India’s inspiring war on polio

Friday 13 January marked a major milestone for India. It celebrated one year without any new reported cases of wild polio. For a country of 1.2 billion people that is still battling the scourge of poverty and an image of being riddled with disease and destitution, this is a huge success worthy of applause. Only a couple of years ago, polio was still considered endemic in India.

This landmark is proof of real progress and it flies in the face of the cynics who worry about India’s unrestrained development ambitions and its growing population. If India can stay polio-free for another two years, it will have successfully eradicated this highly infectious disease, which would also be a huge step towards polio’s global eradication.

Poliomyelitis is an infectious viral disease that typically affects children and is spread through contaminated food and water or through contact with the fecal matter of an infected person. It attacks the central nervous system, causing paralysis, muscular atrophy, deformity and, in some cases, even death. A polio-afflicted child dragging himself along the streets and begging at traffic lights has been an enduring image of a poor and diseased India. It is a sight Western tourists often take home as testament to the unsanitary conditions in the country.

Yet it wasn’t long ago that this image was familiar in Western industrialised countries, too. Contraction of the disease among children was quite common in days when now-developed countries still had open sewers running through their streets. In the late nineteenth and early twentieth centuries, the urban parts of northern Europe and the United States were hit by polio epidemics. New York City reacted with panic to an epidemic in 1916 during which 9,000 cases were reported. That year saw 27,000 cases nationwide in the US and among the afflicted there was a 22 per cent death rate (1). The discovery of the polio vaccine in 1957 ensured its elimination from the Western world; in the 1960s, vaccinations were administered on a massive scale. In the US, the last case of wild polio was reported in 1979. In Britain, the last known case occurred in 1982. Meanwhile in India in the 1980s, as many as 200,000 new cases were still being reported annually.

When the Global Polio Eradication initiative was launched in 1988, India had the highest number of polio cases in the world and so, unsurprisingly, was the biggest challenge. In 1995, 14 years into its own National Immunisation Programme to eradicate polio, India still had more cases than anywhere else in the world. After some success, in 2006 there was an epidemic in Uttar Pradesh, one of India’s poorest states. India was widely regarded as undermining the global initiative to eradicate polio. The government was even accused of fudging numbers and not showing enough political will. By contrast, there is now a celebratory mood among health officials, health workers and doctors in India – and rightly so. From having 741 reported cases just two years ago – the highest in the world – the figure went down to 42 in 2010, and to zero in the past year. Even if the target year for eradication had to be pushed back twice, this is indeed a huge achievement.

To put all this into perspective, one has to consider the odds that were stacked against the programme’s success. Out of the 1.2 billion population, 70 per cent still live in rural areas, many of whom have limited access to healthcare facilities. Although the infrastructure in India has improved in the past two decades, it still leaves much to be desired. The sheer expanse of the country also means that the underdeveloped areas get left out. The government estimates that 25million children are born in India every year. Those with population-paranoia, who constantly fret over multiplying Indians, would likely see that number alone as a major constraint for the polio-immunisation programme. But the numbers have, in fact, also contributed to its success. The sheer scale of the programme and an innovative army of volunteers and health workers ensured that every single child in urban areas, slums, remote rural areas and small towns received the vaccine. Even migrant and mobile populations, like construction workers and homeless people, were administered the vaccine.

According to the World Health Organisation, in just one round of the national immunisation days there were ‘640,000 vaccination booths, 2.3million vaccinators, 200million doses of vaccine, 6.3million ice packs, 191million homes visited and 172million children immunised’. And this was done by a network of people in mobile teams at railways stations, markets, construction sites, trains and buses. Community networks, too, assisted in battling superstition among the uneducated and conservative, who were generally suspicious of vaccines.

India’s pursuit of economic growth and unchecked development is often criticised as unsustainable and undesirable – as the logic goes, more ordinary Indians owning cars means more carbon emissions, urbanisation contributes to more filth and disease, the more people who are able to buy stuff, the more waste is added to the planet, and so on. This milestone, however, is a very real manifestation of progress and transformation for the general population, who will benefit from greater health and wellbeing. Such improvements are possible and prioritised thanks to continued growth and development; even the desire for better living conditions is spurred on by these changes.

No doubt, India has still some way to go; a new case in the next two years could mean going back to square one. The country spends only 2.5 per cent of its GDP on health, and the living conditions of the majority are still very poor. Still, this week’s landmark should be a reminder that more development and accompanying improvements are necessary and desirable in India, and globally. Polio and many other debilitating diseases still persist in the world and India’s achievement is a true cause for celebration, as we have moved closer towards wiping out another disease globally.

Sadhvi Sharma was born in Bombay and is currently a PhD candidate at the Rajaratnam School of International Studies at Nanyang Technological University, Singapore.