For decades, public health officials expected India to be the last country in the world to stop the potentially life-threatening and disabling disease of polio. After 23 arduous years of nationwide campaigns led by legions of volunteers and healthcare workers who immunised millions of children against polio in the far reaches of the country, India has defied these bleak expectations.
The last poliovirus case was reported in Howrah district, West Bengal, in 2011, and three years later, India was officially certified polio-free as part of the South-East Asia Region of the World Health Organization (WHO).
This year marks a decade of a polio-free India - one of the country's most profound public health achievements to date.
India's Journey to End Polio: A Battle of Sheer Scale
A hard-won fight of epic proportions, the effort to end polio in India was beset with overwhelming challenges. From misinformation and myths about the polio vaccine to high population density, poor sanitation, and inaccessible terrains, the country overcame what many considered impossible. As recently as 2009, India was a polio hotspot, accounting for more than 60% of all polio cases in the world.
Yet, India responded with resilience, launching one of the largest and most comprehensive vaccination campaigns in history. Through the pulse polio immunisation programme, the government of India conducted multiple rounds of national immunisation days (NIDs) and sub-national immunisation days (SNIDS), where every child up to age five received the polio vaccine. Additionally, complementary health services, such as Vitamin A drops, were included to protect children further and engage parents and families in support of the programme.
Vaccinating millions of children was an arduous task for many reasons, one of which was weather. During seasonal floods in Bihar, thousands of children were trapped in crowded and unsanitary makeshift camps on small islands surrounded by floodwaters. Although this state previously reported the second-highest number of polio cases in the country in 2006 and 2007, healthcare workers were undeterred, reaching the stranded children by boat to ensure they were vaccinated.
Remote terrain was also an obstacle, as was the case in the hills of Himachal Pradesh and Rajasthan. Due to their nomadic lifestyles, migrant populations were difficult to reach. This remained an ever-present concern, as children within these communities were consistently at risk of being either left out of immunisation efforts entirely or of not receiving the required total doses of the polio vaccine.
Healthcare workers trekked for hours, and some rode camels to reach children with the polio vaccine.
They thoughtfully collaborated with communities that held fears about the vaccine. With the support and encouragement of local political and religious leaders and celebrities, they were able to educate parents about the vaccine and calm their fears enough to allow their children to be immunised against polio.
Moreover, the pulse polio programme was backed by India's multi-pronged surveillance and environmental surveillance network, a highly sensitive laboratory-backed system that monitored the circulation of poliovirus strains in stools of paralytic cases and sewage samples. The network enrolled more than 40,000 health facilities across the country to report paralytic cases to help limit the chances of an outbreak. Through real-time, credible data, the nation adapted its immunisation strategies to focus on high-risk areas and vulnerable communities.
Polio immunisation campaigns were a nationwide mission that spanned decades. Millions of vaccinators were united by a singular goal: to protect every child from polio, transcending geographical, logistical, and cultural barriers.
Even today, over 170 million children are immunised during NIDs, and 77 million are immunised during SNIDs every year to ensure India remains polio-free, thus preventing millions of children from possible paralysis and death.
Collaboration: Key To The Endgame
Ending polio in India was achieved through the mass development and distribution of billions of vaccines - all made possible through a strategic alliance with the Global Polio Eradication Initiative (GPEI) and its partners - the WHO, Rotary, the US Centers for Disease Control and Prevention (CDC), the United Nations Children's Fund (UNICEF), Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.
While polio has been eliminated in India, the latest data from the National Family Health Survey (NFHS-5) revealed that only 77% of children (aged one-two years) received all basic vaccinations. While 92% of children (aged one-two years) received the first dose of the polio vaccine, only 81% received the last dose. Additionally, 4% of this demographic received zero vaccinations. Given India's proximity to the remaining two polio-endemic countries, as well as other social and environmental factors, the country cannot let its guard down. It must continue with its polio vaccination activities to sustain population immunity.
Thanks to Rotary and its partners, the incidence of wild polio globally has been reduced by 99.%, and most of the world's children now live in polio-free countries. To ensure every child is protected from polio, all parties must remain united behind this goal.
With robust vaccination and monitoring efforts, the world can finally bid farewell to polio and create a new future where no child will face the threat of this disease. The journey continues, fuelled by optimism, determination, and the shared belief that a polio-free world is not just a dream but an achievable reality.
(The author is Chairperson, Rotary International's India National Polio Plus Committee)
Disclaimer: These are the personal opinions of the author.