After being polio free for three years, India expects a final certification from the World Health Organisation later this month. WHO India-representative Nata Menabde, in an email interview, outlines why it is critical for India to remain polio-free as outbreaks are sometimes reported from previously polio-free countries. Edited excerpts:
Perseverance, resilience and innovations have been the hallmark of polio eradication efforts in India. The programme continued to refine and re-refine the basic strategies of polio eradication over years. It also developed and implemented innovations to ensure high coverage in the most vulnerable sub-populations identified through surveillance and campaign monitoring information. India’s unprecedented progress against polio will lead to polio-free certification of the entire South-East Asia Region of the WHO. The South-East Asia Regional Certification Commission is scheduled to meet in the last week of March.
The Commission is likely to certify this region of WHO as polio-free provided it is convinced that there is no wild poliovirus in the region, surveillance quality is good enough to pick up any wild poliovirus and phase 1 laboratory containment work has been completed.
As India and the region become polio-free, are you concerned on re-infections from Pakistan, Afghanistan and Nigeria?
Yes. India is concerned about the present global situation of polio eradication. There is active circulation of wild poliovirus in polio endemic countries — Pakistan, Nigeria and Afghanistan and polio-infected countries — Somalia, Syria, Kenya and others. As long as the virus circulates anywhere in the world it is critical for India to maintain its polio-free status.
When does WHO expect polio to be eradicated from Pakistan and other polio-endemic countries?
The Global Polio Eradication Initiative through the Polio Eradication and Endgame Strategic Plan 2013-2018 is a comprehensive, long-term strategy that addresses what is needed to ensure a polio-free world by 2018. The focus is now on the remaining endemic areas of Pakistan, Nigeria and Afghanistan. Large parts of those countries are polio-free — just a few areas remain where intensive efforts are being undertaken to ensure that all children receive oral polio vaccine drops. WHO is working to ensure that outbreaks in previously polio-free countries (Somalia, Syria) are rapidly stopped. Such outbreaks prove that polio threatens children anywhere until it is eradicated globally.
Is vaccine-derived polio a worry?
On very rare occasions, vaccine-derived polioviruses emerge if a population is seriously under-immunised and they can circulate if there is low population immunity against polio. If a population is fully immunised, they will be protected against both wild and vaccine-derived polioviruses.
India is in the process of developing the polio endgame strategy with the goal of completing the eradication of all wild and vaccine related viruses. As a part of this, there is a recommendation to introduce one dose of IPV (inactivated polio vaccine) in the routine immunisation before switching from trivalent OPV (oral polio vaccine) to bivalent OPV in 2016.
Can the polio-eradication story be replicated with other diseases and in other countries?
Yes. The success story of polio eradication is already being replicated with other health programmes in India and globally. The programme has demonstrated that it is possible to achieve ambitious health goals through high vaccination coverage even in areas with weak health system through a strong commitment of the government, by developing and using an accountability framework, ensuring meticulous planning, implementation and monitoring of mass campaigns and implementing strategies for effective mobilisation of communities.
India is applying the lessons learned from polio eradication to improve routine immunisation coverage in States with the most unvaccinated children. Moreover, surveillance for measles and rubella outbreaks is being set up by building on poliovirus surveillance. Measles vaccine campaigns have been conducted to vaccinate more than 118 million children.
The best practices and lessons learned from the polio eradication initiative in India are already being applied by Nigeria, Afghanistan and Pakistan.