• India recently marked its third consecutive year without a single new polio case, moving it to the brink of being polio-free nearly 30 years after the Global Polio Eradication Initiative was established. Deepak Kapur, chairman of the Rotary International’s India National PolioPlus Committee, has headed the campaign since 2002. He spoke with “India Ink,” a New York Times blog, about the end of polio in India and next steps for the country to ensure that the disease doesn’t return.
Q. How would you explain the significance of this campaign on a larger scale for the global health community?
A. The success of India, the fact that India can do it against all odds and expectations, is a phenomenal achievement. Now, the lessons from India can be transferred. And it proves that it can be done elsewhere. For instance, Pakistan has a similar mindset amongst the civil society and similar conditions, so they can learn very profitably from the Indian experience.
People used to fret that India would be the last country to do it. Even the global experts felt that India may not be able to do it given the huge population, poor sanitation, impure drinking water, malnutrition and presence of disease. It made it the most fertile ground for the virus to breed in.
In 2002, we had a mini-outbreak of 1,600 cases. I remember Dr. Bruce Aylward of WHO [World Health Organization] was visiting Delhi at the time. He said, “You [India] are holding the world to ransom. Unless you get your act together, it’s going to be terrible for the world.” Then last year, in Abu Dhabi at the Global Vaccine Summit, he said, “You proved me wrong.”
Q. What was the game changer in your opinion?
A. There were a couple of things that were significant:
One, engaging the Muslim clerics, the ulema, by bringing them under one umbrella given that most of them don’t talk to each other. But we brought them together under the Rotary Muslim Ulema Committee, and that melted away the resistance by Muslim households.
Two, the introduction of the bivalent vaccine — the two strains of polio, P1 and P3, could be addressed with just one vaccine.
Three, the whistle-blowing by Rotarians. They went to the chief minister in Uttar Pradesh and the political authorities in Bihar and said they had to place more emphasis on the polio vaccinations. They were very receptive, which was very unexpected. The authorities took action quickly, and that helped immensely.
Q. Will India continue to carry out the immunization rounds in the same manner, now that the country is polio free?
A. Yes, there is always the risk of reintroduction. Look at all the countries that have had outbreaks recently — Somalia, Tajikistan. They were polio-free countries. The disease is just a flight or a bus ride away. So we have to keep up the supplementary immunization rounds. Our routine immunizations have only reached 60, 61%. And in some of the high-risk areas, it would be even lower. So we need to still press forward with them.
There are other questions that we have to address. Such as how long should we continue with the Oral Polio Vaccine? But we cannot shift to IPV [inactive polio vaccine], the injectable, so easily. We would have to train people to give it to 174 million kids with syringes. That’s too difficult to execute.
The only solution is to rapidly get rid of the virus from the rest of the world so we don’t have to fear reintroduction. Bear in mind, that for every one polio case, there are 200 who are carriers of the virus but don’t manifest the disease. So it’s tricky.
Q. How can this infrastructure be used for other public health campaigns?
A. It’s already begun. The National Polio Surveillance Committee and WHO are utilizing the infrastructure to improve routine immunizations. We are asking all Rotarians in India to focus on routine immunizations and alongside polio, focus on promoting other diseases.
The polio model will be in vogue towards the end of this decade for a host of other diseases and social needs.
Q. What are some of the innovations that have come out of the polio campaign, given that it’s been such a learning experience for the global health community?
A. There are quite a few. For instance, advocacy. In the U.S., it’s much more celebrated and the norm. In India, it was much more frowned upon. You can now have advocacy with senior politicians and senior bureaucrats, which wasn’t the case before. Given a social cause, now it’s an accepted practice to advocate to politicians and religious figures.
Rapid development of vaccines: the monovalent and the bivalent. The way that they came up was just the need of the hour, and the world responded to the request so quickly. And then small things: the black ink used to mark the pinky to note children who had been vaccinated or the cold chain transportation system.
Q. Polio is a water-borne disease. How do you address the root of the problem, dirty water and poor sanitation?
A. No government can do it on its own. It has to be a public-private partnership. It has to include civil society. It will be a much longer campaign than was polio, and that’s been long enough.
Q. Will the upcoming elections impact the polio program in any way? [Editor’s note: The national elections were held this week.]
A. The polio program will continue, no doubt. It will simply involve more advocacy to new political leaders and encourage them to keep up the fight against polio.