No child got affected by wild polio virus last year in India; the last reported case of polio was a two year old girl child from West Bengal on 13 January 2011. India is now said to be out of the list of polio endemic countries in the world. In the year 1988, the World Health Organization launched polio eradication initiative to eradicate polio from the world. During the same period, 1000 children used to get affected by polio everyday- half of them were from India. India has begun mass vaccination campaign from 1995. In 2009, India reported 741cases, 42 in 2010 and 1 case in 2011. To achieve this status, 172 million children were immunized by 2.3 million vaccinators through massive campaigns at consistent intervals.
Consistent global advocacy from WHO, UNICEF and Rotary International were successful in bringing in the commitment of Government of India which has consistently announced the share in the yearly budget for polio eradication initiative., Two billion US dollar had been financed by the Indian Government. , In addition to the same amount spent by of USA, Rotary International and BMGF donated one billion each.
Though the initial efforts were aimed at reaching above status a decade earlier, mere implementation of strategies that proved successful elsewhere, did not work in a complex context like India. The complexity of context in India in areas of health delivery system, health governance, hurdles in community participation, supply chain management, poor sanitation, and interfering factors in vaccine uptake posed numerous challenges to the programme.
There was criticism from many in India saying that polio eradication initiative has been getting undue attention neglecting other health priorities. The criticism also voices the concern that India is in a situation of double burden of diseases. Many Communicable diseases like Tuberculosis Malaria and measles are still major concern while incidence of non communicable diseases which need chronic care are also on the rise and needs health system attention.
The vertical disease control programs do have inbuilt negative externalities of affecting the health system functioning. It may put pressure and affect regular health service delivery while at the same time; they also come with positive externalities. As part of this, the polio eradication program in India drew the health system’s attention to maintain the good cold chain system, equipments and training throughout the country that contributed to improving quality vaccine delivery for other antigens of the universal immunization program. Large scale polio campaigns also brought community awareness to other vaccines resulting in community demand for vaccination.
I got an opportunity to witness the measles catch up campaign last week in Rajasthan where the campaigns were planned from the lessons learnt from polio campaigns and community mobilization was being encashed from the set mode of community participation from polio campaigns. Measles injections being administered to children between the age groups of 9 months to 10 years, The micro plans are in place with the details vaccination sites, Vaccinators, mobilizers, beneficiaries and logistics etc. This catch up campaign for such wide age range of children (20% population) will be conducted only once in the lifetime of the district, one time strategy later will be followed up by routine vaccination and follow up campaigns after 3 to 5 years. Unlike polio vaccine which is administered orally we need, vaccinators who can give injections for the children in measles campaign, In Sawai Madhopur in addition to ANM’s from the health sector, general nurses from private, who are already involved in routine immunization on contract basis under NRHM been taken for the campaigns. Campaigns are school based first followed by the community or Anganwadi centers and span upto three weeks.
Parents bringing their children for measles campaign at Sawai madhopur
In the era of National Rural Health Mission and thrust on health system strengthening, future vertical programs need to have components of health system strengthening which will contribute to the general health systems functioning and strategic integration of the programs.
The role of a robust and strengthened health system, high quality routine immunization and a good surveillance system are crucial in sustaining the success of last year of polio and reach the goal of eradication soon.
