Recently, India was declared
Polio-free by the United Nations World Health Organization after three years of
no case of the disease being reported in the country. India, once
considered the core of the world polio problem, is now free of the highly
contagious virus. This achievement, considering the poverty, sanitation and
population of the country is no small feat and has set an example for rest of
the countries that are still plagued by the disease namely Pakistan,
Afghanistan and Nigeria.
For a country to be declared polio free it
should have at least three years
of zero polio cases and it means that the virus has died in the
environment and new cases, if any, would be caused by infection in another
country where infection persists.
Since the launch of UN Global Polio Eradication
Program in 1988, the cases of polio in India have dropped from 150,000 to NIL.
It has taken close to 25 years to reach this far and it has not been easy.
India is a vast country and awareness and education are dismal in rural areas.
There has been intense criticism from those who couldn't see a solution to the
situation considering all the limitations that surround.
But India has proven everyone wrong.
"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. "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.
How the nation defeated
polio?
The oral polio vaccine was introduced in India
in 1978 and in 1985 Rotary International launched its global effort to end
polio. India was a signatory to the 1988 WHO treaty committing participating
nations to be part of that effort. In 1995, the government started organising annual national immunization days and
in 1997, India established the National Polio Surveillance Project. In 1999, it
set up an expert advisory group that monitored the program and provided
continuous evaluation of how the disease was behaving around the country.
All these efforts showed results. By 2009, 741
cases of polio were reported in India. By 2010 that number dropped to 42, and
by 2011 only one case - as of today, India's last - was reported in the entire
country.
Because of its exceptional success, the National Polio Surveillance Project has
become India's most extensive public-health surveillance system. There
are about 27,000 reporting units across the country, being operated through a
combination of funding from the government, WHO, UNICEF, the Bill & Melinda
Gates Foundation and the CDC, along with other groups. India is also now one of
the world's biggest donors to global polio eradication, pouring billions of
dollars into curbing the disease in the home land and also lending its well-
achieved expertise to Pakistan, Afghanistan and Nigeria, where the virus is
still yet to be conquered.
Till today, India has spent over Rs 12000
crores on the Pulse Polio Programme. The program has been in the forefront of adopting technological
innovations. The more successful monovalent oral polio vaccines
were introduced in the Pulse Polio campaigns in 2005 which helped inhibit the
most dangerous type 1 polio strains to record low levels by 2009.
In 2010 the bivalent oral polio vaccine was
introduced which helped curtail both Type 1 and Type 3 polioviruses
simultaneously and as efficiently as the monovalent oral vaccines. India took a
lead in introducing bivalent polio vaccine in January 2010. Despite global
shortage of both bOPV and trivalent Polio vaccine, India readied the
domestic supply machinery for timely delivery of vaccine to ensure pulse polio
rounds without interruptions.
There have been strategies and quick program responses that have
been followed in the past few years which have contributed a lot in the final
polio eradication efforts. As per the Advisory Group on Polio Eradication,
every case, anywhere in the country is being responded to as a public health
emergency. The only case of polio in 2011 in Howrah is an example of rapid
response - with the first immunization round being held within seven days and
three rounds in seven weeks of it being reported. In contrast, a case the same
time in 2010 in Murshidabad saw the first immunization response in five weeks
and three rounds spread over 17 weeks. The rapid and intense response in Howrah
helped stop polio transmission and no other case was reported. This has shown
that an immediate reaction to the problem is crucial.
Besides helping the struggling nations with funding and strategic
help to bring them the same public health success, the wisdom that the country has gained during the long years of hard work
will help design the future health programs. Infectious diseases like
tuberculosis will benefit hugely from the kind of political will and national
coordination that the government has shown in fighting polio. The
infrastructure of the national surveillance project is already being used to
deliver other health services to people living in hard-to-reach parts of the
country.
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