In this two-part video series, we chat with Dr Ananda Bandyopadhyay, Deputy Director of Polio Technology, Research & Analytics, BMGF, about the new tool in GPEI’s kit to combat cVDPV2: novel oral polio vaccine type 2 (nOPV2).
In this two-part video series, we chat with Dr Ananda Bandyopadhyay, Deputy Director of Polio Technology, Research & Analytics, BMGF, about the new tool in GPEI’s kit to combat cVDPV2: novel oral polio vaccine type 2 (nOPV2).
Reposted with permission from Gavi.
Anand Kumar learned to walk later than other children. When he did, he walked with difficulty, dragging his right leg. He was around three years old when his parents reached out for a diagnosis. “I’m sure that they tried all the doctors in Bangalore to just get it corrected. But the thing was: couldn’t do it,” he says.
His route to being an athlete was not remotely expected when he was a toddler. The doctors’ verdict ruled out recovery. Kumar had suffered irreversible damage to both his right arm and right leg as a result of an infection with poliovirus during infancy. He was unlucky: in most babies, the disease would have passed all-but-unnoticed, mistakable for a bout of the flu. But approximately one in 200 poliomyelitis patients suffer permanent paralysis. Around 5 – 10% of people paralysed risk dying if the muscles in their respiratory systems are immobilised.
Although the world’s first safe and effective polio vaccine – the Oral Polio Vaccine (OPV)1 – had been introduced decades before, and countries like the USA were newly polio-free, in the early 1980s, just 2% of India’s children had been administered the recommended three doses. During 1981 alone, India recorded more than 38,000 polio cases. The real tally may have stood much higher: researchers have pegged the actual incidence during the 1980s at closer to 200,000 cases a year.
By 1990, the annual infection figures were in decline. But the trend towards zero cases was halting, and jagged. In 2002, India’s depleted but persistent polio case-load jumped six-fold. A year later, India was home to 83% of all the new polio cases in the world. Uttar Pradesh alone, the vast and troubled northern state in which UNICEF had recently been obliged to launch a social mobilisation scheme to counter vaccine hesitancy, accounted for 64% of the world’s polio burden. The Global Polio Eradication Initiative redoubled its immunisation efforts, but as certain leading anti-polio campaigners would later admit, to some onlookers, the challenges of elimination in India looked at times simply too steep to surmount.
Meanwhile, in the late 1990s, Anand Kumar was leaving school for college with the frustrated awareness that he had been passed over. “Due to my disability, I was not active like other kids, so I was not taken into consideration for cultural activities or sports,” he says. “I was feeling that I was missing something.”
As such, he found his way to badminton late: aged nineteen, years too old to be taken on as a beginner by the coaches he approached for training, but newly cognisant of the existence and possibilities of para-sport. He watched the coach at his local club from the bleachers – “luckily, the coach was a left-hander, and I’m always a left-hand player” – then practised the technique he observed on the court on his own. He improved quickly, began beating his able-bodied opponents.
In 2001, he was invited to represent India at a para-badminton tournament in Germany. “I thought, okay: I’m defeating the able-bodied players – and I can defeat the disabled players also.” Instead, he lost every match. Looking back, he calls it “a very good experience.” That was the year he decided to practice “most seriously.”
Success, Anand Kumar earnestly points out, has not come easily. “I have had to prove myself in each and every field,” he says. He meets young players inspired by his achievements – some 110 medals, including an Asian Games bronze, a BWF Para-Badminton World Championship doubles gold and a prestigious Ekalavya sporting award – “but I always like to share my other part of the story – which was very difficult, in which I struggled hard to come to this level,” he says. “Like, I started in the year 2001 to play an international tournament, but it took 15 long years to be a World Champion”.
That struggle has only been incidentally shaped by his disability, he clarifies. “Life is always challenging, whether it’s in an able body or a disabled body,” he says. The message he shares with the students he now coaches at his own Academy, able-bodied and disabled alike, is to take up life’s challenge with determination – put simply, to never give up.
Likewise, it took a number of tacks and switches to drive down polio in India – the introduction of improved bivalent polio vaccine in 2010; the institution of rolling vaccination at strategic transport hubs; hand-washing and sanitation campaigns to tackle the diarrhoea epidemic that was found to be weakening polio vaccine effectiveness, to name just a few – but in 2012, India finally arrived at zero polio cases.
“Today we are calling India polio-free,” Kumar says. “It’s only because of vaccination.” He’s right. But he’ll also tell you that no victory is ever quite that straightforward.
Ms. Rina Dey has spent over 25 years working in health and development, including front-line efforts to eradicate polio in India and globally.
“Unless we work at the community level, we’re not getting the full story. Ensuring community participation is the only way to achieve social transformation and to ensure that all children get immunized,” she explains.
In her role as Director of Communications for the CORE Group Polio Project, Ms. Dey works tirelessly to bring community perspectives to decision-makers at the national and state levels. Ms. Dey also continues to share lessons and innovative strategies from her work in India with other parts of the world impacted by polio.
Regardless of the location, her message is the same, “We need to take the time to listen. All questions and concerns are valid when it comes to making decisions about the health of one’s family – each deserves to be heard, understood and acted upon – without this, we will not be successful in protecting children.”
India, once thought to be the most difficult place in the world to end polio, was declared wild polio-free on March 27, 2014. A large part of this huge success was the ability to work one-on-one with communities in high-risk areas.
A pivotal moment
Ms. Dey began working in polio as a front-line Health Information, Education and Communication Officer with UNICEF and WHO.
She remembers, “Early in my career, during a field visit to Meerut, Uttar Pradesh, I came with a vaccination team to a house for polio immunization. A man came to the door, armed with a sword, and shouted that he would kill his nine-month old daughter, if we tried to enter and give her polio drops. I took a step back and directed our team to leave the house. It shook me.”
After taking the time to listen to the man’s concerns, Ms. Dey learned that the man was receiving a lot of misinformation from friends as well as his workplace. Out of fear and misunderstanding, he made the most severe threat possible to try and keep the health workers away from his family – in his mind to protect them.
“After taking the time to really listen to him and his friends, we began talking. I assured him that no one would vaccinate his daughter without his permission.”
Health workers need the knowledge and skills to effectively deal with these types of situations and to ensure that communities are receiving accurate information to make choices about the health of their families.
“The key is to address their questions and to build trust. By the following day, he welcomed the vaccination of his daughter and even went on to become an influential member of the community helping to address the concerns of other families.”
Ms. Dey decided to re-shape the way frontline health workers were trained.
“We needed to equip the health worker and vaccination teams with accurate knowledge and enhanced communication skills to understand and address the concerns of the families. There were many myths and misunderstandings to dispel, so I have put a lot of thinking into developing simple and user-friendly materials and methods which are local and participatory.”
“Investing in building capacities of frontline workers works! If they are not technically sound, they won’t be able to answer people’s queries.”
Nothing for us, without us
The Moradabad district in Uttar Pradesh was once an epicenter for polio outbreaks globally. Today, a monument to the district’s success stands tall above the bustling traffic of Moradabad City.
The monument is comprised of a large mother and child sculpture surrounded by the slogan “Two drops of life“. A polio vaccine vial sits on a base with four panels describing the partnership, strategies and journey to a polio-free India.
“No one thought it could be done when we started, but people from Uttar Pradesh, Delhi and West Bengal supported the polio eradication cause with high spirit and the job was done peacefully. A sense of great pride remains in Moradabad, and the whole of India.”
“When communities are heard and feel a sense of pride in the effort, sustained change is possible. But the flip side is also true.”
Ms. Dey remembers how children would come running with excitement, waving and cheering to interact with her team.
“When we were out on visits, the children would run to greet us. They wanted to know who we were, why we were in their neighbourhood and what we were doing. We would talk with them – we knew their names and what they were studying.”
“However, after some time, I realized that the children stopped coming, and some even began hiding from us. This was heartbreaking.”
Communities were being told that the vaccines could cause infertility, and parents were telling their children to run away from immunization teams. Dey took these insights to heart. She pushed her team, government officials and partners to think differently.
“I never thought of quitting. I want to see a polio-free world in my lifetime. I love children. I am working so that they can have a healthy life.”
She decided to develop strategies that would ramp up the involvement of influential members of the community, parents, schools, local government and families to ensure that accurate information was accessible to community members.
“We worked hard, and the scenario changed. Parents deserve to have accurate information so that they can make informed decisions about their children’s health. Many of those we engaged in this project are still advocates for polio eradication and immunization today.”
Women’s contributions cannot be overlooked
“At ground level, we have lots of female health workers. In many countries a majority of frontline health workers and vaccinators are women, but at the higher levels, we find that the majority of leadership positions are held by men.”
“Women can often be sidelined in meetings. Things have improved, but we have more work to do. When women are in leadership positions, you find that other women are promoted and women’s voices from community level are more often heard.”
Ms. Dey recalls her own experience, “Once during a discussion with community leaders, I was not allowed inside one of the prestigious religious institutions. Even as a senior member of the team, I was made to wait outside for hours, while my male colleagues were permitted to speak with the officials inside.”
When asked what advice she would give to women beginning their careers in public health, Ms. Dey says, “Be a good listener. You must visit communities, spend time with them and build strategies for your work that are grounded in the realities of the people you are aiming to reach. You must make communications simple and always put appropriate ingredients into your approaches.”
“The health of our children and families is a very personal and foundational aspect of human life. Ultimately to increase vaccine acceptance, we have to relate to people on a human level first before launching into the science.”
“We’re always ready to give answers, but we also have to listen – at every level,” says Ms. Dey. “We must move away from being instructive and take the time to see people’s concerns as valid and to help people understand the science behind what we’re asking them to do.”
Eradicating polio in India was a feat of dedication, commitment and simply doubling down on immunization activities. Given India’s vast population, tropical climate in many parts of the country, and other environmental challenges, it would be easy to imagine that if polio couldn’t be stopped, India would be the place to fail.
Simply put: it was a challenge. After all, India constituted over 60% of all global polio cases as recently as 2009.
However, in 2014, India was officially declared polio-free, along with the rest of the South-East Asia Region. Thanks to the singular commitment of the Indian Government at all levels, partners of the Global Polio Eradication Initiative, notably WHO, Rotary International and UNICEF, polio was tackled head-on. India has not had a case single case of wild polio virus since 2011.
India had long been considered one of the most difficult geographical locations to eliminate the disease. Success in India really changed the game, and now serves as an example that eradication of polio is indeed possible when the world marshals political will and commits adequate resources to the cause that affects everybody worldwide.
Today, the world is close to making public health history when it comes to polio – as it was when in 1980 small pox was officially eradicated. The goal of reaching a polio-free world is well within reach.
Tune in to listen to the podcast as the UN Dispatch tells the story of how, against all odds, India wiped out polio, and some of the lessons learned along the way.
Front-line health workers and volunteers represent the backbone of the global polio eradication effort. As they work tirelessly to reach and vaccinate every last child against polio – often in remote, hard-to-reach or even dangerous areas – they are not only protecting children from the poliovirus, but also paving the way for other health programmes to reach the world’s most vulnerable children.
The Every Last Child project is a collection of over 30 stories and profiles from India, Pakistan and Afghanistan about the collective efforts of front-line health workers, governments and global health partners to protect children from the poliovirus in some of the world’s most challenging environments. These multimedia pieces illustrate the complexity and scale of polio eradication efforts in each of these key countries through in-depth narratives, compelling profiles and interactive visuals.
To end polio, the global polio programme must reach every last child and take bold steps to take the world across the finish line once and for all. Visit the Every Last Child project page to learn more about the history of these remarkable efforts, as well as stories of heroic front-line workers.
Six years ago today, Rukhsar Khatoon from West Bengal became the last Indian child to be paralyzed by polio. Since that day, India has not experienced a single case of wild polio, paving the way for the South East Asia Region of the World Health Organization to be certified polio-free in 2014.
Once considered the toughest context in the world to eradicate polio, India achieved this feat through a relentless focus on reaching and immunizing every last child: it has since maintained high immunity to polio and very high quality disease surveillance, made the switch from trivalent to bivalent oral polio vaccine in its routine immunization system, and is working to transition its extensive polio eradication knowledge and assets to serve broader public health goals.
Sensitive disease surveillance and high immunity against polio remain important priorities for all countries until the remaining endemic countries stop polio for good.
The Health Minister stated that in a landmark step to provide double protection to our children and securing our gains of polio eradication, the Government of India is introducing one dose of IPV into its routine immunization program alongside the oral polio vaccine. The vaccine will initially be introduced in six states: Assam, Gujarat, Punjab, Bihar, Madhya Pradesh, and Uttar Pradesh. New evidences now clearly show that IPV and OPV together will further strengthen the children’s immune system and will provide double protection against polio, explained the Health Minister.
The South East Asia and Pacific region was declared polio-free in 2014 after three years with no cases in India. Yet with bordering Pakistan still reporting cases of polio, the introduction of IPV into routine immunization programmes will provide an important boost to the immunity of children in India against all types of poliovirus.
By the end of the year, more than 80 % of the global birth cohort will be routinely receiving due to the largest globally synchronised vaccine introduction in history.
“We are utilizing the opportunities to intensify our efforts to ensure full immunization of all children in the country. Every new vaccine introduction gives us the added opportunity of health system strengthening. As part of this introduction we have trained our health officials and frontline health workers”, Shri J P Nadda said.
The Health Minister thanked and congratulated all state governments and the supporting organizations like WHO, UNICEF and Rotary International etc. for partnering in this endeavour. He expressed his gratitude toward the frontline health workers for achieving unique success of polio eradication in the sphere of public health.
Smt. Poonam Khetrapal, Regional Director, SEARO (WHO) stated that launching IPV in India is a historic moment and will further cement India’s achievements on polio to date. She said it is necessary step to eradicate polio virus from the world. She also applauded the Government of India for its commitment to eradicate polio.
Mr. Michael McGovern, International PolioPlus Committee of Rotary International commended India for its success in keeping the country polio-free, and said that Rotary will always support the country’s polio eradication efforts. Rotarians across India played an essential role in stopping polio in India, and are making just as important a contribution to keeping the country polio-free.
Mr. Louis-Georges Arsenault, UNICEF Representative for India commended the strengthening of India’s immunization programme by introduction of IPV and termed this as a “monumental step”. He reiterated commitment and support of UNICEF in India’s immunization endeavors.
The Bill & Melinda Gates Foundation, Norway, and the United Kingdom are generously supporting the introduction of IPV in routine immunisation schedules in 72 Gavi-supported countries, while Canada is supporting its introduction in other lower-middle income countries. The top ten government donors to GPEI include the USA, the UK, Japan, Germany, Canada, the Netherlands, Norway and Australia.
The Global Polio Eradication Initiative (GPEI) is led by national governments and spearheaded by the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), and the United Nations Children’s Fund (UNICEF), with the support of the Bill & Melinda Gates Foundation.
Since its launch at the World Health Assembly in 1988, the GPEI has reduced the global incidence of polio by more than 99%. The GPEI receives financial support from governments of countries affected by polio; private sector foundations, donor governments, multilateral organizations, private individuals, humanitarian and nongovernmental organizations and corporate partners.
“Are we seeing [polio’s] last stand?” asks the Independent Monitoring Board in their latest report. With the tremendous progress achieved in 2012, they certainly aren’t the only ones asking that question.
The year ended with the fewest children paralyzed by polio, in the fewest places, in history. Just over 200 cases have been reported so far for 2012 – a greater than 60% reduction from 2011. Over the year, through the tireless dedication of the on-the-ground heroes of polio eradication, more than 2 billion doses of vaccine were distributed to 429 million children around the world. And too many of these heroes gave their lives to reach some of the most vulnerable children in the world with vaccine.
India success sparks an emergency to finish the job
The year began with a shake-up of the way the Global Polio Eradication Initiative (GPEI) was structured and does business. The partner organizations shifted into emergency mode from the get-go, looking to become faster, smarter and more innovative in getting the polio vaccine into the mouths of every last child. Accountability was a key focus across the board – from the heads of the spearheading partner organizations, down to the vaccinators in the field. And processes were put in place to ensure greater cooperation, not only between organizations, but between country-, regional- and head- offices.
This shift into emergency mode was formalised when the 194 Member States of the World Health Assembly, meeting in Geneva in May, declared the completion of polio eradication a “programmatic emergency for global public health”. This declaration announced that the global community was committed to ending this disease, and granted countries greater powers to prevent its spread.
Risk of international spread still real
Member States also called for the GPEI’s funding gap to be filled – something which has only just been achieved for 2012 with thanks to a number of traditional and new donors. Throughout the year, the increasing risk of a polio outbreak made many uneasy, as vaccination rounds were scaled back or cancelled as a result of this lack of funds, leaving more children needlessly vulnerable to polio in high-risk areas. The year closed with a new outbreak, in Niger – a reminder of the human cost of spreading poliovirus. If the funds can’t be raised to cover the costs of eradication and prevent further spread in 2013 and beyond, we run the risk of a polio resurgence. With so much progress made, there is all the more to lose.
Progress – and the path to success
A key factor in the progress in 2012 has been enhanced country ownership. All three remaining endemic countries – Nigeria, Pakistan and Afghanistan – implemented their own emergency action plans and introduced oversight mechanisms at the highest levels of government (such as the Presidential Task Force in Nigeria). The full force of administration was put into the effort – going beyond the health sector to a whole-of-society approach. This approach and intensity needs to be sustained to deliver ultimate success.
Strong commitment from the top levels of the Global Polio Eradication Initiative spearheading partners and unflinching support throughout the year from the UN Secretary-General, the UN Foundation and the Bill and Melinda Gates Foundation was critical to the progress seen in 2012.
In a historic display of solidarity at the UN General Assembly in September, leaders from around the world – including the heads of state from Afghanistan, Nigeria and Pakistan, donor government officials and new donors from the public and private sector – vowed to capitalize on progress achieved in 2012 and to step up the fight to eradicate polio. Days after, millions watched the web cast of a concert in New York’s Central Park to catalyze citizen action against polio.
Technical and programmatic innovation played a lead role in 2012, with GPS technology making a difference in ensuring that vaccination teams reach every child. The introduction of a direct disbursement mechanism in Pakistan ensured that health workers were paid directly and on time. Delegations from India to the remaining endemic countries helped transfer vital knowledge about micro-planning, accountability, strategies for special populations, and data collection.
All this paid off in more children being reached in the sanctuaries of the poliovirus. Nigeria was the only country which saw an increase in cases – and even there, more children were being reached with vaccine in the latter half of 2012 than in the first half.
Tremendous sacrifices are being made to reach these children. Polio workers in Pakistan and Afghanistan lost their lives this year while working to protect children against polio. In Pakistan, a unacceptable and horrifying series of attacks on health workers brought the year to a tragic close. Their loss highlights the dedication and bravery of those who risk their lives so that the children in their community live their lives free of polio. Parts of all three endemic countries remain off-limits at the end of the year, but through the ongoing negotiations of partners we continue to reach more and more children, including around 30,000 children living in the Tirah Valley of Pakistan who were vaccinated in 2012 for the first time in three years.
Eradication – and endgame
So what’s next? The partnership is working on distilling the lessons learned from 25 years of polio eradication, including from India’s successful programme, into a plan to end polio and make sure it stays ended. Known as the “Polio Eradication and EndGame Strategic Plan 2013-18”, it sets out a blueprint for ceasing the transmission of both wild poliovirus and vaccine-derived poliovirus, providing support for strengthening routine immunization coverage in key target countries, provides for the safe containment of any poliovirus in laboratories and lays out a roadmap to ensure that the infrastructure put in place to fight this disease can be used to support other health interventions and services. In a historic decision, the Strategic Advisory Group of Experts on immunization called for a globally synchronized withdrawal of type 2-containing OPV – necessitating a switch from tOPV to bOPV in routine immunization programs.
Now that India has laid to rest the argument about whether polio eradication is technically feasible, and new emergency approaches are showing impact, this is the time for everyone to double our efforts, including the international development community. Everything is in place to secure a polio-free world, but without the funds to do so it won’t happen. On one side of the balance, a world free of polio where no child will ever know the pain of polio paralysis, and US$50 billion in economic benefits; on the other, resurgence of the disease resulting in 200,000 cases every year, within 10 years. All countries will benefit equally from global success. Ensuring that success is a global responsibility.
7 December – A 24-member surgical team made up of Indian physicians, surgeons, and support volunteers – all Rotary members – are working with their Nigerian Rotary hosts to perform corrective surgeries on about 400 polio victims ages 14 and younger at two sites in the city of Abuja through Dec. 13.
India, once considered the epicenter of the disease, has gone nearly two years without a new case and was removed from the list of polio-endemic countries in February. The surgery project is the latest example of India exporting its best-practices to help the remaining polio-endemic countries: Nigeria, Pakistan, and Afghanistan. In addition to bettering the lives of polio victims, the surgeries also help build trust in the immunization program so that more parents ensure their children to receive the oral polio vaccine. In India, the approach helped increase the numbers of parents seeking vaccination for their children.
While Nigeria is the only country to record more polio cases this year than last, its implementation of an aggressive national emergency action plan is showing positive results with more children receiving vaccinations. The November report of the polio initiative’s Independent Monitoring Board says Nigeria “may be on the brink of a breakthrough” against the virus.
To date, Rotary members worldwide have contributed nearly $1.2 billion to the polio eradication effort, including $75 million over three years announced in September during a special breakout session of the United Nations General Assembly. Currently, Rotary is ramping up its advocacy work in the 200 countries and regions where Rotary clubs exist to encourage every national government to commit to the funding levels needed to close a $700 million funding gap that could severely set back the entire global eradication program.
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18 September 2012 – Indian cricket sensations Virender Sehwag , Suresh Raina, Harbhajan Singh and Rohit Sharma, today met with Afghanistan captain Nowroz Mangal, and his Afghanistan team mates Mohammad Shahzad, Karim Sadeq and Mohammad Ashghar Stanikzai, to exchange cricket bats signed by both national Twenty20 teams. The bats were exchanged as symbols of both countries’ commitment to end polio once and for all. On the teams’ return to their home countries, UNICEF will present the bats to the Governments of Afghanistan and India to underline cricket’s support in the fight against polio. More
1 March 2012 – It was a much-anticipated moment. Weeks after India marked 12 months in which no Indian child had been paralyzed by polio, the World Health Organization notified the national authorities on 25 February that India was officially removed from the list of countries with active transmission of endemic polio. India’s success leaves only three countries remaining polio-endemic – meaning they have never stopped indigenous wild poliovirus transmission: Afghanistan, Nigeria and Pakistan.
As samples from the past year cleared laboratory tests with no sign of wild poliovirus, the data published by WHO today shows – for the first time in history – that there is no polio in India.
The official announcement was made last weekend at the Polio Summit 2012 in New Delhi. A letter written by WHO Director-General Dr Margaret Chan and delivered to the Indian Government on the morning of the Polio Summit confirmed the news.
Prime Minister Manmohan Singh confirmed India´s commitment to continuing to protect its children from possible re-importations of the poliovirus and to strengthening its routine immunization programme. The Prime Minister noted that India´s success proved the viability of global polio eradication: “This gives us hope that we can finally eradicate polio not only from India but from the face of the entire mother earth.”
Amidst thundering applause and a standing ovation by the 1400-plus participants from across the world, India’s Health Minister, Ghulam Nabi Azad, said: “We have won the battle but the war is not yet over. Let us today rededicate ourselves and resolve that we will continue our efforts with the same vigour, so that India can be declared (certified) polio-free by 2014.”
The Prime Minister said that the success of India’s efforts was proof that teamwork pays, adding that the Union and State Governments have worked in close partnership with many community, national and international organizations and partners including Rotary International, World Health Organization, UNICEF and the US Centers for Disease Control and Prevention to eradicate polio.
“The real credit goes to the 2.3 million volunteers who repeatedly vaccinated children even in the most remote areas, often in very bad weather conditions,” the Prime Minister said. “I commend each one of them for their dedication, commitment and selfless service.”
Mr Azad said that since its launch in 1995, the polio eradication programme had made a tremendous effort to reach virtually every child in India. In recent years, as a result, the coverage in polio immunization rounds in the two traditionally endemic states – Uttar Pradesh and Bihar – had crossed 99 per cent. “This level of coverage is unprecedented – not witnessed anywhere in the world on such a large scale,” he said.
Mr Azad attributed the milestone to the strong will and determination of the Government, which ensured there was never any shortage of resources or funds for the programme, the willingness to introduce innovations that delivered rich dividends, the unprecedented scale of the effort to reach every last child, and the preparedness to launch aggressive responses to wild poliovirus cases. The Minister also recognized the tireless efforts of the frontline workers and the patient faith reposed by parents of 174 million children in the polio programme to secure the health of their children.
The Health Minister lauded the strong and effective polio partnership – with Rotary International at the forefront of espousing polio eradication, WHO setting new standards in surveillance and UNICEF helping prove that it is possible to overcome fears and resistance with highly imaginative communication and advocacy strategies.
However, the Minister said the Indian Government was “acutely aware” that it could not drop its guard. “We are excited and hopeful, at the same time, vigilant and alert. We are highly mindful of the risks that persist, not only on account of residual indigenous transmission but also from other countries.”
Stressing that “there is no room for complacency”, Mr Azad said the programme needs to continue with “full force” until polio was eradicated globally.
The two-day Polio Summit was organised by Rotary International in conjunction with the Government of India to commemorate India’s trailblazing effort, focus on the remaining risks and determine the way forward. The Union Ministers of State for Health and Family Welfare, Mr Sudip Bandyopadhyay and Mr S Gandhiselvan; Rotary International President Mr Kalyan Banerjee and The Rotary Foundation Chairman Mr. William Boyd joined senior health officials from Pakistan, Nigeria, Sri Lanka and Nepal, various Indian states, Principal Secretaries, Mission Directors of the National Rural Health Mission, State Immunization Officers, heads and representatives of key partner organisations, together with representatives of the huge polio workforce – the frontline workers, medical officers and community mobilisers, at the Summit.
The Summit deliberated on how to build synergies to ensure that the present momentum against polio is maintained until the disease is eradicated. It provided a platform for all the key players in the end game strategy for polio eradication – government, partners, donors and frontline workers – to renew and reinforce their commitment to eradicate polio in India.
23 January 2012 – In 2009, a short documentary was released that highlighted the dedication and perseverance of India’s four-million-strong army of polio eradication warriors – ‘The Final Inch’. Three years on, the country has not seen a case of polio in more than twelve months. Looking back on ‘The Final Inch’ provides a glimpse of what it took to achieve such remarkable progress.
Over 38 minutes, the film charts the stories of those overseeing the operation from Delhi and abroad, vaccinators and social mobilizers working at the grassroots and those who survived the United States’ mass polio epidemics of the 1950s. Local health workers are the stars of the film, calmly dealing with the queries and objections of concerned parents and communities. The documentary provides insights into the challenges faced by the Global Polio Eradication Initiative (GPEI), in India and elsewhere, and emphasizes that, in the end, trust will play a large role in whether the GPEI will succeed.
The efforts of those featured in the film, and millions just like them, are responsible for India’s success, and their efforts will continue until the country can be sure that is free from the threat of polio. ‘The Final Inch’, directed by Irene Taylor Brodsky, was recognized with a nomination for the 2009 Academy Awards. With the passing of a year since the country saw its most recent case, perhaps this non-violent army deserves similar recognition.
Global polio eradication partners today congratulated India for passing a year without polio, for the first time in history.
Central and state governments led this extraordinary achievement, with the energy and dedication of millions of vaccinators, Rotarians and community mobilizers and the support of religious and local leaders. The polio eradication effort is the most widely-recognized brand in India, with a Bollywood megastar as its public face.
If all pending laboratory investigations return negative, in the coming weeks India will officially be deemed to have stopped transmission of indigenous wild poliovirus (WPV). The number of polio-endemic countries, those which have never stopped indigenous WPV transmission, will then be reduced to a historical low of three: Pakistan, Afghanistan and Nigeria.
India was once recognized as the world’s epicentre of polio. As recently as 2009, India had the highest burden of polio cases in the world (741), more than the three other endemic countries combined. Due to extraordinary measures to reach children with vaccine, India has not seen a case since a 2-year-old girl in the state of West Bengal developed paralysis on 13 January 2011.
The greatest risk in India is now complacency. The country has an aggressive agenda to strengthen routine immunization and maintain supplementary activities in order to maintain high immunity. In addition, sensitive surveillance and emergency response plans are in place in every state to detect and swiftly respond to importations until eradication is achieved globally.
MUMBAI, India, – Lauding India’s unprecedented progress against polio, UNICEF Goodwill Ambassador for Polio Eradication, Mr Amitabh Bachchan, today launched the new Communication Campaign for polio, appealing to parents and caregivers to take advantage of this rare opportunity to “make polio history in India”.
“As Goodwill Ambassador for Polio, I feel proud of the remarkable progress achieved this year. But at the same time, I would like to caution that the job is not finished yet. Polio remains a threat everywhere as long as the poliovirus continues to circulate anywhere in the world. We must continue to immunize all children up to 5 years until polio is eradicated in India and globally,” he said.
Mr Bachchan, who has been persuading and motivating parents to take their children to the polio booths in his nearly decade-long association with the programme as UNICEF Goodwill Ambassador, continues to be the face of the new polio campaign.
The new campaign puts the onus on the parents to seek protection against polio for their children with the tag line “mere bachche ko do boond har bar” and the new logo, depicting a couple and a child taking two drops of oral polio vaccine (OPV).
25-year-old Geeta, a mother of three, has her priority clear – making 300 bricks a day. “I don’t have time to even think of taking my children to the Aganwadi centre for routine immunization,” she admits.
Hundreds of such mothers work in brick kilns in Bihar, northern India; coming from far-away states like Assam, Jharkhand, West Bengal and Andhra Pradesh in search of a livelihood. Most of them are unskilled labourers and keep migrating from one place to another. As a result, their children often miss immunization, including polio.
With increased focus on migrants, UNICEF initiated efforts to generate awareness on polio among brick kiln workers. One way was through getting polio messages painted on brick kiln chimneys. The message was clear and simple – Polio-free India, two drops of protection, every child every time.
“Mobilizing brick kiln owners for getting polio messages painted on chimneys was tough,” says UNICEF’s community mobilizer Mohammad Mannan Alam who works in Araria district of Bihar. “Through our persistent efforts, we convinced them and now they whole-heartedly support the programme,” he says with a broad smile on his face.
It is encouraging that brick kiln owners have come forward in the fight against polio. “We can eradicate polio from Bihar, but everybody has to pitch in”, asserts Ravindra Singh, owner of Kanchan brick kiln in Maner block, Patna. “I am fully committed to the campaign and am happy to have the polio message painted on the chimney of my brick kiln,” he says. Brick kiln workers are happy with the developments. “Every time I look up, it reminds me of getting my child polio vaccine every time it is offered,” says Sunita, a mother working at Hero Brick kiln in Patna, Bihar.
When the mobile teams of polio vaccinators visit brick kilns, the chimneys are a reminder that this dose of oral polio vaccine (OPV) and the subsequent doses are extremely important for every child up to five years to protect against the disease, which cripples for life, has no cure, but can be prevented by taking OPV each time it is offered.</p.
The migrants working in brick kilns are among the highest risk populations for polio. Special interventions are made to track them, counsel them, to ensure they are covered during each polio campaign and also to study their migration patterns for interventions in their home states.
In August 2011, he and a delegation of US Congressional Staff Members travelled to India to gain a first-hand perspective on the country’s polio eradication efforts and related public health advances and challenges. Together with the Government of India and other partners, the United States has been a major supporter of polio eradication efforts since the World Health Assembly resolution launched the Global Polio Eradication Initiative in 1988.
“India has made remarkable progress that has brought the country to the verge of polio eradication,” Dr Frieden said. He also cautioned against complacency and called for maintaining high-quality vaccination efforts and sensitive surveillance systems.
Global immunization activities are a critical part of CDC’s support to ministries of health around the world. During his visit to India, Dr Frieden met with the Minister of Health and senior officials of the Indian Ministry of Health and Family Welfare, CDC, WHO, and other partners. In addition, he made a field visit to Ghaziabad, a district at high risk for polio in the state of Uttar Pradesh, to observe activities in the field. He was accompanied by the Congressional Staffers; staff members from WHO, and UNICEF; and Mr. Deepak Kapur, Chairman of Rotary International’s National PolioPlus Committee in India.
Dr Frieden visited a shantytown in Ghaziabad, where he observed polio vaccination efforts among a colony of migrant garbage sorters. He also visited a nearby construction site and met with migrant laborers and their family members from different polio-endemic and recently infected Indian states. Later, as part of his assessment of the Acute Flaccid Paralysis (AFP) surveillance system, he examined a patient with newly diagnosed AFP to rule out polio. Finally, he visited a local primary health care centre, where he and the visitors met district and local medical officers, vaccinators, and community workers and observed vaccine storage and use. Wherever the CDC Director went, local polio vaccination teams, field supervisors, and community mobilizers were eager to meet and talk with him about polio eradication.
Later in the day, Dr Frieden met with Dr Poonam Singh, Deputy Regional Director, WHO/SEARO, and Dr Nata Menabde, WHO Representative, India. In those meetings, Dr Frieden reiterated CDC’s strong commitment to polio eradication and his great appreciation of the productive enduring partnership between CDC and WHO. Recognizing the risks to polio eradication and the need to strengthen routine immunization in India, Dr Frieden reaffirmed that CDC will continue to support the WHO National Polio Surveillance Project and other shared public health priorities of both agencies in India, including control of tuberculosis, tobacco use, and noncommunicable diseases.
The community leaders, or ‘Hardos’, among the Fulani people in Katsina State, Nigeria, have come together under the Myetti Allah organization to help the GPEI vaccinate the hardest-to-reach children against polio, with spectacular success.
The Myetti Allah organization, led by the Hardos, is devoted to the development of the Fulani people and the protection of their unique cultural heritage. The Fulani ethnic group are a traditionally nomadic people, although many have now joined static settlements. Tracking those who are on the move or who have very recently settled can be difficult for vaccination teams. This is where the knowledge of the Hardos is invaluable.
Earlier this year, the community leaders were invited to attend meetings held in three senatorial zones of Katsina in order to facilitate an exchange of ideas. The Hardos were provided with information about polio and vaccination, and the GPEI was provided with information on the local situation. The meetings resulted in the mapping of common routes of travel for the nomadic people and many of the Hardos agreed to help spread the polio eradication message within their communities.
Since the meetings were held, a substantial increase in the number of children vaccinated is already being seen. In the Safana local government area, for example, nearly 10,000 more children were immunized in May compared to January.
Stories such as this abound across Nigeria as the partner agencies of the GPEI engage with community leaders. This exchange of ideas allows community leaders to share their knowledge and provide local solutions to local problems. Local communities and their leaders have an important role to play in the effort to eradicate polio, and it is crucial that they are allowed to take ownership of the programme’s implementation.
An aggressive strategy to ensure the cessation of polio transmission was decided upon by the Indian Expert Advisory Group (IEAG) at their meeting on 13-14 July. The Government of India requested the group to provide recommendations on how to consolidate the gains towards interrupting poliovirus transmission and ensure that the job is finished. After reviewing recent supplementary immunization activities (SIAs) and surveillance data, the IEAG agreed on a set of measures designed to ensure that no polio cases are overlooked and no children are missed by vaccinators.
Each state has been called upon to produce a detailed risk analysis and an emergency plan to deal with any new cases, in line with recommendations from the Independent Monitoring Board’s most recent report. These risk analyses will also guide nation-wide planning – shining a light on any surveillance gaps and allowing supplementary immunization activities to focus on areas with gaps in immunity. Serosurveys will be conducted in the highest risk areas in August to provide definitive information on immunity status in the areas posing the greatest risks and ensure that any immunity gaps are filled. Further measures suggested by the IEAG include an aggressive schedule of SIAs running clear into the first half of 2012.
The IEAG also called upon the Government of India to expand surveillance. Plans to expand environmental surveillance into Kolkata, West Bengal will be completed by end 2011 with further expansion in other high risk states recommended for 2012. Reviews of surveillance quality will continue, with the focus on improving sensitivity among migrant populations.
The Government of India pledged its ongoing support at the IEAG meeting and vowed to do whatever it takes to finish off the virus. This support will be crucial as India now heads into the high season for polio transmission. Several religious festivals will also be held in the coming months, leading to high levels of population movement and creating the potential for the disease to spread. The IEAG and the Government of India are working hard to put the plans in place to deal with any new cases and put a stop to polio transmission in India for good.
West Bengal Chief Minister Mamata Banerjee called upon parents and caregivers across the state to ensure that they immunize their children against polio in a week-long immunization campaign starting on 24 June and in all ensuing polio immunization campaigns, and help eradicate the crippling disease once and for all from West Bengal.
“We have to take the vaccine so that there are no cases of polio – we have to eradicate the virus from wherever it is in existence,” Ms Banerjee said, moments before undertaking what she called “the proud privilege” of immunizing four children with oral polio vaccine in front of the State’s media at the Writer’s Building. West Bengal is the only state with poliovirus transmission in India this year.
Ms Banerjee called upon the state’s health workers and parents to take the oath that they would vaccinate their children “in every inch” of the state. “The children are the future of this country. Today we are thinking of our kids and they will have the Polio Plus. We want to see that all those kids are healthy.”
Principal Secretary for Ministry of Health and Additional Chief Secretary Dr Manabendra Nath Roy said he expected Ms Banerjee’s public immunization would give “a big boost so that we can mobilize each and every child to be immunized”.
WHO National Polio Surveillance Project Acting Project Manager Dr Sunil Bahl said all of India – and indeed the world – was looking to West Bengal to finish the job of polio eradication. “We are indeed grateful to you,” Dr Bahl told Ms Banerjee. “We are looking forward to the great boost that this is going to give to the polio eradication programme. The whole country – in fact, the whole world is looking to West Bengal and the whole world hopes that under your leadership that this virus is going to be eradicated from the country.”
UNICEF Chief Field Officer Edouard Beigbeder underlined the remarkable achievement of India falling from 741 cases two years ago to just one solitary case this year: “And naturally we need to go down to zero – to ensure that this disease is only a memory”.
Incoming Rotary International Director of West Bengal, Mr Shekhar Mehta, said that the Chief Minister’s support was “unprecedented”. “This is a big boost for us,” he said.
1 June 2011 – Nigeria has nearly tripled the proportion of children covered by routine immunization between 2006 to 2010, according to a new national study. The increase took place against the backdrop of aggressive supplementary immunization campaigns to eradicate polio.
The results of the National Immunization Coverage Survey (NICS), conducted in October 2010, indicate that 52% of Nigerian children aged 12-23 months are reported to be fully immunized, compared with just 18% in 2006. In 2003, when the first baseline study was undertaken, the corresponding figure stood at just 13%.
The study results clearly demonstrate how routine immunization services can be improved in a polio-endemic country even during frequent supplementary immunization rounds. In Nigeria, these mutually beneficial results are due to the strong leadership of Nigeria’s National Primary Health Care Development Agency (NPHCDA).
The results come at a critical time in the efforts to eradicate polio from Nigeria, with just 21 cases of the paralytic disease recorded in 2010 and eight in the first quarter of 2011 – the lowest number of cases ever-recorded. Global health leaders at the World Health Assembly in May 2011 acknowledged these gains.
The survey demonstrates that coverage of routine immunization contributes to the interruption of poliovirus as well as the sustained protection of children against other vaccine-preventable diseases. In individual states and zonal areas of southern Nigeria (in Nigeria’s administrative structure, several states form a ‘zone’) where delivery of routine immunization services is strongest, transmission of poliovirus has been stopped. In northern states, where coverage is lower, polio continues to paralyse children. In 2010, more than 50% of children paralysed by wild poliovirus had never received a dose of polio vaccine despite intensified efforts.
NPHCDA supported state and local government authorities to implement the approach known as ‘Reaching Every Ward’, which facilitates comprehensive coverage. Polio campaigns are used to disseminate key messages about routine immunization. In several states, polio campaign micro-plans – the detailed plans which drill down to the individual home level to ensure all children are vaccinated – have been adapted to support delivery of routine immunization services. Task Forces that support implementation of polio eradication activities in the highest-risk States and Local Government Areas include strengthening of routine immunization in their terms of reference: this too has contributed to the progress being registered
The NICS aims to estimate the levels of immunization coverage at national, regional and state levels. The survey is regarded by the Nigerian Government and international partners as the most accurate measure of routine immunization services, providing important insights into community and individual attitudes towards immunization.
More than 19,000 households in selected settlements of every state were visited in October 2010 by trained representatives of an independent research company. Coverage was determined by vaccination card and the child’s history as recounted by the family at 52 weeks of age.
Coverage of DPT3 – a measurement of the number of children who are fully protected against three killer diseases Diphtheria, Pertussis and Tetanus and the most common measurement of basic routine services – increased nationally from 25% in 2006 to 68% in the 2010 study. Advances were recorded in all regions of the country.
This progress in Nigeria is tempered by the survey finding that almost one in four children do not receive any routine immunization. The country’s ability to bring this figure down will determine whether or not Nigeria can interrupt polio and deliver on its pledge to meet health-related Millennium Development Goals by 2015.
In collaboration with the Netherlands Vaccine Institute (NVI), and more recently the National Institute for Public Health and the Environment (RIVM) in the Netherlands, clinical lots of inactivated polio vaccine (IPV) produced from Sabin poliovirus seed-strains have been prepared. Traditional IPV is manufactured using wild poliovirus and an inadvertent biocontainment failure could be associated with serious consequences in some areas of the world in the post-eradication era (ie areas with high population density, inadequate sanitation infrastructure and low population immunity levels). Sabin seed strains for IPV have the advantage over wild polioviruses that they are attenuated, and hence are safer for handling and IPV production in developing country settings in the post-eradication era.
In this first phase of a broader intended technology transfer programme, two manufacturers have been selected to receive this new technology for vaccine production: Panacea Biotech, Ltd in India, and LG Life Sciences, Ltd in the Republic of Korea. Both manufacturers have confirmed their intention to use all reasonable efforts to apply for registration of their Sabin IPV products in the country of production within four years from the dates of conclusions of the bilateral agreement with RIVM. WHO and RIVM will continue the technology transfer programme this year with further manufacturers.
This transfer of technology is a significant milestone in preparations for the polio post-eradication era. Following the eradication of wild poliovirus globally, use of all oral polio vaccine (OPV) in routine immunization programmes will need to be stopped due to the risks associated with the continued administration, in the post-eradication era, of the live (attenuated, but not inactivated) polioviruses contained in OPV. These risks include vaccine-associated paralytic polio and the generation of new, circulating vaccine-derived polioviruses. Therefore, after the eradication of all wild polioviruses, and the eventual cessation of OPV for use in routine immunization programmes, any country choosing to continue to immunize its population against polio will need to do so with IPV, the only option which will be available to do so at that time.
Recognizing that the manufacturing costs and price of IPV are currently substantially higher than that for OPV, the Global Polio Eradication Initiative (GPEI) is studying a range of approaches to establish affordable strategies for IPV use in low-income settings following OPV cessation. The development, manufacture and distribution of a safe, effective and affordable Sabin IPV that can be produced securely in developing country settings is a key landmark in this programme of work. This technology transfer will also help to boost more broadly the domestic production capacity for vaccines and the strengthening public of health systems to ensure more equitable access to vaccines.
The development of Sabin IPV and the related technology transfer work has been generously supported by the Bill & Melinda Gates Foundation.
The GPEI is spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF. Since 1988 (the year the GPEI was launched), the incidence of polio has been reduced by more than 99%. In 1988, more than 350,000 children were paralysed each year in more than 125 endemic countries. In 2010, 1,291 cases were reported worldwide, from 20 countries. Only four countries remain endemic: Afghanistan, India, Nigeria and Pakistan.
17 May, N’djamena – In three districts of Eastern Chad with recent polio cases, UNICEF organized community fora on 9 and 10 May. The fora in Biltine, Guéréda and Am Dam brought together all local authorities, religious leaders, women and youth groups, as well as other influential personalities, to reinforce social mobilization against the disease, which is dangerously spreading through the country.
The fora provided a space for open dialogue on the epidemic and the obstacles to polio eradication. This kind of engagement is not merely about convincing parents to vaccinate their children, but is an opportunity to source local solutions to local problems. For example, micro-plans to reach every child were developed with all the operational heads of villages and ferricks, and the representatives of nomads. These fora also provided the opportunity to refute previous immunization coverage figures that were reportedly well above 100% – many villages and ferricks identified during the fora were never vaccinated. More