Ellyn Ogden has coordinated USAID’s polio eradication initiative since 1997 and is a frequent visitor to India.
The news out of India this week marking 12 months with no confirmed case of polio is indeed a landmark event. I have had the good fortune of working with the Pulse Polio Program, as the Polio Eradication Initiative is called here, since 1997, and have seen firsthand the hard work and dedication of the Indian government at the national, state, district, block and panchaiyat levels. Over 2 million health workers, mobilizers, and volunteers have contributed to this success and deserve to be seen as heroes in their communities.
There have been many challenges over the years, not the least of which was figuring out how many children under age five there really are in India. When I participated in my first surveillance review in Bihar, there were no surveillance officers assigned yet and the eradication program was in its infancy. Today, India’s polio eradication program and its surveillance system, the envy of all other polio eradication programs, is often cited as the model to strive for.
With the help of WHO, UNICEF and Rotary international, detailed plans are developed to assure that vaccine reaches every village, data is analyzed and feedback given to constantly improve the work of the teams. Detailed maps help trace the daily route of the vaccination teams. Supervisors provide guidance and quality control. Monitors verify the work of the teams, by checking to see if their fingers are marked and flagging any locations with poor coverage. Sweep teams go back to find missed children. Issues are discussed at evening meetings during the campaigns and corrective action taken immediately. Government accountability and ownership is very visible.
India has overcome many hurdles as it strives to reach 172 million children repeatedly with oral polio vaccine. Keeping the vaccine cold in 40C is not easy; being a vaccinator, carrying a cold box through floods and mud in that heat demonstrates determination and a commitment to India’s children. Recognizing India’s ‘hidden’ children was a major step forward. More than 5 million children are in-transit over the three days of a polio campaign, necessitating special transit teams. Children of nomads, temporary workers, or those confined to areas around brick kilns required special outreach. Immunizing newborns within the first few days of life has dramatic impact on all future doses of vaccine, but the majority of India’s children are born at home – but new and innovative approaches by the government means more newborns are vaccinated against polio and other diseases in greater numbers than ever before.
India has had its share of skeptics and the spread of false rumors questioning the safety of the vaccine. Thousands of mobilizers have joined with religious, traditional and local leaders to provide accurate information and reassure parents that the vaccine is safe and effective. NGO’s, such as the CORE Group, who at first had stones thrown at them or boiling water aimed their way from parents against immunization, are now welcomed into those same communities. Working with local community organizations, women’s groups and self-help groups, the messages have gone well beyond polio to address other immunizations, water and sanitation, breastfeeding and handwashing. Partnerships between local government, community organizations, private doctors who are members of the Indian Academy of Pediatrics or the Indian Medical Association, and religious leaders, are now the norm.
All of this collaborative and detailed effort has increased population immunity, against all three types of polio virus, to a high enough level to stop virus transmission. But this will need to be sustained for three years – a long enough time to know if anything was missed.
Part 2: A Triumph of Coordination: To the Last Case and Beyond