We’ve beaten polio, but let’s move on

January 13, 2016, is a momentous date. It marks five years since the last reported wild polio case in India. This achievement led to the entire South-East Asia region of WHO being certified polio-free on March 27, 2014. With a densely-concentrated population of more than one billion people, migrant populations, and vaccine acceptance and poor sanitation presenting exceptional challenges, India was once considered the most difficult place to end polio. Yet, the country overcame the challenges.

The success is the result of remarkable commitment at all levels, from the highest echelons of the Centre, and the State governments, to the heroic 2.3 million vaccinators delivering polio drops, to mobilising and reaching every child up to five years of age.

High-quality data generated from poliovirus surveillance with the support of WHO’s National Polio Surveillance Programme, community mobilisation, performance monitoring along with seamless partnership between the Indian government and international partners (WHO, Unicef and Rotary International) made this success possible.

But the task is not yet over, and we cannot be complacent. The virus is lurking in our neighbourhood and there is danger of its sneaking back in. India is maintaining a tight vigil and continues to safeguard the gains by sustaining high population immunity and preparing for the polio endgame strategy.

So, what are the lessons and how can we leverage what we have learnt? India is utilising the polio lessons to achieve improved health and equity, with the overall objective of reaching universal health coverage in the country.

The infrastructure and innovations that helped India achieve polio-free status are now being used to strengthen routine immunisation (RI) as well as the global goal of measles elimination and rubella control. The polio network is helping to increase awareness and build demand for routine immunisation, development of microplans, monitoring immunisation sessions and tackling dropouts.

The network has supported the monitoring of indoor residual spray activities in the kala azar endemic districts of the country and played a key role in the validation of maternal and neonatal tetanus elimination. It has the capacity for surveillance of other diseases as well. The surveillance expertise was well-utilised in fighting back ebola in West Africa.

Mission Indradhanush, launched by the Indian government in 2015, exemplifies the polio legacy in action. This equity-based programme builds on polio strategies, tools, techniques and manpower to focus specific attention on the 400,000 high-risk pockets such as slum dwellers, nomadic populations and migrant families living in brick kilns and construction sites identified by the polio programme. These areas are characterised by low coverage, insufficient health services, recent measles and diphtheria outbreaks, and high dropout rates from the immunisation programme. They are now the focus of intensive efforts to improve the routine immunisation coverage in the country.

The initiative uses special strategies to access these high risk, hard-to-reach and underserved communities, including robust social mobilisation and engagement of community leaders. The polio programme and Mission Indradhanush, have the highest levels of political commitment, and senior policymakers are personally involved. This is at the core of the success of both the programmes. To strengthen the health system for sustainable development of other priority programmes and wider health goals, WHO India is broadening its work by transitioning its knowledge, lessons and assets.

Examples of this include intensification of routine immunisation as part of the overall health system strengthening, introduction of new and underutilised vaccines in the country, surveillance for other vaccine preventable diseases using polio surveillance as a platform, and measles elimination and rubella control. This will include mainstreaming critical polio eradication functions into other priority health programmes on the one hand and transitioning certain polio functional areas to government counterparts on the other.

At present, the entire world is looking at India’s inspiring public health achievements of polio eradication and validation of maternal and neonatal tetanus elimination. We have to ensure that the polio learnings and expertise are optimally leveraged to further strengthen public health systems, enhance capacity, and improve programme service delivery for equitable access to immunisation services, They should reach the most marginalised with a wide range of health interventions.

The writer is the WHO representative in India

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