On 13 January, India completed two years without any reported case of polio. It is no mean achievement, considering that just three years ago, we accounted for half of global polio cases. Many public health experts wondered whether India will ever be able to win the war against polio. Today, globally, India’s successful fight against polio is being viewed as one of the greatest public health success stories in the recent decades.

The international monitoring board set up by the World Health Organization (WHO) to independently appraise progress on polio eradication observed, “Polio is gone from India—a magnificent achievement and proof of the capability of a country to succeed when it truly takes to heart the mission of protecting its people from this vicious disease... India should demonstrate to every country, where polio still exists, and to the world that there is no such thing as impossible."

What is it that made this phenomenal success possible? No one thing, but a combination of several smart and innovative things that we managed to do right. First and foremost was the unwavering commitment of the government of India. This translated into making sure there was never any dearth of financial resources for the polio eradication programme in an otherwise resource-constrained setting.

It is remarkable that India’s polio programme is domestically funded; most polio-endemic countries rely heavily on external aid. Also, the scale of operation in India is the largest in the world, with nearly 172 million children up to the age of 5 receiving the vaccine in a single national polio round, invariably launched by the President of India—a clear signal of political leadership at the highest level.

Over 12,000 crore was given by the central government to the states to fight polio, notwithstanding the fact that public health is a state subject.

The states also responded to the call of the central government enthusiastically and made polio eradication central to their health agendas. They were assisted in their efforts by WHO, UNICEF and Rotary, among many other valuable partners. Each partner brought a unique strength to the programme—from highly professional surveillance to overcoming resistance through effective advocacy and community mobilization. The ultimate success of the programme owes a great deal to the seamless, robust and vibrant partnerships that were rather unique.

Continuous innovation can yield dramatic dividends and nowhere is it better seen than in the polio eradication strategy of India. The programme demonstrated an unprecedented openness to learn from the findings from the field and benefit from scientific advancements. India, thus, led the introduction of monovalent vaccine, first in 2005 and, later, bivalent vaccine in 2010. Several innovative strategies were implemented, including bringing a sharp focus on mobile and migrant populations, identifying 107 high-risk blocks in endemic areas of western Uttar Pradesh and central Bihar for a multi-pronged approach to focus on social determinants of health and routine immunization. Surveillance was progressively made more sensitive and professional with zero tolerance for any missed case of polio. Significantly, the programme also opened itself to external appraisal and guidance by the best of international and national expertise represented on the India Expert Advisory Group-National Polio Surveillance Project, a collaborative effort of WHO and the Indian government, which deserves a full-throated kudos for their outstanding contribution to improving the quality of the programme and its management in the states.

The journey of the fight against polio in India has been long and arduous. It was a formidable challenge not to get fatigued and give up. On the contrary, our resolution and efforts only became more determined once polio cases started to drop substantially after the introduction of the bivalent oral polio vaccine in 2010. When polio struck on 13 January 2011, in Howrah in West Bengal, driven by an overpowering sense of stamping the scourge of polio out from the country, the central government made sure that all children at risk in the area were vaccinated within a week of confirmation. This was the quickest response ever and successfully interrupted further transmission of the wild polio virus. Fortunately, the Howrah case became the last case of wild polio virus in India.

India’s success on the polio front will be incomplete without acknowledging and celebrating the role of the 2.3 million volunteers who fan out into every nook and corner of this large and diverse country and make sure that every child in the remotest and hardest to reach areas is given polio drops. All children, be on roads, in trains, in religious congregations, in brick kilns, or in temporary structures, are successfully reached by these dedicated and full-of-hope volunteers. In a single national round, 2.36 million houses are visited by these volunteers and 1.72 million children are administered polio drops under the supervision of 155,000 supervisors. Such a large-scale mobilization of human resources, with high levels of enthusiasm and determination, is unprecedented.

While we celebrate our success, sweet as it is, we are mindful of the risk that persists, particularly of importation with our neighbouring countries still having wild polio cases, the threat of re-infection is quite real. We have put in place an emergency preparedness and response plan, which we also had the occasion to test recently on account of a false scare. The preparedness was fully validated. There is no room for complacence and governments, partners and communities need to continue their efforts till polio is eradicated, not only from India but from the world.

Anuradha Gupta is an additional secretary in the health ministry and was the officer in-charge for implementation of the Pulse Polio campaign since 2010.

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