Western Uttar Pradesh was once seen as the world's largest reservoir of polio virus. Four districts, namely Moradabad, Bareilly, Rampur and Badaun, were considered the "Hot 4" and for many years, people speculated that the last polio cases would be from these districts. But the skeptics were wrong. The districts pulled together, involved all ministries, not just the health sector, and held everyone accountable for performance. The District Magistrates took charge and became personally involved in solving any obstacles that would crop up. Vacant medical officer positions were filled and progress was monitored closely.
Across India messages travelled the TV and radio airways. Celebrities and sports legends lent their support. Rotarians urged everyone to participate, provided much needed financing, and rolled up their sleeves to help out during the campaigns. CORE and UNICEF Mobilizers spent countless hours answering mothers' questions, and in some places visited every pregnant woman to sensitize her in advance of the need for immunization. When the baby was born, the mother would then receive a "congratulations" card, an immunization card and education on how to protect the child from a range of diseases. These extraordinary efforts make a difference far beyond polio eradication.
The last polio case in India was in Howarah District of West Bengal. It was not in the "Hot 4." It was in a child who was never vaccinated against polio in the routine system. It was in an unexpected area, demonstrating the importance of a robust surveillance system. The rapid outbreak response by the West Bengal government has been exceptional. The health team in the area knows how fragile the situation is. Still, far too many families refuse vaccination, there are periodic shortages of the trivalent vaccine used in the routine system, there are vacant medical officer posts, and routine immunization sessions happen once a month rather than the needed once a week in many rural areas.
In a meeting with mobilizers and vaccinators on the day of the one year anniversary of the last case, January 13, I was asked "What are the strategies that work? What are the tricks to success?" There are no special tricks I said, it takes a candid acknowledgement of what the problems are, no matter how difficult or embarrassing that may be. It takes hard work. People here say they've worked harder for polio than anything else in their lives. It takes reaching every child, every round. It takes excellent surveillance and "whole of community" involvement.
India has made historic progress. Now everything possible must be done to sustain population immunity, assure all newborns coming into the world are vaccinated and don't lead to a large number of susceptible children, and that active searching for cases continues. India is still at risk of importations from countries that have not yet stopped polio transmission. Silent transmission and the potential for vaccine derived virus if routine immunization levels drop too low is still possible. Guarded optimism prevails.
India has a great opportunity to voice its concerns to other countries that are lagging behind. Urging other countries to take the necessary steps to fix the gaps they are facing is good for India and children everywhere. It has been a great privilege to work with so many dedicated individuals and a true demonstration that big dreams can be achieved if we all work together with good tools, strategies, commitment and willingness to identify and overcome often difficult obstacles. Just two years ago India had 741 cases. India has proved that it is possible to have rapid progress. If polio can be eradicated in India, it can be eradicated anywhere.
The U.S. government has provided $2 billion of the $9 billion spent thus far on polio eradication. USAID works in partnership with the government of India, WHO, UNICEF, Rotary and the CORE group of NGOS.