10 Years of Polio Eradication in India

India’s journey toward polio eradication is one of the most remarkable public health achievements. The country was officially declared polio-free by the World Health Organization (WHO) in March 2014, following no reported polio cases for three consecutive years since January 2011. Read here to learn more.

The eradication of polio was not a singular event, but the culmination of decades of dedicated efforts, starting with India’s participation in the Global Polio Eradication Initiative (GPEI) and complemented by the robust national immunization efforts under the Universal Immunization Programme (UIP).

The strategic integration of new vaccines, innovative surveillance systems, and government-led immunization campaigns played a crucial role in making India polio-free.

This achievement was made possible through the tireless efforts of the Government of India in partnership with key global organizations, including UNICEF, the World Health Organization (WHO), the Bill & Melinda Gates Foundation, Rotary International, and the Center for Disease Control and Prevention (CDC).

Together, they mobilized resources, provided technical expertise, and created widespread public awareness about the critical need to vaccinate every child under five against polio.

Polio eradication in India

Pulse Polio Immunization Programme (PPI):

• Launched in 1995, this mass immunization campaign aimed to vaccinate all children under 5 with oral polio vaccine (OPV).
• National Immunization Days (NIDs) were observed to ensure high coverage.
• The campaign became iconic, with the slogan “Do Boond Zindagi Ki” (Two drops of life) becoming synonymous with India’s efforts to eliminate polio.

Extensive Surveillance:

• India established a robust Acute Flaccid Paralysis (AFP) surveillance system to detect and investigate any potential polio cases.
• AFP Surveillance: This system involves monitoring cases of unexplained paralysis in children under 15, as this is a common symptom of polio.
• Environmental Surveillance: Monitoring sewage water to detect poliovirus strains also helped identify pockets where the virus may still be circulating.

Routine immunization:

• India also strengthened its routine immunization efforts under the Universal Immunization Programme (UIP).
• The UIP provided free vaccines against polio, diphtheria, pertussis (whooping cough), tetanus, measles, hepatitis B, and tuberculosis, ensuring that children received vaccinations as per the national immunization schedule.
• Through these routine efforts, India aimed to maintain high immunity levels and prevent the re-emergence of vaccine-preventable diseases.

High-Risk Area Focus:

• Targeted campaigns were conducted in high-risk states such as Uttar Pradesh and Bihar, which were major reservoirs of the virus.

Community Mobilization:

• Local influencers, religious leaders, and community health workers were engaged to dispel myths and encourage vaccination.
• Special efforts were made to reach marginalized and migrant populations.

Cross-Border Coordination:

• Collaboration with neighbouring countries like Pakistan and Nepal ensured vaccination coverage for migrant and border populations.

Inactivated Polio Vaccine (IPV) Introduction (2015)

• In line with the Global Polio Endgame Strategy, India introduced the Inactivated Polio Vaccine (IPV) in 2015 as part of its commitment to polio eradication.
• IPV provides additional protection against polio, especially against type 2 poliovirus, and was gradually introduced in six states before being expanded nationwide by

Use of Monovalent and Bivalent Vaccines:

• Transitioning from trivalent OPV to more effective monovalent (mOPV) and bivalent (bOPV) vaccines helped tackle specific strains of the virus.

In 2011, India saw the last case of wild poliovirus in Howrah, West Bengal. Following that, the country ramped up its surveillance efforts, and no further wild poliovirus cases were reported.

Current Focus

Maintaining polio-free status involves- Routine immunization for new births, Continued surveillance for poliovirus, and Vaccination of international travellers from polio-endemic regions.

• Annual Polio Campaigns: India continues to conduct National Immunization Days (NID) and Sub-National Immunization Days (SNID) annually to keep immunity levels high and ensure that no child is missed.

• Surveillance and Border Vaccination: Continuous surveillance through AFP and environmental monitoring remains critical. Vaccination at international borders continues to mitigate the risk of polio re-importation from endemic regions.

• New Vaccines and Expansion: In addition to IPV, India has introduced several new vaccines under its immunization program, including Rotavirus, Pneumococcal Conjugate Vaccine (PCV), and Measles-Rubella (MR) vaccine, as part of broader efforts to prevent other vaccine-preventable diseases.

• Mission Indradhanush: Launched in 2014, Mission Indradhanush aims to increase immunization coverage to 90%. Special attention is given to hard-to-reach areas with low immunization rates. In its Intensified Mission Indradhanush phase, the program has significantly increased immunization coverage, further reinforcing India’s commitment to child health.

What is Polio?

Polio, short for poliomyelitis, is a highly contagious viral disease caused by the poliovirus. It primarily affects young children and can result in lifelong paralysis, disability, or even death in severe cases. Polio is transmitted through contaminated water, food, or contact with an infected person.

Key Features of Polio:

• Transmission:
  • Spread via the fecal-oral route (most common in areas with poor sanitation).
  • Occasionally spreads through oral contact (e.g., saliva).
• Symptoms:
  • Mild Cases: Fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs.
  • Severe Cases: The virus invades the central nervous system, leading to paralysis or muscle weakness, especially in the legs.
  • Asymptomatic: Many infections (90-95%) show no symptoms but can still spread the virus.
• Types of Polio:
  • Non-paralytic Polio: Does not lead to paralysis; causes flu-like symptoms.
  • Paralytic Polio: Affects the spinal cord, brainstem, or both, leading to paralysis.
  • Post-Polio Syndrome (PPS): Long-term muscle weakness or fatigue seen in individuals years after recovery.
• Vaccination:
  • Oral Polio Vaccine (OPV): Widely used in immunization campaigns; provides community-level immunity.
  • Inactivated Polio Vaccine (IPV): Administered via injection; safer but requires professional administration.

Global status of Polio

Polio remains a significant global health challenge, despite decades of eradication efforts. Currently, outbreaks continue to occur, particularly in regions facing instability, conflict, and weak healthcare infrastructure.

In 2024, countries like Afghanistan, Nigeria, and South Sudan reported new cases of both wild poliovirus and vaccine-derived strains, highlighting persistent gaps in immunization coverage and surveillance systems.

Pakistan reported its 50th case of polio in 2024, raising global health concerns. The latest case in Khyber Pakhtunkhwa highlights the continued spread of the virus.

Key Challenges:

• Conflict and Fragility: About 85% of polio cases occur in fragile and conflict-affected countries, where healthcare systems are compromised, and vaccination campaigns are disrupted. Countries like Sudan and Gaza have experienced a resurgence in polio cases due to declining vaccination coverage during conflicts.
• Low Immunization Rates: Many regions with active outbreaks report immunization rates below the 95% threshold required for herd immunity. This is particularly concerning in parts of Africa and Asia.
• Vaccine-Derived Poliovirus: The use of live oral polio vaccines in some areas has led to rare cases of vaccine-derived poliovirus, necessitating the deployment of novel oral polio vaccines with enhanced safety profiles.

Current Efforts:

• Mass Vaccination Campaigns: Organizations like UNICEF and WHO are conducting large-scale vaccination drives in high-risk areas, even under challenging conditions such as in Gaza and Sudan.
• Innovative Vaccines: The novel oral polio vaccine type 2 (nOPV2) is being deployed in many countries to reduce the risk of vaccine-derived outbreaks.
• Global Coordination: The Global Polio Eradication Initiative (GPEI) continues to support countries in surveillance, vaccine delivery, and outbreak response efforts.

In news

2024: The World Health Organization (WHO) has reported that poliovirus has been detected through routine surveillance of wastewater systems in five countries in the WHO European Region (Finland, Germany, Poland, Spain, and the United Kingdom) since September 2024.

“While no cases have been detected to date, the presence of the virus underscores the importance of vaccination and surveillance, as well as the ongoing risk that any form of poliovirus poses to all countries everywhere,” the WHO said.

Conclusion

India’s journey to becoming polio-free is a remarkable story of determination, collaboration, and innovation. The country’s achievement was the result of an integrated approach combining mass immunization campaigns, strong political leadership, effective surveillance systems, and community mobilization efforts.

With continued vigilance and sustained immunization efforts, India remains committed to maintaining its polio-free status and contributing to the global goal of eradicating polio once and for all.

The success of the Pulse Polio Programme and the Universal Immunization Programme serves as an inspiration for other nations and highlights the transformative power of public health interventions when supported by effective systems, robust policy, and community involvement.

While substantial progress has been made, the persistence of polio in conflict-affected regions and the re-emergence in areas previously declared polio-free underscore the need for sustained political will, funding, and international cooperation.

Strengthening routine immunization and addressing the underlying conditions that hinder healthcare delivery are crucial for achieving global eradication.

Frequently Asked Questions (FAQs)

Q. When was polio eradicated in India?

Ans: India has been certified Polio-free by the Regional Polio Certification Commission on the 27th March 2014. To maintain the polio-free status of the country, the government is taking the following measures: Population immunity against polio is being maintained by observing polio campaigns every year.

Q. Who invented the polio vaccine?

Ans: In the early 1950s, the first successful vaccine was created by US physician Jonas Salk. Salk tested his experimental killed-virus vaccine on himself and his family in 1953, and a year later on 1.6 million children in Canada, Finland and the USA.

-Article by Swathi Satish