Keeping India Polio Free

Keeping India Polio Free

There are only three countries in the world where Polio remains endemic now that India has been officially declared Polio Free.  So why the need for continuing immunisation in India?  The simple answer is that one of the countries is Pakistan which has a long border with India and cases of Polio continue to rise there, with 306 last year.  The risk of the polio virus being brought into India remains high and the Indian government recognises the need for continued vigilance to prevent its re-emergence in the country.

National Immunisation Days (NIDs) have been held in India for many years.  The aim is to immunise children under the age of five with an oral vaccine on a regular basis and the statistics are staggering.  In one day, there are:

• 709,000 vaccination booths
• 2,500,000 vaccinators
• 1,170,000 vaccination teams
• 155,000 supervisors with 155,00 vehicles (cars, motorcycles, mopeds, bicycles, boats, elephants, camels whatever it takes)
• 225 million doses of polio vaccine, carried around the country in 2 million vaccine carrier bags
• 6.3 million ice packs to keep the vaccine cool
• 209 million homes visited
• 170 million children vaccinated

Just consider the logistics and the scale of the operation in one day.

NIDs began in 1995 with a successful pilot in Delhi. After a presentation to the state governments, it was agreed to rollout the process to vaccinate 120m children under 3 years through two NIDs per year.  This was then increased to under 5 year olds and the number of NIDs increased to 4 per year, then 5 then 7 then 10. Some of these days were "sub national", i.e. just covering parts of the country and in 2014 there were two nationwide and three sub-national immunisation days.

This year, again only two national days are planned in January and February.  The focus will be on at risk areas, particularly in the North of the country.

In addition to NIDs, all people entering the country from Pakistan, Nepal and Myanmar are immunised, regardless of age or nationality.  Immunisation booths have been established at all border posts and visas are refused to anybody who refuses to be vaccinated.

To date, the immunisation has been by an oral vaccine which is trivalent i.e. it contains vaccine against all three polio strains.  P2 has long been declared eradicated, but caution has maintained the vaccine.  One of the risks inherent in trivalent oral vaccine is the possibility of contracting polio from the vaccine itself.  From 2016, India is moving to bivalent injected vaccine with the result that full NIDs will no longer be feasible due to the increased difficulty of coverage, given the additional time and safety issues needed.

The message is that to keep India Polio Free:

• It's not over until it's over everywhere; and
• The price of freedom is eternal vigilance.

The alliance between the World Health Organisation, Unicef, Government of India and Rotary has proved successful in getting to the stage where only Pakistan, Afghanistan and Nigeria remain with endemic polio.  The only reported cases this year, anywhere in the world, have been in Pakistan and the government there has finally woken up to the fact that greater efforts are needed to finish the job of eradication.

The world end game plan is to certify global eradication in 2018.  This may be slightly optimistic but it is achievable with a strong will from all concerned. The funding requirement for the period 2013-18 was $5.5 billion.  Already $5 billion has been committed.  The last push is needed and we can finally be proud of Rotary's achievement in ridding the world of this pernicious and debilitating disease.

This is Rukhsar. Let's ensure she is the last polio case in India!

Another Passage to India

I travelled to India for what might be the last full NID in which Rotarians may reasonably be expected to participate (see separate article on the End Polio Now project).  At the time, I was not aware of the importance of the event but I did know that there was a record number of UK Rotarians (76) taking part.

The flight to Delhi was with Jet Airways, which was a new experience for me. Being an overnight flight, arrival in Delhi was mid-morning and, once the tedious protocols of the airport had been completed, I checked in at the Royal Plaza and made acquaintance with Philip Leason, a Rotarian from Stone & District Club, who was to be my roommate for the duration. (Anything to save £500!)

In the afternoon, the totality of the Rotarian party gathered for a briefing session.  In addition to the UK group, who had arrived at different times from different places, there were four Australians and a large group from Netherlands, Belgium and Luxembourg.  Raman Bathia from the Indian National Polio Committee gave a valuable presentation on the Polio project so far, and the plans for seeing it through to the end (see separate article).

Separate briefings for travel to the various NID locations were made and I was pleased to find that my group of sixteen who were going to Moradabad would not be leaving before 6.30 next morning! Virtually the whole of the UK group met up at the Kwality (sic) restaurant that evening for a welcome meal.

Because Moradabad was not suitable for a coach (despite the fact that it is home to 3.3m people!), we left the next morning in four, six-seater people carriers. We had been warned to travel light, as there was not much room for luggage but, as usual, certain Rotarians seemed unable to comply.  It was only three days for goodness sake!

The journey was fairly tedious on busy roads, particularly getting out of Delhi, but we arrived in Moradabad at 10.15. The rally we were due to join had waited for us to arrive, which was pretty special as there were dignitaries and TV cameras there.  It showed us how much we were honoured for coming.  The march down the main street was rather shorter than we expected, but the crowds came out and we succeeded in drawing attention to the NID next day.  

The rally at the Oxford Public School (sic) was attended by many schoolchildren and speeches were delivered in a miscellany of languages, including one from our leader, Paul Harvey from Bishops Stortford. (Two of our party saw a broadcast on local TV that evening.)

We were picked up in our cars and taken to a couple of schools where toilet and sanitation projects had been funded by Dutch Rotary Clubs and we were entertained to dance and singing performances.  We also visited a slum camp where 125 families, primarily from West Bengal, were living.  Their only source of money was to go out on the streets of Moradabad between 4 & 6am to collect rubbish (of which there is plenty), take it back to the camp for sorting, and sell it to contractors. The rate they receive is 18 rupees (20p) for a kilogram of plastic bottles. There are maybe 50 bottles to a kilo. A charitable trust, set up by a past Rotary District Governor, arranges a regular health check up at the camp and Australian Rotarians have donated a minibus to transport medical staff and medicine to the camp (and other sites).It was remarkable how seemingly cheerful the people were despite their obvious deprivations, and how keen they were to have their photos taken.  I decided to use some of the funds made available to me by Council to make a donation of 10,000 rupees (c £100) to the charity to help its work.

After a late lunch at our hotel, we attended a briefing meeting with the World Health Organisation (WHO) representative in Moradabad.  He explained the situation in the District (3.3m people) and the need to concentrate on the areas where the response to NIDs was falling.  There were 64 cases of polio in Moradabad in 2009 and since then there have been none.  The percentage of under three year olds being immunised was said to be 99.4% (a statistic hard to believe), but the health workers are becoming disillusioned and our role would be to encourage the local populace to participate, to ensure that the work done previously was not undermined.

The return to the hotel was a concern as neither our guide nor the drivers knew the route, and a half hour journey took an hour through previously unknown areas of Moradabad.  Dinner in the hotel proved an immensely difficult logistical exercise for the staff (probably partly due to a wedding taking place at the same time, but primarily due to incompetence!) and the efforts to pay bills equally complex!

Next morning, we battled through traffic to our allocated immunisation booths.  Philip and I were on a main road near to the bus station.  We worked with four volunteers from the Moradabad Institute of Technology (MIT) who were very keen engineering students.  One was a former polio sufferer but now with only a slight leg affectation, who immediately wanted the official Rotary polio worker shirt off my back.  All he got was my cap, as I had brought the unofficial, Indian one I had "obtained" on my last NID trip.

Our role was to pull under fives off the street, usually by stopping rickshaws, tuk-tuks or whatever transport they came by in.  This involved me standing in the middle of the busy carriageway and, on spotting a child (not always easy when there could be six or more people crammed in a vehicle), attempting to stop the vehicle so that immunisation could be given.  My Hindi skills are not legendary but I was generally successful in at least stopping the vehicle so that someone else could do the deed! Apparently, polio is a fairly universal word.

The advance publicity proved effective and whilst immunisation is not legally enforceable, most were easily persuaded.  One woman refused to have her child immunised on the basis that the vaccine is given to monkeys!

It was hot and tiring work.  The students were concerned for my safety but I assured them that not even Indian drivers would run over an Englishman.  I was not quite so certain myself! The health workers seemed to live up to their reputation from the previous day's meeting and settled down to sit and watch, leaving the rest of us to do all the work. Balloons and other small gifts seemed to be effective in calming tearful children and even the armed police who seemed ever present wanted a share.

Early afternoon, we were collected and said goodbye to our fellow volunteers.  Some of us had lunch at a local restaurant (where we had stopped to ask directions the previous evening) and I risked Chicken Afghani which was excellent.  The rest of the afternoon was spent relaxing (maybe with a bit of shuteye).

In the evening, we attended a meeting of the Moradabad East Rotary Club where National Anthems were sung, banners exchanged and more speeches were made.  A late buffet was enjoyed and then a return to the hotel late.

Monday morning and we set off for the house to house visits to immunise children who had not attended a booth the previous day.  The village we went to was Mugalpur Urf Agwanpur Mustakh, which seemed to me to be about the size of Daventry!  In fact, it has 22,000 inhabitants in 3300 homes.  I joined Nisha from Unicef and four health workers as we headed into the back streets to call at houses where under fives were known to be present (it was impressive how much information the workers have on the location of all newly born children).  An examination of the left pinkie for the tell-tale ink stain proved whether the child had been immunised the day before and, if not, out came the drops.  Very few omissions were found.

Families were generally happy for us to enter their modest homes and, as usual, children followed us everywhere. At the end, the lead health worker invited us into her home and gave us tea and biscuits.

After a rapid lunch at another local restaurant, we went back to the MIT for a handover of some tricycles which had been funded by Dutch Rotarians.  By this time, four of us had had enough and were keen to get back to Delhi before the traffic got too bad, so we ducked out and headed off, rather to the annoyance of our leader!

The journey back to Delhi was again tedious and the final section into Delhi very slow. But we all felt the trip had been worthwhile, enjoyable and satisfying, but at the same time very humbling.  The welcome we had received everywhere was wonderful and people were truly grateful that we had come all that way to help Keep India Free.

Brian May

I followed up with a three day visit to Darjeeling but I am sure no-one wants a report of my holidays!  I would mention that the seven of us attended a meeting of the Rotary Club of Darjeeling and met Jamling Tensing, son of Sherpa NorgayTensing, which was a birthday treat for me.