New Delhi: Orin Levine, director of vaccine delivery at the Bill and Melinda Gates Foundation, spearheads the organization’s efforts to accelerate the introduction of new vaccines and related technologies to improve routine immunization coverage. India, which recently celebrated two years without new polio cases, and the Gates foundation are now looking to use the infrastructure built for the implementation of the polio eradication campaign to expand routine immunization in India, Levine said in an interview. Edited excerpts:
Targeted intervention such as the polio campaign has come at the cost of routine immunization. What lessons can be learnt from the polio eradication campaign to address this challenge?
Not everywhere has success in polio eradication translated into strengthening of routine immunization coverage. India is an exception to this. It is true that the polio campaign succeeded because it was focused.
To a certain extent, the criticism that other immunization campaigns suffered because of prioritizing polio is also true. At the Gates Foundation, we are now shifting focus to routine immunization in general and trying to focus on measles vaccination in particular. Bihar is a good example of this shift. While polio was being eradicated, the number of children coming in for routine immunization was also going up. We are now looking at ways to use the infrastructure built for polio to broaden the limits of immunization coverage.
What is the most critical element of the polio campaign that can be used in combating other diseases?
The success of polio in India lies with the “feedback loop” created by the government, partnering organizations and field workers. The practices of administering vaccine has changed in India. Practices like counselling, capturing data, monitoring coverage rates and even simple things like safely using syringes, storing vaccines etc. will be extremely useful if improving routine immunization coverage.
These are simple yet powerful contributions of the polio campaign to India’s health sector. Most importantly, the Indian polio campaign adapted as per the situation on the ground. This model of responsive governance, political leadership and the use of data generated by field workers can be useful if implemented in other mass health campaigns. In Bihar, polio volunteers are now being used for measles vaccination. We hope that other states will follow a similar model.
The polio campaign was implemented almost entirely outside of India’s public health sector, through parallel structure with help from partnering organizations. Do you think this has weakened the public health programmes as it is not feasible to make targeted intervention for each disease instead of strengthening the public sector as a whole?
It is partly true that parallel structures were created to implement the programme and it became a political priority. Having said that, while disease interventions and implementation cannot prioritize one disease over others, because of prioritization in polio programme, workers, anganwadi workers and auxiliary nurse midwives (ANMs) have been empowered with information they would otherwise not have access to. They now know how to generate data, (understand) tracking mechanisms for newborns, standards for medical waste disposal, etc. What a single disease intervention like polio has shown us is this: the model works. We now have tangible evidence that such a model can be used to create a functioning health system with a little help from governments, civil society organizations, etc. in other developing countries.
India still faces a serious threat of polio virus infections from neighbouring countries. The campaign in Pakistan has suffered serious setbacks. How critical is it to contain the virus in Pakistan before it threatens the global eradication campaign?
We have been following the developments in Pakistan very closely, and with growing concern after each round of violence. We have seen in countries like India and Pakistan that the virus has been contained largely because of motivation from the community and volunteers. It is difficult to imagine that people will gun down such motivated people. While my heart goes out to those whose loved ones have been killed, I am certain that guns are going to be no match to this commitment.