Polio Elimination

In the article titled “Can the Polio Elimination Success Story Breed More Successes in India?” by T Jacob John (EPW, 5 April 2014), the author makes a comment that India would have eliminated polio decades ago had it used inactivated poliovirus vaccine (IPV) in the universal immunisation programme (UIP) and oral poliovirus vaccine (OPV) in Pulse Polio campaigns. While it is easy to say this in hindsight, any effect of such a change would have been only marginal. Coverage for three doses of OPV (National Family Health Survey–1) was only 53.4% in 1992 in India and much lower in Uttar Pradesh (37.1%) and Bihar (31.6%) and the rate of improvement was very slow until recently. Even if IPV was used instead of OPV in the UIP, not much could have been achieved and we would have still needed to depend heavily on Pulse Polio for the elimination, as has actually happened.

Another point the author makes is that India would have done much better if instead of the National Polio Surveillance Project (NPSP), UIP had been streng­thened with all the necessary support and expertise. Here he has overlooked the fact that this success was achieved not just with the intense hard work of NPSP but also with the quality and impartiality of the data collected by the NPSP and the impetus provided at the field level by its workers through a stringent monitoring and feedback mechanism. This ensured the much-needed near 100% coverage round after round. I cannot imagine any internal agency matching NPSP on any of these fronts. In the post-polio scenario, NPSP is continuing to support the UIP through monitoring and capacity building and also transferring the learnings of polio elimination to improve the programme.