India’s fight against Polio
Polio, or poliomyelitis, is an infectious disease spread through poliovirus. Since the early twentieth century, polio has been widespread in many countries, causing paralysis in thousands of children every year. With the help of various nonprofit organizations and the Global Polio Eradication initiative, the disease is now narrowed down to a handful of nations.

In 2014, India was certified as a polio-free country, leaving Pakistan, Nigeria and Afghanistan on the list for polio eradication programs. India’s fight against polio is a remarkable achievement because of the various challenges the country faced. Nicole Deutsch, the head of polio operations for UNICEF in India, called it a “monumental milestone.”

Polio: Cause and Prevention

Poliovirus is highly contagious, infecting only humans and residing in the throat and intestine of the infected person. It spreads through feces and can contaminate food and water in unsanitary conditions.

The virus affects the brain and spinal cord of the infected person, causing paralysis which cannot be cured. Immunization through inactivated poliovirus vaccine and oral poliovirus vaccine are the only possible methods to fight against the virus. In the case of India, it was the second option which was administered.

India’s Fight Against Polio: the Challenges Faced

India’s fight against polio faced unique challenges, such as its huge population density and an increased birth rate. The number of people living in impoverished conditions with poor sanitation is huge, making them vulnerable to the polio disease.

Lack of education and prejudice among certain sects of the population also hindered the immunization process. Other challenges faced were the unstable healthcare system, which does not support people from all levels of society, and the geographically-dispersed inaccessible terrain, which made the immunization process difficult.

Overcoming these Challenges

Overcoming the challenges of polio eradication was possible due to the combined help provided by UNICEF, WHO, Rotary Club, the Indian government and millions of frontline workers. They took micro-planning strategies to address the challenges faced by the socially, economically, culturally and linguistically diverse country that is India.

India began its oral polio vaccine program in 1978 but it did not gain momentum until 1994, when the local government of New Delhi successfully conducted a mass immunization program for children in the region. From the year 1995, the government of India began organizing National Immunization Day, and in 1997, the first National Polio Surveillance Project was established.

Other initiatives taken include:

  • Involving almost 7,000 trained community mobilizers who went door-to-door, educating people in highly resistant regions.
  • Engaging 2.3 million vaccine administrators who immunized almost 172 million children.
  • The government running advertisements on print media, television and radio.
  • Enlisting famous Bollywood and sports celebrities to create awareness among common people.
  • Involving religious and community leaders in encouraging parents to vaccinate their children.

Inspiration for Other Countries

In 2009, almost 741 polio cases were reported in India, which dropped down to 42 in 2010, until the last case was reported in 2011 in the eastern state of West Bengal. This unprecedented success is an inspiration for countries like Pakistan, Afghanistan and Nigeria, where the disease is still looming at large.

India’s fight against polio has set an example in the world that the country can be proud of, but the fight is not over yet. Although India has been declared polio-free by the WHO, it is of the utmost importance that the nation continue to assist other nations still facing the polio epidemic.

– Mahua Mitra

Photo: Flickr

Polio in Ethiopia
The World Health Organization confirmed that polio in Ethiopia has been eradicated after an assessment team concluded the evaluation process from June 8 to June 12, 2015. This last polio outbreak began almost two years ago in the Horn of Africa, specifically in Ethiopia, Kenya and Somalia.

The assessment team consisted of experts from the Centers for Disease Control, Rotary International, the United States Agency for International Development, the Bill & Melinda Gates Foundation, CORE Group, the United Nations Children Fund, the World Health Organization Headquarters and the World Health Organization Horn of Africa Polio Coordination Office.

The assessment team worked together throughout the outbreak in all three countries to determine that global standards had been met in response to the outbreak and that the transmission of polio had been interrupted. To do this, the team monitored updates from the Federal Ministry of Health on such matters as immunization progress and activities, funding aspects, communication and surveillance.


Polio in Ethiopia: Remaining Polio-Free


The assessment also provided a framework for the efforts still needed to maintain a polio-free status. In order to remain polio-free, Ethiopia needs to update its outbreak and preparedness response plan, strengthen routine immunization and fortify their implementation of acute flaccid paralysis (AFP) surveillance.

AFP is the symptom that indicates that polio could be present. It means that limbs are floppy and lifeless. However, its presence could also be due to other causes. As a result, AFP must be reported in every child less than 15 years of age and tested for poliovirus within 48 hours of onset.

It is expected that there are one to two cases of AFP in every 100,000 children under the age of 5. If there are no reports of AFP in such circumstances, then a region is considered to be “silent.” “Silence” indicates a weakness in the surveillance system, and a failure to end this “silence” could prevent the eradication of polio.

According to WHO, “As long as a single child remains infected […] as many as 200,000 new cases could result every year within 10 years, all over the world.”

Polio is caused by a highly infectious virus, poliovirus, which invades the nervous system. However, 90% of infected people have no symptoms or just very mild symptoms that go unnoticed. In other cases, symptoms could consist of fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. One in 200 infected people become irreversibly paralyzed, usually in the legs. Five to ten percent of those paralyzed die because their breathing muscles become paralyzed.

Across the Horn of Africa, 223 children became paralyzed during the last two years, due to the poliovirus.

Since there is no cure for polio, the polio vaccination is the only protection. In Ethiopia, social mobilizers were successful in their efforts to raise parents’ awareness of the risks of polio and upcoming campaigns to vaccinate children.

It is these connections among informed social mobilizers, healthcare workers and parents within a community that not only leads to vaccination but also builds understanding and commitment to recognizing and reporting AFP to authorities.

Although vaccination and AFP are critical in the eradication of polio, this is not accepted knowledge everywhere. Taliban militants strongly resist vaccination campaigns and are considered responsible for deadly attacks on polio vaccination workers. They “view the campaign as un-Islamic and the health workers are Western spies,” according to The New York Times. Pakistan accounted for 85% of the polio cases reported in 2014.

Ethiopia reported its last case of polio on January 5, 2014. Kenya has also halted the transmission of polio, having reported its last case of polio on July 14, 2013. Somalia has not yet been assessed for eradcation, even though it reported its last case on August 11, 2014. The Somalian government is unable to reach approximately 350,000 children under the age of 5 in order to administer vaccinations, and the assessment team has found gaps in their surveillance efforts.

In spite of these hurdles, the Global Polio Eradication Initiative, launched in 1988 by the World Health Assembly to eradicate polio worldwide, has made enormous progress. Since that time, the number of people infected with the poliovirus has dropped more than 99%. In 2014, only 3 countries remain polio-endemic: Afghanistan, Pakistan and Nigeria.

Janet Quinn

Sources: Global Polio Eradication Initiative, The New York Times, Outbreak News Today 1, Outbreak News Today 2, WHO
Photo: Flickr