That India has been declared polio-free is an accomplishment of which the country can legitimately feel proud. This has been an arduous task, considering that in 2009 India accounted for nearly half of the world's total polio cases. Total eradication of this crippling disease in such a short period seemed unthinkable at that time. But the challenge has been effectively met; no fresh case of this scourge has been noticed anywhere in the country since January 13, 2011. With this, the decks are cleared for the World Health Organisation (WHO) to pronounce not only India but all of Southeast Asia as a polio-free zone.
However, regardless of this success, the combat against the wild paralytic poliomyelitis virus that causes irreversible paralysis of limbs among children below five is not over yet. An equally formidable challenge is to preserve polio-free status by effectively staving off fresh importation of this virus. Several countries, such as Syria, Cameroon, Ethiopia and Kenya, had also managed to banish polio but subsequently failed to prevent its re-entry from abroad. The chances of this happening in India are greater, given that some of the country's immediate neighbours - including Pakistan and Afghanistan - are still heavily polio infested. Of course, New Delhi has already begun administering the polio vaccine to children under five crossing from Pakistan, Nepal and Bhutan, which is a step in the right direction. But such arrangements would need to be expanded to cover children arriving from other polio-infested countries too. Moreover, since polio has no cure, and prevention is the only option for containing the disease, it is imperative to sustain the domestic "Pulse Polio" campaign for some more time.
Among the factors that have led to the triumph over polio are political commitment and the dedication of health workers, including those of non-governmental organisations. They not only conducted periodic national and regional polio vaccination camps, but also followed them up with home visits to ensure that no at-risk child was left unvaccinated. The assistance provided by the United Nations bodies, notably the WHO and Unicef, also needs to be acknowledged by the government. Initially, Muslim-dominated areas in Uttar Pradesh, Bihar and, to some extent, West Bengal proved to be the most problematic regions due to dissemination of misinformation about the adverse effects of polio drops. What worked ultimately was the involvement of Muslim clerics in removing such misgivings through their sermons in mosques, madrasas and religious congregations. Saudi Arabia's move to make the polio vaccination certificate mandatory for Haj pilgrimage also contributed to dispelling the misguided notions about polio drops.
The lessons learnt from the result-oriented Pulse Polio campaign should not be frittered away. Similar drives are needed to prevent other vector-borne and vaccine-preventable diseases, such as malaria, dengue, chikungunya, pneumonia and diarrhoea. There are reports that another paralytic infection - acute flaccid paralysis - is spreading rapidly. Measures are urgently called for to check the spread of this infection. Moreover, Pulse Polio-type commitment is needed in implementing the routine infant immunisation programme to protect children against diphtheria, tetanus and pertussis (DPT), which still lacks universal coverage. Unless such issues are addressed, India's programme for child health cover will remain inadequate.
