The Final Inch

In order for a country to be taken off the endemic list, they must be polio-free for at least 12 months. India’s last reported polio case was of a two-year-old girl in West Bengal on 13 January 2011. In 2010, there were only 42 reported cases, down from 741 in 2009. With India successfully achieving the 12-month milestone, it is now the first country to be taken off the endemic list since Niger and Egypt in 2006.

The journey so far hasn’t been as smooth. The efforts to stop this disease in India have been dramatic and it has been a roller coaster with significant ups and downs.  After 741 new cases in 2009, there were only 42 in 2010 – the country was almost there. And then in 2011, the single case of Rukhsar from West Bengal played the spoilsport. It was a heartbreaking occurrence, but efforts persevered.

The importance of achievement could be well ascertained from the WHO’s executive board’s congratulatory statement. It reads: “India - arguably one of the most technically-challenging places from where to eradicate polio - has been polio-free for more than 12 months now.”

Too early to party

As India marks an important milestone in its fight against polio, international health experts say that it is too soon to declare victory. Mass vaccination has eradicated the crippling disease in many parts of the world. But polio transmission and sudden outbreaks remain a challenge in large regions of the Indian subcontinent, including Pakistan and Afghanistan, as well as in west and central Africa.

India's polio success has led to a 34% decline in cases of paralytic polio last year globally as compared to the year-ago period (505 cases against 767 cases).

However, the flip side is that the other three polio endemic countries have seen a massive increase in their polio cases. In Nigeria, 2011 saw a four-fold increase in cases compared to 2010. Afghanistan and Pakistan suffered a 135% and 22% increase in cases, respectively (20 cases compared to 47 cases and 111 cases against 136 cases).

Celebration with Caution

Bill Gates, co-chair of Bill and Melinda Gates Foundation, has praised India for managing to eradicate polio despite all odds. “In 2012, we need to keep India and all the other places that are polio-free from getting re-infected,” he said.

Only three years ago, India had more polio cases than any nation, Bill noted. He called upon global leaders to invest in innovations that accelerated progress against poverty, or risk a future in which millions needlessly starved.

Message in the bottle

Czechoslovakia became the first country in the world to scientifically demonstrate nationwide eradication of poliomyelitis in 1960. The early success of these mass vaccination campaigns suggested that polioviruses could be globally eradicated. The Pan American Health Organization (PAHO), under the leadership of Ciro de Quadros, launched an initiative to eradicate polio from the Americas in 1985.

By the year 1994 America was polio-free. Same year, Indian Government launched the Pulse Polio Campaign to eliminate polio.

Polio, which was pronounced dead in the Western Hemisphere years ago is stealing through a tiny Amish community in central Minnesota, spreading from an 8-month-old girl to four children on two neighboring farms.

So far, no one has been crippled by the disease, which has no known cure; only 1 in 200 cases of polio results in paralysis. But worried public health officials say it may be only a matter of time.

The story of how polio is back in the US is both a medical whodunit and a cautionary tale, suggesting that eradicating polio may prove far harder than anyone thought, even in the developed world.

Story Eradication

Throughout history only one infectious disease - smallpox - has ever been eradicated. Today, two more diseases - polio and guinea-worm disease - are on the verge of eradication. Several more are gradually being brought under control or reduced to a level manageable within the existing health system.

But progress is not always straightforward. Environmental change, internal conflict, mass population movements and the collapse of basic health services can rapidly overwhelm efforts to control infectious diseases. And, in the final stages when a disease becomes less visible, progress is often hampered by complacency. Success can never be taken for granted.

The global eradication of poliomyelitis is a public health effort to eliminate all cases of poliomyelitis (polio) infection around the world. The global effort, begun in 1988 and led by the World Health Organization, UNICEF and The Rotary Foundation, has reduced the number of annual diagnosed cases from the hundreds of thousands to around a thousand.

If polio is the next disease to be successfully eradicated, this will represent only the third time this has ever been achieved, after smallpox and rinderpest.

Overall, since the Global Polio Eradication Initiative was launched, the number of cases has fallen by over 99%. In 2011, only four countries in the world had remained polio-endemic. India out of the list, persistent pockets of polio transmission in northern Nigeria and along the border between Afghanistan and Pakistan are key epidemiological challenges.

Killed but not dead

Polio is one of a limited number of diseases that can actually be eradicated. And the world is this close to making that a reality.

With India now out of the list, the three remaining polio-endemic countries that haven't stopped the transmission of the disease: Afghanistan, Nigeria and Pakistan are posing big danger of re-spread of the virus.

In 1994, the WHO Region of the Americas (36 countries) was certified polio-free, followed by the WHO Western Pacific Region (37 countries and areas including China) in 2000 and the WHO European Region (51 countries) in June 2002.

In 2010, the European Region suffered its first importation of polio after certification. In 2011, the WHO Western Pacific Region also reported suffering an importation of poliovirus. Till the virus remains alive in part of the world, coming generations aren’t completely safe.

Lesson from Home

The story of leprosy stands to be an ideal sample story. India continues to battle the disfiguring disease which though officially been “eliminated” in 2005. There are about 209 out of 640 districts in the country where the number of new cases exceeds the WHO target of less than 10 new cases per 100,000, says the top health body.

A Government’s recent report on the progress under the National Rural Health Mission (NRHM) corroborates the fears. The Health Ministry’s Fifth Commission Review Mission report notes that the States which have already reached or is near the goal of elimination are still reporting increasing number of leprosy-causing bacterium cases suggesting active transmission of disease.

“Many States like Andhra Pradesh, Assam and Odisha which have already reached or near the goal of leprosy elimination are still reporting increasing number of new cases suggesting active transmission of the disease. In Andhra Pradesh, 14.7 per cent of new cases are in children. UP and Bihar are stagnant. Over 200 blocks in UP are having a prevalence over 1 and 2.3 having disability,” it points out suggesting that guards cannot be lowered.

The disease which officially stands eliminated from the country in 2005 is fast returning lately with the experts attributing it to the Government’s complacency as it loses its focus on its complete eradication.

Hope that the leprosy story doesn’t find a repeat for polio. The eradication is so, in true, complete and permanent sense.