India Scores a Major Victory Against Polio

20120112 _120113Polio_400MEERUT, India - India is set to reach a milestone today in the global battle against polio, recording a full year without a single case of the virus in the country that was long its epicenter and its biggest exporter.

It is a massive global public health achievement that has defied the odds and confounded the skeptics, a victory - reached with U.S. financial support and expertise - that will see India removed forever from the list of just four countries where the crippling disease remains endemic. The other three countries are Afghanistan, Pakistan and Nigeria.

The feat raises the very real chance that polio, like smallpox, could one day be consigned to history, and with it the heartbreaking image of the Indian beggar, crawling on twisted, thin legs, pleading for alms.

Until 1995, India recorded between 50,000 and 150,000 cases of polio each year. In 2009, 14 years into India's campaign to eradicate polio, 741 Indian children still contracted the incurable disease, more than anywhere else in the world, and morale was sagging.

In 2010, that number had fallen to 42. In 2011, it fell to just a single case, a 2-year-old girl who fell ill Jan. 13.

Anuradha Gupta, a joint secretary in India's health ministry, said the mood was now one of hope and enthusiasm, but not smugness, given the risks the disease could still find a way back from abroad.

"We needed this kind of success to keep morale up and to enhance public confidence in the program," she said. "We do now feel it is possible, it is doable."

In 1988, when the World Health Organization launched the global campaign to eradicate polio, the virus was paralyzing 1,000 children around the world every day, nearly half of them in India. Inspired by the success of the smallpox eradication campaign a decade before, the organization aimed to eliminate polio by 2000.

It took seven years before India's government mustered the political will, resources and manpower to act. And even when India finally began its first mass vaccination campaign in 1995, the hurdles seemed almost insurmountable, especially in the desperately poor, astonishingly overcrowded plains of northern India, where illiteracy was rife, malnutrition and disease rampant, and hygiene and public sanitation inadequate.

To make matters worse, rumors spread through the massive Muslim population of the region that the polio vaccination campaign was an American conspiracy to wipe them out, by making their sons impotent and their daughters infertile.

"There are 500,000 Muslims in this area, but there is no proper drainage, no post office, no bank, no government school, no hospital where a mother can take her child," said Qari Anwar Ahmad, the head of a madrassa in a Muslim neighborhood in the city of Meerut, just 45 miles northeast of the capital New Delhi. "So people were skeptical. 'Why does the government only care about polio and not about these things?' they asked."

Vaccinators were stoned as they approached Muslim neighborhoods. "The general mindset was that the immunization campaign was aimed at ending our lineage," Ahmad said.

That was the start of a massive public education and advocacy campaign, led by UNICEF and Rotary International, that began by convincing religious and community leaders that the vaccine was safe, and the goal of a polio-free world achievable.

After word came down from some of India's leading Muslim scholars, Ahmad was finally won over to the cause, first taking the oral vaccine himself and then administering it, in front of a crowd of onlookers, to his 1-year-old son a decade ago.

Today, the mosques of Meerut broadcast to the faithful from their loudspeakers when a vaccination campaign is under way, and imams open vaccination booths.

Despite India's success, the battle is far from won. The virus is still endemic in Afghanistan, Pakistan and Nigeria. In Africa, Angola, Chad and the Democratic Republic of the Congo seemed to have won the battle against polio, only for the virus to be re-imported from abroad and person-to-person transmission to restart.

It will take another two years to declare India completely free of the virus, but even a setback now would not derail the program.

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