reported case of polio, paving the way for it to be declared free of the crippling virus and giving impetus to efforts to eradicate the disease globally, the World Health Organisation (WHO) said.
The last case of the wild polio virus was detected on Jan. 13, 2011, in a 2-year-old girl in India's West Bengal state. Three years without any new cases means India can be declared polio-free, leaving the virus endemic in only Afghanistan, Pakistan and Nigeria - down from more than 125 polio-endemic countries in 1988.
“We give huge credit to the government… it makes us extremely proud and highly responsible for having helped the government to reach this incredible achievement,” Nata Menabde, the WHO's head in India, told the Thomson Reuters Foundation in an interview.
“It has given confidence to donors, it has given confidence to and (put pressure on) governments of polio-endemic countries, and it has demonstrated that persistent efforts can make a difference.”
Menabde said the WHO would officially declare India - and in fact the South East Asia region - polio-free by the end of March, when the legal procedures for certification are completed.
Until the 1950s, polio crippled thousands every year in rich nations. It attacks the nervous system and can cause irreversible paralysis within hours of infection.
This highly infectious disease often spreads in areas with poor sanitation - a factor that helped it keep a grip on India for many decades. Children under five are the most vulnerable, but the virus can be stopped with comprehensive, population-wide vaccination.
VACCINATIONS ON TRAINS
India had been considered one of the toughest places in the world to eradicate polio. Many families in high risk areas such as Bihar and Uttar Pradesh states migrate for work, while some communities are remote and inaccessible.
Menabde said millions of health workers, community mobilisers, and vaccinators were involved in the drive to immunise children with polio drops.
Health workers targeted mobile families at bus stations, on trains and at construction sites, as well as at local festivals and gatherings. Some trekked by foot to reach remote villages.
More than 170 million children are immunised every year during national immunisation days, with millions more through house visits - costing the Indian government $2.5 billion since 1995.
“This is unprecedented in terms of scale. India is one of the toughest areas in the world for these kinds of initiatives, but many operational and strategic innovations have been implemented over the years (and) have been very important,” Menabde said.
“For example we enlisted the help of clerics and imams when we were dealing with some resistance in Muslim communities who had an impression that the vaccination was a hidden sterilisation effort and that it would lead to impotency.”
In 2009, 741 Indians fell sick with polio, which was nearly half the world's cases that year. The number dropped to 42 in 2010, and only one in 2011.
EVERY LAST CHILD
Menabde said India's success has given impetus to the global fight to rid the world of the virus, adding that as long as a single child remains infected, children in all countries are at risk.
“While the whole global eradication was stagnating, India has been the rescuer of this belief that it is possible,” she said.
“Polio eradication is a very costly operation and so donors and partners were losing hope and patience. Now they are all very actively mobilised into channeling their efforts to stopping the virus.”
There were 148 cases of polio in Afghanistan, Nigeria and Pakistan in 2013, and 224 cases detected in non-endemic countries such as Somalia, Syria and Kenya.
Experts say these countries face a range of challenges such as insecurity, weak health systems and poor sanitation. In Pakistan, a Taliban ban on vaccination has seen health workers being repeatedly attacked.
The WHO office in India has sent teams of medical officers to Nigeria, while delegations from both Afghanistan and Pakistan have visited the country to learn from India's experience.
Yet Menabde cautioned against complacency after this landmark moment.
“We have to be very well aware that there have been many occasions when polio has travelled out of India to countries, for example, like Tajikistan. So it can easily travel back into India, just as it has travelled out,” she said. “We have to constantly be ready to respond to any emergencies.”