Polio eradication strategies in India Successes, concerns & future perspectives

Polio Eradication Initiative (GPEI) was launched in 1988 with a multinational effort (World Health Assembly resolution) to control, eliminate and eradicate Poliomyelitis from the world by 2008. Prior to 1988, 3,50,000 children were getting paralyzed due to Poliomyelitis. The objective was to achieve global immunity against wild polio viruses (WPVs) by the year 2008. By the year 2000, there were only 2971 confirmed cases with the elimination of P2 Virus since 1999. Polio incidence remained around 2000 cases a year. During the years 2000–2007, there was a mixture of success and unanticipated set backs, viz. there was a continued reduction in the number of Polio cases but continued circulation of the Polio Virus in the four Polio endemic countries—India, Pakistan, Afghanistan and Nigeria. By the year 2009, 210 Countries were Polio free, of which 134 were certified and there were only 1606 cases in 4 endemic countries with 23 infected countries. The Advisory Committee On Polio Eradication (ACPE) initiated the “Program of Work 2009” and the “Strategic Plan 2010–2012”. As of 1st June, in 2010, only 21 Cases were reported from India (WPV1–3 & WPV3–18) as against 59 cases for the corresponding period in 2009. 2 cases, due to cVDPV2, were reported from UP. bOPV 1 & 3 were introduced in the endemkic zones of western UP and Kosy river belt in Bihar since January 2010. This is an encouraging trend for the first time in 22 years since the inception of GPEI. The interruption of WPV 3 could happen by the low force of transmission (FoT) season of 2011. The hope is that by 2011, India would achieve the elimination of WPVs 1&3. Since Polio eradication means the elimination of both wPV and vDPV, India should move to the bOPV 1&3 — eIPV sequential / exclusive eIPV schedule, as recommended by the India Experts Advisory Group (IEAG), in future even in the pre eradication phase and continue the same strategy in the post eradication phase as guided by the WHO. By all positive signals, India could obtain “Polio free certification” from the World Health Organization (WHO) by the year 2015.