CASE STUDY:

POLIO-FREE INDIA
Karunya Vinukonda
MSc NC SY
CONTENTS
1. Introduction
2. Challenges
3. History of polio in India
4. Statistics
5. The polio-free India
6. The difference-a!ers
". Inno#ations$
%Sur#eillance
%&olio Iuni'ation
%(esearch
%Social o)ilisation
%I*C aterials
+. &u)lic (elations Strategies, -essons
.. Conclusion
1/. (eferences
INTRODUCTION
0&olio1 eans grey and 0yelos1 eans spinal
cord
(oute of transission$ faecal-oral route
2ge group$ 2ny age )ut ostly affects
children )elo3 5 years.
&athology$
It in#ades the central ner#ous syste and
destroys the ner#e cells that acti#ate
uscles.
This causes irre#ersi)le paralysis 3ithin a
fe3 hours.
5-1/4 of the paralysed children die due to
the io)ilisation of the )reathing uscles.
I5T(678CTI65

9ut polio can )e pre#ented )y #accination. 2nd

3hen sufficient nu)ers are iuni'ed
against polio: the #irus 3ould )e una)le to find
suscepti)le children to infect and 3ould
e#entually die.

Children in the age group of /-5 years are

adinistered polio drops e#ery year. 2)out 1"2
illion children are iuni'ed during each
5ational Iuni'ation day ;5I7<
CH2--*5=*S
1. &opulation
2. &opulation 7ensity
3. Insanitary Conditions
4. Ipure 7rin!ing >ater$ se3age?drin!ing H26
5. @alnourishent$ -iunity
6. *nteric diseases
HIST6(A 6B &6-I6 I5 I57I2
1.++$ India is one of the 125 countries
3here polio is endeic.
HIST6(A 6B &6-I6 I5 I57I2
1..4$ 2 pilot polio iuni'ation acti#ity is
conducted in 7elhi
1..5$
&ulse polio iuni'ation prograe 3as
launched
1.."$
5&S& ;The 5ational polio sur#eillance proCect<
is esta)lished.
HIST6(A 6B &6-I6 I5 I57I2

!""":

Type 2 polio #irus is eradicated. -ast glo)al

case of type 2 polio is reported in 2ligarh: 8ttar
&radesh.

House to house strategy )egins

India is di#ided into high: ediu and lo3 ris!

States. Su) 5ational iuni'ation days held in
ediu and high-ris! States.

The India eDpert ad#isory group for polio

;I*2=< constituted.
HIST6(A 6B &6-I6 I5 I57I2

#$$!:

85IC*B esta)lishes the Social @o)ilisation

5et3or! ;S@5et< in 8ttar &radesh to o)ilise
the counity for polio iuni'ation.

2ita)h 9acchan )ecoes 85IC*B 9rand

2)assador for polio.
HIST6(A 6B &6-I6 I5 I57I2

#$$#:

The =o#ernent of India ta!es the lead role in

financing polio eradication acti#ities in the
country using its o3n resources.

>H6-5&S& eDpands net3or!.

HIST6(A 6B &6-I6 I5 I57I2

#$$%:

@ore effecti#e ono#alent oral polio #accines

;@op#< tac!ling either type 1 or type 3 3ild
polio #irus are introduced.

Social o)ilisation intensifies 3ith enhanced

in#ol#eent of religious leaders: @usli
institutions: osEues and adrasas.

Influencers fro 3ithin the counity are

identified and assigned to #accination teas to
enhance acceptance of polio #accine.
HIST6(A 6B &6-I6 I5 I57I2

#$$&:

*nueration: #accination and trac!ing of

ne3)orns )egins in 8& and 9ihar. The
#accinators are gi#en a special )oo!let to
register all ne3)orns and iuni'e the for
at least eight polio rounds.

6perational strengthening ta!es place to

ipro#e icroplanning for re#isits to
households 3ith un#accinated children
follo3ing the first contact 3ith #accinators.
HIST6(A 6B &6-I6 I5 I57I2

#$$':

(otary International fors 8leas1 coittee

in 8& to enhance @usli counity support.

2ccelerated iuni'ation rounds ta!e place

alost onthly in polio endeic states of 8&
and 9ihar: using efficacious 6&Fs

@igrant strategy is introduced. &eople o#ing

out of the endeic states 3ith failies are
identified and iunised in &unCa): =uCarat:
>est 9engal: @aharashtra: 7elhi.
HIST6(A 6B &6-I6 I5 I57I2

#$$(:

Gosi (i#er &lan dra3n up to intensify and focus

efforts in 9ihar.

High-ris! )loc!s are apped and additional

stay points )uilt for enhanced super#ision and
efforts in the hardest to reach areas 3here
children are )eing issed.

>H6-5&S& further eDpands. 333 sur#eillance

edical officers on the ground co#er all parts
of India.
HIST6(A 6B &6-I6 I5 I57I2

#$$":

1/" 9loc! plan is introduced in 8& and 9ihar.

8nderlying factors for polio are targeted$

routine iuni'ation: sanitation: diarrhoea
anageent and eDclusi#e )reastfeeding.

Bocus on igrant populations in )ric! !ilns:

construction sites: slus and noadic
settleents.
HIST6(A 6B &6-I6 I5 I57I2

#$!$:

9i#alent oral polio #accine ;)6&F<: 3hich

tac!les )oth type 1 and 3 3ild polio #irus
serotypes is introduced.

The =o#ernent of India: through the India

*Dpert 2d#isory =roup on polio eradication:
recoends responding to each case of polio
as a pu)lic health eergency.
HIST6(A 6B &6-I6 I5 I57I2

#$!!:

2ggressi#e response to the lone case of polio in

Ho3rah: >est 9engal.

2 large scale op iuni'ation acti#ity is

launched 3ithin se#en days of notification of
the case: 3ith three additional op up rounds
conducted in se#en 3ee!s fro the
confiration of the case.

2ll States and 8nion territories prepare

*ergency &reparedness and (esponse &lans
;*&(&s< to respond to any case of 3ild polio
#irus as a pu)lic health eergency.
HIST6(A 6B &6-I6 I5 I57I2

#$!#:

India is reo#ed fro the list of polio endeic

countries after copleting a year 3ithout
reporting any case of polio in Hanuary: a aCor
ilestone in the history of polio eradication.

The last polio case in the country 3as reported

fro Ho3rah district of >est 9engal 3ith date
of onset 13
th
Hanuary 2/11. Thereafter no polio
case has )een reported in the country.

>H6 on 24
TH
Be)ruary 2/12 reo#ed India
fro the list of countries 3ith acti#e endeic
3ild polio #irus transission.
ST2TISTICS
ST2TISTICS
TH* &6-I6-B(** I57I2

India has )een declared as )eing &olio-free )y

the 8nited 5ations >orld 6rganisation after 3
years of no case of the disease )eing reported
in the country.

India 3hich 3as considered as the core of the

3orld polio pro)le is no3 free of the highly
contagious #irus.

This achie#eent: considering the po#erty:

sanitation and population of the country is no
sall feat and has set an eDaple for the rest
of the countries that are still plagued )y the
disease: naely &a!istan :2fghanistan 257
5igeria

Since the launch of the 85F =lo)al &olio

*radication &rogra in 1.++: the cases of polio
in India ha#e dropped fro 2//:/// to /. It
has ta!en close to 25 years to achie#e this
TH* 7IBB*(*5C* @2G*(
I556F2TI65S.

2 nu)er of aCor inter#entions and

inno#ations ha#e )een ade o#er the years to
strengthen the polio eradication initiati#e in
India and o#ercoe the challenges and
)arriers that the prograe faced.

These 3ere re#ie3ed: assessed and ipro#ised

to atch the efforts that are focused on the
issues related to !ey #ulnera)le areas and the
suscepti)le populations.
A) SURVEILLANCE
!) Po*io ca+, id,n-i.ica-ion:

Initially polio cases 3ere classified )ased on

the clinical features of polio or on a la)
confiration. In 2//1: the case identification
schee 3as changed to a #irological schee
3here cases 3ere classified as polio )ased only
on a la) confiration.
INNOVATIONS
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R,/or-in0 n,-1ork ,2/an+ion:

2 large net3or! of health facilities including

pu)lic and pri#ate health facilities ha#e )een
enrolled as reporting sites for acute flaccid
paralysis cases in India. ;2B&- suspected polio
cases<.

This resulted in an increase in the nu)er of

2B& cases and hence increased the sensiti#ity
of the syste.
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Incr,a+, in +,n+i-i3i-y o. AFP +ur3,i**anc,:

In 2//4: the case definition of 2B& 3as

)roadened to a!e the sur#eillance ore
sensiti#e.

There 3as a draatic increase in the nu)er

of cases reported and in#estigated.

C4an0, in *a5ora-ory -,+-in0

6,-4odo*o0y:

2 ne3 ethodology 3as introduced for testing

stool speciens in the la)s in 2//" 3hich
reduced the testing tie )y half ;5 3ee!s to 2
3ee!s<.

@ore speedy action after detection of the #irus

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Su//*,6,n-ary +ur3,i**anc, .or /o*io:

Since polio spreads through faecal-oral route:

en#ironental se3age specien testing 3as
started in @u)ai in 2//1 to detect the #irus.
This has )een eDpanded to other cities later.
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7,n,-ic +,8u,ncin0 o. -4, /o*io 3iru+:

=enetic apping and atching of the #irus

conducted to deterine the origin of the #irus:
trac! the speed of transission and to
deterine the nu)er and spread of genetic
clusters of the #irus.

This helped in the identification of areas of

origin of the #irus.
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POLIO IMMUNI9ATION:

ou+,--o-4ou+, 3accina-ion:

>hen the progra started: the &ulse &olio 3as

a )ooth-only acti#ity.

The )ooth acti#ity 3as later eDtended to

house-to-house iuni'ation to acti#ely
search for and #accinate issed children.

Id,n-i.ica-ion o. 6i++,d c4i*dr,n:

Binger ar!ing of e#ery #accinated child 3as

launched in 1... to facilitate identification of
issed children.

The little finger of the left hand of the child 3as

ar!ed 3ith indeli)le in!.

The #accinators also ar!ed houses as & Iall

children in the house are iuni'edJ or K
Ichildren issedJ to ensure the copleteness
of the co#erage.
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Ca-,0ori+a-ion o. : 4ou+,+ 3i+i-,d:

The K houses are categorised into su)

categories li!e loc!ed houses: houses 3ith a
sic! child: houses that resist #accination: etc.

8sing this categorisation: houses 3ith sic!

children can then )e #isited )y doctors: refusal
failies can )e #isited )y influencers: etc.
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;ack-u/ <;=-,a6:

The )ac! up tea concept 3as introduced to

ensure iuni'ation of all children 3ho ha#e
)een issed )eing #accinated despite re#isits
of the Faccinators during the days of the
capaign 3ho coe under the #accination
tea 021.

In-,0ra-ion 1i-4 NRM:

The 5ational (ural Health @ission is aied at

ensuring effecti#e healthcare through a range
of inter#entions at indi#idual: household:
counity and health syste le#els. The
counity 3or!er 02SH21 is in#ol#ed in
o)ili'ation and #accination for polio.

Tran+i- +i-,+ 3accina-ion +-ra-,0y:

Children on the o#e iss polio iuni'ation.

So to #accinate the: transit #accination teas

are deployed to gi#e the #accine to children in
transit. ;In trains: )us stand: high3ays:
ar!ets: road crossings: etc<

Con0r,0a-ion +i-, 3accina-ion:

-arge gatherings at fairs and festi#als pro#ide

regular opportunites for the polio #irus to
spread.

Hence: iuni'ation is carried out at all fairs

and festi#als L at the #enue and also along the
routes 3hich people ta!e to reach these
#enues

N,1 5orn -rackin0

2s polio occurs in children ostly 3hen less

than 2 years of age: a syste 3as introduced
in 2//6 to identify: trac! and iuni'e e#ery
ne3)orn child in the high ris! areas of 8ttar
&radesh and 9ihar.

Ko+i ri3,r ar,a in-,n+i.ica-ion:

The difficult to access areas along the Gosi

ri#er )asin in 9ihar 3as tac!led )y arranging
satellite offices and o#ernight stay points in
these areas to ena)le huan resources to )e
scaled up )ased in the area to facilitate )etter
planning: super#ision and onitoring of the
capaigns.

Vaccina-ion o. 6i0ra-ory /o/u*a-ion+:

In 2//": identification and #accination of the

igratory populations )egan. This initiati#e
3as intensified in 2//..

The children in construction sites: noadic

settleents: peri-ur)an areas and ur)an slus
are especially focused.

i04-ri+k 5*ock /*an:

1/" high-ris! )loc!s 3ere identified that 3ere

responsi)le for the persistence and recurrence
of the polio in 8& and 9ihar in 2//..

2 ulti-pronged strategy 3as rolled out in

these )loc!s to address polio-associated ris!
factors 3ith rapid ipro#eent in sanitation:
a#aila)ility of clean 3ater: hygiene practises
and the pre#ention and control of diarrhoea.
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S/,cia* 3accina-ion dri3, durin0 .,+-i3a*+:

These are carried out at aCor transit sites to

protect igrants returning hoe to endeic
states. ;8&: 9ihar and >est 9engal<

I66uni>a-ion a*on0 -4, In-,rna-iona*

5ord,r+:

This 3as carried out to itigate the ris! of

iportation of the #irus across the )order.

It has )een carried out along fi#e sites along

the India-&a!istan )order: in the states of
&unCa): Hau and Gashir and (aCasthan.

&olio iuni'ation is also )eing carried out at

the +1 )order posts along the Indo-5epal
)order in 8& and 9ihar.
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R,+/ondin0 -o /o*io a+ a /u5*ic 4,a*-4

,6,r0,ncy:

The aggressi#e and rapid response to the polio

case in Ho3rah: >est 9engal. 2 large scale
op-up iuni'ation 3as launched.

E6,r0,ncy /r,/ar,dn,++ and r,+/on+,

/*an:

2ll States and 8nion territories prepared *&(&

to respond to any case of polio as a pu)lic
health eergency.
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RESEARC:

Introduction of @ono#alent #accines.

Introduction of 9i#alent 6&F

Faccine trials
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SOCIAL MO;ILI9ATION:

SMN,-:

The S@5et 3as launched to generate

counity support for polio iuni'ation
acti#ites.

It has no3 gro3n to ore than ":///

o)ili'ers 3hich coprises of ostly 3oen
fro the sae counity and area.

The counity o)ili'ers go house to house

counselling and eDplain the iportance of polio
iuni'ation and to !eep a record of the
#accinations of the children.

Mi0ran- +-ra-,0y:

The S@5et trac!s and reaches the ost

#ulnera)le igrant populations: re#isit
failies: counsel parents and caregi#ers and
ensure #accination of igrants 3hen they
return hoe during popular festi#als.

Con3,r0,nc,:

The S@5et shares inforation a)out routine

iuni'ation: eDclusi#e )reastfeeding: the use
of 6(S: personal hygiene: sanitation issues
and safe 3ater supply.

Und,r- +,r3,d +-ra-,0y:

This 3as a special strategy to reach the under

ser#ed @usli counities.

It ais to tac!le the disproportionately high

percentage of polio cases in the @usli
counity. In 2//3: the counity accounted
for 1"4 of the population )ut constituted
nearly 5.4 of polio cases in 8&.

9y confidence )uilding easures: acceptance

to 6&F 3as gained.

2d#ocacy: iuni'ation and prayers for polio

eradication: religious influencer support:
osEue announceents: appeals and fat3as in
support of the progra: special I*C )oo!lets:
greeting cards: religious calendars: etc
I556F2TI65S

M,*a+ and con0r,0a-ion+:

I*C: i!e announceents: street theatre:

puppet sho3s: fil sho3s: etc all arranged for
the special counication inter#ention.
I556F2TI65S

;ui*din0 -4r,a- /,rc,/-ion:

2n eergency counication !it 3ith all the

posters: freEuently as!ed Euestions: religious
appeals: radio and TF spots: and i!e
announceents.

R,3i,1 o. co66unica-ion +-ra-,0y:

The counication progra is re#ie3ed

annually )y International and 5ational eDperts.
Thee-specific recoendations are pro#ided.
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IEC MATERIALS:

;randin0 o. /o*io co66unica-ion 6a-,ria*:

9right colors li!e yello3: agenta: )lue are

used: supported )y catchy lines and logos.

The tag line has e#ol#ed fro 07o )oon 'indagi

!i1 adding 0har )accha: har )aar1 to 0ere
)acche !o do )oond har )ar1. The last one
pro#ides a onus or responsi)ility of the parents
to ensure their 3ell )ring.
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SPECIAL IEC FOR MI7RANTS:

Hoardings li!e 0Cahaan )hi Cao Cahaan )hi raho:

polio !i tura! a#ashya pilao1 these essages
are put up on e#ery3here fro the roads to
)uses to )order posts.
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;rand a65a++ador+ and c,*,5ri-i,+:

9rand a)assadors li!e 2ita)h 9acchan

acted as a !ey point in generating counity
support for polio #accination. Se#eral other
actors li!e 2ir Ghan: &reity Minta: etc ha#e
)een chosen too.

In counities 3ho ha#e toughest refusal

areas: actors li!e @anoC Ti3ari and soe
others #isited and interacted to garner support
for the #accination progra.

Cric!eters ha#e also )een used as )rand

a)assadors
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Fund Rai+in0? Ad3ocacy And Par-n,r+4i/+

&( ST(2T*=I*S,-*SS65S
1. Geep the >ritten @essage Siple
2. 8se &o3erful -anguage
3. Share Soething 5e3
4. Geep the Fisual @essage Interesting
5. Target Aour 2udience
6. Create 7eand$ Bor Health
". Strategic (ole of @edia in &ulse &olio &rogra
&rootions
+. Health prootion training and guidelines
.. @ultiple channels of counication
&( ST(2T*=I*S,-*SS65S
1/. 7esigning Health counication capaigns
for purpose of eradicating polio$
a. @edia coponents
). Structure of capaigns
11. Co)ating ruors L Health education
12. @oti#ation of health 3or!ers Iuse of
#olunteersJ

2chie#eent

&o3er

2ffiliation
C65C-8SI65

8nderstanding 3hat 3ent )ehind this huge feat

helps us a great deal in shaping future
inno#ations for siilar progras.

Since the launch of the 85F =lo)al &olio

*radication &rogra in 1.++: the cases of polio
in India ha#e dropped fro 15/:/// to /. It
has ta!en close to 25 years to achie#e this.

NThis 3as the one that e#eryone said could

ne#er )e doneO: said 7r. 9ruce 2yl3ard: the
>orld Health 6rganisation1s top person for
polio eradication.

NIndia1s success is argua)ly the greatest pu)lic

health achie#eent and has pro#ided a glo)al
opportunity to push for the end of &olio.
Stopping polio in India reEuired creati#ity:
perse#erance and professionalis- any of the
inno#ations in polio eradication 3ere spar!ed
)y the challenges in India. The lessons fro
India ust no3 )e adapted and ipleented
through eergency actions to finish polio
e#ery3here:O said >H6 director-=eneral
@argaret Chan in a ne3s release.
(*B*(*5C*S

(eport on the pulse polio prograe )y the =o#ernent of

India: 2/12.

2ssessent of Counication &rogras In Support of &olio

*radication$ =lo)al Trends and Case Studies )y Sil#io
>ais)ord.

Introductory note of &ulse polio prograe 3ith proposed

ne3 initiati#es )y the =o#ernent of 7elhi: 2pril: 2/14.

&olio )oo!let )y 85IC*B: Be)ruary 2/12.

(ole of ass edia in healthcare.

Social edia o)ili'ation lessons fro the C6(* group

proCect in India: 2ngola and *thiopia )y *laine @urphy.

0Ho3 did India )ecoe polio free L -essons for the future1 )y
the =i'odo India: Be)ruary: 2/14.

Iages$ =oogle.
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