The name Rukhsar Khatoon may not ring many bells, but in the world of international health she is somewhat famous. But it is not the sort of fame any parent would want for their child, because 18-month old Rukhsar became the last child in India known to have contracted poliomyelitis –polio –in India. That was in 2011. Since then, the vast country has had no new cases reported and was declared "polio-free" by the World Health Organisation (WHO) in 2014.
The disease is caused by a virus (Wild Polio virus or WPV) but symptoms appear in only 5 to 10% of people infected. Most recover unharmed but for 0.5% the consequences are devastating. The virus acts fast and causes spinal and muscle damage that leads to permanent and irreversible paralysis, and in rare cases death. There are no cures, but the disease is easily preventable through vaccination.
The first polio vaccine was developed in 1952. Mass public vaccination campaigns started soon after. The introduction of an easier to administer oral vaccine (OPV), facilitated campaigns and in industrialised countries, the disease was defeated within a few decades. The last cases of infection by WPV in the USA were recorded in 1979 and in the UK in 1982.
The main breakthrough in India’s fight to eradicate polio came in 2010 with a major campaign mobilising vast numbers of volunteers to immunise a staggering 170 million children. In 2009 India had 741 reported cases of polio. This figure plummeted to 42 by the end of 2010 –a 94% decrease. Little Rukhsar was the only reported case the following year. Polio had been endemic in the states of Uttar Pradesh and Bihar, but by 2010 both were clear.
The achievement is all the more important since WPV of Indian origin had been associated with major outbreaks in several countries where it had not been considered endemic previously, including Angola, Russia and Tajikistan.
Difficulties
Polio is now considered endemic inonly three countries: Nigeria, Pakistan and Afghanistan.
Nigeria’s immunisation efforts were seriously hindered when, in 2003, the vaccination programme was interrupted in a northern province because some political and religious leaders preached against immunisation calling it a Western conspiracy against Islam. The government was slow to respond but eventually engaged with the local communities and clerics. The dramatic surge in polio cases convinced reluctant parents that the disease does exist, that it has devastating consequences and that the vaccine is safe and effective.
However outbreaks of vaccine-derived poliovirus (cVDPV2) in the period 2005-10 did not help.
Afghanistan and Pakistan face very similar issues. Health workers are unable to access the regions where Taliban authorities spread similar rumours about the vaccine being part of a plot to sterilise the Muslim population.
To make matters worse, in 2011 the CIA organised a fake Hepatitis B immunisation campaign in an attempt to locate Osama Bin Laden in Pakistan. This further fuelled suspicions among local populations about the genuine vaccination campaigns. It has also led to the killing of several health workers in Pakistan, and to a reversal of the downward trend of recorded polio cases in 2013 and 2014.
Experience has shown that when governments impose aggressive immunisation campaigns without involving local communities and their traditional, religious and political leaders, and without taking into account local habits and traditions, they are rarely effective and often fail to reach their goals. In Nigeria, for example, one of the factors raising suspicions among people was that the vaccine was being offered free. In a country where even basic medical treatments are hard to come by, rumours about vaccines being some kind of political or religious weapons spread easily.
Prospects of a polio-free world
However Nigeria has not had any reported cases of polio since July 2014, and no other African country has reported a case so far in 2015. That could mean the entire continent could be declared polio free by mid 2017.
The virus remains endemic only in Afghanistan and Pakistan, but the results of both governments’efforts seem encouraging. In the first five months of 2015, only one case was reported in Afghanistan against four for the same period in 2014. And in Pakistan only 22 cases have been reported in sharp contrast with the 61 reported for the same period the previous year.
The virus seems to be more prevalent in the hot months. While in May 2014 Pakistan had only registered 61 cases, by the end of the year the figure had jumped to 306. So the low numbers so far for 2015, while encouraging, are unlikely to be the final count for the year.
Nonetheless WHO is confident that the disease can be completely eradicated by 2020. That would require both Afghanistan and Pakistan to eliminate the virus from their territories by the end of 2016. And it will require continued diligence in those countries where it was once considered endemic.
The last child ever in the history of humanity to be infected by the wild polio virus may, even now, be happily jumping and running around with his or her friends, or may not have been born yet. B one thing is certain. No parent will want their child’s name to be added to Rukhsar’s in the medical history books.
Lila Guha is a student of journalism at the University of the West England, Bristol, UK. She was part of a journalism and public health training organised by the World Health Editor’s Network (WHEN) and The News Minute on the sidelines of the WHA