Three years ago, on Jan. 13, 2011, Rukhsar Khatun, then 15 months old, was diagnosed with polio. She now has a crippled leg and struggles to keep up with her friends.
This little girl, from a West Bengali village, can claim some fame, however: She is, with luck, the last Indian ever to be infected with the wild polio virus. Enough time has passed with no new cases that India shortly will be certified as free of the scourge.
That is a big success. India’s anti-polio campaign began in 1995 with severe disadvantages. The country spends little on public health, barely one per cent of GDP, and has been awful at immunizing children. Too few parents know the basics of hygiene and nutrition, let alone the benefits of vaccines. India has bad sanitation, large remote populations and vast migration from village to slum.
Nonetheless, much has gone right. The anti-polio campaign received more than $3 billion, mostly from within India itself, and deployed 2.4 million vaccinators. UNICEF, the World Health Organization, Rotary International and the Gates Foundation gave technical help. Religious leaders reassured people suspicious about vaccinations, and politicians knocked on doors to make sure that children took their medicine.
At the peak of coverage, 99.7 per cent of the target population swallowed anti-polio drops, says Anuradha Gupta of the national health ministry. That is startlingly high, considering that a decade ago “universal” vaccination coverage for seven preventable diseases such as diphtheria, tetanus and hepatitis B was a pitiful 30 per cent in Bihar, a big, poor state in northern India.
India’s campaign has been successful enough for its lessons to be applied in Afghanistan, Nigeria and Pakistan, the last places with endemic polio — though foreign fighters may have reintroduced it to Syria.
Vaccinators learned to attend especially to mobile populations, such as seasonal workers at brick kilns, and found that many migrants are best reached in bus and railway stations.
Good monitoring also was crucial. In Uttar Pradesh and Bihar, vaccinators visited 60 million households several times a year, says Hamid Jafari of the WHO. To compile data on recipients, some 400,000 hard-to-reach population groups were tracked and plotted, down to each household. Data passed early to decision-makers, at the district-official level, allowed a quick response to new cases.
India now looks more capable of fighting deadlier diseases. By 2020 it plans to eradicate measles, which killed 66,000 children in 2010, half the world total. In the past three years 140 million children have been injected with extra doses of measles vaccine, so the toll should fall. Universal vaccination is rising too. In Bihar it has reached 70 per cent, and Gupta suggests it is more than 78 per cent nationally.
The next step is to give the army of vaccinators more tasks. A vaccine is being developed against diarrhea, which is responsible for the deaths of many of the 1.4 million Indian infants and toddlers who still die every year.
The vaccinators also could lead a planned campaign on hygiene and nutrition. A screening program, launched in 2012, involves 5,000 mobile health centers. These have diagnosed 700,000 children with one of 30 common medical conditions and treated, so far, 100,000 of them.
Spreading education, as well as care, would bring greater success yet.