Legacy of PolioPlus lives on in India

Photo Credit: Rotary International/Alyce Henson

From the October 2015 issue of The Rotarian

India reported its last case of polio in 2011. Since then, the toddler behind that statistic has grown into a child who laughs, plays, and runs, albeit with a limp. Past RI President Rajendra K. Saboo is gratified that no other children will be afflicted with the disease in his native country. “But you still see a few, above ages 12 and 13, and one starts feeling, ‘We came too late for them,’” he says. This inspires everyone to remain committed to keeping the poliovirus at bay, Saboo notes, especially with the risk of the disease’s return just a border-crossing away.

The lessons and partnerships that have emerged in the decades of halting polio’s spread in India have left a legacy: a cadre of trained health workers with skills in disease surveillance, education, collaboration, and care – and they are already being redeployed to address other health and social needs.

The battle against polio in India never was the single focus of the campaign there, notes Jay Wenger, director for polio eradication at the Bill & Melinda Gates Foundation, which since 2007 has invested more than $1.5 billion to help end the disease, with another $1.8 billion committed through 2018. “While the national network collected polio information from across the country, we used the infrastructure for other things,” says Wenger, whose résumé includes a five-year stint as project manager of the World Health Organization’s National Polio Surveillance Project, based in the New Delhi area. “When bird flu came up, we got a call from the Indian government to figure it out. Later they asked if we could help them find out how many measles cases there were. This is a major way in which the polio program has helped.”

One of Rotary’s key roles in ending polio in India was advocacy, says Sunil Bahl, medical officer for polio eradication with the WHO Southeast Asia Regional Office. “Rotary had a voice that would be heard by the government,” he says. “If any challenges were highlighted, Rotary was there to ensure there was some solution to overcome them.” Rotary’s voice is still vital, Bahl says, especially in Mission Indradhanush (“Rainbow”), which the Indian government and its partners initiated to target seven vaccine-preventable illnesses: diphtheria, pertussis (whooping cough), tetanus, childhood tuberculosis, hepatitis B, measles, and polio. Their goal is to expand immunizations to all children by 2020.

Rotary supported the first phase of the endeavor, from April through July, by working to promote vaccinations in 201 of India’s highest-risk administrative districts. That effort aimed to reduce by half the nine million babies, out of the approximately 27 million born every year in India, who do not receive these critical immunizations. “We estimate that one of every three does not get all seven vaccines by the age of one year,” Bahl says.

“The [routine vaccination] coverage is 65 percent,” says Deepak Kapur, chair of Rotary’s India PolioPlus Committee. “The government wants to cut the number of unvaccinated children essentially to zero in five years.”

Rotary’s expertise will help the most underserved populations, Bahl explains. “Rotary clubs are involved, and as we are finding there are pockets of resistance, just like with polio, we see that Rotary can apply some of the same strategies and tactics” used in the past, he says.

Rotarians have organized street rallies, distributed handbills and fliers, and held meetings to motivate health workers. PolioPlus workers in India and dozens of Rotarians have monitored routine immunization sessions and organized free medical camps that address other health concerns. “It’s information, education, and communication, creating awareness through community mobilization and interventions, especially in convincing religious leaders” – notably the ulema, or Muslim councilors – that the vaccines are safe and effective, Kapur says.

The need for medical care in India is acute, but “the legacy of PolioPlus is that Rotarians have discovered their own strength: that they can take up challenges,” Saboo says. One step has been to instill better water, sanitation, and hygiene practices through an educational program directed at 10,000 schools in India. “If children get this cultural mindset, they would be the instrument of bringing this philosophy of hygiene into the homes,” he notes. “Combined with a cleaner environment, that will translate to healthier babies and children. That is the long-term, sustainable aspect. And it is already a program in which Rotary is deeply involved.”

But for Saboo, the ultimate legacy of victory over polio in India is a sense of hope, particularly because success came in one of the most unlikely of places. “We would think that we were going in the right direction, and then there would be a peak of polio cases and we would not understand. Fortunately, we did not let our hope be overtaken by frustration.”

The Rotarian