Global fight against polio challenged by armed militias

India is on the verge of completing three years without reporting a single new case of polio. Another eight to nine months and, hopefully, we will also join the group of polio-free nations. But is our journey to eradicate this old scourge really coming to an end?

Recent reports from the WHO say that virus importation from Nigeria has affected two polio-free African countries of Somalia and Kenya which have seen fresh cases of the wild poliovirus type 1 (WPV1). India is in a similar situation, with two polio-endemic nations, Pakistan and Afghanistan, as its close neighbours. In the past, India has exported the polio virus to African countries such as Congo and Angola, and the same route could lead it back to us. All our efforts to eradicate polio from the country would be wasted if even a single new case gets confirmed in the days ahead.

In recent times, the global struggle against the virulent virus has faltered because of armed militias targeting polio health workers in various parts of the world. Such attacks in Pakistan, understood to be a consequence of the hunt and subsequent killing of Osama bin Laden, have raised fresh questions about the strategy to reach out to polio-affected communities. Armed militias have prohibited all immunization efforts in Pakistan, rendering Pakistani children vulnerable to polio. In the northern parts of Nigeria, militias have taken a cue from Pakistan and unleashed terror among health workers.

In India too, the polio virus posed a big challenge for health workers but fortunately they never faced hostility or violence. The challenge was of a different kind – a chunk of the population boycotted polio vaccination due to religious or civic reasons. In response, the anti-polio campaign evolved over time, finding solutions and means to overcome these obstacles.

One such solution was Rotary’s Muslim Ulema Committee that was formed after experiencing resistance to the polio campaign from the minority community. It helped dispel rumours and myths about the polio vaccine and convinced parents about the benefits of child vaccination and its importance to polio eradication. Once the people got convinced of the good intention behind the polio campaign through these influencers, they wholeheartedly accepted the need for vaccination, literally throwing open the door to get their children protected.

Also, some communities used polio vaccination as a bargaining chip for the development of civic infrastructure in their areas. As a condition to get their children vaccinated many demanded building of roads, bridges and clinics. that was neglected or inadequate. To address this issue, Rotary introduced free health camps in underserved regions to build goodwill among the people. This paved the way for their eventual acceptance of polio vaccination.

Seeing such success, delegates from Pakistan visited India recently to understand the lessons learned in the anti-polio drive. They toured high-risk areas to witness the campaign first-hand. Simultaneously, Indian Muslim leaders appealed to their Pakistani counterparts to come out in support of polio vaccination.

Cross-border travel

Unfortunately, in Pakistan, the WHO has indefinitely suspended the June immunization drive and other activities of the polio campaign because of a firing incident that targeted female health workers. This has increased the risk of virus importation to countries such as India and China. The latter, in fact, reported a polio outbreak in 2010 after remaining polio free for a decade. The cause: virus importation from Pakistan. The same can happen to India, too, due to cross border travel.

The efforts to ensure that the virus does not sneak into polio-free countries is strengthened by a new commitment and resolve declared at the recently held Global Vaccination Summit in Abu Dhabi. A new ‘Polio Eradication Strategic Plan 2013-2018’ -proposed by GPEI and endorsed by all - has set the year 2018 as the target to banish polio from this world. This is achievable with a projected $5.5 billion investment.

The six-year plan aims to eradicate all types of polio disease (both wild polio virus and vaccine-derived cases) simultaneously. It incorporates cutting-edge knowledge about the risk of circulating vaccine-derived polio viruses and the lessons learned from India’s success in becoming polio free in early 2012. At the Summit, commitments and pledges totalling $4 billion against the $5.5 billion projected cost were pledged for implementation of the plan.

India is being commended worldwide as the nation that could help guide three endemic nations – Pakistan, Afghanistan and Nigeria – to attain success in containing polio. The country has much in common with Pakistan (except the armed militia compromising the polio campaign!). The lessons learned and the practices followed by it could be replicated with similar success across the border. Instead of reinventing the wheel, we need open discussions on such pressing issues between the two nations, leading to exchange of best practices and ideas.

Several challenges need to be overcome by the polio-endemic countries to win the final battle against the crippling disease. The momentum to engineer a polio-free world has to be sustained by not only them, but also by the countries which till recently were in the same boat. The India success story has a lot to offer to the world. We need to find specific solutions to problems and customize them for different cultures. Advocacy efforts must continue with political leaders, bureaucrats and religious leaders where necessary, with on-ground implementation, lest complacency sets it. With a resolute will, a polio-free world can definitely become a reality in the next six years.

(The writer  is Chairman, Rotary International’s India National PolioPlus Committee)