SPECIAL ON HEALTH
Are we a polio free Republic now?
By Dr Harsh Vardhan
Some years ago, the people watching the Republic Day parade in New Delhi saw an unusual tableau. On a moving platform, young boys and girls sang, danced and performed vigorous unusual feats. They were all physically disabled, most of them rendered so by polio. Some wore calipers, some were on wheelchairs and others too had orthopaedic aids for support.
They did not fumble anywhere, did not lose pace or rhythm and did their Bhangra, wheelchair dance and other kinds with almost boisterous spirit. They were performing some of the feats which might appear difficult even for able-bodied persons. They got a thunderous applause from all those watching them at Rajpath and from millions watching them in the country on their TV screens. Many in the crowd, and many more watching the Republic Day parade on TV all over the country had tears in their eyes—tears of joy and sorrow at the same time. They were performing wonderfully well even with their disability. This was a question uppermost in the minds of the watchers. Sensitive people are moved whenever they see the otherwise handsome and strong willed children, talented in many ways, with deformed legs and dragging them with an effort. The very thought that they have a life long disability is disturbing, rather unnerving. I too got moved often in my life to see them and have wished that they had escaped the wrath of polio, that they could walk and run like others of their age and that they did not have the ‘stigma of the handicapped’ in the eyes of the less sensitive section of the society. It is only when we study some of these cases coming in contact with our life closely that you know what a grave human tragedy it is to be polio-afflicted and what a struggle it is for the physically disabled to survive! The plight of their parents and kins is not easy to ignore either. At the time of writing this article on the eve of the Republic Day in 2012 in the Republic Day Special of this magazine it gives great satisfaction and pleasure to know that the country is likely not to witness polio cases anymore in the future and has already covered a very historic journey of one year on January13, 2012 without a single reported polio case anywhere in the country.
Polio disease has forced millions of people to live a crippled life. But fortunately its spread was successfully interrupted after invention and further improvement of polio vaccine by Dr Jonas Salk and Dr Albert Sabin. The two drops of polio vaccine are no magic wand, nor a miracle. It took years of dedicated effort, toil and sweat by scientists to come up with an answer to the problem which afflicted billions. Hundreds and thousands of children had their dream of life ahead shattered. It is the story of just two drops of vaccine which turned out to be most potent weapon against a deadly disease and created a protective shield, a kawach or armour around those millions of children who could have fallen victim to it. It is single most important factor that helped health workers around the world wage a battle against the polio virus and which has reached a crucial stage. Through the ages, parents have wished a healthy child. Even today, nurses and doctors congratulate new mothers saying that they have been blessed with a healthy child. People in India, like elsewhere in the world, have always prayed to God for physical strength and a healthy, long life. Saints and sages have included good health and physical fitness in their blessings to the devotees. Scriptures were written, systems of medicine were evolved and developed a wholesome dose of diet and physical exercise was introduced to achieve this. An important aspect of this desire is to have all limbs and faculties of the human body functioning normally. It needs no proof to say that functional arms and legs are vital to carry out daily activities and it is natural that one wishes them to be normal. At the same time, there are diseases which target these limbs in particular and make life difficult for those suffering from such diseases. Polio is one such disease and has attracted the attention of governments and the medical professionals who are very keen to eradicate it from the globe.
The forty first World Health Assembly with delegates of 166 countries in the year 1988, adopted a resolution calling for global eradication of poliomyelitis by the year 2000. WHO was aware of the fact, though 3,50,000 cases had been reported worldwide in 1988, most polio cases were not reported. It was estimated that only about 10 per cent of the total number of cases were reported each year. One in two hundred infections leads to irreversible paralysis. Among those paralysed 5 to 10 per cent die when their breathing muscles become immobilised. In India, for instance, it is well known fact that there is a social stigma attached to some diseases and the families try to keep the fact a secret. To achieve this goal by 2000, WHO established a global partnership involving Rotary International, UNICEF, The US Centre for Disease Control and Prevention (CDC), non-governmental organisations, donor governments and Ministry of Health in polio endemic States. All these agencies not only funded the initiatives but also provided technical expertise, advocacy and volunteers.
In India the call from WHO in 1988 fell on deaf ears of the governments of the day till 1993 when towards the end of 1993 the BJP government was installed in the city of Delhi and the writer had the privilege to head its Health Ministry. That was the time when India was contributing 50 per cent of the total polio cases of the world and the city of Delhi contributed 10 per cent of the country’s total. The trans Yamuna area of the city of Delhi had the highest incidence of polio cases in the world. With a logical reasoning to begin with that if the country could provide ballot papers to every citizen on a single day in every nook and corner why can’t it deliver polio drops to every small child in the vicinity of his or her home on one single day; resulting in a programme being conceived to immunise all children simultaneously on a single day. That was exactly the pulse polio technique scientifically needed for eradication of poliomyelitis. Clouds of fear and uncertainty hovered over Delhi at that time. Everybody was talking about or hearing about plague of which 67 cases had already been reported in National Capital Region (NCR). They could have originated from here or could have been imported from Surat which was experiencing an outbreak. Inspite of fear of plague spread haunting everyone in a big way, the city of Delhi organised in 1994 the pulse polio campaign on October 2 and December 4 with participation of virtually every Delhiite, organisation or government agency and for the first time in the history of the nation a successful campaign involving immunisation of 12 lakh children simultaneously in a day was successfully launched. The dream for a polio free Delhi saw the light of the day and taking shape for becoming reality in future. The success of Delhi efforts catalysed the nation to start the initiative at the national level in 1995 which further motivated countries in the South East Asia region to take up the programme in 1995 and 1996. Nelson Mandela impressed with the performance of the country contributing 50 per cent of the world’s total for polio gave a call to his countrymen to initiate ‘Kick polio out of Africa’.
The whole programme of global eradication of poliomyelitis has seen many ups and downs all over the world and particularly in India and Africa. The success of the programme planned for 2000 appeared destined to be over delayed. It may be worth recalling the agenda of a Cabinet meeting under the able leadership of Atal Behari Vajpayee some time in the year 2000 where exclusively polio was discussed and a determined resolve was undertaken to do everything possible to get rid of the scourge of polio. The states of Uttar Pradesh and Bihar and the issue of minority resistance for polio drops remained in limelight throughout the last decade. The programme received the blessings of the then RSS Sarsanghachalak Rajju Bhaiya and senior BJP leader Shri LK Advani from the day one and of the then senior RSS Pracharak late HV Sheshadri who guided in the planning meticulously from the beginning till the last moments of his life. Some time in 2002 when the programme received a set back in UP and Bihar and suddenly the number of polio cases shot up. The World Health Organisation’s regional office in South East Asia in New Delhi wrote to 185 distinguished senior leaders of the RSS and its sister organisations to help in containing the sudden spurt in cases. The letter was written by Dr Palitha Abeykoon one of the senior Directors associated with the programme in WHO (SEAR). Shri HV Sheshadri ensured that the writer was invited to the RSS national executive meeting in Karnavati, Ahmedbad to explain in detail about the current polio situation in the country to all the Pracharaks of RSS. The meeting was followed by an appeal from the then RSS Sarsanghachalak Shri Sudershan and Sarkaryavah Shri Mohan Bhagwat to all the swayamsevaks in the country particularly in UP and Bihar for helping in the polio eradication campaign.
After a long wait of over 17 years since the launch of the programme for the first time in Delhi in 1994, on January 13, 2012 India completed one full year since the onset of paralysis of its most recent case of poliomyelitis on January 13, 2011 in Howrah, West Bengal. This is great news for India and country needs to reaffirm its pledge to continue the efforts very sincerely, cautiously and scientifically for at least the next two years to get global certification for polio eradication from WHO. The country needs to ensure that the disease surveillance efforts meet international standards and there is not even an iota of laxity on this front. We have to illustrate ably our capacity to detect, report and respond to “imported” polio cases. India definitely appears to be on the right track to finish eradication, however, a more dynamic and aggressive approach for rapid, high quality emergency response is essential to manage the risks along the path. It is heartening to know that in 2011 only four countries Afghanistan, India, Nigeria and Pakistan remained polio endemic, down from more than 125 in 1988. Persistent pockets of polio transmission in Northern Nigeria and the border between Afghanistan and Pakistan are the current focus of the polio eradication initiatives.
Once polio is eradicated the world can celebrate the delivery of a major global public good that will benefit all people equally, no matter where they live. Economic modelling have found that the eradication of polio in the next five years would save at least US $ 40 to 50 billion in low income countries. Time has come to thank on behalf of all countrymen the global polio eradication initiative spearheaded by WHO, Rotary International, CDC and UNICEF.
The polio eradication coalition includes governments of countries affected by polio; private sector foundations (e.g. United Nations Foundation, Bill & Melinda Gates Foundation); development banks (e.g. the World Bank); donor governments (e.g. Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, Japan, Luxembourg, Malaysia, Monaco, the Netherlands, New Zealand, Norway, Oman, Portugal, Qatar, the Republic of Korea, the Russian Federation, Saudi Arabia, Spain, Sweden, Switzerland, Turkey, United Arab Emirates, the United Kingdom and the United States of America); the European Commission, humanitarian and non governmental organisations (e.g. the International Red Cross and Red Crescent Societies and the Global Poverty Project) and corporate partners (e.g. Sanofi Pasteur and Wyeth). Volunteers in developing countries have played a great role in the success of the eradication movement which is likely to be the next big news in the field of health after the certification of eradication of small pox from the world in 1980. The children of the world shall remain indebted to all involved in global efforts for eradication of poliomyelitis throughout their lives but we should not forget that as long as a single child remains infected anywhere in the world, children in all countries are at risk of contracting polio. The news that in 2009-2010, 23 previously polio free countries were re-infected due to imports of the virus should be an eye-opener for everyone involved in these gigantic efforts and should motivate us enough to take the last of the last few steps of polio eradication initiative with thorough caution. Let us once again take a pledge in 2012 on the Republic Day to revive the national spirit of the year 1995 to fight polio and unite again to uproot polio disease and develop health as a big social movement in the country. If we can ensure ‘Health for all’ we can ensure a better and stronger future for our country too. This is every countrymen’s chance to make history. Let us not allow it to slip away.
(The writer is former Health & Education Minister of Delhi Government)