Polio in India: Going, going, gone

Last year there wasn't a single reported case of polio in India.  Wow!  While there is still polio in Afghanistan, Pakistan and Nigeria, India is now off the list of countries where polio is endemic.  Against incredible odds, the World Health Organization and the Indian government, with funding help from Rotary International and lately the Bill and Melinda Gates Foundation, has been working for 27 years to reach this landmark.

2006 TED Prize winner Larry Brilliant described the eradication of smallpox in his ringing acceptance speech.  The last case of smallpox on earth was diagnosed on October 26, 1977.  Look up smallpox in Wikipedia and you'll read "Smallpox was an infectious disease unique to humans...." How powerful is that past tense!   Smallpox simply doesn't exist any more.  Polio might soon be referred to in the past tense as well.

However, polio will be tougher to lick than smallpox.  Since polio is usually transmitted through contact with the stool of an infected person, it is particularly tough to beat in densely populated, low-income areas with poor sanitation.  A long incubation period means that an infected person can pass it on to many people before being diagnosed.  And the vaccine requires multiple boosters to be effective.  In places where kids don't regularly go to school it can be hard to identify and inoculate all those who need it.

The states of Uttar Pradesh and Bihar, the poorest in India, are perfect breeding grounds for polio.  A recent article in the Stanford Social Innovation Review documents the size of the problem.   In Uttar Pradesh alone, 500,000 children are born every month. To vaccinate all children under five, that translates to 170,000M children to be vaccinated each year.  Just one national campaign involves stunning numbers: 700,000 vaccination booths, 2.5M vaccinators, and 200,000 homes visited.  And this combination of partners, led by the Indian government, have been doing this for 27 years.  27 years!

But the key to the campaign is communication.   This year's TEDxChange conference included a video about the Daredevils, a group of activist kids in a Kolkata squatter community who wanted to move their vaccination rate from 80% to 100&.  They started by wandering the neighbourhood with handmade megaphones announcing a vaccination clinic that weekend.

But they soon became even more effective with some outside help.  The community had never been mapped - a great big blank on Google maps.  So the kids created that map, numbering and plotting every house in the area.  Then, using smart phones equipped with GPS, they visit every home and record whether everyone has had all their shots and boosters.  If the adage is true that you succeed at what you measure, that neighbourhood should soon hit 100% vaccination rates.

Bruce Aylward, the Canadian physician who heads the polio eradication program at WHO, gave a passionate TED talk about polio.  Worried that the world could become complacent when the goal of total eradication is so close, he exhorted the world to continue supporting this important public health initiative.   The news that India has accomplished this feat should give heart to those out there fighting the disease.