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2:48 pm
Fri January 13, 2012

India Marks A Year Free Of Polio

Originally published on Fri January 13, 2012 3:08 pm

A year ago today, India saw its last recorded case of polio in an 18-month-old girl in West Bengal named Rukhsar Khatoon. She recovered without lasting paralysis.

One year without another case is an impressive milestone in the decades-long effort to wipe the poliovirus from the face of the planet. Only a few years ago, India reported more polio cases than anywhere else — as many as 100,000 cases a year.

"India is a major, major victory," Dr. Hamid Jafari, who leads the World Health Organization's polio eradication efforts in India, told Shots. "It has established the feasibility beyond doubt of eradication. (If) it can be done under such tough conditions in India, this can be done anywhere else."

India's victory, if it's validated by careful vetting over next few months, comes at a time when the possibility of global eradication has never never looked so close. When all the numbers for 2011 are in, WHO expects to count about 700 cases of polio — about half the total in 2010.

If polio is eradicated, it would become only the second human infectious scourge to be conquered — after smallpox, in 1979. As in the case of smallpox, polio eradication is feasible because the virus only infects humans and there are effective vaccines against it.

A polio-free India means that there are just three nations where polio is considered endemic: Pakistan, Afghanistan and Nigeria.

The poliovirus has popped up in other places recently — notably China, where cases were imported from Pakistan, and Chad, from Nigeria. But India's long-standing role as the world's biggest exporter of polio to other countries has apparently ended.

The lessons from India will be sifted for years to come. But it's clear that conquering polio in that nation of 1.2 billion people is as much a story of massive persuasion as it is one of medical science.

India started its war on polio 17 years ago, and gradually the virus was eliminated in much of the country. But not from a wide swath in the north, in predominantly Muslim communities, such as Moradabad, a city of 4 million about 100 miles from the capital of New Delhi.

"Moradabad really was the litmus test for India. If it could get rid of polio there, it could get rid of it anywhere," says Michael Galway of the Bill and Melinda Gates Foundation.

Galway, who worked with UNICEF on polio eradication in India, says many cases of polio throughout India were traced back to Moradabad and surrounding areas in the states of Uttar Pradesh and Bihar.

"Genetically we tracked every single virus in the country," Galways says. "We could tell you exactly where that virus came from. And in the end, all roads led back to Uttar Pradesh and Bihar."

And that's where the tactics of persuasion were crucial. These districts have big Muslim populations, and many Muslims believed rumors that polio vaccination was a plot against their community. It's a conviction that has hampered polio vaccination campaigns elsewhere – most notably in northern Nigeria.

"There were two kinds of misconceptions," says Hakeem Syed Masoom Ali Azad, an influential imam, or Muslim leader, in Moradabad. "No. 1, people said the medicine contains ingredients derived from pork, which is prohibited in Islam. Second, they said the medicine would make our children infertile."

But this week, Varisha Gul had no qualms when she took her 18-month-old daughter Mozamma to a child health clinic in Moradabad to be vaccinated.

"No, no, we give (the vaccine) to our children," she told Elliott Hannon, an NPR stringer based in New Delhi. She says she knows of no parents in Moradabad who refuse to have their children vaccinated against polio.

That's a testament to the massive educational campaign conducted over years by the polio strategists – beginning with respected scholars in Muslim universities and reaching all the way down to trusted shopkeepers.

So-called influencers were identified alley by alley in the neighborhoods of Moradabad and elsewhere. Eventually, imams began to preach sermons endorsing polio vaccination, issued fatwahs of approval, and announced vaccination clinics from their mosques.

"We went and changed their minds," the Moradabad imam says. "We took the (vaccine) ourselves in front of them and gave it to our children in front of them. People slowly began to come around, thank God! Because of our effort, our district hasn't had any new polio cases."

But Jafari of the WHO says India's work is far from finished.

"High levels of immunity in India will have to be maintained until there is global eradication achieved," he says. Otherwise imported cases could cause the whole effort to unravel.

So this Sunday, 100,000 vaccinators will fan out across high-risk districts such as Moradabad to vaccinate 40 million children. Other, nationwide, vaccination days will occur later in the year.

Every newborn Indian child needs to be vaccinated in case the virus reappears. Every child crossing the border from Pakistan will be vaccinated to detect importation of the virus. Sewage across India will be carefully monitored to detect even a single wild poliovirus.

Jafari's main worry is complacency. But his team allowed itself a quiet celebration.

"We will perhaps maybe have some cake and pass that around because people have worked extremely hard over the years," he said.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

AUDIE CORNISH, HOST:

One year ago today, India recorded its last case of polio. That's a major milestone in a long struggle to wipe the disease off the Earth. As NPR's Richard Knox reports, authorities hope eradicating polio from India will help conquer it in the three countries where it's still a menace.

RICHARD KNOX, BYLINE: India started its war on polio 17 years ago. It used to have more cases than anywhere in the world. Gradually, the virus was eliminated in much of India, but not from large areas of the north in predominantly Muslim communities such as Moradabad, a city of 4 million, 100 miles from New Delhi.

(SOUNDBITE OF CRYING CHILD)

KNOX: This week, at a busy clinic there, 18-month-old Mozamma Gul got her polio vaccination. Her mother, Varisha, had absolutely no qualms about the vaccine.

VARISHA GUL: (Through Translator) No. No. We give it to our children.

KNOX: But not so long ago, many parents in Moradabad refused polio vaccination. They were afraid of the vaccine. Now, she says...

GUL: (Through Translator) There's nobody here like that. Everyone here gives their children the medicine.

KNOX: That acceptance is crucial in the great achievement India is cautiously celebrating today: a whole year without a single case of polio anywhere. If analysis over the next few months confirms it, this means polio is still circulating only in neighboring Pakistan, in Afghanistan and in Nigeria. A few other places, such as China and Chad, have recently battled importations of polio from these countries.

DR. HAMID JAFARI: India is a major, major victory.

KNOX: That's Dr. Hamid Jafari, who leads the World Health Organization's polio eradication team in India.

JAFARI: It has established the feasibility beyond doubt of eradication. That if it can be done under such tough conditions in India, this can be done anywhere else.

KNOX: And conditions were no tougher anywhere in India than in Moradabad.

MICHAEL GALWAY: Moradabad really was the litmus test for India, whether it could get rid of polio there, it could get rid of it anywhere.

KNOX: Michael Galway of the Bill & Melinda Gates Foundation says many cases of polio throughout India were traced back to Moradabad and surrounding areas, in the states of Uttar Pradesh and Bihar.

GALWAY: Genetically, we tracked every single virus in the country. We could tell you exactly where that virus came from. And in the end, all roads led back to Uttar Pradesh and Bihar.

KNOX: Victory over polio in these areas is a story of massive persuasion as much as medical science. That's because these districts have big Muslim populations. And many Muslims believed rumors that polio vaccination was a plot against their community.

Hakeem Syed Masoom Ali Azad is an influential Muslim cleric, an Imam in Moradabad.

HAKEEM SYED MASOOM ALI AZAD: (Through Translator) There were two kinds of misconceptions. Number one, people said the medicine contain ingredients derived from pork, which is prohibited in Islam. Second, they said the medicine would make our children infertile.

KNOX: Unable to have children of their own. So vaccination strategists began a massive education campaign, beginning with respected scholars in Muslim universities and reaching all the way down to trusted shopkeepers. So-called influencers were identified alleyway by alleyway in the neighborhoods of Moradabad. Imams preached sermons, issued fatwas of approval, and announced vaccination clinics from their mosques.

AZAD: (Through Translator) We took the medicine ourselves in front of them and gave it to our children in front of them. People slowly began to come around. Thank God. Because of our effort, our district hasn't had any new polio cases.

KNOX: But Dr. Jafari of the WHO says India's work is far from finished.

JAFARI: High levels of immunity in India will have to be maintained until, you know, there is global eradication achieved.

KNOX: So this Sunday, 100,000 vaccinators will fan out across high-risk districts such as Moradabad to vaccinate 40 million children. Every new Indian baby needs to be vaccinated in case the virus re-appears. Every child crossing the border from Pakistan will be vaccinated to prevent importation of the virus. Jafari's main worry is complacency. But his team is allowing itself a quiet celebration today.

JAFARI: We will maybe have some cake and pass that around because people have worked extremely hard over the years.

KNOX: In 2011, the WHO thinks the world had around 700 polio cases. That's half the number in 2010. Richard Knox, NPR News.

CORNISH: We had help with this report from Elliott Hannon in Moradabad. Transcript provided by NPR, Copyright NPR.