Critical need to maintain immunity to poliovirus in India until global eradication achieved
ATLANTA / EVANSTON, Ill. / GENEVA / NEW YORK / SEATTLE ¦ 12 January 2012 – India appears to have interrupted wild poliovirus transmission, today completing one year without polio since its last case, in a 2-year-old girl in the state of West Bengal, on 13 January 2011.
India was once recognized as the world’s epicentre of polio. If all pending laboratory investigations return negative, in the coming weeks India will officially be deemed to have stopped indigenous transmission of wild poliovirus. The number of polio-endemic countries, those which have never stopped indigenous wild poliovirus transmission, will then be reduced to a historical low of three: Pakistan, Afghanistan and Nigeria.
However, there remains no room for complacency. India must maintain sensitive surveillance and high childhood immunity against wild poliovirus to guard against any importation of polio until eradication is achieved globally. In 2011, Pakistan and Afghanistan have both seen alarming increases in polio cases, and poliovirus from Pakistan re-infected China (which had been polio-free since 1999). In Africa, active polio transmission continues in Nigeria, Chad and the Democratic Republic of the Congo, with outbreaks in West and Central Africa in the past 12 months reminding the world that as long as polio exists anywhere, it remains a threat everywhere.
Global health leaders today paid tribute to the Government of India for its leadership and financial commitment to the polio eradication effort, and to the millions of vaccinators, community mobilizers, Rotarians, parents and caregivers who have supported polio eradication for more than a decade. The scale of the eradication effort in India is mind-boggling: each year, more than 170 million children under the age of 5 are vaccinated in two national immunization campaigns, with up to 70 million children in the highest-risk areas vaccinated multiple times in additional special campaigns; the whole effort requires nearly a billion doses of oral polio vaccine annually.
India’s achievement in stopping polio will save hundreds of thousands of children from lifelong paralysis or death each year. Poliovirus can travel easily to polio-free areas. Stopping polio in India will prevent a recurrence of the polio outbreaks – due to virus of Indian origin – seen in recent years in countries as diverse as Angola, Bangladesh, Nepal, Tajikistan, and Russia.
"India’s success is arguably its greatest public health achievement and has provided a global opportunity to push for the end of polio," said World Health Organization Director-General Margaret Chan. “The Global Polio Eradication Initiative is in full emergency mode and focused on using this momentum to close this crippling disease down. Stopping polio in India required creativity, perseverance and professionalism – many of the innovations in polio eradication were sparked by the challenges in India. The lessons from India must now be adapted and implemented through emergency actions to finish polio everywhere.”
The key to India’s remarkable progress in the fight against polio according to UNICEF Executive Director Anthony Lake, has been the strong leadership of the Government of India and state governments, which launched a comprehensive polio eradication programme that has enabled sustained high immunization coverage in states like Uttar Pradesh and Bihar with high rates of poverty, high population density and poor sanitation and infrastructure, conditions in which disease like polio can thrive.
“India’s achievement is proof positive that we can eradicate polio even in the most challenging environments — in fact, it is only by targeting these areas that we can defeat this evil disease,” Mr Lake said. “We have the ability to protect every last person, especially children, from this entirely preventable disease — and because we can, we must finish the job of eradicating polio globally, once and for all."
Rotary International first launched the global polio eradication effort in 1985, and President Kalyan Banerjee said that with the intensity of transmission in India, many experts had predicted it would be the last country in the world to achieve eradication. “India is undoubtedly the biggest domino to fall in the polio eradication effort,” Mr Banerjee said. “India’s success is a great credit to the Indian government and to Indian Rotary members – as well as those from around the world – who have worked with local leaders to conduct these immunization efforts to reach every child with the polio vaccine."
Like all countries that have stopped indigenous wild poliovirus transmission, India must continue to protect its children through supplementary immunization activities and improved routine immunization coverage rates or risk a potentially horrific re-importation event, said the Director of the U.S. Centers for Disease Control and Prevention, Dr. Thomas Frieden. “Polio’s history contains many cautionary tales,” Dr. Frieden added. “Polio anywhere in the world is a risk everywhere in the world, and to protect itself from a setback, India is appropriately planning to continue meticulous monitoring and intensive childhood vaccination against polio.”
“Polio can be stopped when countries combine the right elements – political will, quality immunization campaigns, and an entire nation’s determination” said Bill Gates, co-chair of the Bill & Melinda Gates Foundation. “World leaders must continue to raise the funds needed to run the global campaign and help to ensure that no child suffers from this crippling disease ever again.”
With India’s achievement, the global polio eradication effort now focuses on improving the implementation of emergency operations plans in Pakistan, Nigeria and Chad. Success depends on local ownership and accountability at all levels of government and international partners.
Notes to editors:
India is one of the largest donors to polio eradication, being largely self-financed. By 2013, India will have contributed USD 2 billion.
When all pending specimens are processed (stools from children with acute flaccid paralysis and samples from sewage sampling), if no wild poliovirus is detected, India will no longer be considered polio-endemic. The laboratory system is expected to clear all samples within 4-6 weeks of collection.
The Global Polio Eradication Initiative (GPEI) is spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF.