India’s Feat in Public Health: Polio
This Sunday, January 13, was the anniversary of India’s major polio milestone – marking two years without reporting a single case of polio. We talk with Dr. Naveen Thacker, a pediatrician and polio expert, who has been part of the country’s leadership that’s been actively pushing for a polio-free India.
There has been significant press recently on the polio effort, ie. TIME magazine’s feature story on the fight against polio in Pakistan. What would you advise the other polio-endemic nations, having seen success in India?
That ‘it’s possible’ and to keep going! We’re closer than ever before to eradicating polio globally. Experts once said that eradication in India was impossible but by proving them wrong, we’ve provided a blueprint for Afghanistan, Pakistan and Nigerian, the only three remaining endemic countries, to eradicate the disease.
India provides important lessons that can be replicated to ensure success. For example, in India we set up an Expert Advisory Group which looked holistically at the eradication programme and made recommendations as challenges arose. Critically, a strong partnership between the Government of India and a public and private sector partnership saw $2 billion being put towards polio eradication. This meant that a partnership that involved all levels of Government, the World Health Organisation, UNICEF, Rotary International, the U.S. Centers for Disease Control and Prevention and the Bill & Melinda Gates Foundation, was able to develop the largest and most successful vaccination drive in the world which meant every child in India was reached with the polio vaccine.
Advancements in technology meant we were able to quickly identify where polio outbreaks started from, which helped us control it quickly and reduce the number of children being affected by polio. Furthermore, a new vaccine (called Bivalent OPV) that was cheaper and effective against both Wild Poliovirus type 1 and 3 helped us over the final hurdles. Now we’ve reached zero cases, we have to remain vigilant to ensure that the disease does not return.
What would you like to see the polio infrastructure be used for in coming years once the fight against polio is complete? Are there any early thoughts in place as to how this infrastructure can be used for other public health campaigns?
If we reach three years without a case of polio, India will officially be declared polio free by the World Health Organisation, however while there’s a single case of polio in the world we won’t be free of the disease. We’ve seen importation of polio before, in 2010 polio returned to China (imported from our common neighbour, Pakistan) and although plans are in place to both prevent and treat importation; vigilance is critical and will remain so for many years to come.
The polio structure developed over two years has already dramatically affected other health interventions. For example, as part of the Government’s efforts to reduce the incidence of measles, the illness now comes under the polio programme, highlighting the effectiveness of the programme. Furthermore, in large States like Bihar, routine immunisation has increased dramatically alongside polio coverage. Discussions are on going to use this vast network of NPSP and lab network for surveillance of other Vaccine Preventable Diseases . More needs to be done but we’ve shown that we can reach every child in the country, repeatedly. Polio eradication isn’t a fluke and we must use it to ensure that we stop children dying of other preventable diseases. With 1.66 million children dying every year from preventable disease like pneumonia and diarrhoea the highest child mortality in the world, now is the time to ensure that the polio success is scaled up.
The underlying cause for polio has been poor sanitation and water conditions in states such as UP and Bihar. What can be done about this for future public health campaigns?
Well, there’s a number of underlying causes that include everything from a lack of trained and fully supported health workers to parents refusing to take vaccines. We got past many of these problems by developing an army of vaccinators that were able to reach out to 172 million children each vaccination round but I agree that one of the underlying causes of polio was poor sanitation, hygiene and a lack of clean water. This has an effect on multiple public health challenges and urgent action is indeed needed to solve these big problems.
However, it’s not about any one intervention being the silver bullet to solve all public health problems, it’s about looking at health holistically and developing a continuum of care that ensures that from the cradle to the grave, everyone has the right to access quality health information and services. To do that, a strong public health movement is needed to ensure that health rises up the political agenda, strong policies are put in place that are ultimately implemented and evaluated by the people at the local, State and national levels. It is promising to note that India is making significant progress by strengthening its health programmes and policies but this needs to be scaled up and accelerated.
While there are ad hoc campaigns to help polio patients, there has not been a national or regional system put into place to help those afflicted in polio. Do you see that happening? Will India move from vaccination to treatment?
Again we need to be doing everything. I don’t think anyone would deny that those affected by polio need good health care and support systems to help them cope with the disease. The right to health is enshrined in our constitution and we must develop a system to ensure that all people affected by the disease are suitably treated. Govt is well aware of this fact and there are systematic attempts with help of NGOs most importantly Rotary International for rehabilitation therapy for these polio affected children
As well as making sure that people like Ruksa (the last polio case) are well looked after, we must also ensure that we vaccinate all children against polio and other diseases that are preventable. The threat of polio importation from endemic countries will remain in every country until polio is wiped out globally. Treatment versus prevention is the wrong paradigm; we need to be doing both.
Would does the victory against polio in India mean for you personally?
Achieving polio eradication is my life time mission and I have been working on polio since 1994. It is most satisfying to see that happening . As a young pediatrician, I remember seeing 55 cases of polio in just a month in my home state of Gujarat. I was shocked at the speed and devastation of the disease. When outbreaks happened, it was like dealing with a tidal wave that couldn’t be stopped. We fought back though and I initially created small booklets about the polio eradication . These were delivered to pediatricians nationwide and to Rotary clubs of polio-endemic countries. I personally wrote over 8,000 postcards every year to pediatricians and Rotarians to support the Government’s Pulse Polio campaign and report cases of paralysis.
It was an honour to be invited to serve as a member of the India Expert Advisory Group and to work for over a decade with other experts and the Government to ensure that the polio programme was utilising national and international best practice to overcome major challenges. I have also published a great deal of literature and delivered hundreds of speeches about polio so I feel like I’m heavily invested in India’s polio success.
In 2012, India’s polio eradication was the public health story of the year but we must build on this both nationally and globally. With 222 cases of polio so far recorded globally last year, down from 650 in 2001, we stand on the cusp of the biggest public health achievement of our generation. If we fail now, polio has shown through history that it is a resilient virus and it will come back. I’m proud of India’s achievement but this is not the time to celebrate. We must remain vigilant nationally and celebrate with the world when we finally reach the golden number for global cases of polio. Zero.