We can look back with great satisfaction the
successful elimination of wild polioviruses (WPVs) types 3 and 1 in
India, in 2010 and 2011, respectively. That was a major milestone in the
global journey for polio eradication. We present this Supplement of
Indian Pediatrics to celebrate India’s achievement, and to extract many
lessons from it.
Smallpox eradication was the prototype for disease
eradication, but the effort needed was much less than for polio. Its
transmission was slower than that of WPVs. One inoculation of vaccine
sufficed – that too only for the contacts of every case of smallpox, in
a manner of ‘ring vaccination’ around the case. A large contingent of
public health workers from other countries worked shoulder to shoulder
with Indian counterpart to achieve that. Since then India has eliminated
Guinea worm disease and yaws in humans, and, rinderpest in cattle,
managed fully indigenously. India succeeds when India sets its goal and
strives with seriousness of purpose.
Global eradication of polio posed formidable
barriers, many of which had been foretold in India, but remained
unaccepted by global experts for a long time. Remedial tactics were also
designed in India – their belated acceptance and inclusion in the global
efforts has helped in overcoming all biological barriers everywhere. WPV
type 2 was eradicated in 1999 and certified by the authorized Global
Commission. Since November 2012, WPV type 3 has not been detected
anywhere in the world, and in all probability it also has been
eradicated. Two nations that have yet to succeed eliminating WPV type 1
have man-made barriers and not biological barriers. Hopefully they will
succeed sooner than later.
India has another cause for celebration. Research in
India had pinpointed the need to transition from live attenuated oral
polio vaccine to the inactivated polio vaccine in order to eliminate all
vaccine related polio also. This tenet became globally accepted in 2012
and we in India, along with all other OPV-using countries, are shifting
the target and changing the tool for the completion of global polio
eradication. The new target of eradication is to create a world with no
transmission of polioviruses, wild and vaccine. And the tool to achieve
that will be the inactivated vaccine and not the live vaccine which
consists of polioviruses that are genetically unstable and also
transmissible. This special supplement of the journal highlights these
shifts – for pediatricians, policy makers and public health workers to
understand why and how.
The saying ‘health is wealth’ has been taken as a
figurative adage, not substantive. Many thought that expenses incurred
for polio elimination in India was a huge drain on our economy. On the
contrary, the gains through productivity of the hundreds of thousands of
young people protected from polio paralysis, have shown polio
elimination to have been a national wealth-creating endeavor. This is an
important lesson for taking control and elimination of other diseases
seriously, not merely as humanitarian do-good effort but also as
investment for economic development.