India on track to become polio-free, says UN health agency

Children with polio at the Amar Jyoti Research Centre, Delhi, India. Photo: WHO/P. Virot

If all pending samples for the virus test negative, India – once regarded as the world’s epicentre for polio – will become free of the disease for the first time in its history, reducing the number of polio-endemic countries to three: Pakistan, Afghanistan and Nigeria.

“India’s success is arguably its greatest public health achievement and has provided a global opportunity to push for the end of polio,” WHO Director-General Margaret Chan stated in a news release.

“Stopping polio in India required creativity, perseverance and professionalism – many of the innovations in polio eradication were sparked by the challenges in India. The lessons from India must now be adapted and implemented through emergency actions to finish polio everywhere,” she said.

UN Children’s Fund (UNICEF) Executive Director Anthony Lake attributed India’s remarkable progress to strong leadership at a national and state level, which pushed for the launch of a comprehensive polio eradication programme that enabled very poor and populous states to have high immunization coverage.

“India’s achievement is proof positive that we can eradicate polio even in the most challenging environments – in fact, it is only by targeting these areas that we can defeat this evil disease,” Mr Lake said.

“We have the ability to protect every last person, especially children, from this entirely preventable disease – and because we can, we must finish the job of eradicating polio globally, once and for all.”

The scale of the eradication effort has been described by WHO as “mind-boggling,” with 170 million children under the age of five being vaccinated each year in two national immunization campaigns, and up to 70 million children in the highest-risk areas being vaccinated multiple times in additional special campaigns.

Implementing the campaigns also required a big financial commitment from the Government. According to WHO, India will have by next year have spent $2 billion in eradication efforts, making it one of the largest donors to polio eradication.

In spite of the current progress, WHO warned that there is no room for complacency. “It is a very welcome milestone, but it is not the end of the road,” WHO’s spokesperson for the Global Polio Eradication Initiative, Sona Bari, told UN Radio.

She added that the Government of India must remain vigilant and respond very rapidly to guard itself against any importation of polio from other countries.

The Global Polio Eradication Initiative (GPEI) is spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF.

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India records one year without polio cases

One year polio free in India is a major achievement; the country was once the world’s epicentre of polio

India was once recognized as the world’s epicentre of polio. If all pending laboratory investigations return negative, in the coming weeks India will officially be deemed to have stopped indigenous transmission of wild poliovirus. The number of polio-endemic countries, those which have never stopped indigenous wild poliovirus transmission, will then be reduced to a historical low of three: Afghanistan, Nigeria and Pakistan.

However, there remains no room for complacency. India must maintain sensitive surveillance and high childhood immunity against wild poliovirus to guard against any importation of polio until eradication is achieved globally. In 2011, Afghanistan and Pakistan have both seen alarming increases in polio cases, and poliovirus from Pakistan re-infected China (which had been polio-free since 1999). In Africa, active polio transmission continues in Chad, the Democratic Republic of the Congo and Nigeria, with outbreaks in West and Central Africa in the past 12 months reminding the world that as long as polio exists anywhere, it remains a threat everywhere.

Global health leaders today paid tribute to the Government of India for its leadership and financial commitment to the polio eradication effort, and to the millions of vaccinators, community mobilizers, Rotarians, parents and caregivers who have supported polio eradication for more than a decade. The scale of the eradication effort in India is mind-boggling: each year, more than 170 million children under the age of 5 are vaccinated in two national immunization campaigns, with up to 70 million children in the highest-risk areas vaccinated multiple times in additional special campaigns; the whole effort requires nearly a billion doses of oral polio vaccine annually.

Hundreds of thousands of children will be saved

India’s achievement in stopping polio will save hundreds of thousands of children from lifelong paralysis or death each year. Poliovirus can travel easily to polio-free areas. Stopping polio in India will prevent a recurrence of the polio outbreaks – due to virus of Indian origin – seen in recent years in countries as diverse as Angola, Bangladesh, Nepal, Russia and Tajikistan.

An opportunity to end polio

“India’s success is arguably its greatest public health achievement and has provided a global opportunity to push for the end of polio,” said WHO Director-General Margaret Chan. “The Global Polio Eradication Initiative is in full emergency mode and focused on using this momentum to close this crippling disease down. Stopping polio in India required creativity, perseverance and professionalism – many of the innovations in polio eradication were sparked by the challenges in India. The lessons from India must now be adapted and implemented through emergency actions to finish polio everywhere.”

The key to India’s remarkable progress in the fight against polio according to UNICEF Executive Director Anthony Lake, has been the strong leadership of the Government of India and state governments, which launched a comprehensive polio eradication programme that has enabled sustained high immunization coverage in states like Uttar Pradesh and Bihar with high rates of poverty, high population density and poor sanitation and infrastructure, conditions in which disease like polio can thrive.

Polio can be eradicated in challenging environments

“India’s achievement is proof positive that we can eradicate polio even in the most challenging environments – in fact, it is only by targeting these areas that we can defeat this evil disease,” Mr Lake said. “We have the ability to protect every last person, especially children, from this entirely preventable disease – and because we can, we must finish the job of eradicating polio globally, once and for all.”

Rotary International first launched the global polio eradication effort in 1985, and President Kalyan Banerjee said that with the intensity of transmission in India, many experts had predicted it would be the last country in the world to achieve eradication. “India is undoubtedly the biggest domino to fall in the polio eradication effort,” Mr Banerjee said. “India’s success is a great credit to the Indian government and to Indian Rotary members – as well as those from around the world – who have worked with local leaders to conduct these immunization efforts to reach every child with the polio vaccine.”

India must continue to protect its children from polio

Like all countries that have stopped indigenous wild poliovirus transmission, India must continue to protect its children through supplementary immunization activities and improved routine immunization coverage rates or risk a potentially horrific re-importation event, said the Director of the U.S. Centers for Disease Control and Prevention, Dr. Thomas Frieden. “Polio’s history contains many cautionary tales,” Dr. Frieden added. “Polio anywhere in the world is a risk everywhere in the world, and to protect itself from a setback, India is appropriately planning to continue meticulous monitoring and intensive childhood vaccination against polio.”

Ensuring no child suffers polio

“Polio can be stopped when countries combine the right elements – political will, quality immunization campaigns, and an entire nation’s determination” said Bill Gates, co-chair of the Bill & Melinda Gates Foundation. “World leaders must continue to raise the funds needed to run the global campaign and help to ensure that no child suffers from this crippling disease ever again.”

With India’s achievement, the global polio eradication effort now focuses on improving the implementation of emergency operations plans in Chad, Nigeria and Pakistan. Success depends on local ownership and accountability at all levels of government and international partners.

Notes to editors

India is one of the largest donors to polio eradication, being largely self-financed. By 2013, India will have contributed US$ 2 billion.

When all pending specimens are processed (stools from children with acute flaccid paralysis and samples from sewage sampling), if no wild poliovirus is detected, India will no longer be considered polio-endemic. The laboratory system is expected to clear all samples within 4–6 weeks of collection.

The Global Polio Eradication Initiative (GPEI) is spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF.

For more information, please contact:

Sona Bari
Telephone: +41 79 475 5511
E-mail: baris@who.int

Tarik Jasarevic
Telephone: +41 79 747 27 56
E-mail: jasarevict@who.int

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