Maha Bharat: Episode 25

How did we eradicate Polio?

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Restaurants, malls and movie theatres are closed. People are advised not to gather in groups and stay at home. Everyday, the newspaper publishes the number of people infected. Their houses are identified and marked. The families are put in quarantine. A virus is on the loose — and everyone is waiting for a vaccine.

Sounds familiar?

This is not the Corona Virus we’re talking about, but more than 70 years ago, India went through a similar fight and eventually won! This is the story of how we eradicated polio in India.

Show Notes

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Full Transcript of Episode 25 –

Restaurants, malls and movie theatres are closed. People are advised not to gather in groups and stay at home. Everyday, the newspaper publishes the number of people infected. Their houses are identified and marked. The families are put in quarantine.

A virus is on the loose — and everyone is waiting for a vaccine. 

Sounds familiar?

Actually, I’m not talking about the Coronavirus pandemic, but something that started more than 70 years ago. Something very similar to what’s happening today. 

[We hear an old documentary excerpt on the spread of Polio in the U.S.A]

That’s right. Poliomyelitis – also called Polio. An illness caused by the Polio virus, one which swept over the world. 

And this virus was no less dangerous in India. In the 70s and 80s, it left children paralyzed, weak and even killed many. But there’s another aspect of polio in India that we often talk about — how we fought it. 

In a matter of ten years, India went from 1,600 cases a year to being completely polio-free. This was magic, for a country like ours! Well, magic — and a little bit of what we often call the Indian spirit. 

So, how’d we do it? How did we eradicate a deadly virus? 

First, let’s take a few minutes to understand what exactly Polio is. 

Like I told you, polio is caused by a virus called the Wild Polio Virus or WPV. There are actually 3 types of WPV – Type 1, Type 2 and Type 3. All three are dangerous, and slightly different from each other. 

Polio is an unfortunate disease that will stay with you for a lifetime. You can be affected in several ways. If you’re lucky, the disease will leave you with only weakness in your lower body. But often, it causes respiratory problems, tiredness, fever. Over the years, polio patients can develop muscle and joint problems and paralysis. 

It can also kill you — and in the 20th century, it took many lives around the world. 

Polio especially affected children under 5 years old, even ones that are a few months old. But — how does it spread? 

The virus enters the body through the mouth, mainly from the feces (मल) of an infected person. Infection from sneeze droplets is also possible, but it is not very common. 

Lekin doston, we know all of this now. When the first cluster of polio cases appeared in the USA, people were not sure of what was happening. Suddenly, children were falling sick and getting weak every summer. 

There was a long road ahead of them. 

[We hear an excerpt about Polio in the US]

Here’s an interesting fact:

Cases of polio existed long before you or I — or even our grandparents — were alive. No, no — not a hundred years ago. I’m talking about nearly 5000 years ago, in Ancient Egypt. We’ve found paintings that show people with weak limbs, and children walking with canes. Of course, at this time, people had no idea what polio was. 

Aate hai many many years later, in 1773, when Scottish novelist Sir Walter Scott had a pain in his teeth, a fever and lost power in his right leg. He recorded his symptoms, his pain and his experience. At that time, polio still wasn’t discovered as a virus — but his records helped experts identify the disease and symptoms later on. 

At the end of the 1800s, scientists and researchers started studying this disease and finally, in 1908 it was found that haan, polio is caused by a virus. But it would be almost half a century until a vaccine would be developed for this virus.

One of the first significant polio outbreaks was recorded in New York, in the year 1916. That year, more than 27,000 people were infected with the virus in the United States, and 6,000 died. Inme mein se, 2000 deaths were in New York alone.

I know what you’re thinking. This seems like a small number, given the times we are living in right now…

But at that point, polio had only been found in isolated cases. Matlab, kisi kisi logo mein, and not in the same place. Suddenly, many people, especially children, were getting infected. 

[We hear excerpts from a film about Polio in 1916 in the US]

Things were not going to get better any time soon. After the world war, the number of infections only increased.

[We hear figures about Polio casualties]

And If I were to paint a picture of the U.S.A at this time, where the polio cases boomed, well — it would be very similar to something we experienced earlier this year. 

[We hear a description of the 1955 Polio Outbreak in the USA]

By this time, the virus had spread to other countries — including India. But let me tell you this: even in 1949, The Indian Council of Medical Research, matlab the ICMR, had the foresight (door drishti) to set up a Polio Research Unit in Mumbai. And what was happening?

Children who contracted the virus would experience symptoms such as losing sensation or developing weakness in their legs. Some adults were left paralyzed in the lower parts of their body. And many children even died of polio.

In 1953, we finally had some good news. 

[We hear a news report about the Polio Vaccine]

Funded by American President Franklin D. Roosevelt, a vaccine was developed at the University of Pittsburgh. The President himself had developed Polio, and this was something he was deeply passionate about. This vaccine was developed by Jonas Salk and could be given using an injection.

Only a few years later, in 1959, Albert Sabin developed one that can be given through the mouth. Like me, I’m sure you remember opening your mouth, getting a drop of the polio vaccine and tasting something kadva-khatta. This is the Sabin Vaccine – or the OPV! 

But at this time, when the United States was celebrating, India was witnessing a steady growth in polio cases. In Vellore, every 8 out of 1000 children contracted polio. In the northern states, 3 out of every 6000 children caught the virus annually. These were worrying numbers — but thankfully, the OPV vaccine came to India in 1962.

But that doesn’t solve our problem. India was a country of 49 crores. There were 24 crore children who had to be given the vaccine. In every city and village — to those who knew about the virus and those who didn’t. Aur us sab se pehle — we had to manufacture that much vaccine. How did we do it?

In this story, friends, the vaccine was not the happy ending that we all hoped it would be. 

Like I told you, India got the OPV Virus in 1962. This was the Oral Polio Vaccine. The other kind of vaccine used in the USA was IPV, the inactivated polio vaccine. But we did not have the licence for IPV, and so used OPV in different parts of the country. In 1964, we used it in Mumbai and next year, in Vellore. But soon enough, it was found that this vaccine wasn’t effective enough. The children who were given 3 doses of the OPV Vaccine were still contracting Polio. Immunity was low. 

From here, we tried a few different strategies. In 1974, the World Health Organization launched the Expanded Programme of Immunization – EPI – in India, and started giving children the DPT and BCG vaccines. You must have taken these vaccines in your childhood, and so have I. But these weren’t vaccines for polio – they were to prevent tuberculosis, diphtheria, and tetanus. Slowly, the OPV vaccine was once again imported and given to children. 

But in the early 1980s, there was another outbreak of Polio in India. 

In the next ten years, annually, almost 2 lakh to 5 lakh children developed polio. That means that almost 500 to 1000 children were contracting polio every day. These ten years were really difficult for India. 

But, why? We had a vaccine, right?

Baat yeh hai doston, that a vaccine does not end an epidemic at once. Yes, we had the OPV vaccine. But first of all, it was not as effective as we had hoped. Second of all, the surveillance and tracking of children and the vaccine was not efficient. The number of cases that were being reported were only 10% of the real cases. Awareness about this virus and the ways to stay safe was also low — so, people did not take precautions. 

A report in the Indian Journal of Medical Research suggests that because so many children were now paralyzed, this would lead to a loss of productivity for India in the next thirty years. Iske upar add kar dijiye the cost of healthcare and medicines and parents quitting their job to take care of children. This report calculates this loss at Rs. 45,000 crores!

Polio was not only a health emergency. In a country like ours, which depends on labour, it was a socio-economic emergency. Which is why we needed to work harder to get it in control. 

But we’re getting to the good part now. 

In 1988, the World Health Assembly made a resolution. A promise (prann) – that by 2000, the entire world will be free of polio! This was a target for India as well, and India was ready to achieve this target. 

The number of polio cases declined for a few years, but a proper plan to eradicate polio in India began only in 1995. 

This is an important year. 

In 1995, the Global Polio Eradication Initiative (GPEI), Centre for Disease Control and Rotary International came together to devise a plan for India. An Immunization program called Pulse Polio Immunization was launched in Delhi in 1994 and this was now extended to the whole country.

In Delhi, this program was successful in immunizing more than 90% of children under 3 years of age with 2 doses of vaccine. It was overseen by Dr. Harsh Vardhan, who was the State Minister of Health for Delhi at the time. But, this program and others that would follow, have been successful because of frontline workers and health care staff, who gave vaccines to more than 1 million children. And what a success it was!

[We hear the voice of a Delhi resident talking about the effective polio vaccine]

These vaccines were given in two doses. And so, in 1994, the Pulse Polio Program came up with a tagline that I probably don’t need to remind you of: Do Boondh Zindagi ke. 

By 1999, the Pulse Polio Immunization program was successful in completely eliminating Type 2 of the Poliovirus. But 2 other types were still prevalent — and could not be eradicated by 2000. We had missed the goal!

This only motivated us to strengthen the PPI program in 2001. That year, there were only 268 cases in India. This was 99% less than 1988, but still not zero. However, Polio seemed to be in control. 

But we wanted to eradicate it completely. 

Now, research increased to improve diagnosis of Polio in children. This is because polio was also being confused as AFP, or acute flaccid (फ्लैसिड) paralysis. It was found that polio was limited to children in UP and Bihar. So, vaccination programs were set up in these states. Things were going well. 

But then, in 2002, there was a massive outbreak. 1,600 cases and most of these were in U.P. and Bihar. It had also spread to Karnataka, Tamil Nadu. This was a major setback! 

Kuch toh karna padega. The PPI programs were in full force, but there was something that was still holding people back from getting vaccines. This is when the Ministry of Health and UNICEF had a great idea. It was time to stop looking at this from a health perspective, and start looking at it from a business perspective.

They approached the advertising agency Ogilvy and Mather (ओगिल्वी एंड माथर) ya O&M to bring awareness of the Pulse Polio program into people’s living rooms. 

This was the Polio Eradication Campaign of 2002. There had been so many strategies used until now to battle this epidemic. You could probably argue that one of the most powerful ones was this:

[We hear the voice of Amitabh Bachchan in a Polio vaccination ad]

That was – aur kaun, but Amitabh Bachchan. He became the voice of the Polio Campaign in India. “Do Boondh Zindagi ke” and “yeh Ravivar, Polio Ravivar” were slogans that you would hear on the TV and radio constantly. 

But you know, the interesting marketing strategy here was not that Amitabh Bachchan should gently persuade the citizens to vaccinate their children. No, no. When Piyush Pandey worked on this campaign, he decided that Amitabh Bachchan should be the “Angry Young Man” that we have always seen him as, and scold us for being so careless!

The campaign might surprise you:

[We hear another Amitabh Bachchan advertisement]

Doston, this campaign worked brilliantly. In 2002, this message communicated through 184 radio stations in rural areas, and encouraged mothers to take their children to immunization booths. 

And this campaign continued for many years. Shah Rukh Khan, Aishwarya Rai, Sachin Tendulkar, A.R. Rahman and other celebrities joined Amitabh Bachchan and spread the message. But it wasn’t just radio and TV – this message was spread through posters, wall paintings, village seminars, melas, folk dramas. Arre, “do boondh zindagi ke” was even written into episodes of TV serials like Baa, Bahu aur Baby!

This publicity campaign was definitely extremely successful in encouraging people to get polio ke do boondh. 

But there was a massive effort happening off-the-screen that we cannot forget. 

It was found that of the children infected in the outbreak of 2002, 60% were from Mulim Communities in Uttar Pradesh. While many of these families refused to get the vaccine, others had no permanent residence. They lived in slums, railway stations, colonies and weren’t approached by health workers. To solve this problem, UNICEF and WHO conducted something called a mapping exercise. Matlab, tracking down each and every family and where they lived. To do this exercise, they formed a network of 20,000 informers – local shopkeepers, residents, police officers, who would provide information about such families.

They would inform the organization when new migrant families entered the villages. This effort took a couple of years. But it was realized that the cases kept increasing because migrant families were not tracked. Now, nearly 20,000 migrant families were tracked and included in the programs. Community workers were hired to contact these families, inform them about the program and get the vaccine to their children. When a child was vaccinated, his or her finger was marked with ink.

But migrant (pravasee)…matlab these families must always be travelling, right? How to get to their house and vaccinate their children?

Mobile teams, that’s how. 

Teams of health workers were formed to vaccinate children of travelling families. Imagine this if you can, because it happened: Vaccinators would jump onto trains and walk down the bogies, putting drops into the mouths of children that they assumed to be under 5 years of age. Other transit teams would be present at railway stations, bus stations and other transit points (jaha se pravasee guzarte hai).

But it was not just migrant families that needed to be looked at. Other families refused to vaccinate their children. Some felt polio is not that serious, others believed that the vaccine may have side effects. There were many rumours in the Muslim community. 

To help encourage these members and remove rumours, the program included religious and community leaders. These leaders started advocating for the importance of the polio vaccine in masjids and prayer meetings. Healthcare workers went door to door in these neighborhoods to assure the families that the polio vaccine was safe, and immunized their children. 

Even in very difficult terrains such as the Kosi River plateau, vaccinators stayed in tents and vaccinated children. These were such remote areas that no Amitabh Bachchan campaign could work. Only careful planning and the hard work of health workers. 

All of this happened over many years. 

By 2009, the type 1 of the Poliovirus had been eradicated. We were still cautious, and the Immunization programs continued. 

In 2010, only 42 cases of polio were detected in India. 

In 2011, January, only 1. 

After January, 2011, India was polio free!

The WHO continued the Polio-eradication program, setting up campaigns and vaccinating children. 

And then in 2014, officially, 

[We hear a new report declaring India polio free.]

Let me remind you, that polio immunization did not stop in 2011. To this day, we have polio days where children under 5 years old are vaccinated to stay safe from the virus. Awareness programs for polio still continue, and Amitabh Bachchan is still the face of it!

But, the story of how we eradicated polio is extremely relevant today.

As we all wait for a vaccine for the COVID-19, India is preparing for what to do next. Who gets the vaccine first? How long will it be before we are Covid-free? It took so many years to eradicate polio — will it take that long to eradicate coronavirus too?

These are questions we cannot answer now. But if there’s anything that we can learn from our exercise to eradicate polio, it is that we will have to come together as a country and defeat this virus, when the time comes. 

That’s all for today – I hope we learnt something new, as always. I’ll be back next week with a brand new episode of Maha Bharat!

Credits

Narrated by – Dhruv Rathee
Producer – Gaurav Vaz
Written by – Anushka Mukherjee and Gaurav Vaz
Title Track Design – Abhijith Nath
Audio Production – Madhav Ayachit