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Q+A: India at risk until polio is eradicated globally-Rotary

Source: Thomson Reuters Foundation - Thu, 27 Mar 2014 17:59 GMT
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A child receives polio drops during an Indian polio eradication programme in Jammu. Picture February 19, 2012. REUTERS/Mukesh Gupta
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NEW DELHI (Thomson Reuters Foundation) - The World Health Organisation declared India free of the crippling polio virus on Thursday, lauding its almost two-decade-long, multi-billion dollar effort as one of the biggest public health achievements in recent times.

Thomson Reuters Foundation spoke to Deepak Kapur, chairman of Rotary International’s India National PolioPlus Committee, about the end of polio in India, what it means for the world and what lessons other countries can learn from India.

Q: How long did it take India to wipe out the wild polio virus? How much did it cost? What was Rotary’s role?

A: The National Polio Eradication campaign, part of the Global Polio Eradication Initiative spearheaded by Rotary, was launched in 1995 in India by the Government of India with global partners Rotary International, the World Health Organisation and UNICEF. Rotary has invested nearly $178 million in India out of its global contribution of $1.2 billion. India’s annual budget for eradicating polio is close to 100 crores ($16.6 million), the largest amount spent by any government.
Rotary … is not only one of the biggest private funders of the global anti-polio campaign but the spearheading partner. Rotarians are involved in the Advocacy and Social Mobilisation aspects of the campaign to ensure the necessary political will, mass participation and implementation. Because Rotarians belong to local communities, they also manage operational glitches, and in some hard to reach areas, Rotary has organised polio booths for immunizing children.

Q: What do you think is the secret behind India’s success?

A: India persevered, despite the mounting challenges over the years … India raised the quality of the campaign … by identifying and addressing shortcomings.
Some points to consider:
1. Government leadership. The government put an unparalleled amount of manpower, resources and political engagement into the campaign.
2. Working closely with partners. Close cooperation while carrying out the project was an important aspect of the Indian campaign. Wherever there was a gap, a partner had to come in to fill it and ensure smooth implementation.
3. Robust surveillance and monitoring system. India’s ‘micro-plans’ pinpointed all the children and every vaccinator in every household to ensure no children were missed.
4. Extensive social mobilization. Work was done to encourage everyone to participate in the campaign.
5. Excellent government ownership, with the commitment of massive resources.
6. Identifying high-risk blocks. There was a special focus on these areas.
7. Rotary’s Muslim Ulema Committee. This group helped to educate the Muslim minority, end any ignorance about the campaign and ensure its acceptance.                                                                

8. Introduction of bivalent Vaccine (bOPV) to target two strains simultaneously.
9. Free health camps in high-risk areas. This was done to help address families’ other medical needs in those areas.

Q: Why is this a huge milestone?
A: India’s triumph means the world is much closer to ending polio than it was three years ago. India is a case study for what innovation, perseverance and strong partnership can achieve. To feel that no child’s life in India now will be wasted because of polio is a huge enough milestone for us. India is a huge country, with numerous challenges. I personally believe that the legacy of polio eradication will be much more than just the end of a disease.

Q: Why is this being called one of the biggest public health achievements in recent times?

A: Although most of the world is free of polio, India still reported half the world's new cases. Its
burgeoning population putting pressure on a weak health infrastructure, diverse groups and faiths, migratory communities, contaminated water and sanitation problems, along with hard to reach areas, made it one of the most difficult regions in which to end polio. Health experts believed that if India could do it, then any country could end polio.

I think the global community of public health experts needed this big boost to feel confident that mankind can collectively triumph over such dreadful illnesses as polio thanks to science and human ingenuity – and that we could soon see the end of diseases like AIDS, cancer, TB and many others.

The polio eradication campaign is the largest non-military, global enterprise ever. It involves dozens of organisations, scores of governments, thousands of health workers and millions of volunteers. The Indian achievement shows that what they set out to do can be done, and gives confidence and  momentum to the global movement to end polio by 2018.

Polio campaigners and donors know the historic nature of what they are determined to achieve, and despite setbacks they have always shown confidence and the spirit to march to the end.

Q: What lessons can Afghanistan, Pakistan and Nigeria learn from this?

A: Each country is unique and has its own set of challenges. What worked in India’s favour was strong political leadership and commitment at both the central and the state level. Other factors were:
A seamless partnership between Rotary, WHO, UNICEF and the government.
Strong social mobilisation and communication tools.
Identifying and addressing what was missing.    
Special focus activities for many areas identified as high-risk blocks.
I think these help in other countries too.

Q: Why has it been harder to eradicate polio in other countries?
A: Every country comes with unique challenges and positives. The incidence of polio is at its lowest in many years. The tail end is always the hardest to overcome. Polio is rampant in parts of Afghanistan and Pakistan where access is hindered by conflict and terrain. The virus is flourishing in parts of northern Nigeria, where historically it has been a challenge for health workers and other factors play a part. I believe if India can wipe out polio, any country can.

Q: How secure is India, given that a young Afghan boy was detected with the virus in Delhi recently?

A: No country in the world is secure as long as the polio virus exists anywhere in the world. India’s  immediate neighbours have the polio virus and therefore the risk and the threat remain.
India has an emergency preparedness and response plan ready to tackle any virus detected. India continues to vaccinate children regularly and maintain a robust surveillance system. India has also issued travel advisories for visitors to and from counties with the polio virus.We are also focusing on strengthening routine immunisation, including for other childhood diseases along with polio.

Q: Can India sit back and relax?

A: No! As long as the world is not certified polio free, we cannot afford to relax. What we have achieved is historic and we will protect it, whatever it takes.

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